Transcript (courtesy of the fantastic CadreScripts) further down the page. Image by Keya Zhou. Listen in the embedded player above!
This week on Sinica, I sit down with Dr. Ruby Wang, whose new book, China Cure: The Rise of a Biotech, AI Medicine and Global Health Superpower (Agenda Publishing, out October 31, with a foreword by Kerry Brown), is the explanation general readers have been missing for one of the most consequential and least understood transformations in China today. Ruby is a rare creature in this space: a practicing physician in Britain’s NHS, trained in surgery, who worked London’s hospital wards through the first wave of COVID; the former head of the UK government’s health engagement in China at the British Embassy in Beijing; a former health adviser within the UN system; a onetime medical adviser at AliHealth in Hangzhou; and a Schwarzman Scholar. She now runs the strategy consultancy Lintris Health and writes the excellent China Health Pulse newsletter and podcast, both of which I recommend to anyone trying to follow this space.
Anyone who spent time in a Chinese hospital in the late ‘80s or ‘90s — the pre-dawn queues, the ticket scalpers, the cashier’s window at every step, the IV drips for a head cold — will find the arc of this book hard to believe. Within living memory, China sent barefoot doctors into the countryside with herbal remedies and antibiotics in army-green satchels; last year, Chinese companies signed something like 186 out-licensing deals worth a disclosed $137 billion, roughly half the global total and close to ten times the 2021 figure, with Pfizer, Bristol-Myers Squibb, AstraZeneca, GSK, and Eli Lilly all buying. Since Ruby gave a terrific interview to my friend Kyle Chan on his High Capacity podcast this spring on the apps, data flows, and clinical AI, I deliberately steered elsewhere: to her family — a deckhand grandfather, a father’s crooked splint, a grandmother’s transnational hunt for Gleevec — to the four reinforcing conditions she argues made the transformation possible, to the “China is fast because China is loose” shortcut and what’s actually behind the speed, to BIOSECURE and its successors, to the AI doctor avatars now fielding millions of inquiries a year, and to the burnout and violence that still bedevil the lives of Chinese clinicians.
10:31 – Two family stories from 1970s Zhejiang: a deckhand grandfather and a barefoot doctor’s crooked splint
15:57 – Four reinforcing conditions, part one: demographic pressure and crisis as catalyst (SARS, melamine, fake vaccines)
23:42 – The long view: Healthy China 2030 and why China’s health ministers are technocrats
27:54 – The cultural inheritance: who signs the consent form, and China’s health codes vs. Britain’s billion-pound app
35:26 – Grandma and Gleevec: a family’s transnational hunt for a drug in 2003
40:17 – The reversal: hǎiguī, copycats to first-in-class, and the tenfold surge in out-licensing
42:35 – Is China fast because China is loose? Where China leads (oncology, GLP-1s) and where it lags
50:22 – BIOSECURE, COINS, and BINSA: who loses when politics meets pharma
55:37 – Digital health in three systems, Ant Afu’s AI doctor avatars, and whether the silver generation can keep up
1:08:44 – “A lifetime of eating bitterness”: Dr. Wang of Guangzhou, burnout, and yī nào
Paying It Forward
Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations and professor at Seton Hall — the go-to voice on the geopolitics of China and health, and Ruby’s first port of call.
Afra Wang, writer of the Concurrent newsletter — Ruby admires how she reads the cultural currents beneath technology, and finds it endlessly useful to take those insights to the health-tech angle.
Olivia Plotnick, Shanghai-based founder of Wai Social — on-the-ground work on branding and consumer behavior across some 30 lower-tier Chinese cities, including health and wellness.
Recommendations
Ruby: Deep China: The Moral Life of the Person, edited by Arthur Kleinman with Yunxiang Yan, Jing Jun, Sing Lee, and others — what being sick reveals about society and culture in China: psychiatry, caregiving, and how patients and families have changed as the country has. Kleinman’s The Soul of Care is also worth your time.
Kaiser: Augustus by John Williams — the third of his novels I’ve recommended on the show, and the National Book Award winner: an epistolary novel of imperial Rome told through a crazy quilt of letters and fragments from family, friends like Agrippa, and poets like Virgil and Horace, each given a completely distinct voice. Quiet campus novel, anti-Western, imperial Rome — the range, and the restraint, are astonishing.
Also: Ezra Klein’s conversation with Carnegie’s Matt Sheehan — a masterclass in clarity on AI safety and the U.S.-China relationship, and the best thing to listen to in the wake of Dario Amodei’s “Pacing the Frontier” essay.
Transcript
Kaiser Kuo: Welcome to the Sinica Podcast, a weekly discussion of current affairs in China. In this program, we look at books, ideas, new research, intellectual currents, and cultural trends that can help us better understand what’s happening in China’s politics, foreign relations, economics, and society. Join me each week for in-depth conversations that shed more light and bring less heat to how we think and talk about China.
