BON seems genuinely concerned with creating high level, thought out content about China, and have invested money into a studio to try and make it happen.  They could very well push of the game here, by creating a platform (and recruiting the people) that can efficiently integrates all of the current English-language coverage of China into something palpable for mass, global consumption.

The niche to become the exclusive distributor of China news is wide open. I had a classmate from undergrad who worked at the NBC new China headquarters, in Beijing, before the Olympics, and the office only had 8 people.  That’s just not big enough to cover much of anything, in China.  The scene is begging for some serious competition.

Anyway, this friend, from BON, is preparing a story on China’s healthcare reforms (covered extensively on this blog, and if you want more information the search bar is at the top right of this page) and wanted some information about how to proceed, who to contact, etc.

It’s not the first time that media has asked James and I about how to approach a healthcare story.  So, I figured that one way we could help is by providing guides on China story angles.

So, adapted from an email I sent to my BON friend, here is a guide about how to approach China’s healthcare reform.

1) China’s healthcare reform is not politically polarized.  No one party is the obvious health reform proponent and no one  is completely against it.  That kind of divide is uniquely America.  The Chinese actually want healthcare reform

2) To get a better idea of what this might mean for a story,  define ‘reform’

1. A change for the better; an improvement.

2. Correction of evils, abuses, or errors.

3. Action to improve social or economic conditions without radical or revolutionary change.

You see that the meaning of a ‘reform’ is very context specific – a change that produces better in one place, may not produce better in another, and the needs of different places are, well, differnt.  In the US healthcare reform means covering 36 million people, cubing malpractice, sorting out financing.  In China, it means constructing a 1st world healthcare system through infrastructure improvements, sorting out incentives of healthcare workers, medical education expansion, etc.

3) In China people like socialized medicine.  They think its great.  People can’t contemplate spending more than 30 yuan to see a doctor for a regular check up.  Instead, what you will find is widespread fear that China’s health system is getting too capitalistic, and that health reform should stay away from overly privatized models.

4) The actual pipework of the reforms is being constructed by healthcare system experts, not politicians.  So, if you’re actually talking to someone who is familiar with the reform that person is going to give you a nuanced opinion of the major challenges going forward, the problems of today, and the potential pitfalls of the reform.  A professional architect is necessarily more balanced in her opinions than a professional politician.

5) This point is related to point 4.  Everyone involved is well aware that designing a system that works for 1.3 billion people is unexplored territory.  Like all things, in China, they’ll take this slow – there is no point of getting too much wrong at once.

6) This point is related to point 5.  The Chinese are building a new system, and they are aware that problems in the system are better tackled early on, before they compound, and its too late or costly to turn back.

7)  If you want to juxtapose opinions on the reform your best bet is to talk to post 80s/90s youth, with medical students being the clear best choice.  Someone young and idealistic, and informed, is apt to want the very best healthcare for China right now and to be able to clearly express why.

If you want to know whether the healthcare reforms are doing what they’re supposed to, monitor the rural regions.  The thrust of the money is going to fund rural clinics and health systems so that overcrowded tier2/3 hospitals can get some relief.

9) If you want an informed and accessible Laowai perspective, check back to this blog often.

Being able to send soldiers into a warzone sends a message.  But, bringing medical aid to a war zone sends a different kind of message; lets just say that Afghanistanis trust Italian medical doctor Alberto Cairo more than they do military personnel.

So, I was glad to find a great paper by the Jamestown Foundation that describes how China has used it’s medical expertise, in the past, to form ties with Africa, and how the continued presence of that health diplomacy, ironically, may be threatened by the modernization of China’s healthcare system.

Article: “CHINA’S SOFT POWER IN AFRICA: FROM THE “BEIJING CONSENSUS” TO HEALTH DIPLOMACY,” The Jamestown Foundation’s China Brief: Volume 5, Issue 21 (October 13, 2005), By Drew Thompson

…

“China has a long history of conducting active “heath diplomacy” programs with African and Middle Eastern countries. China’s early relations with many African nations included significant aid in the form of infrastructure, scholarships for African elites to study in Chinese universities and the deployment of teams of doctors. Today, these institutions remain, either as direct government support or under the auspices of the China-Africa Cooperation Forum.

…

China’s capacity to send large numbers of medical doctors to Africa is limited, and the program faces an uncertain future over the long term. Many provincial budgets are increasingly stretched by a shrinking tax base since rural tax reforms have been implemented. The health needs of many Chinese are also not being met and government doctors are increasingly called upon to deal with public health issues at home. Additionally, given that the Chinese medical system is increasingly privatized, more doctors are less inclined to accept a two-year posting in Africa, particularly because they currently subsidize their meager government stipend with income generated through patient fees and medicine sales.”

