A huge part of the problem is driven by Chinese hospitals. The PRC decided that they wanted China to catch up to the west in science, so made a role that to get

A huge part of the problem is driven by Chinese hospitals. The PRC decided that they wanted China to catch up to the west in science, so made a role that to get promoted as a doctor you have to get some papers published in international journals. That applies to all doctors. But they're, you know, busy doctoring and don't have time out energy to do that. At the same time they'd like to get promoted. So they buy papers.