China’s Innovation Ambition and Its Consequences
Warnings of an impending trade war between China and the U.S. fill the recent newspaper headlines. President Donald Trump, both as a candidate and now in office, has similarly railed against the country, saying it is responsible for hurting the American people through low-cost manufacturing and its large trade surplus relative to the U.S. The two governments have been trading tariffs and threats of tariffs as each vies to create the most favorable environment for their goods.
A parallel, perhaps more important, rivalry is brewing between the U.S. and Chinese scientific communities. For decades, the West, especially the United States, led the world in innovation and the production of useful new inventions.
China is quickly catching up and could become the world leaders in fields like artificial intelligence (AI) and biotechnology. China’s global ranking of published science and engineering papers rose from fourteenth in 1995 to second behind the U.S. by 2007. China is also projected to overtake the U.S. in R&D spending by 2022.
An important contributing factor to this quick growth is the detailed science and technology development plan published by the Chinese government. The plan sets goals of being a major innovation center by 2020 and the world leader in science and technology by 2050. China has built the infrastructure needed to achieve these goals and will likely surpass the U.S. in the next decades if current trends hold steady.
Observing these trends, many experts fear the consequences of an order in which China is the innovation capitol of the world. They criticize China’s R&D system and characterize it as a “Wild West” devoid of caution and restraint.
This portrayal is actually misinformed. China does demonstrate that it understands the need for proper oversight of cutting edge scientific research and has erected the necessary regulatory framework to protect its citizens.
In fact, the West would be wise to observe the Chinese system and adopt some of the elements that have allowed it to flourish so quickly and help patients in ways doctors in America and other industrialized nations have not or are only now beginning.
China’s AI Ambitions
Current President Xi Jinping reinforced and expanded on the national science and development plan in several of his official speeches. He especially emphasized growing China’s big data and AI capabilities. Last year, the country issued “The New Generation AI Development Plan,” which declares China’s intention to lead the world in AI by 2030, and directs billions of dollars of state grants to the industry. China already has the elements needed for AI dominance: committed government money, large internet population, world-class research institutions, and a society hungry for technology.
For AI, data is like the fuel that runs physical machines. The algorithms behind AI are trained by feeding them enough data for the computer to detect patterns. The larger the data set, the faster the algorithms will improve. And China has an overwhelming amount of data for scientists to use. The country boasts over 750 million internet users generating a steady stream of data every day.
Furthermore, the nature of the Chinese government also makes that mountain of data more actionable. The “command-and-control economy” and authoritarian government mean that citizens have less control over their data, even sensitive data like medical records, than their western peers. This arrangement clearly contributes to the quick growth of China’s AI industry, but it unfortunately jeopardizes privacy.
While some citizens have used social media to emphasize these privacy concerns, technology industry insiders point to a growing trend of Chinese internet users agreeing to give up their data to their favorite apps and programs. This is likely because many in China support the government’s goals for the growth of AI, even if some concerns about method exist. Unlike the negative press AI gets from some popular American figures like Elon Musk, there exists a general enthusiasm for new AI technology in China. Citizens are focused on the benefits of the new technology, an outlook that will likely boost adoption rates. Wider adoption, more quickly may lead to even faster Chinese growth.
China is also better than the West at encouraging collaboration between government and developers in both academia and industry. For example, Malong Technologies, a private startup in Shenzhen, opened a joint AI research lab with Tsinghua University in Beijing, with official support from the Shenzhen government. This extensive collaboration among all of the important stakeholders could further speed China’s development in AI technology by uniting the best scientific minds in the field with the necessary funding and facilitating the sharing of data and breakthroughs.
Already, this focused campaign of AI development has begun paying dividends. The opportunities for data and funding are enticing American-trained, Chinese AI engineers to move back to China and work for Chinese companies and universities. Jiebo Luo, a professor at University of Rochester, estimates that Chinese researchers can make salaries of about $500,000 at top American technology companies. In China, he says, those same researchers could command salaries double that amount.
