Published on Linkedin on Nov 23rd
I visited Wuhan once, in 2004, teaching for a couple of weeks as part of EMBO’s World Program. I can’t claim the trip left me with profound insights about China – the city was unremarkable if enormous, nothing that prepared me for what it would become or mean to the world two decades later. But reading Dan Wang‘s “Breakneck: China’s Quest to Engineer the Future” (https://a.co/d/eGrJ3ol), I found myself thinking about that visit, not because I understood China then, but because Wang’s framework helped me understand something else entirely: why the Gulf has become central to my strategic thinking.
Wang’s thesis is elegantly simple: China is an engineering state, approaching problems with technical sledgehammers, while America has become a lawyerly society, blocking everything with procedural vetoes. China builds high-speed rail; America generates environmental impact statements. Chinese engineers dominate the Politburo; American lawyers dominate Congress. The contrast explains our current moment with uncomfortable clarity.
The book resonated because I’m now directing my efforts toward the Gulf Cooperation Council countries, in particular Qatar, Saudi Arabia, the UAE, where the parallels to China’s engineering state seem obvious. These are states with engineering ambitions, centralized decision-making, and capital to build at remarkable speed. Vision 2030 frameworks read like engineering specifications. Mega-projects materialize as if summoned and the paralysis gripping the US and Europe seems absent here.
Yet something fundamental distinguishes the GCC approach from China’s engineering state. Having worked across Portuguese, British, and US institutions for nearly three decades in biomedical science, and now beginning to collaborate with Gulf-based ones, I’ve come to see it clearly: the GCC states have adopted the speed and ambition of Chinese engineering while preserving something China never had or has systematically eroded, an irreducible commitment to human dignity.
This isn’t a minor difference or diplomatic softening. It’s a fundamental aspect of the GCC countries’ culture. And it’s why I believe the future of precision medicine, perhaps the most humanistic application of engineering we have, will be written here, not in China or the paralyzed West.
The Engineering State and Its Costs
Wang’s framework illuminates China’s trajectory precisely, if perhaps oversimplifying. The engineering mindset that built the world’s highest bridges and most extensive high-speed rail network is the same mindset that implemented the one-child policy, sterilizing 108 million women based on extrapolated population charts. The state capacity that controlled COVID-19 through digital surveillance and mass lockdowns also trapped families in their apartments for months, leading to preventable deaths when hospitals refused to admit patients for fear of inflating official case numbers. Wang lost two grandparents to this rigid efficiency.
This is engineering without any regard for individuals, treating social problems like bridge calculations, optimizing variables without recognizing that those variables are called Wei, Li or Fang and each represents a universe of fears, dreams, aspirations. When your leadership consists of chemical engineers, hydropower engineers, and electrical engineers, you get a government superbly equipped to build infrastructure and catastrophically equipped to handle the irreducible complexity of human life.
America’s lawyerly society (Wang’s term!), by contrast, has perfected the art of blocking things. Every project faces litigation, environmental review, permitting battles, and procedural challenges. This protects against some catastrophic errors but creates its own pathology, a society that can’t build, can’t move, can’t solve problems that require doing rather than debating. The result is infrastructure decay, housing crises, and institutional sclerosis.
Europe, though Wang doesn’t discuss it, suffers, in my opinion, from similar paralysis, perhaps even worse. Add to the lawyerly blocking, the infighting of 27 member states and a never-ending number of regions, each with veto power or political clout, and you get a system where ambition dies in committee or is always relegated to the lowest common denominator. Grand projects announced with fanfare dissolve into years of negotiation over jurisdiction, funding formulas, and regulatory harmonization (this is actually good, I think, and I’ll come back to it in a later article). The result is a continent that can barely build a railway line without a decade of debate (four decades, if it is Portugal trying to build a new Airport!).
But coming back to China and USA, Wang argues, correctly in my opinion, that both countries need to learn from each other. China needs rights, process, and political reform. America needs to recover its capacity to actually build things. But in framing this primarily as China versus America, engineering state versus lawyerly society, the book misses a third path that’s emerging in an unexpected place, one that addresses not just the US-China binary but the broader paralysis afflicting the entire Western world.
The GCC’s alternative
When I first began observing the Gulf region closely, I expected to find the Chinese model transplanted: top-down technocracy, breakneck development, individuals subordinated to collective goals. The superficial similarities are real. Qatar can decide to host a World Cup and reshape its entire transportation infrastructure within a decade. Saudi Arabia can launch NEOM and marshal tens of billions toward a moonshot vision. The UAE can position itself as a global aviation hub through sheer governmental will. This is engineering-state thinking.
But look closer and fundamental differences emerge. Vision 2030 frameworks across the GCC don’t just measure GDP growth and infrastructure metrics, they explicitly include happiness indices, quality of life indicators, and citizen wellbeing. This isn’t rhetorical decoration; it reflects a different underlying philosophy. When Saudi Arabia’s Vision 2030 speaks of enhancing quality of life, or Qatar’s National Development Strategy emphasizes wellbeing alongside economic diversification, they’re expressing something foreign to pure engineering-state logic.
The concept of karama – human dignity – runs deep in Islamic thought and Arab cultural traditions. It’s not a Western import or democratic concession; from what I perceive, it’s a core tenet of how these societies understand human value. Every person possesses inherent dignity regardless of utility or productivity. Hospitality traditions, I’m learning, treat strangers as sacred. Even in contexts of significant governmental authority, there remains a sense that individuals matter not as inputs in optimization functions but as ends in themselves.