There is a good research question to be explored here – Is it possible to be both a economic and military global superpower and to engage in effective health diplomacy?

We were talking it up on G-chat the other day, and somehow we got on the topic of good ‘China’ bloggers.

The term ‘China blogger’ drives me crazy because it communicates approximately as much as sarcasm – nothing.  I tried telling someone that I was a ‘China blogger’ once and immediately wanted to punch myself in the face.  Compared to China I am so small.  How I could even try to tell someone I blog about China and keep my dignity in tact  is beyond me.  It’s basically like telling someone that you’re a professional at life. Or better yet, a professional at America blogging.

Him: “I don’t have a job right now, but  I’ve become a professional America blogger.”

Her:  “So you’re unemployed and unmotivated to find any purpose for your life.”

Him:  “No, no, you don’t get it.  I write about America stuff.”

Anyway, Adam liked this line of thought so much that he expanded on its implications in a post called “To All You “China Bloggers” Out There: There Is *No Such Thing* As An “America Blogger”.  My favorite part:

“[...]we desperately need a new terminology for those people interested in blogging about China, Sinology, or other things related to the PRC in general, but who don’t have any basis on which to make “expert” claims.

We must engage in a narrowing of the formerly expansive nomenclature, a tightening up of this truly exclusive field, and a better and proper way of referring to these folks so that they don’t completely humiliate themselves as they stuff their yob with hot canapés at the cocktail party or around the tiddlywinks table when people ask them what they do and they reply with faux gusto: “Oh, me? Well I’m a China blogger.”

No you’re not! You can’t possibly be. And why? Because there’s no such thing as one, Frank!

If there’s no such thing as an America blogger, there’s certainly no such thing as a China blogger.

Ten years ago, the “China blogging” might have been an appropriate terminology. We were still in internet flux. Web 2.0 was still but a glimmer in Facebook’s Mark Zuckerberg and Twitter’s Biz Stone and Evan Williams’ eyes.

Today it doesn’t hold any baijiu, my friends.”

I encourage you to check it out, and don’t give me too much flack for the overly gracious accolades that Mr. Mezei heaps on me at the start of his article.  I promise that’s not the reason I am recommending that you read this one.

Asia Catalyst

The NGO just launched a new AIDS law database, a “free, user-friendly resource, searchable in Chinese and English, to help researchers to find HIV/AIDS-related statutes throughout Asia.” This looks like it could become a strong tool for researchers, and lawyers.  The interface is really straightforward, allowing one to parcel down articles through a three tiered search filter composed of Region, Subject Matter, and Level of Government.

I encourage you to check it out.  The press release is reprinted below, via Chinese Law Prof Blog.  The PDF can be found, here.

(Gejiu, China, March 9, 2010) — Asia Catalyst is proud to announce the “public beta” launch of its Asian AIDS Law Database.  The database is a free, user-friendly resource, searchable in Chinese and English, to help researchers to find HIV/AIDS-related statutes throughout Asia. It is the first database exclusively dedicated to this purpose.

With the “public beta” launch, Asia Catalyst invites lawyers, experts and organizations to share AIDS-related laws and policies from around Asia that may not yet be online. The database has over 100 records, ranging from Cambodia’s draft law on drug control to the national policy on HIV/AIDS of Bangladesh.

“The database will enable lawyers to analyze AIDS-related laws, and use them in their own advocacy,” said Ken Oh, editor of Asia Report (http://www.yazhoudiaocha.com), the news site that hosts the database. “Asian AIDS activists tell us that some governments are more responsive to model language from another Asian law.”

The project was born in response to growing demand from Asian AIDS advocates engaged in legal analysis and advocacy. The database was created by a volunteer team of law students and pro bono lawyers working with Asia Catalyst.

Asia Report, the Asia Catalyst-sponsored site that hosts the database, provides Chinese and English-language news about economic and social rights in North, South and Southeast Asia, with links to Asian rights groups, and announcements of upcoming conferences and events.

Asian AIDS Law Database users may choose countries, topics and levels of government from drop-down menus in both English and Chinese. The database will provide the text of the law or policy and a link to its location online. All records are in English, with Chinese translations provided where available.

“The international AIDS law field is growing quickly,” said  Ken Oh.“We hope our colleagues in Asia will use the database to analyze existing laws–and draft new ones.”

The database may be visited at http://www.yazhoudiaocha.com/laws/.

Asia Catalyst is a US-based resource for grassroots organizations working on HIV/AIDS in Asia. For more information, please see our website at www.asiacatalyst.org.

According to an academic quoted in Anthes’ article, the field of Environmental Psychology developed around the question “‘What is there about people that we need to find out about in order to build buildings that respond to people’s needs?’

