GQ Report | Suspicious "Chinese Medicine God"
Original: Jin Jin GQ Laboratory 2017-06-19
Lu Yong's life after the age of 34 is linked to medicine. He had cancer and depended on drugs to support his life. He was overwhelmed by the financial burden. He found a way to go to India to buy generic drugs, and introduced the reliable and cheap generic drugs to his patients. Generic drugs brought all kinds of adventures to Lu Yong. He was arrested and spent 135 days in a detention center, but prosecutors later announced that no charges would be charged.
He has appeared in the mainstream media of the country and is known as the "Medicine Man". In the eyes of cancer patients, he is a hero who steals fire like Prometheus. It was not until this year that his influence reached a new frontier—it became the prototype of a movie, supervised by Ning Hao and starring Xu Zheng.
People discuss the conflict between the right to life and the law in this story. However, the basis of this story, the generic drug itself introduced by Lu Yong, has been ignored. Patients, media, and cooperative institutions have not verified the details of the drug. Why is it selected among many similar products? Why does it have a more intimate connection with Lu Yong? More importantly, is this drug legal and compliant in India?
In March this year, "GQ" and Lu Yong went to India together. Through on-site interviews, it was found that the generic drugs introduced by Lu Yong were not sold in pharmacies, the Food and Drug Administration could not find relevant information, and their production licenses were also doubtful. At the foundation of the story, some gaps begin to appear...
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Generic life-saving drugs
On March 13, Nanjing, patient Lu Yong came from Wuxi on purpose to meet the cast of "Indian God of Medicine" (now known as "Chinese God of Medicine"). The crew is star-studded, with producer Ning Hao, director Wen Muye, starring Xu Zheng, and Lu Yong is the prototype of the film.
Xu Zheng sat next to him and asked a lot of questions. How is your treatment after your illness? What do you think after taking the medicine? Lu Yong spoke for more than two hours. He has told his story countless times over the past two years.
At the age of 34, Lu Yong was diagnosed with chronic myeloid leukemia and took the anticancer drug Gleevec for two years, costing 564,000. He later switched to Indian generics, which cost only 1/20 the price. He recommended these medicines to other patients and helped to buy them on behalf of him, but he was arrested on suspicion of "obstructing credit card management and selling counterfeit medicines."
Lu Yong's experience was widely sympathized. 1,002 cancer patients signed a joint letter in solidarity with him, saying that Lu Yong "has enabled more patients to obtain a path of self-help, thereby gradually stepping out of the abyss of life disasters". It's the release of "Dallas Buyers Club," and the protagonist battles cancer, prejudice, and the U.S. Food and Drug Administration. Xu Zidong said in "The Three Walks of Qiang Qiang" that Lu Yong is more like the protagonist of this movie.
A year later, prosecutors decided not to charge Lu Yong.
Lu Yong spent a total of 135 days in the detention center, and this experience endowed the story with proof that the story has been tested. He was seen as a Prometheus figure who stole fire from the sky for his patients at his own risk. Officials also began to ask him for help, and the Yunnan Federation of Industry and Commerce hoped that he could take the lead and facilitate the cooperation between Yunnan pharmaceutical companies and Indian pharmaceutical companies to set up factories.
Being a movie prototype means that Lu Yong is no longer just the protagonist of an event and a representative of a marginalized group. His story is about to enter popular culture. This is the latest frontier that Lu Yong's influence has reached.
Lu Yong got a book signed by all the creators, and two days later, the movie officially started. A week later, Lu Yong left for Delhi to negotiate cooperation with Cyno, an Indian generic drug company.
Lu Yong's story is built on Gleevec's generic drug. Gleevec is the first molecularly targeted anticancer drug in humans, which has increased the five-year survival rate of chronic myeloid leukemia patients to more than 90%. Drugs are also an astonishingly profitable business. The annual sales of Gleevec from Novartis in Switzerland is nearly 5 billion US dollars, continuing the strategy of high premium. box. For cancer patients, they have no choice.
The generic drug is the same as the original drug in terms of dosage, efficacy, etc. The only difference is that there is no patent. India's 1970 "Patent Law" gave up intellectual property protection for pharmaceutical compounds, and domestic companies began to mass-produce generic drugs, which quickly developed into a pillar industry. Months after a drug is launched in the United States, cheap generic versions can be found in India.