This phenomenon is widespread enough that, in January, Bloomberg published an article entitled, “Chinese Workers Abandon Silicon Valley for Riches Back Home.” The marquee example is internet company Baidu recruiting AI super star and Microsoft executive Qi Lu to move to China and lead Baidu’s AI venture.
China also expects to be able to rely more heavily on homegrown talent in the near future. In the past, Chinese companies had to recruit employees from American engineering universities if they wanted the top talent. But Qi Lu says that is changing and that Chinese technology companies are increasingly looking close to home for new hires.
The state of Chinese AI research is also improving rapidly. A 2016 White House report noted that China has surpassed the rest of the world in number of deep-learning papers published in academic journals. McKinsey Global Institute reported that the country had taken the third spot behind the U.S. and the U.K. when ranked by paper influence.
Even American technology leaders are beginning to recognize the formidable prowess of their Chinese counterparts. Sundar Pichai, CEO of AI giant Google, praised China’s advances in a recent speech at the annual China Development Forum in Beijing. His company has invested in several Chinese startups and has a partnership with internet conglomerate Tencent. Google also announced in December that it would open a new AI center in Beijing staffed mainly by Chinese scientists, which they are now expanding. Pichai believes that China is playing and will continue to play “a big part in how AI will shape our futures.”
America’s AI Jitters
China’s progress intersects a period of American technological nervousness. The recent Facebook data scandal, pedestrian fatality due to an Uber autonomous vehicle, and general anti-“big tech” talk have many reevaluating the role that technology has in our modern lives. These concerns have manifested in sliding technology stock prices and legislation like the Stop Enabling Sex Traffickers Act of 2017. Such public skittishness, even if justified, could spur a backlash that will hinder American AI progress.
Perhaps the most noticeable contrast between the U.S. and China is the difference in how the two governments approach AI development. Unlike China’s President Xi, Trump hardly ever mentions AI or other advanced technology. Trump also called for deep cuts to scientific research in his fiscal year 2018 budget. The document called for an eleven percent cut to the National Science Foundation’s budget. The original fiscal year 2019 budget request also asked for more large cuts. It seems clear that the Trump White House does not intend to prioritize spending on basic scientific research.
This “retreat from basic science” has worried experts like Paul Scharre, a Senior Fellow at the Center for a New American Security. He says, “Clearly [Washington doesn’t] have any strategic plan” when it comes to supporting technological development. This fear caused Scharre’s colleague at the Center Elsa Kania to warn readers that the U.S. is facing an “innovation deficit” due to the pull back in research spending. This continuing retreat could endanger American competitiveness and jeopardize U.S. power and technological dominance.
China Embraces Genetic Testing
Another growth industry that President Xi believes China could potentially come to dominate is medicine and biotechnology. Recently, Xi made improving China’s national health an integral piece of national strategy. In October 2016, he announced the “Healthy China 2030” initiative, his public health corollary to the AI development plan.
One pillar of the plan involves developing the Chinese healthcare industry in order to increase innovation, discover new drugs, and create new treatment methods. By 2030, China intends to “substantially” increase its “global market share of new drugs and medical devices,” eventually becoming a globally competitive, or perhaps even dominant, pharmaceutical producer.
As part of Healthy China and the latest five year plan, China has also embraced genetic sequencing and testing services. The goal is to use these services to develop a world-class precision medicine field. Many of the assets that give China an advantage in AI are also advantageous in precision medicine: millions of willing patients, strong governmental support, and plenty of cash.
The five year plan announced a budget of about $3 billion dollars over its five years for precision medicine, specifically to “incorporate genomics into a range of clinical and research applications.” Chinese media estimated that as much as $9 billion could be spent by government and private companies on this field by 2030.