I’m Kaiser Kuo, coming to you this week from my home in Beijing.
Listeners, please support my work by becoming a paying subscriber at sinicapodcast.com. I know there are a lot of Substacks out there, and yes, they do start to add up. It’s a problem for me too, but this is a very worthwhile subscription. In addition to Sinica itself, you also get great content from wonderful partners like Trivium, a strategic advisory that puts out the excellent Trivium China Podcast, part of the Sinica Podcast Network, as well as, of course, the China Global South Project and its fantastic podcast. It’s really, literally my favorite podcast. And of course, Jay Carter’s This Week in China’s History. So please do subscribe so I can continue to bring you these conversations and lots more.
I’ve been in and out of China since the 1980s, as many of you know, and living here for most of the years since. Of all the transformations I’ve watched in that time, healthcare may be the one that’s kind of hardest to convey to anyone who wasn’t around for the early part of it. If you spent any time in a Chinese hospital, woe betide ye, in the late ‘80s, say, or the ‘90s, you remember. You remember getting there before dawn to queue up for, you know, a registration ticket, and you remember the piào fànzi, the ticket scalpers who had already, you know, bought up all the morning slots or whichever doctor you actually wanted to see.
You remember the cashier’s windows at every single step. Pay here, you take your little slip, you go do your thing, come back, pay again, get another slip. And you remember corridors that were really crowded with people who were being seen in them. IV drips for most of them for some reason, for more or less everything. They were handing out antibiotics willy-nilly for even just a head cold.
And underneath all of it, a kind of low-grade dread, the sense that if something genuinely serious were to happen to you, your outcome was going to depend on whether you knew somebody. I’ve been lucky enough to mostly avoid it, though, you know, the many trips that I’ve taken with siblings and girlfriends and friends, and then of course the wife and kids, have etched the experience into me rather deeply. The world that I’ve described has not disappeared completely. I do want to be careful here because I live in Beijing, which is about as good as it gets in this country.
And the distance between a Beijing, even like tertiary hospital and a county hospital, say in Guizhou is still going to be enormous. Nobody should come away from this episode thinking China has Seoul’s healthcare. It clearly hasn’t, but even allowing for all of that, the change is still pretty hard to overstate. I mean, I book appointments now on my phone, payment and insurance settle inside the same app that you booked on, test results come back on your phone, prescriptions get delivered to your door. And there are hospitals in this country where a newly diagnosed cancer patient can go from genetic sequencing to a matched therapy inside of a couple of days.
There are people listening to this right now who have better digital continuity of care in Hangzhou than I could get from an American health system I’ve paid into for decades. And the delivery side isn’t even the part that I find most striking. It’s actually what’s happened to the drugs themselves. So last week, if you heard my show last week in my little preamble, I was talking about how staying relevant to the discourse on China seems now to require unmanageable levels of familiarity with all sorts of different areas of specialization, especially tech, AI, and semiconductors, all the ins and outs of trade policy, rare earths, of course, which is what we talked about last week.
Add one more to the list because the next thing is almost certainly going to be pharma and biopharma. Now, I am a complete neophyte to all this, so do bear with me if you are somebody who knows this area much better than I do. For a long time, China’s role in the global pharmaceutical business was, you know, the unglamorous end of it, active pharmaceutical ingredients, you know, the chemical building blocks that go into other people’s medicines. Plus, of course, generics, like India had done for a long time, copies of molecules that were invented somewhere else.
That was the reputation, and mostly it was deserved. The work that companies like WuXi AppTech, which was still called WuXi PharmaTech back when I visited them 20 years ago as a reporter, was this kind of unglamorous work. Screening compounds, you know, boring molecular assays, lots of pipette stuff. We’ll see before the conversation that follows is finished how far they’ve now come. What’s happened over the last few years is just a different thing entirely.
China has moved into biologics, you know, the really large, complex molecules that are grown in living cells. The antibodies and antibody-drug conjugates and cell therapies that represent the actual frontier of cancer medicine. In late 2024, a drug from the Chinese company Akeso outperformed Merck’s Keytruda, one of the best-selling cancer drugs in the world, in a phase three trial. Last year, Chinese companies signed something like 186 out-licensing deals with a disclosed value of around $137 billion. That is roughly half of all out-licensing valued globally and close to 10 times what it was in 2021. Just think about that.
Five years, it’s gone 10 times in value. Pfizer, Bristol-Myers Squibb, AstraZeneca, GSK, Eli Lilly- they are all buying from China. So, a country that within living memory sent barefoot doctors into the countryside with herbal remedies and Western antibiotics in the same kind of army green satchels is now the place where global pharma comes shopping for its frontier assets. That is a genuinely extraordinary arc, and it has not so far been well explained to general audiences.