Lu Yong has successively purchased two kinds of Indian generic drugs. Initially, he found Veenat produced by Natco from Google, and the trustee bought it back from Japan at a price of 4,000 yuan. After getting it, he hesitated for a long time. The packaging of the medicine box is rough, the bottle mouth is not delicate enough, and the green capsule looks suspicious in color. With an experimental attitude, he took it with Gleevec's tan tablets for a while. After all the tests were normal, he established his trust in Indian generic drugs. Lu Yong introduced Veenat to other patients, becoming the first person to promote Indian generic drugs in China, and has a considerable influence in the patient circle.
In 2011, after taking Veenat for seven years, Lu Yong changed the recommended medicine to Imacy, a brown-yellow tablet produced by Cyno Company, which is similar in color to Gleevec. The price dropped sharply to only 750 yuan. , 3 years later reduced to 200 yuan. "We have 100 percent trust in Lu Yong," said patient Pan Jiansan.
Lu Yong has a closer relationship with Cyno, and has done publicity for their new drug, and has held four promotion conferences in China. In the QQ group he founded, the drug company on the drug purchase template was replaced by Cyno. And it was the Cyno company that got Lu Yong into legal trouble and got involved in a lawsuit that attracted national attention.
In 2013, in order to facilitate patients to buy medicines from Cyno, Lu Yong bought a bank card online and was eventually arrested.
In subsequent media reports, Cyno became synonymous with imitation Gleevec and was widely popularized. The Procuratorate's "Decision on Non-Prosecution" listed the testimony of many patients, "The testimony of most of the 21 patients who purchased the drug proved that the drug is indeed effective and has no adverse reactions, and no one has proved that the drug has caused harm to human health. Damage." "Lu Yong provided an account for the convenience of patients to pay for the medicine, so that the patient could obtain the medicine in time and prolong his life. The patient is deeply grateful to Lu Yong."
According to Chinese law, all medicines that have not been approved in my country are all counterfeit medicines. The legend of Lu Yong is based on the fact that the Indian generic drug itself is legal in India, but due to various reasons, it cannot be legally purchased by Chinese patients, thus being forced to break the law. If there is another version of this story, then thousands of patients will face another possibility.
In March 2017, Lu Yong and I went to India together. He wanted to meet an old friend, Sanjay Jain, the owner of Cyno, to talk with him about the project of building a pharmaceutical factory in Yunnan to produce generic drugs. Such cooperation has no precedent in China.
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"Bad Company"
"There is no such medicine in the system, and I have not seen it."
Yunus, the manager of the Apollo pharmacy, checked on the computer for a while after seeing the photo of Cyno's Imacy, and said to me.
Two days ago, we just arrived in India to take pictures at this pharmacy. India is still at the tail end of the cool season, the time of year when the temperature is cooler. During the day, it climbed to a maximum of 35 degrees Celsius, and pedestrians had room to shelter from the heat, but there was a lack of precipitation and it was dry and dusty. Lu Yong put on a cotton shirt made in India, which was breathable and adapted to the climate here.
Delhi was heavily congested, and Lu Yong did not show the slightest impatience. "India is orderly in chaos," he said. When he first came to India, he found that most of the cars on the road did not have rearview mirrors. But no matter how much traffic is stuck, it will move forward slowly. There is no emphasis on neatness and order here, and it has the meaning of barbaric growth. He seems to have understood what the country looks like and the logic behind it. The same goes for the generic drug industry, breaking the rules and eventually making India the "pharmacy of the world".
In Connaught Place in the center of Delhi, Lu Yong pushed open the door of this national chain pharmacy. The front of the pharmacy is small and long, with medicine cabinets stacked to the ceiling on the left and right sides. He asked naturally, "Where is the store manager?" Deep in the room, the store manager Yunus looked up from the computer and smiled at him. "I have introduced many Chinese customers to you," said Lu Yong.
Generic drugs are now a feature that Chinese tourists buy in India, just like cosmeceuticals are in Japan. In Yunus's pharmacy, 20% of the anti-cancer drugs are sold to the Chinese. In order to do business better, he carried books to learn Chinese with him, and added more than 1,500 friends to WeChat.
GQ photographers wanted to take a photo of Lu Yong holding the medicine. "Take a box of Veenat," he said to Yunus. The Veenat box was small, striped in yellow and green, and prominently emblazoned with the company's name, Natco.
"I've been taking this medicine for seven years." Lu Yong rubbed Veenat's box. Veenat has side effects. After eating it, you will vomit, and the vomit is green water the same color as the capsule. After repeated practice, he found a way to live in harmony with this medicine: take the medicine in the middle of meals, and if you feel like vomiting, quickly drink a bottle of Coke.