Since the field took off some 40-50 years ago, we have seen the results in various modern design.  The most famous variation of that design, today, is the ‘Green Building’.  It’s not simply that these buildings make efficient use of energy, they also make use of things like light and space to help occupants feel at ease.  A new generation of Green Hospitals is even showing that certain environments which feature ample amounts of natural light and views of the landscape aid patient outcomes.

That hospitals should be more than featureless monoliths of tile, small windows, and and off-color white hallways is probably obvious to many.  Less obvious is the question of why within a fairly short period in the 19th century, the notion of what constitutes the ideal healing environment transformed from a picturesque, countryside manor, into a dim hospital room.

The Ounus blogger has this answer:

It seems obvious that architecture would affect human behaviour and capabilities, and it’s exasperating that in the West we so often have to reinvent the wheel, usually by employing science to restore knowledge – in this case architectural and kinaesthetic knowledge – that has been developed over centuries and even millennia in other places. I’m thinking of the carefully worked-out design of monasteries and churches as places that generate inspiration and contemplation for example, or the genius of  Japanese house design. But if we have to reinvent the wheel, then I guess we have to reinvent the wheel.

She is pointing out that in our eagerness to modernize all of our knowledge, to make it more rigorously scientific, a lot of our common sense knowledge that’s been built up over hundreds and thousands of years, gets needlessly lost.  Thinking about where I would rather recuperate from an illness, a country manor/beach house or a hospital room,  I tend to agree with this line of logic.   The continual loss of knowledge in society is fact. Common sense wise,  it makes sense that I would recover faster in a place where I was happier and more relaxed.

I am also aware that this is the exact same reasoning  used by Traditional Chinese Medicine advocates, and advocates of other traditional medicine traditions.  So, I know that the reasoning has its flaws when applied too broadly – not everything from the past makes sense just like not every TCM medicine can beat out a placebo.

So, check out the article and the links provided.  Give it some thought.  Then, if you want, share some ideas here on the blog.

According to the Livestock Breeding and Veterinary Department ( LBVD), the first case in the bird flu recurrence this year occurred in Yangon’s Mayangong township and the second in Mingaladon township both in the same February.

Dealing with the first case in Mayangong township, unusual deaths of some chickens were found in a farm where 2,500 chickens were bred and the suspected deaths were proved to have been caused by the HPAI after experiment.

As for the second case in Mingaladon township, two domestically- bred chickens died of virulent avian influenza in a poultry farm and were later confirmed with carrying the virus after laboratory test.

The authorities took control measures by culling hundreds of similar chickens, some ducks and eggs, banning sale of chickens and eggs in six bazaars, 7 km around the poultry farm, where bird flu recurred to prevent the spread of the disease.

These efforts at containment are a good first step, but it’s important to remember that Myanmar is one of the most chaotic areas on Earth.  Calling the place ‘governed’ or ‘accessible’ is Orwellian double-talk; Myanmar is, in many ways, a failed state.  Just like the virus wasn’t truly stamped out of Myanmar two years ago, so it is not stamped out now.

The concern has always been that areas like Myanmar, which have poor oversight, can end up as incubation hubbs for avian viruses.  The worst case scenario is a virus with a long incubation period because infected birds would be able to carry it long distances, without dying, passing it on to other birds, and making it more likely that humans, too, would get infected.

For now, however, as the report from which the graphic on this page was taken , makes clear, H5N1 in the human population has mostly been limited to individuals who have prolonged contact with birds.  And, bird migration routes have not been as much of an issue because birds have been dying en route.

My prediction is that H5N1 will never be completely contained because of failed country states like Myanmar which next to ensure that seasonal H5N1 is to become a reality of life – at least until H5N1 and H1N1 mutate to give us a whole new baddy to worry about.

Thomas P.M. Barnett Weblog: Expect Beijing to push its own technology rules. Our job is to push back.

“China makes ever stringent demands on producers of IT trying to enter its markets….Commercially, the rules force outside companies to maintain special lines for Chinese products, creating an inefficiency that benefits local companies. Politically, its all about mastering encryption so as to be able to circumvent it with censorship.”

Thomas P.M. Barnett Weblog: Would we want a R&D-busted China “rising”?

“China’s demand for global resources skyrocketing and environmental problems piling up,but entire apathetic (and rapidly aging) population sitting on its ass, when not otherwise engaged in stupid, government-organized political demonstrations; Chinese premier says, ‘What do we need with education anyway?; Millions in America comforted by news that R&D lead growing!” It would be some weird alternative history where Mao’s economic policies actually worked!

Unfortunately for the China doomsayers, Mao’s policies stopped being a factor in Chinese economic calculations years ago.  R&D in China is bound to surpass the US, and education is on the forefront of every Chinese family’s mind.

Core77: Announcing the Winners! 1 Hour Design Challenge: Emergency Shelters

Neat contest, and this post shows off the best ten entries.  The picture to the left is the contest winner – a backpack based tent, that is easy to deploy anywhere.

