The Pushpin on Global Drug Development Is Moving East
For Western CROs, the shift represents both a model to learn from and a competitive challenge.
As modern research and development efforts expand across the continents, long-standing assumptions about where and how drugs should be developed, trialed, and tested are being challenged.
The increasing demand for efficiency has reshaped the drug development landscape geographically, but concerns over data quality may limit the translation of advancements into tangible patient benefits.
Few leaders have observed these changes as closely as Dr. Ali Pashazadeh, founder and chief executive officer at Treehill Partners, a global healthcare advisory firm integrating drug and corporate development strategies.
As a trained surgeon turned banker and biotech founder, Pashazadeh offers a unique perspective on the intersection of clinical and financial considerations in drug development. In this interview, he explored the drivers of global industry shifts, misconceptions about data quality, and why a renewed focus on patients—not just performance—is crucial.
Evolution of the drug development landscape: A shift, not a shock
What has driven the geographic shift in drug development?
Pashazadeh explained that the rise of drug development in non-Western countries is no sudden change; in fact, it has been underway for decades.
"These changes have been coming for 20 years. As a banker, I have worked with Chinese, Korean, Japanese, and Brazilian companies on their drug development programs,” he reflected. “In particular, China is one country that has been progressing, which is not a surprise.”
Pashazadeh noted that Chinese contract research organizations (CROs) move at a greater speed than CROs in the West.
Having been a key player in generics manufacturing since the late 1900s, China later demonstrated similar capabilities across more complex therapeutics such as biologics.
Pashazadeh argued that their next step, the innovation of novel drugs, was predictable. In 2024, China listed more than 7,000 clinical trials on the International Clinical Trials Registry, surpassing the United States, which listed 6,000.
With this in mind, he explained that recent strategic partnerships, such as the collaboration agreement between Bristol Myers Squibb (BMS) and Hengrui Pharma, are simply evidence of an existing movement.
The recent shift has not been in geography, but perception.
“The slight skepticism on Chinese-generated data is where the news is. People are talking about where the data was produced and whether we need to discount or replicate it.”
Pashazadeh highlighted that the BMS–Hengrui merger is “one of equals,” and skepticism surrounding data should be inherent to drug development worldwide, not dependent on location.
China’s evolution from drug manufacturing to innovation:
- China’s rise in drug development reflects long-term progression, not a sudden shift.
- Advances follow a logical pathway from manufacturing to innovation.
- Skepticism should be present across all data interpretation.
Efficiency vs quality: Challenging the trade-off narrative
Should unprecedented efficiency in early-stage drug development be a concern?
Pashazadeh challenged the widely held belief that faster development compromises quality: "If a molecule doesn't have religion, gender, or origin, every molecule is the same. Whether it is in Shanghai or Seattle or Spain, it’s the same molecule."
“Medical treatment and drug development have a relatively narrow standard of deviation. There’s no reason why, globally, we are not all able to meet the same standards and the same speed,” he added.
When asked why Western CROs cannot keep pace, Pashazadeh reflected on his own experience as an investment banker within a large company.
He remembered that it would take him weeks to do something he can now do within days: “The reason is no politics, no verticals, no silos, and no permissions needed.” Ultimately, he believes Western inefficiencies are often structural rather than scientific.
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The global potential for speed and quality:
- Perceived trade-offs between speed and quality can be overstated.
- Organizational inefficiencies—not science—are a major barrier to faster development in Western countries.
Accountability in drug development: Who owns failure?
Why has the Western world not kept pace with drug development?
Pashazadeh offered a critique: "If a drug fails, very rarely—if ever—do you have a CEO stand up and say, ‘I chose the wrong drug.’"
He argued that molecules themselves are unfairly blamed when failures often result from poor selection or flawed development strategies, which developers could learn from to reduce attrition.
Pashazadeh has repeatedly raised this lack of ownership, but felt that high failure rates are generally accepted because of the significant financial benefits when a successful drug is acquired or licensed.
“The industry thinks it is normal. In our view, ~95% of those failures could have been avoided,” he added.
Having worked with hundreds of companies on clinical hold, Pashazadeh stressed the importance of reassessing data, determining where things went wrong, and how failures could have been avoided.