In the shot, Lu Yong's complexion was pale, somewhat swollen, and there were a few patches of pigmentation on his cheeks, which were traces left by the drug.
After taking the photo, Lu Yong did not mention Cyno. The next day, I went to the pharmacy again, showed Yunus the picture of Imacy, and asked him if he had the drug. Yunus denied it.
"My personal advice is, if you're going to buy it, buy Natco's medicine," Yunus said. I asked him if he knew about Cyno. He hesitated, as if deciding whether to tell me, and eventually he said, "I know, but that's a bad company."
Of the five pharmacies I've been to in India that are affiliated with different companies, none of them sell any Cyno medicines. The only way for Chinese patients to buy is to order by email. Cyno has a Chinese official website and only lists two drugs, gefitinib for the treatment of lung cancer and imatinib (brand name Imacy) for the treatment of chronic myeloid leukemia. In the "Online Order" column, the mailbox is marked in bold black.
I sent an email and quickly received a reply with detailed price list, remittance method and mailing process. A box of Cyno's generic Gleevec, Imacy, is priced at $65, or about 448 yuan. If you buy 20 boxes, the cost per box can be reduced to about 202 yuan. The purchase process was a bit too simple, the other party didn't even ask me to show the prescription, and there are Chinese instructions in the medicine box. The email also pointed out that the bank information of the remittance is only valid for one week, and the next order needs to be sent again to inquire.
On the Indian market, a box of Veenat produced by Natco is priced at 8,496 rupees, or about 905 yuan. An Indian who has been shopping for more than a decade said that the Veenat price given by the dealer will be between 600 and 800 yuan, "but it has never been lower than 600."
"It (Cyno) is not available in the Indian market," Lu Yong said. Sitting in a high-end apartment in Gurgaon, he took the initiative to mention this issue, with a relaxed expression, and made a pot of tea. "It's only exported to foreign countries," Lu Yong said. It can only be bought by contacting Cyno via email, so that the price is transparent and counterfeit goods are eliminated.
Lu Yong is very confident in his medical knowledge, and will quickly throw out his own opinions on a question, and then let out a hey laugh, as if to express his approval for the answer. The proper nouns in the pharmaceutical industry are common in his speech, and he is familiar with the new policy of the Food and Drug Administration. Although his condition has long since subsided, his focus on the pharmaceutical industry has become part of his life.
The apartment is also rented by the Silk Road travel agency he works with. Last year, the travel agency approached him, hoping to develop a medical tourism program to India with him. Lu Yong is responsible for domestic publicity and registration. His influence goes beyond the slow-grain group. The cross-border medical treatment on the Silk Road is mainly for hepatitis C patients, and many people come to Lu Yong's name. Some patients are still not at ease after calling, and they must see him. "After seeing me, he will pay with confidence," Lu Yong is very proud.
Before his illness, Lu Yong had a sense of frustration in life. He failed in his first marriage and did not have much success in his career. He was a "very ordinary" person. The drug case caused a stir and unexpectedly became his most fulfilling thing. In 2015, he attended a seminar on pharmaceutical affairs law held in Tsinghua, where he talked about the suffering of high drug prices from the perspective of patients. Wang Zhongliang, a chronic granule patient who also attended the seminar, said at the meeting that what Lu Yong gave everyone was not prestige, he existed as a hero. Some people dare to fight, and some people dare to go public.
Including CCTV "Face to Face", "Today's Argument" and other programs have reported Lu Yong's case. During the period of his release on bail pending trial, Lu Yong had been receiving reporters at home and bought 100 pairs of shoe covers, but soon they were not enough, so he had to buy another 50 pairs.
The Lu Yong case happened at a time of rapid change in medical reform. After 2015, the approval process for new foreign drugs was shortened; the CFDA issued a document requiring Chinese generic drugs to complete the biological consistency evaluation by the end of 2018, which means that the quality of domestic generic drugs will be guaranteed. A series of policies were introduced, and his name was constantly mentioned.
Gleevec, who saved Lu Yong, broke the law and made him famous, has been included in medical insurance in many provinces and cities.
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more complicated story
When he came to India this time, Lu Yong had more time and went to Varanasi, a religious holy place. Riding the Ganges River, he saw that a cremation ceremony was being carried out on the bank. A body wrapped in marigolds was placed on a log, and the fire was burning. A group of teenagers lurked on the shore, waiting to pick up jewelry from the ashes, and more people bathed and washed in the river, living and dying next to each other, peaceful and undisturbed.
