Why Must Americans Fly to China for Cutting-Edge Cancer Care?
A 2-hour experimental biomarker scan in Beijing? Investigational trials that move from idea to patient in 18 months? An American Medical Scientist’s eye-opening trip.
As regular readers know, China is advancing—rapidly and simultaneously—on almost every technological frontier and has already surpassed the United States in Medical Science1, a backwater in America where funding, careers and fortunes go to develop pharmaceutical palliatives—while life expectancy continues falling. Ferocious media attacks on surgical/innovative trials failures, plus 1000-page trials applications leave the field open to Chinese scientists. Jacob Stern, an American medical scientist (PhD in protein design) is just back from a trip with VC Sid Sijbrandij. A few excerpts to tempt you to read his entire report:
Last August, Sid Sijbrandij and I traveled to Beijing for an experimental scan to look at a biomarker that’s specifically upregulated in his cancer.2 At that time, the only place we could do this was in China, using a molecule developed by Yang Zhi (杨志)’s group at Beijing Cancer Hospital. So that’s where we went.
We were stunned. The whole experience — from international patient check-in, to preparation of the radiotracer, to injection, to imaging, to discussing the result with the physician, to leaving with a glossy printout of the whole-body scan — took two hours. Even in Germany, where clinics are experienced in using developmental tracers, this process would take most of a day. Beijing broadly and the hospital specifically were surprisingly straightforward to navigate for foreigners such as us who speak no Chinese.
The “investigator-initiated trial” (IIT) is an important fundamental concept to understand. Through IITs, individual physicians at major hospitals in China can propose and run studies for cell and gene therapies under the oversight of local scientific and ethics committees. There’s no need to clear a single, centralized national gate before enrolling patients. Compare that to the United States, where early trials are usually company-driven and require formal approval from a national regulatory body (like an IND filing with the FDA) before anything can begin. The tradeoff is pretty straightforward: the US system emphasizes uniform standards and upfront rigor, while China’s IIT model pushes decision-making closer to the doctor and the patient, making it easier to start trials quickly and iterate as data comes in.
Based on what I heard on the ground, it takes about 6 months to go from a first conversation between a doctor and a patient to that patient getting dosed, and people noted that exciting programs with support from senior investigators can go even faster. This means new therapies can get to patients faster, and companies and physicians start learning from and improving the underlying therapies earlier in their development.
On my trip, I was repeatedly quoted a timeline of 18 months from a company having an idea for a therapy to testing it in a patient. My lived experience from my week on the ground backs up this speed. I experienced a sense of urgency at every level. Not just from start-up companies themselves, but also the ecosystem of third-party vendors that perform services for these companies.
During a visit with a CDMO focused on cell therapy manufacturing in Suzhou, I asked the business development rep giving the presentation about the company’s experience with non-viral gene editing. He picked up his phone. As we were preparing to leave 10 minutes later, the principal scientist responsible for the non-viral editing platform caught us by the door. He answered my questions, and we figured out the next steps to evaluate the suitability of their platform for the non-viral editing approach our collaborator is using.
It is ironic to me that the ‘marketplace of reputation’ that seems to govern China’s IIT ecosystem is more market-oriented than the regulatory apparatus we use to govern early-stage trials in the US. Every system has its strengths and drawbacks, China’s included. The parts I saw up close show how the Chinese ecosystem is leaning into its strengths — velocity of science and engineering, urgency, close-knit relationships within the ecosystem, compassion for patients. I’m hopeful that, as a country, we can reflect on and actively lean into our strengths as an ecosystem too. For more, please visit sytse.com/cancer. Please write to us with thoughts or questions at cancer@sytse.com.—Thanks to Jacob Stern and ChinaTalk. From: Clinical Trial Abundance, Made in China. Flying to China for cancer care. APR 17. 2026. ChinaTalk.
How China does it
Leon Liao’s perspective is so valuable that I’ve hoisted it from the comments: This American medical scientist’s experience in a Beijing hospital highlights more than just speed—it reveals the deeper institutional strengths of China’s healthcare system. China’s investigator-initiated trial (IIT) ecosystem operates with stronger reputation effects, physician-led decision-making, and local ethics/scientific oversight, making it in key ways more market-oriented than the current U.S. early-stage clinical trial system, which relies heavily on rigid top-down procedures.
The real advantage lies in China’s ability to deliver speed, cost predictability, and high technical credibility—simultaneously—which many Western systems struggle to provide. What was once dismissed as basic “medical tourism” has evolved in China into a sophisticated option, supported by integrated tertiary hospitals, fast diagnostic and treatment pathways, aggressive procurement, and high-throughput specialist environments.
