"I am not a drug god" has touched the hearts of many people. In the movie, the high-priced cancer drugs developed in the United States make ordinary patients with chronic myelogenous leukemia unaffordable, and people struggle between the illegal Indian generic drugs and the hope of birth.
The film has a prototype in real life. "Pharmaceutical Man" Lu Yong was prosecuted for the multinational purchase of the generic drug "Gleining". Thousands of patients with chronic myeloid leukemia wrote a joint letter for him, and Lu Yong was acquitted.
The gap between the gray area of ​​law and the medical level of China and the United States, in addition to the dilemma shown in "Pharmaceutical God", has also spawned a fast-growing market - cross-border medical care.
Research and Markets data show that by 2026, the cross-border medical market will grow to $150 billion. China is one of the important source countries in the global cross-border medical market.
Cancer patients, older unmarried young women, and couples, these people who go to the United States have a variety of reasons, but also have their own fears and anxiety.
Some people want a choice for the next generation. Some people just want to do their best in front of the god of death.
Hope and choice
San Francisco is about 9486 kilometers from Beijing, and the direct flight takes 12 hours. At the same latitude of 40 degrees north latitude, but the weather is very different, Beijing in July is very hot, San Francisco is cool in the evening to wear a jacket.
In order to take care of the sick mother, Shen Yu has flown twelve times on this route in the past two years. At the end of 2014, her mother diagnosed a blood cancer, and after a year and a half of chemotherapy in China, her condition became more serious. Under the side effects of chemotherapeutic drugs, the patient's body is also weakening, and various organs continue to be damaged. The most damaged is the kidney. In severe cases, "there is no effort to chew the rice."
“There are many new drugs in the United States that are more effective and have fewer side effects every year, but these new drugs can’t enter China... New drugs in the United States have a life-saving opportunity.†This is not only the result of her research data, but also in her mother’s presence in China. Advice from the attending doctor.
In 2018, the authoritative medical journal Lancet published the Global Cancer Survival Report 2000-2014, covering 37.5 million patient data in 71 countries over 15 years. In terms of common cancer survival rate, the United States can almost be said to be far ahead. The 5-year survival rate of cancers such as melanoma, lymphoma and prostate cancer is 30%-40% higher than that of China.
Shen Yan sent her mother to Stanford Hospital and settled her in a relative's home in California outside of the treatment. Some of her past classmates who settled in the United States also helped.
At Stanford Hospital, Shen Yu's mother's treatment team consists of an attending physician and two nurses, as well as a cardiologist and a nephrologist. The treatment team used a combination therapy, tracking, and cooperation with the indulgent mother. The two new drugs used included a biological antibody for injection and a chemotherapeutic drug, Polymast.
"In fact, Polymast is an upgraded version of domestic chemotherapy drugs, but domestic drug side effects are large, although the effect is slow, Polymast is effective, and side effects are almost imperceptible." Shen Yu recalled.
At the end of 2017, Shen Wei suddenly received a message from her mother from the United States: "The male nurse who treated me today suddenly opened the door of the treatment room, with a plate on both hands, followed by ten nursing staff, me and Dad suddenly stopped, I don’t know what it is, just listen to them singing their birthday songs. It turned out that when I was born, it was just today, they were so hearted and sent a birthday cake! A group of people came to congratulate. This deep human touch is amazing, warm, friendly, I don't know how to express it, I can only thank you again and again."
The treatment team gave different stages of treatment according to the condition of Shen Yu's mother. By the time of this review in July this year, it was announced that the heart of Shen Qiang's mother did not need to be reviewed within one year, and the kidney index was stable. The family was relieved.
Recalling the treatment of these two years, Shen Yu is not easy. "The most worrying thing has always been that the US medicine does not work, and its income cannot support the mother's treatment." Fortunately, the former has already proved, while the latter, It can still be supported today, but she is not willing to disclose the total cost of this time.
According to the New York Times, it is estimated that medical expenses for patients who go to the United States to treat cancer are estimated to be between 700,000 and 1 million. This is not a higher cost of accommodation, food, etc. than in China.