In using this approach to learn and rebuild, many struggling programs can be revived.
Clinical hold
A clinical hold means that a regulatory authority has stopped or delayed a clinical trial due to safety, quality, or procedural concerns.
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“The Chinese are better at trialing things with a possibility. If they fail, they fail. Then, they move on to the next,” he explained. This acceptance of failure, at an earlier stage, enables faster iteration.
However, Pashazadeh warned that trying to keep pace could negatively impact patients. Upon donning his “medical hat,” he appreciated the potential for efficiency gains to come at the expense of patient welfare.
"Achieving success isn't getting to the next node… It's about asking: Does this change the patient's life?" — Dr. Ali Pashazadeh
Failure could lead to success:
- Lack of accountability for drug failure can reduce learning opportunities.
- Earlier acceptance of failure can accelerate innovation cycles.
- In reiteration, real-world patient impact must be considered: is the benefit worth the risk?
Why reporting drug development failures is critical
What will be most important to ensure early-stage drug development remains scientifically robust and sustainable as models continue to change?
Pashazadeh circled back to one of the industry's key concerns: data quality.
He highlighted a fundamental yet often overlooked issue: the lack of transparency in how data is reported globally, noting that the industry tends to prioritize positive outcomes, which limits collective progress.
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"As an industry, we report successes, but we don't report failures; we also don't report the route by which we succeeded or failed," Pashazadeh explained.
This selective reporting creates a critical knowledge gap. Without visibility into unsuccessful approaches or the decision-making processes that led to them, researchers risk repeating avoidable mistakes. According to Pashazadeh, this limits subsequent teams' ability to meaningfully build on earlier work.
"Most of the data is published as positive data. I think we learn a lot more out of negative data." — Dr. Ali Pashazadeh
This lack of comprehensive reporting has implications beyond traditional research and development.
As AI becomes embedded in drug discovery workflows, Pashazadeh highlighted that its effectiveness will be directly tied to the quality and completeness of available datasets: "If we want to really improve the way we do things, we're going to need to provide more transparency."
Without access to the full spectrum of outcomes, AI models risk reinforcing existing biases, rather than accelerating innovation.
Transparency could drive innovation:
- Reporting negative and inconclusive results is essential to avoid redundant research.
- Broader information sharing is required to maximize the potential of AI-driven discovery and development.
- Cultural change is needed to prioritize learning above success reporting.
Global collaboration is key
How must organizations adapt to the evolving drug development landscape?
As the industry adjusts, Pashazadeh predicted a level of disruption, likening it to the technology sector, where some organizations failed to adapt: "We're going to go through the same journey as the telephone industry. There's going to be a lot of Nokia moments.
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“Companies did incredibly well, and then suddenly, a different type of screen came out. They didn't adapt, and they went from being market leader to being no longer relevant,” he continued.
Additionally, Pashazadeh emphasized the need for collaboration across borders and how COVID-19 highlighted missed opportunities: "The global coordination wasn't there, and yet we had one common enemy.”
“We all generated our own individual data sets per country, not as a globe,” he added.
Breaking down barriers to accelerate innovation:
- Companies must adapt rapidly or risk becoming obsolete.
- Cross-border collaboration is essential for future success.
- Global crises highlight the need for coordinated data-sharing.
A turning point for the drug development industry
The drug development industry faces a critical inflection point.
Efficiency gains, global competition, and technological advances offer unprecedented opportunities, but only if the Western world is willing to accept them.
Whether viewed as a success to learn from or a challenge to respond to, the progress made elsewhere can no longer be ignored.
If former leaders want to keep pace, they will need to address systemic barriers and become comfortable with accountability. Across all corners of the globe, developers shouldn’t lose sight of the ultimate success metric: improved patient outcomes.
- Leading hubs for drug development are evolving rapidly, largely driven by efficiency.
- Accountability and transparency are essential to increasing speed and improving success.
- Real-world patient impact should be considered at the heart of drug development efforts.
This content includes text generated with generative AI and has undergone editorial review before publication. Technology Networks' AI policy can be found here.
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