Drawing on the latest data from the Web of Science Core Collection, Medline, Nature Index, Highly Cited Researchers list, as well as reports published by WHO, FDA, NMPA, and IQVIA, this study systematically examines the evolution of global medical science and technology strategies, the shifting landscape of basic research, and current pharmaceutical R&D dynamics, with a particular focus on China–US comparative innovation performance. Findings reveal that global medical science and technology have transitioned into a strategic system central to national security, bioeconomic development, and supply chain resilience, with pathogen surveillance, vaccine platforms, and biomanufacturing emerging as critical priorities. Basic research has entered a high-plateau stabilization phase, where the United States continues to dominate in research scale, leading institutions, and talent concentration; China, however, has surpassed the US in Nature Index high-quality output within biological sciences, though it remains comparatively weaker in health sciences and clinical research. In pharmaceutical R&D, investment and M&A activities increasingly converge on ADCs, cell and gene therapies, GLP-1 agonists, and AI-enabled drug discovery, with emerging biotech firms becoming key generators of first-in-class therapeutics. Both China and the United States remain global leaders in new drug approvals, yet the US retains clear advantages in first-in-class innovation and rare disease therapeutic ecosystems. Overall, China is evolving into a pivotal force in global medical innovation, but further progress requires strengthening health sciences, clinical translation capacity, research platforms, and systemic innovation infrastructure.