There are still some patients who do not necessarily need to cross the border to get access to the US treatment plan.
Tian Fang is also a family member of cancer patients. At the end of 2017, his father was diagnosed with cortical cancer by one of the best cancer hospitals in the country. This is a very rare cancer with an incidence of only one in a million. After many trade-offs, he temporarily gave up going abroad for medical treatment and chose to take his father to Beijing for an adrenal tumor resection.
During this process, he gradually discovered that due to the extremely low incidence of cortical cancer, domestic doctors have very limited understanding of this type of cancer.
"At that time, I just wanted to ask the doctors in the United States whether there is any better treatment for cortical cancer. Please consult a foreign expert." To this end, he contacted the Massachusetts General Hospital and Dan through a cross-border medical institution. An endocrine gland tumor specialist at the Nafab Cancer Center conducts an online consultation.
Unexpectedly, both American doctors have reported that this is probably not a cortical cancer, and more than a dozen detailed judgments are listed.
Due to the time factor and the previous diagnosis of several hospitals in China, he has already bought the best known mitoxantane and started treatment for cortical cancer. During this time, his father's condition has continued to deteriorate.
When the two were combined, he found two American pathologists and asked for expedited treatment. Finally, one month after the start of mitoxantan treatment, the previous cortical cancer was misdiagnosed. His father actually transferred to Adrenal gland adenocarcinoma. Just because there are no lesions on the lungs, there was no indication of lung cancer when initially doing pathology in a domestic hospital.
"In the four or five months of seeing a doctor in China, more than 30 expert numbers were hung. The overall feeling is that the doctors in China are too busy. The expert number of 100 can only be said for five minutes." Tian Fang recalls. On the other hand, he believes that some Chinese doctors are not too daring to use new drugs and experience in immunization drugs. After the diagnosis of lung cancer, genetic testing revealed that there is high expression of PD1 in his father, and there is no other sensitive target gene. It is applicable to Merck's immunological drug PD-1 monoclonal antibody Keytruda (Pembrolizumab, commonly known as K medicine), but the attending physician has never It is recommended to use immunization drugs completely, but insist on doing two traditional chemotherapy first, and then start a combination treatment with immunization drugs plus chemotherapy drugs.
In the treatment of Shen's mother, the standard of Chinese hospital treatment is also an attending doctor, plus a hospitalized assistant doctor in the department. “It is impossible to have a treatment team composed of doctors in the United States.â€
It's hard to blame the Chinese hospitals. Chinese doctors may face ten or even twenty times more patients per day than their American counterparts. Because excellent medical resources are heavily concentrated in first-tier cities, these hospitals, which are numbered in the country, are home to critically ill patients from all over the world. After all, going abroad for medical treatment is only an option for a very small number of people, and the price of hundreds of thousands or even millions has already been A large number of critically ill patients and their families can be dismissed. According to the National Bureau of Statistics, the average annual wage of non-private employees in urban areas in China was 67,569 yuan in 2016, and the average annual wage of employed persons in urban private units was 42,833 yuan. These excellent hospitals in China are almost the best resources available to ordinary Chinese people.
"If it is determined that it is a cortical cancer, it may be considered to go to the United States for treatment later. After confirming that it is lung cancer, China has a more standardized treatment plan for more common cancers. China also has excellent doctors, and we feel that it is not necessary." Tian Fang said.
However, he was still glad that he was thinking of "walking on two legs" and seeking medical advice in China and the United States. He did not delay too much treatment.
In the US consultation service, he spent a total of 6,000 US dollars on the previous consultation, and added another 3,000 US dollars to purchase a follow-up service for one year. "I have questions before I ask, I ask once a month, but I still want to have an additional source of information."
select
For others, the United States means an opportunity that has never been seen before.
In 2015, Xu Jinglei had a contract with Lu Yu, and gave the frozen egg a definition of great communication. "The only regret medicine in the world."