Responding to this cash inflow, several major universities set up sequencing centers. In early January 2016, the Chinese Academy of Sciences announced a program to sequence the genomes of four thousand volunteers over four years. Similarly, Sichuan University’s West China Hospital announced a plan to sequence the genomes of one million people by itself. This is the same amount as the entire U.S. National Institutes of Health “All of Us” initiative.
Private sector companies like Shenzhen-based BGI have also shown dominance in the sequencing industry. BGI began in relative obscurity in 1999, but quickly became a globally recognized genome sequencing company, commanding up to twenty percent of the global market. Since then, other Chinese companies like Novogene and WuXi PharmaTech have challenged BGI’s hegemony and diversified the field. These companies have established China as one of the top sequencing powerhouses in the world.
This growth in sequencing capacity intersects with an enthusiasm among Chinese citizens that could lead to exciting medical insights rivaling those made by American scientists. As with AI, China has an abundance of data that can fuel insights into the genetic foundation of disease. Jason Gang Jin, the co-founder of another sequencing company called CloudHealth Genomics, believes that “China will be faster than the United States at sequencing genomes and identifying mutations that are relevant to personalized medicine” due to the large population. Ta Jen Liu, a project director at MD Anderson Cancer Center who develops collaborations with Chinese partners, comments that when it comes to precision medicine, “China wants to do it, and everybody is very excited.”
In fact, Chinese parents have already demonstrated a desire to utilize genetic testing services for reproduction. Many older women wishing to have a second child seek out assisted reproductive technologies like in vitro fertilization (IVF) to help them conceive. To increase their chances of having strong, healthy children, these mothers-to-be often pair pre-implantation genetic diagnosis (PGD) with IVF. PGD allows the physician to test the DNA of each embryo created during IVF so that she can implant embryos free from potentially harmful genetic diseases.
In China, utilization of these techniques is beginning to “explode.” The country’s use of PGD has already surpassed that of the United States and is growing around five times as fast. In 2016, the largest fertility clinic in China, located in the Hunan province, performed 41,000 IVF procedures singlehandedly. This is about one-quarter of the number of IVF procedures performed in the entire United States in the same year. And between 2014 and 2016 the use of PGD at this clinic rose almost 300%.
The adoption rate of all forms genetic testing demonstrates the enthusiasm for harnessing these technologies in China. It seems most levels of government and society are embracing this positive attitude and are committed to helping the country lead the world in sequencing technology.
China Explores CRISPR
In accordance with the Healthy China initiative and the five year plan, the Chinese medical industry is using the vast data gathered through sequencing to develop cutting-edge cures for life-threatening diseases like cancer. One category of treatments in which China undoubtedly leads the world (at least in terms of quantity and timing) is gene editing using CRISPR.
CRISPR is a family of systems that functions as a bacterial immune system in nature. The system employs a CRISPR associated protein and a guide RNA sequence to snip precisely targeted DNA sequences and disable attacking bacteriophages. New attacks can diversify the guide RNA sequences that can be created, thus growing the immune system. Several teams of scientists published papers showing that CRISPR could be programed to cut any sequence of genes in practically any organism, including humans. Scientists all over the world soon put the system to work in a dizzying array of experiments and new applications.
Perhaps the most high profile CRISPR experiment done in China was a paper published in the online journal Protein & Cell by a team from Sun Yat-sen University in Guangzhou in 2015. For the first time ever, scientists used the gene editing tool CRISPR-Cas9 to edit a non-viable human embryo to correct the gene that causes beta thalassaemia, a blood disorder. Since the publishing of this paper, Chinese scientists have remained at the cutting edge of genetic science, editing human embryos in at least two more studies.
Yet China has been concentrating most of its research on CRISPR’s application to oncology. As of January 2018, the Wall Street Journal discovered eleven Chinese clinical trials testing CRISPR on humans, going back as far as 2015. At the time that article was published, the newspaper reported that eighty six patients in China had undergone a CRISPR-based treatment. By contrast, the first U.S. clinical trial using CRISPR to treat cancer, run by researchers at the University of Pennsylvania, just found its first volunteer in February 2018, after several years of regulatory delays.
