For more than 50 years, U.S. academic medical centers (AMCs) have been the global engine for pharmaceutical innovation. These university-affiliated hospitals are dedicated to fulfilling the mission areas of medical education, scientific research, and patient care. They have developed a distinctive innovation model in which patient care inspires research questions, public investment supports discovery, and public-private partnerships enable the translation of these breakthroughs into clinical practice. But U.S. AMCs are now facing a major challenge from China, which has emerged as a major rival in the last decade. Its pharmaceuticals R&D sector is on track to become the global industry leader, displacing its U.S. counterpart.