That system has been fueled by what are known as investigator-initiated trials, or ITTs, in which researchers were long permitted to launch clinical trials without sign-off from the National Medical Products Administration, China’s equivalent of the Food and Drug Administration, and without the rigorous review that would otherwise come with it. The studies have allowed China to speed up the translation of medical research, encourage physicians to become a part of the country’s drug innovation engine, and help produce billions of dollars in sales of newly approved medicines.

They also appear to have come at a price, raising questions about patient safety, a lack of transparency, and the use of intellectual property.

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