Regulatory differences between the American and Chinese medical fields drive the time gap between the countries. Before proceeding with the clinical trial, Penn researchers had to make their case before the Recombinant DNA Advisory Committee, a committee formed by the National Institutes of Health that reviews the safety and ethics of government funded clinical trials involving gene editing. After clearing that hurdle, the researchers needed the approval of the Penn’s own institutional review board (IRB). The IRB also reviews safety standards in accordance with minimum standards laid out in regulations from the Department of Health and Human Services and the Food and Drug Administration (FDA). It also ensures that the trial treats its human subjects as prescribed by the ethical standards of the Belmont Report. NPR reported that the trial also needed the approval of a second committee at Penn. Once the IRB had given its blessing, the researchers finally had to seek the approval of the FDA, which regulates human trials. After more than a year of discussions with the FDA, the agency finally gave its approval earlier this year and allowed the trial to get underway.
In China, Wu Shixiu and a team of scientists have been running a similar CRISPR-based cancer trial at the Zhejiang Cancer Hospital about one hundred miles southwest of Shanghai. To begin his trial, Wu only had to receive the approval of one hospital IRB, since the Chinese health ministry had promulgated regulations granting IRBs the power to allow or prohibit human trials without seeking further approval from the ministry. Nine members comprised the hospital’s IRB: a lawyer, a bioethicist, nurses, doctors, a journalist, a representative for cancer patients, and a representative for the public. After a short deliberation and a sign off from the committee, Wu’s trial began within two months of his first proposal.
The regulatory disparity between the two countries means that China has the advantage of several additional years of actual clinical experience with new gene editing treatments. Carl June, a respected immunologist and leader of the CRISPR trials at Penn, believes that China could beat the U.S. in the race to apply and perfect genetic technology like CRISPR. For Wu, China is something of a stepchild that has stolen the biological child’s birthright. “China shouldn’t have been the first one to do it,” he says, “But there are fewer restrictions.”
America On The Edge
These developments in Chinese AI and biotechnology have caused experts to fear that the U.S. could lose its long-held place as the center of scientific innovation. Such a loss would be a blow to national pride and give away bragging rights, and plenty of scientists support efforts to maintain America’s historical place atop the research world to retain such rights. But falling out of the top echelon has other, more serious implications as well.
Scientific discovery plays an important role in growing the U.S. economy and improving the lives of Americans. Businessman Steve Case writes in the Washington Post, “America’s best chance to achieve robust, sustainable growth and prosperity is by ensuring that the United States increases its entrepreneurial competitiveness relative to the rest of the world.” One of the best methods to increase entrepreneurialism is a strong R&D culture generating new ideas that aspiring businesspeople can commercialize.
Similarly, strong biomedical research often translates to advances in our understanding of human diseases and a more highly trained generation of health professionals. Both of these effects contribute to better health and well-being for patients. Not being the center of these discoveries comes with a chance that the benefits from such discoveries will take longer to reach American patients.
Ceding America’s place as the epicenter of scientific discovery may also result in an outflow of top talent, as is beginning to occur in AI research. Losing talent can in turn fuel further retreats in discovery power as more and more young scientists seek better opportunities abroad.
Loss of talent at home necessitates a reliance on scientists in other countries. Adam Segal wrote in Foreign Affairs that, “Such dependence … could become a critical weakness for the United States in the future.”
Whether these possibilities are realized is far from sure. Fears of America’s scientific decline have been discussed for over a decade. Segal’s article was published in the November/December 2004 issue of the magazine. It is undeniable that countries like China have made immense progress since then, but, as yet, it is still difficult to argue that the U.S. has been unseated. Nevertheless, it would be foolish to believe that such a thing could never happen, especially if nothing is done to facilitate America’s continued scientific progress.
The Wild West
Experts fear that if the U.S. does lose the top spot, China would take its place. Such a scenario would be concerning because of the less stringent nature of China’s regulations.
