Notes from China, Q3 2026 | Milan CvitkovicContext: I recently spent 2.5 weeks in China visiting universities, research institutes, clinical sites, companies of all sizes, and investors. Most meetings focused on biotech, neurotech, and AI.<br>Conventional wisdom my trip corroborated<br>US cities feel medieval compared to Chinese cities. I was expecting the cleaner, safer, greener cities with better trains, EVs, consumer electronics, etc. But I was surprised that Chinese cities didn&rsquo;t feel bleak. I thought that would be the required tradeoff.

China : Orwell :: US : Kafka<br>VC is different in China. Well covered elsewhere: Chinese VCs avoiding losses rather than seeking power-law returns, the role of financial advisors, personal liability for founders, redemption rights, etc.

Chinese and US tech entrepreneurs are more similar to each other than to either the modal Chinese citizen or the modal US citizen. At least in terms of personality, interests, and motivations. They might be similar in politics, too, but people were less open with me about that.<br>They&rsquo;re dissimilar in information diet. US entrepreneurs consume US media. Chinese entrepreneurs consume all the media the US entrepreneurs do plus Chinese media. This is mostly an issue of lack of interest, not lack of access, on the US side.

Chinese companies feel less obliged than US companies to differentiate themselves or define themselves by a core competency. Hence the abundance of near-clone products, even in capital-intensive industries like implantable BCI.

China and the US seem equally capable at translational biotech and neurotech R&D, overall. The standard caricature of comparative advantage seems right:The US funds a more diverse portfolio of companies and academic projects.<br>China has more efficient regulators and clinical trials and supply chains and lab construction and just generally has more industrial fervor.<br>The US&rsquo;s market for therapeutics dwarfs China&rsquo;s (and everyone else&rsquo;s), and accordingly has larger pharma incumbents and more late-stage capital.<br>Funding for Chinese translational R&D labs and startups is more independent of financial returns than in the US, and more R&D infrastructure is funded (and successfully built) than in the US.

China is clearly getting better faster.<br>Biotech/neurotech talent density seems equal in the US and China. But China has more talent mass.China has ~4x the population of the US and something like 2x the STEM workforce.

Clinical trials are faster and cheaper in China than in the US, with comparable quality and ethical standards. 1Anecdata suggest 2x faster for early trials and 5x cheaper, with large variation between sites and indications.<br>Key reasons for speed:Faster regulatory approvalMainly because G[LMC]P requirements are less time-intensive and because the G[LM]P service industry delivers faster<br>Ethics Committees (ECs, China&rsquo;s IRB equivalents) anecdotally respond faster to submissions than US IRBs or the FDA, but also require more revisions, so overall a wash.

Faster recruitingLarger population<br>More specialized tier-3A hospitals + better transportation infrastructure = aggregation of more patients with the same indication at single sites, especially for rare diseases<br>I was told Chinese patients are more motivated to enroll in trials than US patients for cultural reasons like greater respect for clinician authority and a general pro-technology attitude. No idea how true this is.

Everyone, not just sponsors, is graded on speedClinical trial throughput is a KPI in the performance reviews of nurses, CRAs, hospital and university administrators, doctors, professors – everyone.

Key reasons for low cost:Almost everything is cheaper in China<br>Healthcare costs borne by trial sponsors are dramatically lower in ChinaAnecdotally from 5-20x lower total inpatient cost per day

Government-subsidized clinical infrastructureRepresentative example: Tiantan Hospital built a 30-bed dedicated BCI research ward within 1 year, entirely with government funding.

New to me<br>In China, big tech companies compensate employees less than startups. Both base salary and total comp. Presumably because startup equity is (perhaps correctly) not valued as much as the credential and security of a big tech job.

Most Chinese companies have CCP organizations embedded within them. It&rsquo;s required for companies with three or more CCP-member employees.<br>Not clear whether they matter much.

Doctors in China are graded on their research output far more than in the US. Doctors are evaluated for promotion based on publications as much as on clinical outcomes, not just at research-focused institutions but seemingly everywhere.

Chinese startups are quieter. Typically have little or no social media presence, issue few or no press releases, and stay in stealth longer - just generally less legible.Also usually no website, but seems like that&rsquo;s just because the web is used much less than apps in...