In China, frozen eggs are still in the gray area of ​​the law. The recent regulations, Human Assisted Reproductive Technical Specifications, only allow women who are married or have difficulties in receiving this medical service. Unable to find a legal way, unmarried women who want to freeze eggs can only go to the ocean.
In fact, this regret does not necessarily work. The effect of frozen eggs is different. According to the data provided by Reproductive Medicine Associates of New York, between 2013 and 2014, hundreds of patients served by the institution thawed their eggs. And the probability of successful conception is only 24%.
The RSMC (Reproductive Sciences Medical Center) in California said that the operation process of the clinic and the diagnosis of infertility may be factors influencing the success rate. One of the most important factors is the age at the time of freezing eggs, the younger, The higher the success rate.
But for older women who have no plans to marry but want to have the opportunity to have a baby in the future, frozen eggs are almost their only choice.
Han Xiaoyang is a divorced Shanghai white-collar worker. After the age of 30, her parents' patience with her almost disappeared. Reproductive anxiety is one of her greatest pains.
"It’s harder to find a suitable man for the second marriage. It’s almost close to the 35-year-old line of 'gradual decline in ovarian function'. But now I’m more cautious about picking a partner than I used to, and I don’t want to be led by others. The nose is gone." She made up her mind to go through a series of procedures such as physical examination, taking birth control pills, ovulation-promoting needles, and surgery. She went to the United States to make frozen eggs and took out 12 healthy eggs.
This is a journey of RMB 140,000. After that, we still need to pay a storage fee of US$600 per year, but she is relieved. "The next step is to wait for the real person to appear."
“The reason people choose frozen eggs seems to be changing. Six or seven years ago, we saw that most women who chose frozen eggs were worried about their future fertility. Now many women around the age of 35 come to find us. I hope to control my own rhythm." Reproductive Medicine Associates of New York's reproductive expert Dr. Alan Copperman said in an interview with Time.
In vitro fertilization is a more mature assisted reproductive service with a higher success rate than egg resuscitation and successful fertilization. Due to the maturity of US laws and regulations, the success rate of in vitro fertilization technology is also guaranteed. Many Chinese couples with reproductive difficulties choose to go to the United States for treatment. In 2016, 10% of Chinese medical patients in the United States were for this purpose. According to the report provided by the US CDC, in 2016, 263,577 cases of artificial insemination were made in 463 reproductive aid institutions across the United States, which successfully brought 65,996 newborns.
With advances in technology, in the latest case of RSMC, the success rate of in vitro fertilization for women aged 35 and younger is as high as 75%, up to about 50% at 44.
Scientific and technological progress, lower cross-border medical threshold
Just a few years ago, for most Chinese, whether it was intensive care or reproductive support services, cross-border medical care was something that could only be thought of.
Traditional cross-border medical institutions generally provide similar intermediary services to help patients prepare visas, translate medical records, and arrange hospitals in the United States. Multinational hospitals set up offices in China to accept appointments and referrals. But these services are often very expensive.
As mentioned above, for cancer patients, such medical expenses range from 700,000 to 1 million.
The main reason is that the Chinese have no way to purchase medical insurance in the United States. They need to pay high medical expenses in full, and the labor costs are even more expensive. Take the dressing change as an example, the same drug, hospital nurses to change, charge 300-400 knives; and in the United States pharmacy CVS buy drugs to replace themselves, the cost is only 44 knives.
In addition, visas, language, information, and other factors have made many Chinese patients unable to consider this option.
However, with the rise of a large number of Internet medical services, scientific and technological progress, and the relaxation of the US sign, the number of people who can reach cross-border medical care is gradually increasing. This is no longer a choice for only high-net-worth people.
"New technologies represented by AI and big data are improving the efficiency of medical research and development. The cooperation between China and the United States also promotes the development of medical services to 'popular'." Chen Jie, co-founder of Crossover Hub, a cross-border incubator in China and the United States, told reporters.
A remote consultation is an example. The American doctor that Tian Fang eventually found for his father was contacted by MORE Health, a cross-border medical institution that was reported by a titanium media. Its founder Dr. Robert Warren is a director of the American College of Surgeons and former director of oncology surgery at the University of California, San Francisco Medical Center.
