The practice of farming bears for bile extraction is legal in China and involves an estimated 10,000 to 12,000 animals, primarily Asiatic black bears (Ursus thibetanus). This study outlines the compromises to health and welfare suffered by bears on bile farms and is based on the results of visits to more than 50 bear farms; 15 years’ worth of interviews with bear farmers, Chinese officials, practitioners of Traditional Chinese Medicine and vendors dealing in bear parts; and from the observation and care of approximately 250 bears that have been rescued from bile farms. Bears that have been rescued from farms display evidence of severe and chronic physical and psychological suffering. Medical complications arising from the husbandry and the gall bladder fistulation significantly, and often fatally, compromise bears’ health.