Indians can only appreciate the philosophy of looking forward to the afterlife. For the Chinese, the present world is the most important thing. At the age of 34, when Lu Yong received the diagnosis of chronic myeloid leukemia, the first question he asked the doctor was, how long can I live? In order to survive, he searched for all possibilities, contacted foreign bone marrow banks for matching, and took Chinese medicine for nine years. Gleevec is currently the best solution a cancer patient can hope for. In order to provide him with medicine, in 2005, his father had a car accident on the way to contact the business and died after rescue efforts were unsuccessful. It happened suddenly, and not a word was left.
"If it wasn't for my illness, he wouldn't have to go out to work," Lu Yong said. Medicine made him live, but also made him regret.
He needs this medicine for the rest of his life. The only time he stopped taking the medicine was at the Yuanjiang City Detention Center. The police forgot to bring it here. He stopped for 7 days and started thinking about the question he had asked the doctor. The Yuanjiang City Procuratorate finally decided not to prosecute Lu Yong, finding that he did not profit from Gleevec generic drugs and that his behavior of buying bank cards was "significantly minor". Among the hundreds of cases of purchasing imported drugs on behalf of others in recent years, Lu Yong was the only one who was not convicted. In 2015, Hu Fang, deputy to the People's Congress of Jinhua City, Zhejiang Province, also wrote a motion based on the Lu Yong case.
Lu Yong became the "Medicine Man" in the media's mouth. He liked this title and used it as his WeChat name.
After reading the script of "Indian God of Medicine", Lu Yong was not satisfied with the characters in it. In the script, he became a drug dealer who wanted to make money, and later found his conscience to help patients. The producer explained to him that, in addition to the reason for censorship, if it was written realistically, the characters would be smoother and less likely to be sublimated.
Lu Yong and his business partners estimate that when the film is released, there will be another media exposure after the drug case. At that time, he will definitely explain his innocence, "I really can't accept it, because there is still a difference in my image." He feels that his story is more complicated than "Dallas Buyers Club", "Dallas Buyers Club" "The protagonist was only limited by the supply of medicines, and he himself went through the judicial process, "sent me, arrest me, sue me, and then turn around, and in the end nothing happens."
In 2014, Liu Zhengchen knew about Lu Yong from the media. He is the chairman of Beijing New Sunshine Charity Foundation and has been suffering from chronic granulation for many years. In 2002, the day after Lu Yong fell ill, he sent an email to Liu Zhengchen, hoping to learn about his treatment process. But Liu Zhengchen really noticed Lu Yong's name on the news 12 years later; the focus of his attention was not on the decriminalization of purchasing generic drugs, but on the pharmaceutical company called Cyno.
Liu Zhengchen had never heard of this pharmaceutical company. He asked a patient for a box of Imacy made by Cyno, but there was no instruction manual in it at the time. "This is a bit like a three-no product," Liu Zhengchen said. He wrote another email to Hari Menon, an Indian doctor he met at the World Cancer Congress, asking if he knew about the drug company. Dr. Menon wrote back, "This is the first time I've heard of this pharmaceutical company."
At the internal meeting of New Sunshine, Liu Zhengchen told his patients not to take Cyno's medicine. But when Cyno first entered the Chinese market, it was bundled with Natco's medicines, and Lu Yong was invited to promote it. Liu Zhengchen also told the patient that if he bought two medicines, he would throw away the Cyno one.
"No, no," Lu Yong immediately denied that Cyno had any propaganda during the interview, "If you want medicine, please contact it (just do)." I mentioned that some patients had seen the propaganda activities, and he changed his words again, "Cyno has just started. When I came here, it was just the beginning that it was going to be listed, and the patients who came to promote it, I helped it organize patients." "Its purpose is very obvious, and I want to help it promote it through my influence."
In 2011, Cyno held four promotion conferences in Hangzhou, Suzhou, Chengdu and Wuxi, and Lu Yong helped organize, platform, and formally introduce Cyno to patients. At the promotion meeting in Hangzhou, a doctor from Zhejiang Traditional Chinese Medicine Hospital was invited to give a lecture, and the appearance fee was 2,000 yuan.