When it comes to regulation of potentially ethically concerning technologies like AI and biomedicine, “China’s like the Wild West,” says June. One primary fear is that such regulatory laxity will induce Chinese researchers to recklessly attempt an experiment without proper preparation or oversight that ends up causing a patient death or other harm. Such a tragedy could lead regulators around the world to issue strict prohibitions or enact burdensome oversight frameworks that significantly inhibit any kind of progress, safe or otherwise.
The “regulatory asymmetry” between the two countries also raises fairness concerns among Western scientists operating under the more stringent regime. Multiple scientists and ethicists have published calls for an international consensus on the issues surrounding AI and genetics so that there is a “level playing field.” Jeffrey Kahn, director of the Berman Institute of Bioethics at Johns Hopkins University, says the question international regulators ought to be asking is how researchers everywhere can be brought under the “same tent” when it comes to rules of scientific conduct. China’s lenient attitude penalizes countries like the U.S. that adopt a responsible approach to innovation and puts them at an unfair disadvantage. Only under uniform, more stringent regulations can cutting edge fields move forward safely and fairly.
Contrary to its portrayal by these experts, the Chinese science field is not a laissez faire free for all. Chinese researchers are concerned about the societal effects of the advances they are making and regulations are in place to guide development of potentially disruptive technology.
Late last year, representatives from academia, industry, and government met in Beijing in order to discuss the societal impacts of AI. Specifically the attendees discussed topics like algorithmic bias, autonomous weapons, and privacy issues. These deliberations, published in Chinese in early March 2018, show that Chinese experts are exploring the ethical and social consequences of these new technologies, and that they would like to play a part in guiding its safe development.
Recent moves on privacy reveal an openness to appropriate caution. Chinese internet companies are lobbying for tighter privacy regulation, believing that more serious privacy regulation may allow these companies to better appeal to Western consumers and give them an opportunity to expand their reach. Such requests are being made even though they may slow AI research if granted.
Similarly, the Chinese government has recently moved to increase personal data protections. Earlier this year, the government published a new national standard that covers user consent and how personal information is collected, stored, and used. The standard takes effect on May 1, 2018. According to Samm Sacks, a Senior Fellow at the Center for Strategic and International Studies, the language of the regulation “is comprehensive and contains more onerous requirements than even the European Union’s General Data Protection Regulation.”
Overall, the consideration of the difficult ethical and social issues that accompany AI research by both public and private sectors in China is encouraging. Jeffrey Ding, a researcher at Oxford University’s Future of Humanity Institute and author of a recent report on Chinese AI, said he finds that the “depth of thinking” by all actors in the field “vastly exceed[ed]” his expectations. Chinese AI is not perfect (especially the controls on the government’s use of data), but it is difficult to characterize the progress made as a “Wild West.”
In biotechnology, China also demonstrates consciousness of the gravity of their progress. In a comment for Nature, Douglas Sipp, a researcher at the RIKEN Center for Developmental Biology in Japan, and Duanqing Pei, a professor at the Chinese Academy of Sciences, argue that popular media’s fears about China’s cavalier attitudes toward bioethics are “overblown.” The country has actually “shown care and restraint” when dealing with potentially concerning and far-reaching research like that done on human embryos.
In 2003, the Chinese Ministry of Science and Technology established national guidelines on embryonic-stem-cell research that prohibited scientists from implanting and bringing modified human embryos to full term. Breaching these guidelines carried severe financial penalties along with possible loss of employment. The rules are consistent with a government policy of promoting research but strictly prohibiting the use of experimental techniques for reproduction.
Along with these national guidelines, China has a complex regulatory system with several agencies overseeing biomedical research. Many of the regulations exist in the form of guidance documents published on agency websites. The agencies often do not translate their guidance into English, nor do they frequently publish them in a manner that would command the attention of Western media. For these reasons, Western observers sometimes wrongly assume that Chinese scientists are free to pursue their experiments at their own discretion when actually they must navigate a regulatory scheme that rivals that of the U.S. in scope.
