Why China is currently underperforming in medical innovation and what China can do about it?-Part II.

Quant Imaging Med Surg 2015;5(3):335-339 www.amepc. org/qims Our AME survey-002 results indicated that, compared with Euro-American countries, China is underperforming in medical innovation (1-3) (Supplementary 1). To further explore this point, a metric literature analysis was carried out. The method was similar to the recent Zhang et al.’s paper (4). Ten reputable medical journals were included as the indicator for analysis, i.e., (I) Circulation Research; (II) Blood; (III) Leukemia; (IV) Stem Cells; (V) Haematologica; (VI) Thrombosis and Haemostasis; (VII) Journal of Thrombosis and Haemostasis; (VIII) Arteriosclerosis, Thrombosis, and Vascular Biology; (IX) Journal of Cerebral Blood Flow and Metabolism; and (X) British Journal of Haematology. All papers, including reviews and case reports, published during the periods of 1990-2014 by four countries, China (Mainland), Japan, Germany, and Switzerland, were retrieved, and where the corresponding author was affiliated with the above geographic regions were considered to be research output by the respective regions. As compared with Englishspeaking countries, all these four countries do not have a large proportion of guest researchers. The annual research and development (R&D) expenditure of each region was also retrieved (5); and the results are shown in Figure 1. While the increase over the year 1990-1997 periods represents an overall global tendency to publish more papers (same patter was seen for UK and France), Figure 1 also demonstrates the difficulty to decipher the relationship between R&D expenditure, literature output, and the perceived strength of the healthcare industry of respective countries. It is not easy to understand how the national policies, incentives and linguistic issues played a role. The R&D expenditure of China had a steep increase, Germany and Japan had a relative stable R&D investment with only small incremental increase, while Switzerland had only a fraction of R&D expenditure compared to the other three. China’s publication improved very notably over the years; currently standing at the similar level of Switzerland in paper number. Though I knew Switzerland has good reputation of doing high quality of science and documents published by Swiss scientists tend to rank the top on citation per article (6-8), Switzerland is also the home for pharmaceutical giants like Novartis and Hoffmann-La Roche, it still caught me by surprise with I generated this graph. I congratulate Swiss scientists that they apparently did an excellent job. We also need to take notice that there will likely be a ‘lagging effect’; with the investment associated the performance of Chinese medical scientists will further improve in the future. On the other hand, these data do agree with the common notion that a nation’s scientific performance is not necessarily related to its general population size, such as Miller (9): “good science can only be done by a small minority of each country’s population”; Kanazawa (7): “Science is.inherently elitist”; Murray [(3), p.310]: “Great human accomplishment has not come about just because the world accumulated enough people”. I generated the annual growth rate of Gross Domestic Product (GDP) in purchasing power parity (PPP), R&D expenditure (in PPP), and healthcare expenditure (in % PPP GDP) of China Mainland, the result is shown in Figure 2. The result suggests the increase in R&D investment is associated with the increase of China’s GDP instead of some stimulus measures. The countries with top 20 R&D spending in year 2012 are shown in Figure 3. While China ranked the second in overall Editorial