According to the drugsupdate website, in addition to Natco, there are 7 pharmaceutical companies producing Gleevec generics in India, including Sun, Lupin and other top ten Indian pharmaceutical companies, all of which are priced similar to Natco. Lu Yong said that the reason for only recommending Cyno is very simple, "because Cyno's medicine is the best", and the improved beta crystal form is used. He has seen the list of raw materials provided by Cyno and the production license. "I don't know about other drugs... But Natco's capsule is definitely not beta crystal form, it must be (first generation) alpha crystal form."
In the MSF offices in the southeast corner of Delhi, I met Shailly Gupta and asked her how to tell if an Indian pharmaceutical company is compliant. "It's hard," she frowned, the look of doubt I've seen on the faces of all the Indians I've interviewed since. Xiali explained that the review of some drugs in India is completed by the state-level government, and pharmaceutical companies may also entrust a certain production organization to produce, and there is no unified channel to verify all information. She contacted the people at Natco, and the only certainty was that Natco's generic Gleevec was also in beta form.
"No way," Yunus shrugged. As a pharmacy manager, he can't give any advice on distinguishing between genuine and fake medicines. The Indian drug market is loosely regulated. According to the Times of India, 25% of the medicines produced in India in 2014 were counterfeit medicines. Fake medicines can be packaged realistically and contain certain active ingredients. The only thing a patient can do is, "go to a regular pharmacy and buy it," Yunus said.
In April, I got in touch with Dr. Menon, who emailed Liu Zhengchen, who had worked at the famous Tata Memorial Hospital for 12 years and is now a senior consultant at the Cytecare Cancer Center in Bangalore. He confirmed to me what Liu Zhengchen said, "I have treated thousands of patients with chronic granulation in India, but I have never heard of this pharmaceutical company."
The Central Drugs Standard Control Organization is a white building in central Delhi, east of Connaught Place. There are no tourists here, it is very quiet, and men in suits come in and out in an orderly manner. After many emails with no response, I tried to try my luck here as a friend of the patient, and a man who had worked in the Food and Drug Administration for 6 years agreed to help. He opened the website of the Food and Drug Administration for a while, repeated the process, raised his head and said to me, "I didn't find this pharmaceutical company. This looks a little suspicious."
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Hero or Merchant?
Suraj Mal Vihar is a residential area in the northeast of Delhi. Most of it is a single-family three-story building with private cars parked at the door. In the afternoon of the working day, the community is very quiet, and occasionally there are a few sounds of beating and beating from the people who are decorating. The company address indicated by Cyno in the mail is in the market in the center of the community.
A three-story yellow building appeared in front of me, and the wall paint peeled off, revealing the black material underneath. The doors and windows of the merchants were closed, and graffiti could be seen everywhere on the large billboards. One billboard was crooked and crumbling. In the corridor of the entrance hall, there are slender wild dogs that are common on the streets of India. A tailor set up a sewing machine in the yard, crunching on it, and his wife, who was the only merchant in the market, helped cut.
Cyno's address was on the second floor of the building, a few goldenrods hung on the edge of the door frame, and a monitor was lit above the door. Neither the building entrance nor the doorway has any sign of Cyno Corporation.
A nearby toy store is owned by a community resident who has lived here for years. "I've never heard of a company called Cyno," he told me. The enthusiastic shop owner googled and said that Cyno's address should be in Preet Vihar.
Cyno's other public address, the one it's printed on on the pillbox and marked on Google Maps, is in a reddish-brown building near the metro station Preet Vihar. Go up the stairs on the left to the third floor, you can see a door with a sign "Gukka Pharmaceuticals", and there is the sound of staff walking around. Both Gukka and Cyno are owned by Indian Sanjay. Gukka produces generic medicines and Cyno produces anti-cancer medicines.
Lu Yong and Sanjay are good friends and meet each other every time they go to India. He told me early in the morning that the offices of Indian pharmaceutical companies are very small, "not like we in China like large spaces."
Cyno isn't the first Indian pharma company to turn to Lu Yong for help. In January 2006, Lu Yong came to India for the first time to meet the boss of Natco, hoping that the other party could sell the medicine to China and lower the price.
In the hotel in Mumbai, Lu Yong had lunch with Natco's boss and the head of the international department, and then chatted for more than an hour. He told the other party that there are more than one million chronic granulocytosis patients in China. "Actually, there are not one million chronic granulocytosis patients. He (the boss of Natco) is very happy, because there are so many patients in China, he is very happy." Lu Yong smiled and regarded it as a clever workaround .
"I didn't collect this information," Lu Yong added. It was data provided by fellow volunteers of the Red Cross Foundation.
