Hell-bent on economic development, China last year became the third country to launch a man into space. But, down on the ground, poor health care is a sore subject. China's biomedical researchers—and their supporters overseas—are gathering money for an overhaul of the biomedical research system that they say will dramatically improve the country's ability to deal with disease.

New research institutes such as the one in Guangzhou (L) aim to improve Chinese medicine. Credit: David Cyranoski

People in China suffer from perhaps the broadest spectrum of diseases of any country, says Zhu Chen, vice president of the Chinese Academy of Sciences (CAS). “We have the diseases of the developed world and the developing world,” he says.

Many researchers and pharmaceutical companies are beginning to look at China's massive population as an asset for clinical trials. Emerging diseases such as Severe Acute Respiratory Syndrome (SARS), and diseases that are particularly prevalent in China—such as diabetes and hepatitis—present an opportunity to make rapid advances in clinical research, says Ling Chen, who last December left Merck to head the new Guangzhou Institute of Biomedicine and Health (GIBH) in southern China. “Only China has so many patients.”

At the GIBH, decisions about funding are made by scientists at the local level rather than in the top-down fashion that is common in China. In that, GIBH is joined by several other institutes that have sprung up over the past few years: the National Institute for Biological Sciences in Beijing (Nature 420, 257; 2002), the Institute of Molecular Medicine in Beijing, a joint effort with the University of California in San Diego (Nat. Med. 10, 439; 2004), and a Shanghai branch of the Institut Pasteur that is set to open in October.

The GIBH will benefit from access to thousands of monkeys from China's ample monkey farms, says Chen. This will give its researchers an edge over powerhouses in the US, where laboratories often have to make do with mice, he adds.

The Institut Pasteur launched its Shanghai branch because of China's “impressive capacity to make decisions” during the SARS epidemic, says Antoine des Graviers of the Paris branch. For the Chinese, it sets up a new model, in which government funds for research are mixed with private funds and profit from technology transfer. This “ideal model” could increase the institution's autonomy, says Zhu Chen of the CAS.

Organizers of the new institutes hope that greater independence from government bureaucracy could help them recruit top-level scientists from abroad. But even if those efforts are successful, finding a stable source of funds to extend the model beyond these isolated initiatives is a significant problem. China's Natural Science Foundation is considering adding a new department to fund biomedical research. But critics say that although the foundation is competent at distributing smaller grants, larger projects often move forward without sufficient evaluation and waste valuable resources (Nature 428, 206–207; 2004).

CAS' Chen says one solution is a funding agency akin to the US National Institutes of Health or France's INSERM, which would take funding decisions out of the hands of bureaucrats bent on long-term planning and into the hands of scientists familiar with research trends. “You have to be more flexible,” he says.

Chen's proposed 'Modern Biomedical Research Mechanism' would be a massive boost in research capacity. For 2005, he is asking for RMB5 billion (about US$625 million), half of which would support 500 principal investigators in internal research institutes. The rest would be distributed as external grants with a strict peer-reviewed evaluation system. The proposal, first drafted last year, was recently revised and is now in the government's hands. Chen says he is hopeful it will move forward, but admits it will probably take time.

Most scientists support the call for more funds and a better evaluation system, but some worry that the new trend will jeopardize bottom-up basic science. The intramural program might bring about more big, bureaucratic science rather than less, says one senior scientist. “I am afraid that the 'going to the moon syndrome' is [afflicting] the mind of some Chinese medical science administrators.”