“Designer: Dan Ostrowski
Based on the reports coming out of Haiti, I decided that a natural disaster refugee was a transient person that would migrate to new locations in search of safety, food, and/or medical help. I developed an inflatable tent because of its lightweight, easy transport, and minimal storage space when not in use. A GPS tracker was added so that rescue teams could know, before entering a ND zone, where they are most needed. The Lifestraws were added in an attempt to stave off water born pathogens and the use of mosquito repellent fabric was indented to stave off malaria.”

WSJ: Monuments to Freedom Aren’t Free, But North Korea Builds Cheap Ones

“New York has the Statue of Liberty. France has the Eiffel Tower. Now Senegal is about to get the “African Renaissance”—built by North Korea.

This month, workers from Mansudae Overseas Project Group of Companies, a North Korean design firm, were putting the finishing touches on a giant copper sculpture of a family.

…

“Only the North Koreans could build my statue,” says Mr. Wade, sitting in a red velvet chair in his palace. Moreover, they offer monuments at a good rate, he says: “I had no money.”

…

Over the past decade, Mansudae has built dozens of statues and monuments for cash-strapped African countries. Botswana cut the ribbon on a memorial to three tribal chiefs in 2005. Neighboring Namibia boasts a bronze of its founding president wielding an AK-47.”

Honestly, do you need any more prompting to go read this one?

Stratfor: China’s Wealth Disparity

“[...]The income gap between China’s rural and urban dwellers widened in 2009, according to new figures released by China’s National Bureau of Statistics. Net income per capita for urban Chinese was 3.33 times greater than that for those in the countryside: 17,175 yuan ($2,525) compared to 5,153 yuan ($754). The divide is the widest on record; China began tracking the statistic after opening its economy to international trade in 1978. China’s wealth is concentrated mainly along the heavily populated eastern seaboard. Addressing and narrowing the wealth divide has been a core policy priority for Beijing, as outlined in a five-year plan released in March 2006.[...]“

Wired Science: Back pack Hydroelectric Plant Gives You 500 Watts on the Move

“A human-portable hydroelectric generator that weighs about 30 pounds and generates 500 watts of power may soon be a new option for off-grid power.

Developed by Bourne Energy of Mailbu, California, the Backpack Power Plant can create clean, quiet power from any stream deeper than 4 feet.

The company showed off its more-rugged, militarized version of the Backpack Power Plant at the Cleantech Forum in San Francisco last week. Bourne Energy CEO Chris Catlin estimates the system will cost $3,000 after it goes into production.

“The BPP-2, which operates silently with no heat or exhaust emissions, is 40 percent less visible during operation and can also be bottom mounted to be totally invisible,” the company maintains.

Off-grid solar cells are also quiet, but they don’t make much power relative to the mini-turbine. For example, one commercially available foldable solar panel measures about 12 square feet and produces 62 watts of peak power. You’d need 60 square feet of panels to get the same peak power as the BPP-2, and the panels would only generate electricity while the sun was shining.”

Fast Company: Getting Hospitalized Should Be Like Flying First Class

“PriestmanGoode, a London design house, has worked on everything from cell phones to speakers to first-class cabins for Swiss Airlines. But Britain’s Design Council, hoping to see what serious design thinking might produce, asked them to work on something completely different: Hospital Wards.

PG has just released their proposal today, in a “healthcare manifesto.” In it, they argue that the central problems facing hospital design happen to have already been solved in the design of first-class cabins for airlines.

Think about it: Nurses need to be able to visit patients easily and efficiently. So do airline stewards. Hospitals, meanwhile, need to maximize their square footage utilization, while giving patients privacy and–ideally–a comfortable, homey environment. Which actually happens to be exactly what airlines do, in their first-class cabin[..]“

“China appears to be suffering from rising infertility levels”

is particularly ominous and sets the tone for the rest of the piece. Let’s look at how this story has been distorted, and how it can be corrected by means of a better opening sentence.

It’s important to keep all studies of China grounded within the proper context of 1.3 billion people. Out of context, Chinese statistics will always seem larger than life. One blogger said, “many may be surprised to learn that the home to the world’s largest population also has more infertile couples than several countries combined.” That is true, but one should also point out that these theoretical ‘many people’ would laugh at their own surprise when reminded that China has a lot more people than several countries combined. This means that when looking at universal phenomenons like food consumption, number of hours slept, or infertility, China is always going to have more than another individual country, and depending on which countries you choose, more than several countries combined.

