key: cord-009230-muvoo3pe authors: Chen, Zhu title: Biomedical science and technology in China date: 2008-10-17 journal: Lancet DOI: 10.1016/s0140-6736(08)61352-5 sha: doc_id: 9230 cord_uid: muvoo3pe nan Advances in medicine in the 20th century, along with an ageing population and changes in lifestyles, have altered the nature of diseases. reform, economic issues were the major concern and Deng Xiaoping advocated the notion of "science and technology constituting a primary productive force". 2 In the mid-1980s, when the national high-technology programme (863) was launched, 3 biotechnology was the main priority. Since the mid-1990s, China has used science and education to improve its international competitiveness, 4 with an increase in expenditure on research and development from 0·6% of gross domestic product (GDP) in 1996 to 1·4% in 2006 (a period during which the annual rate of growth in GDP reached more than 9%). 5 At the same time, China set up policies to develop its talent pool in biomedical research, and is ranked fourth internationally in 2005 for patents granted and publications in indexed journals. 6 More than 20% of the Government's research and development budget was spent on life science and biotechnology, including health-related domains. While encouraging investigator-initiated projects by augmenting the budget of the National Natural Science Foundation (a fi ve-fold increase over the past decade, rising to 4·3 billion Renminbi [about £0·32 billion] in 2007), China has also launched the national key basic research programme (973) and established major scientifi c facilities, including synchrotron light-sources and centres for genomics or protein science, drug screening, and biodiversity conservation. By combining resources in human genetics and traditional Chinese and western medicine, a comprehensive medical research system has been developed. In addition to the contribution to sequencing of the human genome and the HapMap Project, 7 scientists sequenced the genomes of several important species (including rice, chicken, the domesticated silk-moth, and Schistosoma japonicum). The molecular pathogenesis of infectious outbreaks, such as severe acute respiratory syndrome (SARS) 8 and avian infl uenza, 9 and several chronic diseases has also been analysed. 1 The development of selective diff erentiation or apoptosis induction in acute promyelocytic leukaemia is an example of how functional genomics can promote targeted cancer therapy. 10 China has joined international research eff orts in proteomics and structural genomics. Crystal structures of several protein complexes, including mitochondrial respiratory chain complex II, have been characterised, 11 and the fi rst human proteome catalogue for the liver has been generated. 12 Advances in other domains have also been made-eg, the eff ect of lymphoid microenvironments on dendritic cells 13 and signal transduction, such as the involvement of β arrestin in the regulation of G-protein-coupled receptor signalling. 14 Biochips have been applied to clinical medicine and food safety. China is the fi rst country to issue approval through the Government's regulator (the State Food and Drug Administration [SFDA]) for the use of biochips to screen for diseases such as hepatitis C. China approved the world's fi rst gene-therapy product (recombinant human serotype 5 adenovirus, Gendicine) for TP53 tumour suppressor. 15 Almost 100 new drugs have either been introduced into the market or are in late-phase clinical trials, such as analogues of artemisinin (a key component in combination therapy for malaria, and recommended by WHO), and quick-test diagnostic reagents for HIV/AIDS. Especially noteworthy are achievements in vaccines for SARS and avian infl uenza, and the establishment of important platforms for antibody studies. In stem-cell research, there have been patents and the setting of standards for animal cloning, generation of human embryonic stem-cell lines, nuclear transfer of somatic cells, somatic stem-cell isolation or characterisation, expansion and directed diff erentiation of stem or progenitor cells, and tissue or organ engineering. For example, the use of mesenchymal stem cells to support haemopoiesis during bone-marrow transplantation is now in clinical trials, and the SFDA has recently ratifi ed a certifi cate for a novel artifi cial skin. Yet China faces several challenges, including: the need to develop a sound infrastructure for health-care insurance; a lack of eff ective partnership between the academic and industrial sectors; insuffi cient investment in drug research and development; and unsatisfactory support for the oversight of food and drug safety. With the move towards the Outlook of Scientifi c Development and the aim of developing an equitable society, China has placed public health at the top of its agenda, with the aim of Health for All by 2020. 16 At present, the country is concentrating on primary health care in rural areas and community medicine in cities. The initial goal is a framework for delivery of health care and an insurance system that will cover most people by 2010, in which governmental funding will take the lead. By the end of 2008, the New Rural Cooperative Medicare Scheme, with an 80% contribution from public coff ers, will cover all 860 million farmers in China. New initiatives to cover all urban citizens have also been launched. To use biomedicine to boost accessibility and equal provision of health care, a strategy of "walking on two legs" has been advocated. This strategy suggests that excellence in cutting-edge technologies should be pursued along with a serve-all approach. In the Guidelines on National Medium-and Long-term Program for S&T Development (2006 Development ( -2020 , drug innovation and prevention and control of major emerging infectious diseases have been listed as two of 16 mega projects. 17 In line with the notion of predictive, preven tive, personalised, and participatory medicine, disease prevention should be a priority, with importance attached to provision of clean drinking water, environ mental health, natural disasters and disaster prepared ness, large-scale production of good-quality food, drug, and vaccine production and regulation, production of reliable reagents for diagnosis and screening, and devel op ment of an e-health-care system to manage chronic non-communicable diseases. Moreover, modern isation of traditional Chinese medicine will be strengthened by multicentre clinical trials to evaluate effi cacy, and to implement standardisation and quality control, and also by studying systems biomedicine. 18 China's translational research capacity will be improved by combining its clinical resources and research strength, while creating an environment that considers ethical, legal, and societal input. While encouraging indigenous innovation, China needs to further extend international collaboration through personal exchanges and joint projects. We believe that all these factors will contribute to the improvement of public health in the 21st century. Minister of Health, Ministry of Health, Beijing, 100044, China; and Rui Jin Hospital, Shanghai, China zchen@stn.sh.cn This Comment benefi ted considerably from constructive discussion with Zhan Qimin, Chinese Academy of Medical Sciences. I declare that I have no confl ict of interest. Life sciences and biotechnology in China Science and technology constitute a primary productive force Offi ce of 863 Implementing the strategy of developing the country through Science and education The International HapMap Consortium. A haplotype map of the human genome Molecular evolution of the SARS coronavirus during the course of the SARS epidemic in China Highly pathogenic H5N1 infl uenza virus infection in migratory birds Acute promyelocytic leukemia: from highly fatal to highly curable Crystal structure of mitochondrial respiratory membrane protein complex II Splenic stroma drives mature dendritic cells to diff erentiate into regulatory dendritic cells A nuclear function of beta-arrestin1 in GPCR signaling: regulation of histone acetylation and gene transcription Chinese gene therapy: splicing out the West? Full text of Hu Jintao's report at 17th Party Congress. 17th CPC Congress Guidelines on national medium-and long-term program for science and technology development