America is 4% of the world's population.

It's about 13% of all the drug buying, but it's also more than half of the sales in terms of dollar amounts.

So it's huge.

And this is a big advantage because, like, you know, innovation does respond to the money and it has to.

We're more likely to have false positives and false negatives in our trials because they are smaller than theirs.

Theirs are less likely to have both. The type 1 and type two error rates are both down for China because they run bigger, better trials. China says, well, no, we're going to make you profitable. We're actually going to make you money. If you are a firm that we are negotiating with and you lower those costs, we're going to help you sell more so that you don't have a reduction in your profit so they become more profitable and we pay less money and everybody's just better off in general.

What happens when the United States is no longer

the leader in biomedical innovation? For decades, the U.S. dominated drug development, producing a large

share of the world's new therapies and setting the pace for clinical research. But over the last few years, that's started to change.

China has rapidly expanded its clinical trial system,

accelerated approvals, and is now leading in both volume and novel drug development.

This shift isn't about scale.

It's about systems, regulatory design, trial structure, funding models, and incentives all shape how quickly new treatments reach patients and where innovation happens.

The question now is whether the U.S. can adapt or whether the center of gravity for biotech continues to move.

Theo Jaffe and Gabriel Dickinson speak with Kremu.

Welcome to MTSC cremieu recue.

How do you pronounce it in the French?

Kremiur okay.

That was pretty good.

We're going to add you.

You had a slight Canadian accent there.

To the tweet wall.

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