After a lapse of two months, Lu Yong went to Natco's headquarters in Hyderabad, India again, and met the other party twice. Natco became interested in the Chinese market and came to China in April to find out if the market is really as big as Lu Yong said. They went to the Ministry of Health and the Red Cross Foundation, and Lu Yong introduced them to his traditional Chinese medicine in Shanghai. After that, Natco had no contact with him.
"On the one hand, I estimate that the number of people who may be sick is not that large, and he feels that the information we provide is inaccurate. On the other hand, its medicines cannot be smoothly brought to China through normal channels, because China has patents. Especially he After meeting with the information center of the Ministry of Health, they must have obtained this information, and they will not believe us." Lu Yong said that Natco is a listed company, and if it ignores the patent and sells medicine directly to China, it will be a big trouble.
After 2011, Lu Yong began to recommend medicines produced by Cyno, which sold medicines directly to Chinese patients. Lu Yong also said that this is a different business model between Cyno and Natco. "Natco is a relatively large company... The distributor may be set at a thousand bottles or a few thousand bottles. For Chinese patients, it is very annoying for each patient to contact them one by one."
San Jie, the owner of Cyno Company, is a low-key person. During the period when Lu Yong’s case attracted intensive attention, he only received a phone interview in Tencent’s “Focus”. He said on the phone, "Our company has all kinds of licenses, please don't treat our medicines as counterfeit medicines."
On April 5, I met Sanjay in this reddish brown building near Preet Vihar. He set the interview location in the conference room downstairs in Gukka. There was no sign at the door, and it looked like an ordinary residential house. The furniture in the house is simple, the decoration is pure white, and there is no text.
Sanjay, a tall Indian Jain, still wore a well-cut three-piece suit in the forty-degree weather, with a folded handkerchief in his left breast pocket. He was discreet and polite, never detailing a question, answering mostly in short sentences, then showing a standard smile, the corners of his mouth raised, signaling the end of the answer.
In 2004, Sanjay received a call from a Chinese who wanted some anticancer drugs, so he met Lu Yong. At that time, Cyno was a distributor, mainly selling medicines to Japan, and Sanjay knew nothing about the situation in the Chinese market. Lu Yong began to introduce him to some Chinese customers who bought Veenat, a generic drug of Gleevec produced by Natco, from him.
Since 2010, Cyno told Lu Yong that he has also started to produce Gleevec generic drugs, and Imacy has subsequently become the main drug Lu Yong introduced to Chinese patients with chronic disease.
There is very little introduction about Cyno in the public information, the official website is brief, and there is no even the company's establishment time. Two of the five English paragraphs on the homepage are repeated. According to Sanjay, he entered the pharmaceutical industry in 1984 and founded Cyno in 1999. Today, the company can produce more than 400 different brands of medicines, with an annual production of 1 million pills and a turnover of five million US dollars. Cyno is mainly engaged in export business, 75% of the market is in Japan, 15% in China. Patients in both countries order directly from the company through the mail, and the company mails out the drug, “and we ask them to show their prescription in the mail,” Sanjay said.
Sanjay estimated that Lu Yong probably brought him several thousand patients. Chronic granulocytosis patients need to take the medicine for life. Cyno now receives about 100 emails from China every day, most of them ordering the Gleevec generic drug Imacy. India's pharmaceutical industry is developed. Sanjay said that there are thousands of pharmaceutical companies in India, and Cyno can probably be ranked in the top 1,000 in India.
"I don't do any publicity," Sanjay said, adding that Cyno's consumers came from word of mouth. "We just focus on the quality of the drug." He didn't show much interest in working with Yunnan Pharmaceuticals, Emphasize that he is fifty years old and is very satisfied with the existing market, "I am not desperate."
I asked him if he could get Cyno in the market in India, and Sanjay said yes, the only problem was that it would take a few days. "In any Indian pharmacy, it's doable."
In fact, Cyno advertised in China in 2011 and bundled its own drug with Natco's Veenat. After receiving the patient's order email, Cyno did not ask to see the prescription. Cyno's medicines are also not available in pharmacies in India.
After the Lu Yong case was reported by the media, the concept of Indian generic drugs was popularized to the public. A large amount of news, subsequent legal decisions, and the motions of deputies to the National People's Congress constitute a chain of mutual confirmation, making Lu Yong the entrance to all information, and the public's trust in him has also shifted to the trust in the products he introduced. Liu Shu, director of the Yunnan Provincial Federation of Industry and Commerce Office, said, "I have been to their (Cyno) company and seen some of its products. We have not seen other qualifications, including its production license."