He told reporters that through remote consultation and MH's legal prescription rights in the United States, MORE Health does not need to let patients travel long distances to the United States, but also cooperate with local oncologists to provide patients with multi-party consultations and US legal. drug. The basic process of a consultation service is: patients submit medical records, pathological sections and other information, MORE Health through its own research and development platform to complete information translation and doctor screening, through a biomedical professional case manager to help patients dock 1-2 appropriate American doctors , completed consultation and follow-up within three months.
“The diagnosis and treatment in the United States is more patient-centered, which means that it is a good supplement for severe treatment in China.†According to Dr. According to Warren, the proportion of people using MORE Health services is increasing year by year, with an annual growth rate of more than 100%.
The Massachusetts General Hospital, the Dana Farber Cancer Center, and the MD Anderson hospitals on the MORE Health partnership list are among the best hospitals in the United States. For ordinary patients or patients, without the assistance of an intermediary, it is difficult for them to access these medical resources without going to the United States.
On the other hand, in addition to a few critical illnesses, the proportion of drugs in treatment costs is not large. Chen Jie pointed out that in China's overall medical expenses, hospitalization is still the main body, accounting for about 30% of the total expenditure, followed by outpatient and prescription drug costs, accounting for 19% and 18% respectively. In addition, a study by the Tsinghua University Center for Medical Service Research shows that the total cost of health care in China has grown rapidly after entering the ageing society, and there is a trend of exponential growth. One of the major reasons is that it is caused by aging. The hospitalization rate of elderly chronic diseases has increased.
"If you can use some advanced health management techniques to reduce the hospitalization rate, you can fundamentally solve the problem of expensive medical expenses. This is also the transition from the previous passive treatment to active health management." Chen Jie said.
Former Yahoo VP and Silicon Valley investor Shao Xuhui also said that in advance, promoting early diagnosis is a more important technical trend that can effectively reduce medical expenses.
"For example, the fourth-generation gene sequencing , DNA passing through the nanopore, can achieve single-cell sequencing, read length, speed, and price." This means that the technology can really enter the clinic and even the family. Doing so that individuals are sequenced quickly, rather than the second or third generation technology, requires dozens or even hundreds of samples, and waiting times range from a few days to a week. Shao Xuhui's previous investment in AXbio and Quantapore belonged to the fourth-generation gene sequencing company. "I think such companies will have a breakthrough in treatment, monitoring and early diagnosis."
For example, microelectronic devices can monitor human vital signs in a long-term and continuous manner, and even actively intervene in chronic diseases such as diabetes.
"The most expensive treatments are often severe or chronic diseases, and if these conditions can be detected early, they can often reduce costs significantly." Shao Xuhui said.
It is worth mentioning that although the United States is one of the most advanced medical technology countries in the world, the American people also have the need for cross-border medical care. According to previous reports from the BBC, many Americans risked breaking the law and went to Cuba, which has been in the United States for many years, to seek a newly released cancer treatment program, the non-small cell lung cancer vaccine in lung cancer.
Due to the US technical blockade against Cuba, under the leadership of former President Castro, Cuba has assembled more than 20,000 scientists and technicians to study innovative drugs. This non-small cell lung cancer vaccine is one example. It fights cancer by stimulating an immune response to proteins in the blood that trigger the growth of lung cancer. After the induction period, the patient only needs to be injected once a month.
Since the vaccine interview, Cuban doctor Elia Neninger has used it to treat hundreds of patients; in the United States, it is still in the process of testing, American patients can not be treated in the country.
“We and many countries have fundamental differences in freedom of speech and individual freedom, but this does not affect our cooperation in areas that benefit both peoples.†Immunization of the Roswell Park Cancer Institute in Buffalo, New York Kelvin Lee, the chairman of the school, commented on the Cuban vaccine and applied it in any other country. After all, in the face of death, the national border is insignificant, and everyone is just racing against time.
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