Keeping things within the proper context for China, means using statistics that deal with percentages and ratios. For example, in the case of infertility, the number of interest when talking about China’s infertility rate in relation to the world’s is 10%. The fact of the matter is that China’s infertility rate of 10% (meaning it effects 10% of couples) is right where one would expect it to be. The global infertility average is 10%. And, according to a 2002 WHO report, “It is commonly accepted that infertility affects more than 80 million people worldwide. In general, one in ten couples experiences primary or secondary infertility, but infertility rates vary amongst countries from less than 5% to more than 30%.”

The rate of infertility in China, therefore, is not uniquely terrible. If the claimed rise in infertility tells us anything it’s that China is now more like the rest of the world: whether or not this is a global issue is another question altogether (it’s definitely something we shouldn’t ignore).

Notice that I use the word “claimed” when referring to the 1983 infertility rate. The statistics from 1983 are all estimates based on very scant, unstandardized data. According to Emily McDonald Evens, MPH, of the University of North Carolina’s Department of Public Health,  infertility is a stigmatized condition and perennially underreported. Moreover, the definition of infertility varies across culture, and changes as culture changes. Evens wrote the most comprehensive shorty study of global infertility trends that I could find. On the subject cultural variation in definitions of infertility she says:

It is important to remember that the definition of infertility varies between cultures and that the Western, clinical definition cited above may not capture variation in cultural perceptions on childlessness. Infertility often does not strictly mean the inability to give birth to a child; in some places the inability to have the number of children that cultural norms dictate maybe considered involuntary childlessness; in other places infertility may be understood as having no sons, or not becoming pregnant soon after initiating sexual activity. (2, Social norms concerning marriage, divorce, and family organization influence perceptions of childlessness to a large degree.

Consider that, in China, a couple’s ability to have children is intimately linked with social status, and that still today, China’s hospital and MoH records are spotty, there is little reason to take serious any estimates about the rate of infertility in China in 1983. Notice also that I put in bold how in some societies the concept infertility is extended to couples who don’t have sons. If , in China, infertility was thought of as an inability to have sons, wouldn’t families want to hide that fact? The rate of infertility in China could have very well dropped since 1983, or it could be pretty much the same.

Now the story about China’s infertility rate is much more grounded than before. The opening sentence of an interesting news story, at this point, could read “China’s rate of infertility has reached the estimated world average, but it is hard to tell whether the rate is higher or lower than before. What lessons does the rest of the world have to offer?”

But, before we have a final story its important to look at one more thing. None of the news stories do a good job distinguishing between primary infertility and secondary infertility. Evens, again, defines the two kinds of infertility like this;

Primary infertility is defined as childlessness and secondary infertility as the inability to have an additional live birth for a parous woman.

Contributing to the panicky tone of news stories on China’s infertility is that all cases of infertility are treated like cases of Primary infertility. As if there is some great pandemic of social irresponsibility, smoking, drinking, and abortion that is making couples not able to have children at all. The opposite is, in fact, true. Couples are still having children, but, increasingly, many couples prospects for children are limited by prior abortions, and careers that force them to have children later. What the journalists actually wanted to describe, but couldn’t due to poor research, is that cases of secondary infertility appear to be rising as a result of life style changes.

So here is our second draft of what the opening sentence should have been: “Lifestyle changes in China could be contributing to the rise of secondary infertility rates. They might be further evidence of China’s development”. The title is informative and still has a dramatic hook, though this time, the hook speaks more honestly about China and gives more informative food for thought. It’s not simply that China’s growing infertility rate is worrying, it’s that the secondary infertility rate seems to be connected to development, and this is worrying for everybody the world over.

Finally, what does the One Child Policy have to do with this? Well, probably something, but definitely not everything. The first thing to realize is that the infertility rate is not the opposite of fertility rate. When one goes up the other doesn’t go proportionately down. They are related, but are not mirror images of one another. The One Child Policy has certainly changed China’s fertility rate, evidenced by China now ranking in the bottom 15% of all countries for fertility rate whereas sixty years ago it added 400 million people to its population. This drop in fertility does not mean that it has cause the infertility rate to go up. One can posit that increase abortions because of the One Child Policy led to a higher Secondary infertility rate, but to my knowledge there have been no studies that have definitively linked the two.

So now, we have our final draft of an opening sentence: “Chinese lifestyle changes could be causing a rise in secondary infertility rates. As the country’s rate comes further in line with that of the developed world, might we be seeing intriguing further evidence of the country’s development? Or is it simply a product of The One Child Policy? Our reporters say that the cause and effect mechanisms are not simple, but are illuminating. “

Nature Publishing Group

1) By some estimates the pharmaceutical market in China grew 27% between 2008 and the third quarter of 2009, and is meant to grow by 20% every year until 2020.

2)  China really wants to move from  chemical science  into actual drug development.  There are many challenges to getting there. Currently, China is behind India when it comes to clinical outsourcing, something China needs to be able to do if it wants to develop novel drugs.