"This drug is an avenue that Lu Yong has opened up for us, and the news is at the bottom. It's all his positive voice. Do you think patients may not choose? How many new patients will choose regular treatment rationally?" Li Yida (pseudonym) said that he has been a chronic granule patient for many years, and is also a member of the slow granule QQ group first created by Lu Yong in 2004. The media's focus is mostly on the high drug prices in China, but it has not paid attention to Cyno itself.
"In fact, it is a performance full of loopholes, but some people believe it." Li Yida said that many patients with chronic granulocytosis hope to believe in a "savior who was born out of nowhere" and can help them get rid of their misery. He speculated that Lu Yong's promotion of Cyno had economic reasons. "A very pertinent comment is that he is a businessman."
But Lu Yong's role as a pioneer is deeply rooted in the hearts of the people. "I don't care if he sells counterfeit drugs, whether he is profitable or not, no matter what the reason is, he has been doing it for many years," said Wang Zhongliang. He suffered from chronic disease in 2012 and once thought about giving up treatment. Pharmaceuticals gave him hope. "He was arrested and detained for more than 130 days. In the end, the Lu Yong incident was broadcast on CCTV as news. He made our disease public to the media and society, which was also a big push."
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final question
On April 6, Lu Yong celebrated his 49th birthday at the Nanjing Hotel in Delhi. It's been 15 years since he got cancer, he's healthy, and he's drinking a big glass of red wine. After a meeting with Sanjay at the end of the month, he returned to his hometown of Wuxi after a one-month trip in India.
India has just entered the hot season with a high temperature of 45 degrees Celsius. But Wuxi is a pleasant spring, with a breeze and the sound of the broad leaves rustling on the streets. In a tea room, Lu Yong brewed a pot of kung fu tea. For the past two months, most of our conversations have been accompanied by the steaming heat of the tea.
"They are still very interested in the Chinese market," Lu Yong said with a smile on his face, saying that the two sides had initially agreed that the investment in the pharmaceutical factory in cooperation with Yunnan would be about 100 million yuan. Cyno proposed to use technology and 3 million yuan investment to account for half of the shares. , manufactures generic drugs in China.
"If we are successful, on the one hand, the promotion of generic drugs in China will be a benefit, on the other hand, lowering drug prices will be beneficial to me personally... If a pharmaceutical company is established, or if I participate in , or if you have a stake, it must be right.” He had this vision before going to India.
Again, I mentioned that Cyno was not found in pharmacies in India. "Yes," Lu Yong suddenly changed his statement, saying that Cyno had sent him a video showing medicines being sold on the shelves of the pharmacy. But he didn't verify it himself. "I've already contacted it, how can I still go to the pharmacy to buy it? Impossible."
Lu Yong kept smiling, still speaking very fast, without any emotion of being questioned or offended. He said he saw Cyno's imatinib production license in 2008 (the term was later changed to 2011), and visited its pharmaceutical factory in the Solan Mountains, "down a cliff," There are about five floors below.” Cyno showed him a test report made in Japan, which showed that the active ingredient of imatinib in the 100mg test drug was 100mg, and the quality was qualified.
"I've checked what you can find," Lu Yong chuckled, "I'm 100% sure."
These materials are provided by Cyno. Lu Yong is confident, saying that he has also done drug testing, and in 2015, he also checked the batch number of Cyno's production license. "There will never be any problem." He used a lot of "absolute", "As far as I know they definitely have. Licensed, they would never dare without a license.”
The tea was cold, but Lu Yong didn't drink it and didn't continue. "I only care if its medicine is good or not. As for its mode of operation, whether it is sold in India or just exported, what does it have to do with me?"
Lu Yong found a test report made privately at Wuxi University in 2011, and divided it into two parts: content comparison and mass spectrometry comparison. From the peak area of the chart, it was shown that the peaks of the submitted drug and the comparison drug were almost the same. And this kind of test "can be done in one day".
"This is not enough to explain anything," said Dr. Yuanming Luo of the Institute of Microbiology of the Chinese Academy of Sciences after reading the test report. The detection of drug components requires multiple repeated experiments and multiple batches of samples, and also requires the use of standard products to create a standard curve, which is time-consuming. This report is too simple. It only gives the peak area displayed by the detector and the TIC peak area of the mass spectrometer. There are no text descriptions.