Furthermore, like the governments of most Western countries, the Chinese regulatory bodies quickly respond to new challenges and incidents that spark a public outcry. For years the country had experienced problems with unauthorized clinics offering potentially dangerous stem-cell-based treatments for a variety of diseases. These clinics ignored existing regulations and took advantage of desperate patients. In 2012, the government instigated a complete ban on unapproved stem-cell therapies, as well as a moratorium on new clinical trials in order to promulgate additional rules to remedy the abuses. Three years later, state media announced the new suite of guidelines aimed at providing more clarity and protection for patients. Some of the measures announced included enhanced informed consent and a stipulation that researchers use clinical grade stem-cells that have been verified by an independent body.
Chinese citizens also display an appreciation of the weightiness of decisions involving advanced biotechnology. A study conducted several years ago surveyed families who had undergone IVF and had successfully given birth to a child. In families in which this child was between the ages of zero and three, over eighty percent opted to keep their unused embryos in storage and not destroy them. While the study found that the chief reason for this decision was the desire to bear more children, an additional factor was the moral status of the embryo, indicating that the general population considers the ethical challenges associated with biotechnology and rebutting a perception of complicity in risky genetic research.
While it is clear that China has an expansive regulatory regime set up to oversee biomedical development and a citizenry that values safety, the country still leads most Western countries in the number of ongoing clinical trials, many of which involve highly experimental treatments like CRISPR. This disparity likely stems from the unique attitude with which China approaches this research.
Wu points out that many Chinese approach advanced medical research believing, “This is going to be beneficial for China.” He contrasts that with approaches in Western countries where tragedies like the Nazi human experiments cause excessive concern to dominate conversations. Wu’s personal motivation in forging ahead with clinical experiments is to save his patients’ lives. Without his trial, “most of them will die in three to six months.” This seems to characterize many doctors’ attitudes.
Patients likewise understand the clinical trial may be their best option and express a great willingness to undergo such experiments. One of Wu’s patients, Deng Shaorong, acknowledged that his doctors had carefully explained that the CRISPR trial he volunteered for was entirely experimental, but he says, “I never worried about this … I believe in science.”
Lessons to Learn
The Chinese system is certainly not perfect. The government is fundamentally authoritarian and frequently restricts the freedom of its citizens. Many problems exist in the Chinese research and development system related to privacy, respecting intellectual property, and more. Nevertheless, the Chinese approach to science and technology holds lessons for Western observers.
Making scientific progress ought to be a stated national goal, signaling to researchers the value and importance of their work. Federal grants are necessary and should be at least maintained. Yet grants are not the only tool available to Western governments. Prioritizing early and higher education will equip students to make the next breakthroughs. Opening immigration policy will attract the best talent from all over the world. Finally, clarifying regulations governing research will allow scientists to proceed without fear of unintentional wrong doing.
Regulation, as a general rule, ought to allow for “permissionless innovation,” especially in the realm of research. Proven oversight mechanisms like IRBs and strong informed consent rules have guided the safe development of science research for decades and are sufficient for the advanced technologies of today. Very targeted prohibitions, like that of disallowing embryos to be modified for the purpose of reproduction, may be appropriate for a limited amount of time, but research should be allowed to continue, especially since these new technologies have great potential to benefit patients.
Finally, regulation and research ought to be motivated by a desire to improve patients’ well-being. This includes allowing patients to make decisions for themselves, even potentially dangerous decisions. Most individuals are capable of assessing the costs and benefits of a treatment, if provided sufficient information, and deciding if they are willing to bear those risks.
America and other Western countries have historically been the leaders in scientific research, but China has built the infrastructure to challenge this world order. The West can and should learn from certain aspects of the Chinese system. Only by doing so can the West remain competitive and ensure a global environment that ultimately benefits patients.