Estimates of approval time for moving on to clinical trial range [in China] from 9 to 12 months. This puts China at a disadvantage compared with its clinical outsourcing rival, India. There,late-stage clinical trial approval takes 2–3 months. India also has an advantage because of fluency in English, cheaper labor and a more westernized commercial environment.

Furthermore, Chinese hospitals are overburdened due to still unmet patient needs, which makes it difficult to organize Phase I trials.

“Almost all hospitals in China were established for and are overwhelmed with patient care,” says Zhen. But with more trials and the presence of big pharma, this situation is improving. “We anticipate that the overall sophistication of investigators in major academic hospitals and the quality of trials in general will quickly get up to the standard as required by international regulatory bodies in the near future,” says Zhen.

3) China’s idea for how to get there is to reduce the amount of redundant paperwork that goes into clinical trials, and to invest a lot of money into research parks. Last September the MoH started funding large health discovery project, and absorbed the previously independent State Food and Drug Administration (SFDA), after the administration’s chief executive was executed for corruption charges (!!!!!).  The government has instituted a ‘megaproject’, which will disburse $12 billion over the next five years to help Chinese research institutions to develop internationally competitive drug development programs.  According to insiders, just around $1 billion has been earmarked for the first phase.

Greg Scott, founder and CEO of consulting and research firm ChinaBio has tracked 80% of the megaproject funding and its matching funds from local governments and industry. According to Scott, US$525 million is going to some 50 “large projects,” over US$10 million each, focused on drug safety and clinical trial infrastructure. US$670 million is being divvied up among hundreds of small new drug development projects with specific drug targets in mind. In China, there is always concern that extra funding will go merely to buy impressive buildings. Scott says his trips to 53 universities and institutes have shown otherwise—that rather than “real estate” scientists are investing in expensive, crucial instruments such as mass spectrometers and electron microscopes. “The majority of people receiving funding are research scientists. From our experience, they are sharp people who should be able to put the funding to good use,” he says.

“The big money goes to academic research institutes for preclinical and discovery infrastructures and to hospitals for creating centers for Phase I clinical trials. Companies working on new drugs are the smallest part of the pie,” says Chipscreen’s Lu. Chipscreen is however getting about US$2 million from science and technology ministry as one of the National Innovative Drug Centers, “a showcase of innovation by China.”

4) China figured out how to make generics, but when it comes to making innovative products, the SFDA made a real mess of things. Up until recently, a lack of proper cataloging mechanisms for newly developed compounds, corruption, and slow processing times  made it very unattractive for companies to try and create novel compounds since “the few truly novel drugs are mixed in with hundreds of copycat products.”

5) The SFDA has been improved, and a new, faster “Green Channel” has been developed

“The SFDA is aggressively trying to remodel itself,” says Zhang, who chaired BayHelix’s SFDA working committee that sought advice from US FDA counterparts. In January 2009, for example, the SFDA started the Green Channel, an accelerated application process for new chemical entities, new combination treatments, or in case of severe medical need. At the same time, the SFDA established the office that gives pre- IND consultation.

6) The leaders of China Biotech are the ’sea turtles’, Chinese PhD’s and research experts coming back to China from overseas.

(This now familiar phenomenon still astounds in degree: education ministry figures show the number of returnees jumping nearly 60% in 2008 from a year earlier to 70,000). A growing number of biomedical-industry hands, many with experience in multinational pharmaceutical companies, are establishing profitable arms of multinational contract research organizations (CROs) or independent domestic CRO start-ups. These companies, of which Shanghai claims the lion’s share, are fiercely competing, setting a premium on international standards in preclinical research.

7) The reports itself is overly optimistic about reform. Specifically, it assumes that China’s health reform plan is a done deal.  It’s not.  If the promised $120 billion dollar health reform, in China, were not to fully manifest, that would be very much in line with the PRC’s pattern of talking a bigger game than it is willing to play.  To wit, this means that one should make conservative estimates for when China’s medical schools, management structure, and hospitals are going to be strong enough to fully support a large scale research operation.  I’ve italicized and marked in bold the overly optamistic assumption in the following excerpt.

“We anticipate that the overall sophistication of investigators in major academic hospitals and the quality of trials in general will quickly get up to the standard as required by international regulatory bodies in the near  future,” says Zhen.

The report is appropriately confident about one thing – sooner or later, a Chinese company will join the ranks of drug development giants.

The pieces of the drug discovery puzzle are falling into place in China. Will China start producing potential blockbuster candidates? All agree it is matter of time, with some arguing for 4 years and some saying 20 years. As Kewen Jin says, “the next step is to show in China that you can take a compound all the way from candidate stage to Phase II trials.”

If you can bear to read along with this monster of a post, know that we had a lot of fun writing it.  Whereas I set the tone in this conversation,  the first marathon conversation, led by Damjan, can be found, here.