This creates a different kind of state capacity, one that can move quickly and decisively while maintaining constraints that pure engineering logic would dismiss as inefficient. When the UAE develops its healthcare system, it’s not just building clinical capacity; it’s manifesting care for residents. When Qatar invests in education, it’s not just producing human capital; it’s recognizing that individuals deserve development. These aren’t decorative additions, at least from what I’m seeing, they’re core to how these societies understand governance.
Consider the contrast with China’s engineering state at its most brutal: the one-child policy that sterilized 108 million women based on population projections, zero-COVID lockdowns that trapped families for months regardless of individual circumstances, surveillance systems that treat minority populations as security variables to be optimized. These aren’t aberrations; they’re what happens when engineering logic operates without moral guardrails, when technical efficiency becomes the only metric that matters.
The GCC states have chosen differently. They want the speed (clearly!), but not at the cost of treating humans as engineering inputs. This isn’t naivety about governance challenges – no nation has a perfect record, and GCC states have well-documented failures. But beneath those imperfections lies what seems to me a fundamental choice about what is to be optimized and what must remain non-negotiable.
Precision Medicine: Engineering For Dignity
This brings me to my field: precision diagnostics and genomic medicine. If there’s a domain that embodies “engineering with dignity,” it’s precision medicine.
Consider what precision medicine fundamentally rejects: the idea that populations are uniform, that statistical averages capture individual reality, that efficiency of treatment at scale matters more than accuracy for the specific person in front of you. A cancer patient is not a demographic category. A liver disease case is not a population mean. Every genome is unique; every disease progression is individual; every treatment response reflects irreducible biological and contextual particularity.
Precision medicine is engineering: it requires sophisticated molecular diagnostics, computational biology, AI-driven pattern recognition, and industrial-scale genomic sequencing, etc. But it’s engineering in service of recognizing and honoring individual biological dignity. We build complex technical systems precisely to refuse the simplification that treats humans as interchangeable units.
Early detection through precision diagnostics minimizes harm. Validated biomarkers reduce false positives that cause unnecessary anxiety and false negatives that delay life-saving treatment. Population-level screening programs must be calibrated to diverse genetic backgrounds, not assumed to work uniformly. This is technically harder than one-size-fits-all medicine. It’s more expensive. It requires more data, more validation, more nuance. But it’s right, I believe (!), not just clinically but philosophically.
China has remarkable genomic capabilities and can implement population screening at unprecedented scale. But precision medicine constrained only by engineering logic risks becoming another optimization problem: maximize throughput, minimize cost, treat populations as datasets. The (my…) West, both America and Europe, has the scientific tradition but increasingly lacks the state capacity or political will to implement at scale, leaving precision medicine trapped in research papers and pilot programs.
Why the Gulf Can (Will?) Lead
The GCC states occupy a unique position: they possess the engineering ambition and state capacity to build at scale, the capital to invest in cutting-edge technology, and the willingness to create a modern and economically diverse society, fast. They also have specific characteristics that when taken together give them advantages on the world stage.
Consider Qatar specifically. A modest population of 3 million, nearly universal healthcare coverage, centralized governance, world-class genomic and biobank infrastructure, and a demographic structure that mirrors global diversity within a single coordinated system. When you develop a diagnostic validated across Qatar’s population – Qatari nationals, South Asian expatriates, Arab populations, European residents – you’re generating evidence that’s internationally transferable. The small scale that might seem limiting becomes an asset: you can move from pilot to population-wide implementation faster than any fragmented system. Saudi Arabia brings different advantages: scale for industrial development, capital for moonshot investments, and increasingly sophisticated research infrastructure. The Kingdom’s emphasis on manufacturing capacity complements Qatar’s validation strengths. The UAE’s focus on digital health infrastructure and attracting global corporate presence creates distribution channels. These aren’t competing strategies but potentially complementary elements of a regional ecosystem.
But in my opinion, they have something that is equally important: a philosophical framework that aligns with what precision medicine requires. What unites them is something deeper than infrastructure or capital: a development model that can embrace engineering ambition without abandoning human dignity. When precision medicine requires both technical sophistication and philosophical alignment with individual biological dignity, the Gulf states are positioned to deliver both.
Note that this isn’t about choosing between Chinese efficiency and Western rights-based paralysis. It’s about believing that speed and dignity aren’t opposites, that you can build advanced diagnostic capabilities, implement population-level screening, and generate globally relevant evidence while maintaining that humans are ends, not means.
Why the Gulf Has Become Central to My Strategic Thinking
After nearly three decades spanning Portuguese, British, and US institutions, I’m directing my efforts toward precision diagnostics in the Gulf because I’ve seen where the current models fail. Western fragmentation traps innovation in research papers and implementation in committees. At the opposite end, Chinese scale risks optimizing populations rather than serving individuals.
When I develop diagnostic tools for liver disease, I’m not just building molecular assays, I’m developing tools aimed at enabling human beings, individually, to live longer and healthier lives. That individual-centered mission needs a place that can both build at scale and maintain that humans aren’t variables in an optimization function.
The Gulf offers that combination: engineering ambition constrained by human dignity. I’m betting that precision medicine will advance fastest where state capacity meets humanistic constraint, where you can move decisively without treating patients as population averages.
I believe that place is the Gulf. Not because it’s perfect – no nation is – but because it’s attempting something genuinely new: speed with humanity, ambition with dignity, engineering in service of particular human lives. This is, in my view, just good medicine. It can also serve as a model for how we might build the future without crushing the people it’s meant to serve.