My guest today has written the book that explains all that and much more. Dr. Ruby Wang is, I think, a genuinely rare creature. I’m actually not aware of anyone else working in this space with her particular combination of vantage points. She’s a practicing physician in Britain’s NHS, the National Health Service. She’s trained in surgery. She worked the London hospital wards through the first horrible, horrible wave of COVID. She then moved to Beijing to lead the UK government’s health engagement in China and later served as a health advisor within the United Nations system.
Before that, she’d been a medical advisor at Ali Health in Hangzhou. So, she’s seen the Chinese platform health world from the inside of one of the companies that’s building it. She grew up between China and the UK. She now runs a strategy consultancy, Lintris Health, and writes the excellent China Health Pulse newsletter and hosts the podcast of the same name, both of which I would recommend to anyone trying to follow this space.
So, clinician, diplomat, UN advisor, tech company insider, and China hand, most people working on Chinese healthcare, maybe have been one of those things. She has all of them, and you can feel it in the book, which moves from a village in Zhejiang in the 1970s to licensing deals in European capitals without ever losing the thread back to actual patients and to practitioners. Her new book is called China Cure: The Rise of a Biotech, AI Medicine, and Global Health Superpower, published by Agenda Publishing, with a foreword by someone I very much admire, Kerry Brown, who’s been on the show.
It comes out next month at the end of October, and it is sure to make quite a splash. Dr. Ruby Wang, welcome to Sinica.
Dr. Ruby Wang: Thank you so much for having me, Kaiser. It’s such a pleasure to be here. I’ve been a longtime fan of your show.
Kaiser: Thank you. Thank you so much. Ruby, before we get started, I want to note that you did a terrific interview with my friend Kyle Chan of Brookings on his High Capacity Podcast back in the spring. And as anyone who knows Kyle’s research interests would have expected from him, he asked you a whole bunch about, you know, the apps, the data flows, the clinical uses of AI, the Internet hospitals, the device trends and other stuff broadly, you know, in his wheelhouse.
So, I’m kind of going to deliberately steer, not completely clear of those things, but I’m going to focus on things that he didn’t really center from his podcast interview with you about your very rich book. So, I’m going to ask you more stuff about, you know, your family, your own clinical life, and some of the issues that still bedevil the Chinese medical system, some of the multinational health institutions that you’ve been involved with, and stuff like that.
Let me also note one thing here. This isn’t a book or a conversation, for that matter, about TCM, about traditional Chinese medicine at all. I know that lots of my listeners will be disappointed to hear that. I know some people in my family will be disappointed, but that is the topic that we’re going to cover in this conversation. All I can say is sorry. And maybe at some point I’ll revisit that topic. But for now, you’re just going to have to wait.
So, with all that out of the way, listeners, I do encourage you to go listen to Ruby on Kyle’s podcast as well. Let’s get going. Okay. So, Ruby, the book doesn’t open, you know, with policy or with big numbers. It opens actually with your grandfather, who’s a cargo ship deckhand in a fishing village on the Zhejiang coast in the ‘70s. Tell me about him, and what it was that connects him to your story.
Ruby: It’s a great place to start. I guess with my grandfather, I never met him. He died when my father was 14. But he was a cargo deckhand on a ship, ferrying packages from the coastline of Ninghai to Shanghai and to Ningbo, all of his life. And he had liver cancer that was undiagnosed until it was far too late. He was jaundiced, and he was fatigued and unwell, and finally collapsed before he was taken to a hospital a long way away from his hometown through the ingenuity of my grandmother, his wife, because, at the time, the village only had a Chinese doctor who was maybe a TCM doctor with some knowledge of, you know, some access to Western medicines like painkillers.
It was a long time ago, and it was a different world from, you know, what we’ve described today. And by the time he got there, the doctor said it was far too late. The cancer had spread everywhere. And that, you know, the best thing to do was for him to come back home and just rest. And so it was something that perhaps in the West, even at that time, could have been treated. But because China was still developing, still rural where he was, then there was nothing to be done. So, my father had the task of, you know, feeding him, looking after him as one of his sons. And then he finally passed. In the short decades since then, we’ve seen China transform.
And it’s interesting for me as a doctor and someone who’s lived between the UK and China, West and East, to think about how far someone in my family, how they would have very different care today.
Kaiser: Yeah, indeed. Before we come to the present, let’s stay a little bit in the past because the barefoot doctors, the chìjiǎoyīshēng (吃饺医生), are one of the few things about Chinese healthcare with kind of a genuinely romantic international reputation. I mean, there were 2 million of them within a decade, you know, when this first started. And there’s kind of a direct line between them and the Alma-Ata Declaration and the global primary care movement.
Your father grew up with him, but his account, his story is not quite so romantic. Can you tell me about that, about your father’s encounter with a barefoot doctor.
Ruby: Yeah, so when he was, you know, very young, less than 10, he fell in a ditch,