China compresses timelines (e.g., an experimental biomarker scan in two hours or moving from trial idea to patient in 18 months) not through isolated miracles, but through tighter coordination among doctors, hospitals, CDMOs, and research platforms, combined with lower administrative friction and stronger system-level integration.Western healthcare’s core challenge is systemic: multi-payer fragmentation, administrative burdens, specialist shortages, and referral/approval bottlenecks turn speed itself into a scarce resource.
In contrast, China has chosen a different tradeoff—lower unit prices, higher physician intensity, and concentrated top-tier capabilities—in exchange for dramatically shorter waits.Formal regulatory review timelines can also be misleading. A 30-day FDA clock matters little if reaching the starting line already takes 12–18 months and millions of dollars in preparation. China’s faster hospitals are downstream of faster regulators and lower entry barriers for early clinical experimentation.
Caveat on sensitive areas
While system coordination explains many efficiency gains, domains like organ transplantation require extra scrutiny. Short wait times there raise legitimate questions about donor sourcing, transparency, and independent verification, even as China has increased official voluntary donations and built national allocation systems in recent years.In short, China’s edge is not merely cheaper care or more hospitals—it is a structural ability to reduce coordination costs and waiting times in complex medical processes, making it a rational choice for patients seeking timely, credible advanced care.
Most recent item in the newsletter: In 2010, China accounted for less than 8% of global clinical trials; by 2020,
While Sid has no evidence of disease, we want to use biomarker-targeted PET tracers for imaging — both to look for potential recurrence, and to do personalized biodistribution analysis of druggable targets. B7-H3 was a top target for us, as his cancer has high expression of B7-H3; were his cancer to return, we would think of treating it with a B7-H3 targeted agent, possibly with a highly potent CAR-T that Kole Roybal and his group at UCSF are developing.
This American medical scientist’s striking experience at a Beijing hospital perfectly complements my earlier post, Why Must Americans Fly to China for Cutting-Edge Cancer Care?
https://leonliao.substack.com/p/why-more-western-patients-are-coming
What matters here is not just speed at one hospital. It is the system behind that speed. China’s IIT ecosystem — shaped by reputation effects, physician-led decision-making, and oversight from local ethics and scientific committees — is, in an important sense, more market-oriented than the current American early-stage clinical trial system, because it relies more heavily on real-world judgment by frontline doctors, patients, and institutions, and less on rigid top-down procedures.
My own post approached the issue from the patient side and made a related point: more Western patients are coming to China not simply because China is cheaper, but because China is increasingly able to offer three things that many Western systems are finding harder and harder to provide at the same time: speed, cost predictability, and sufficiently high technical credibility.
For a long time, many people understood “medical tourism” as flying to Southeast Asia for dental work, cosmetic surgery, or routine procedures. But China is entering a much more sophisticated category of decision-making. What is emerging is not a fringe alternative, but a rational cross-border choice built on top-tier hospitals, stronger specialist capacity, fast-moving diagnostic and treatment pathways, and dramatically lower total cost.
That American scientist’s observations — a two-hour experimental biomarker scan, eighteen months from idea to patient, and extremely fast coordination among doctors, hospitals, CDMOs, and research platforms — are not isolated miracles. They are the output of the same institutional logic.
China’s advantage is not simply that it has “more hospitals.” Its strongest capabilities are concentrated inside large tertiary hospitals, where outpatient services, imaging, pathology, inpatient care, and surgery can be tightly integrated within a single organizational structure. On top of that, there is stronger price control, more aggressive procurement discipline, and a physician workforce operating under high-intensity, high-throughput conditions. The result is a system that is structurally better at compressing waiting time, reducing coordination costs, and turning complex medical processes into a more efficient service chain.
So the real question Western systems should be asking is not, “Why was this one scan in China so fast?” The deeper question is: why have so many Western healthcare systems concentrated the worst frictions of medicine precisely where patients are least able to bear them — waiting, referrals, approvals, opaque billing, and fragmented organizational boundaries?
That is why I think this post gets at something important: healthcare is, at its core, also a systems design problem. America’s problem is not an absolute lack of technology, nor a total absence of top hospitals. Its problem is that multi-payer fragmentation, administrative friction, and specialist supply constraints have turned speed itself into a scarce good. In Britain and Canada, the problem looks somewhat different, but the mechanism is similar: budget constraints and queue-based rationing often translate directly into waiting lists.
China is not costless. It has simply chosen a different set of costs. It compresses unit prices, pushes doctors harder, and concentrates top capabilities in exchange for higher throughput and shorter waits. That tradeoff has real downsides. But it also helps explain why, in a growing number of cases, China is starting to look less like a peripheral medical destination and more like a serious alternative for patients who need timely, credible care.
China is the new shiny city on the hill. Don’t cha know? Follow the damn money.
If you want to know what the future looks like… follow the money.