Adam:

~~~~

So let’s make our way to back to China by way of…Korea.

Now, if you recall, Korean Air used to be legendary for its headline-making crashes. It got to a point where Korean Air — with their telltale powder blue fuselages  — was crashing so often that it hardly seemed news anymore. To (foolishly) take a flight on Korean Air was to take your life into your own hands, and there were few people, save for some chest-thumping nationalistic Koreans and perhaps several brave Chinese who were looking for a bargain, who were willing to take such risks.

Fast-forward to today: Korea’s brand stalwarts like Samsung, Hyundai, KIA, and Daewoo have done a remarkable job extending their reach around the globe and contributed to the extraordinary comeback of Korea in Western markets on a legendary scale. In fact, my very first car was one of Hyundai’s best-selling sports coupes in the introductory price range — the Scoupe — and I bought it — going back fifteen years now — because it had the best warranty in the business, for the value.

Cut to China: it finds itself in a present-day malaise similar to what Korean companies used to suffer from back in the dirty ’80s. Have a look at some of the notorious black stains on the Chinese brand record — search for “Chinese crash tests” on YouTube but make sure your jaw doesn’t get bruised — and witness what I’m talking about.

As far as the West is concerned, there are few Western consumers I know who’ll be persuaded to “buy Chinese,” and this likely irks Chinese manufacturers to no end. I bet they’d be willing to do practically anything — yes, anything — to change this state of affairs. Sure, all-Chinese brands like Chery, Geely, and others certainly do make inroads into developing world markets like Moldova or Uzbekistan, but I challenge you to tell me about one low-income American or European family who would be pursuaded to buy a Chery on their own volition (unless they have a death wish). Strategic acquisitions like Sichuan Tengzhong Heavy Industrial Machinery’s buying out GM’s Hummer unit and the on-again off-again Volvo buyout by Geely appear to be vertical moves by these Chinese mainstays to sanitize their brand images and play with the big boys, but so far the market isn’t cottoning on.

Basically, the entire Chinese brand scene needs a concerted rejiggering and there’s no telling how, when, or even if it might be successful in our lifetimes, D.

What ails Chinese brands isn’t going to be repaired in a day, even with the most focused of strategic rollouts and any Western-devised blueprints for how to cure this “brand cancer” isn’t a monkey see-monkey do thing. I’m talking about celebrity endorsements for Chinese stuff (if Western celebrities could even be convinced to hawk Chinese products), sponsorship of large international sporting events where Chinese athletes compete, Chinese swag, or even embedded products for films and TV series — “by the book” approaches all, so I don’t think I’m proposing anything novel here.

What are you seeing out there?

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Damjan:

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Seeing as how we are both Malcolm Gladwell fans, I think that you are trying to set me up with an easy jump off point by leading with the example of Korean Airlines when alluding to the rebirth of the Korean brand.  The troubles of Korean airlines are well documented in Gladwell’s book Blink: The Power of Thinking Without Thinking.  Turns out, the airlines troubles stemmed from the co-pilots inability to correct the actions of the captain, a hierarchy problem.  It’s interesting that you would pick this example to kick off a discussion about China’s supposed branding woes.

Not being able to fly a plane is an operational problem in the most literal sense of the phrase. Oddly enough, if we change the context of problems stemming from strict hierarchies to a business setting, operational problems can again be said to occur, though in a much less literal, and more management oriented sense.  And, isn’t over adherence to hierarchy the problem all China analysts point to when pushing a lack of creativity as the reason why China doesn’t have brands?

Like Gladwell points out, this is a big problem because it takes cultural change to solve.  The other big component to building a brand, quality, is the easy part.  It takes experience, and money.  Both only take time to accumulate.  I am confident that like the Koreans, the Chinese will one day build a competitive car, and scenes like this failed crash test will be relegated to the past, or at least become a staple of the future emerging Vietnamese car market.  It might happen sooner than you think.  When Suzuki entered the American and European markets its cars were not high tech.  But, they were cheap and fairly reliable.  Cheap and reliable are both doable, and dependent  largely on experience.  I would also remind you that Yugo once broke into the American market, and most of its parts were ten years behind the times before they hit American showrooms.  I will also vouch for the cars awesomeness; I rode around in one until the age of six.

But, because of the cultural component, which was hard enough to implement in the relatively small cultural setting of the Korean air fleet, I agree with your overall assessment of Chinese brands “there’s no telling how, when, or even if it might be successful in our lifetimes.”  Plus, I think that China has one big financial downturn to weather before it really becomes a big world player.

I also really like Dan Harris’s point about how Chinese professional basketball players are about as good as really good high school players in the United States.  Americans start playing basketball seriously when they are very young and skill is proportional to the number of reps one takes.  This, he says, holds true for basically anything.

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Adam:

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Brands are indeed funny across Asia. I can’t really wrap my mind around them.

Take the Japanese case for example. The world’s second largest economy by GDP, but a nation which peculiarly deems practically anything that’s cheap to have a quality that’s lower than albatross guano. The only thing which seems to impress Japanese consumers are products which not only carry the loftiest of brand recognitions, but also the ones which boast the steepest price tag. Have you ever heard of a Shibuya Square dollar store? Or how about an all-you-can-eat Tokyo sushi joint? Just doesn’t happen in Japan. The Japanese are inured against low prices. It’s a luxury goods porn movie.

Then you’ve got the Koreans, straddling an always contentious seismic line — viced firmly as it is between the two rival powerhouses of 21st-century Asia — the Japanese juggernaut and the soaring Chinese tiger. At the end of the Korean War, both halves of the Korean peninsula were almost at a per capita GDP doldrums par. But like two thoroughbreds at the Kentucky Derby — first the North pulls ahead, no wait…it’s the South, no WAIT, it looks like it’s the North, no…uh, the South, I tell you, it’s the South in the lead! — since then — almost Shaft-like — South Korea (ROK) has been “outta’ sight,” and North Korea under the Kim cultists has no chance of making a comeback.

But it’s that ROK story whuch has been most instructive. South Koreans have gone from being a backwater agrarian nation relegated to picking up the shards of the War’s devastation into one of the wealthiest brand consuming societies on the face of the Asian continent. The Koreans, always prepared to outdo their former Japanese colonial oppressors, can be as brand-lusting as their island neighbors to the east. Definitely a market sandbox that Western brands want to play in.

And finally, there are the Chinese. If you’ve ever hung around a Guangdong or Shenzhen cafe, you’d readily notice the way Chinese post-’89ers wear their flash threads or tote around their shiny electro-gear: labels out, y’all! They want you to know they bought that Real McCoy Tommy Hilfiger coat or that shiny Gucci bag, not a cut rate shanzai facsimile of same. And they aren’t ashamed to show you the price tag and proof-of-purchase to back it up! Chinese consumers are only too proud to have squandered three months of their hard-earned salary just to afford the privilege of strutting around their city’s high street for an afternoon so that you can eat your heart out. In a nation with a per capita GDP less than Guatemala’s, that’s no small feat.

The overall trend in all three nations seems to be for their citizens to continually upgrade by seeking out ever-more lucrative brand purchasing opportunities. Western brands.

Prominent Beijing-based marketing swami David Wolf, of Wolf Group Asia, recently pointed out how the previously supposed best and fastest way for the Chinese to make big brand impacts globally was through vigorous M&A activity. But Wolf cautions that, if this persists into the coming decade, buying other companies to catapult them into more secure Western markets will prove to be the PRC’s undoing.

Having said all that, I don’t know what else Chinese manufacturers can do in the short-term to make big marketing and brand splashes in the West. Considering the devastating auto crash test YouTube clips being passed around virally, there’s just too steep of an upward climb.

Sure, it’s inspiring to watch the Chinese — by hook, or, er…by crook — recovering quickly and taking evasive action in dominating various key markets, and I refuse to believe they can’t overcome their present challenges, as they have all others. They’ve shown the world too many times and in so many otherwise hopeless cases that they refuse to be outlasted. But as concerns global branding — a case which can be as precariously delicate as a gauze bandage — I’m having trouble seeing the how, not the if.

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Damjan:

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When talking about big questions, answering the if is a fairly straightforward affair, since it is beholden to trends that are often studied, and therefore as obvious to pick up on as the question is big. Conversely, the how is always to answer when a question is big, because big questions have many variables working together; here the vast amount of information presents a problem.

When the question is contained within a smaller canvas, a smaller niche, the if is often harder to answer because the information for it is not as obviously attainable.  The how question, however, is easier to get at since the number of variables is often smaller; this is where a prediction can readily be attained by looking at stake holders, policies, and markets because, again, the variables are limited.

That’s why psychics and most (but not all) economists are able to make money. For example, lets pretend I am an economist looking at China’s fast growth, it’s current lack of international brands, and Asia’s love for brands that communicate status.  From here it’s reasonable for me to assume that many Chinese entrepreneurs have noticed all three of these these trends and that many of them are trying to cash in by creating domestic worthwhile brands.

I do believe in two things when it comes to marketing: a natural human drive to sell, sell, sell, and a a corresponding human willingness to buy, buy, buy.  Those two are probably enough for American consumers to eventually start buying Chinese brands.  America’s capacity for innovation is falling: we’re not training enough scientists, and we’re not making products.  In fact, we’re only really getting better at things like marketing.  But, what happens when we have nothing left to market?  Well, we help China market it’s goods.