At the end of March 2017, Liu Zhengchen sent Cyno's generic drugs and Gleevec to the Institute of Microbiology, Chinese Academy of Sciences for testing. On May 2, he got the inspection report. The report compares two specifications of Cyno generic drug and Gleevec, and the ratio of active ingredient imatinib per 100 mg of generic drug is about 55% and 83% of Gleevec, respectively (Note: this test only tests Cyno two batches of drugs, and one of the batches has a longer production date, there may be deviations, which is for reference only).
"This kind of disease, it doesn't mean that if you don't eat well, it will show up in a short time," said Dr. Jiang Qian of Peking University People's Hospital, "because this kind of disease can survive for an average of three to five years without taking this kind of medicine. Individuals can be as long as ten years, and it is difficult to say whether there are positive side effects between drugs.” She once published a study on 949 patients, and the results showed that compared with patients who took the original brand drug, the patients who took the generic drug had a poorer treatment response. . At present, patients taking generic drugs can obtain drug sources through informal channels, and "lack of standardized management" may be an important reason.
Lu Yong presented a Cyno imatinib production license and two application forms. The production license is issued by the Indian state of Himachal Pradesh, but the types of drugs marked above (other than those specified in Scehdule C,C(1) and (X)) do not involve prescription drugs. Even so, the website of the Himachal Pradesh Food and Drug Administration shows that the production license is valid from March 25, 2010 to March 24, 2015, and Cyno’s drugs produced in January 2017 are still used. batch number. The production license number of Sanjay's other pharmaceutical company, Gukka, also expired in 2015.
This means that Imacy is not only an imitation product in terms of patents and technologies, it has not received permission to enter the Chinese market, but its production in India is also illegal.
"I don't know this," Lu Yong said silently on the other end of the phone, "I'm not an expert in this field."
Dr. Menon in India said that if there is no formal production qualification, the biggest problem is the lack of supervision of drugs, so that the quality of each batch cannot be guaranteed. I emailed Sanjay to ask and he never got back to me.
Every day, Lu Yong's two mobile phones kept flashing, and he could receive requests from nearly ten patients to ask him to buy medicines. These people found his contact information on the Internet, saying that they did not understand remittances, did not understand English, and the process of writing online was too complicated. Lu Yong was quite angry and said, "These patients are actually irresponsible to themselves, because you have been taking this disease for a long time, and you must not rely on others," he said, "It takes half a day to look at a mobile phone. Is it good or not, something very important to your life, how can you just watch it for ten minutes and immediately say I don't understand something."
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Editor: Zeng Ming Interview, Writing: Jin Jin Vision: Liang Shuang Photography: Luo Yang
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Since the report itself has a high reading threshold, I hope you can read the report patiently first.
This report is of great significance, but before discussing its significance as news writing, there are more pressing and needing attention. I hope that you will not only take this as a Zhihu answer, but promote it as a social issue that requires your thorough understanding and help.
Let’s first talk about the most urgent situation at present, which can also be said to be the major difficulties in advancing this matter:
1. There are about 100,000 chronic granulocytosis patients in China, and the group controlled by Lu Yong covers about 10,000 people, which is one-tenth. The generic drugs he purchased and promoted have been proved by the Chinese Academy of Sciences that the active ingredients are far less than the original drugs. That is to say, the life of one-tenth of the chronic granulocytosis patients in China is now controlled by Lu Yong alone. And he has been conferred a god among chronic granule patients, and the circle of chronic granule patients and most terminally ill patients is an unimaginable circle for ordinary people. Common characteristics of these patients and their families are:
- Inability or even energy to independently identify the quality of generic drugs and make cross-border purchases
- Extreme despair, loss of judgment in this despair, a little hope will be regarded as a life-saving straw
- Desperately need a heroic myth to save oneself
Therefore, Lu Yong, who is "the first person to purchase generic drugs in China", has not only monopolized the purchasing of generic drugs in the circle of chronic patients, but has also become a mythical and unshakable authority. After the report came out, very few patients with knowledge did not dare to publicly mention, question or oppose Lu Yong and the generic drugs he purchased on his behalf. Lu Yong himself has not responded yet.
2. Lu Yong was shaped by the media. A few years ago his story was called "China's version of Dallas Buyers Club", he was called "Medicine Man", and more than 150 media reported him. So, the deputies to the National People's Congress made a proposal, and the Yunnan Federation of Industry and Commerce asked him to cooperate. Produced by Ning Hao and starring Xu Zheng, the movie "Chinese Medicine God" based on him is about to be released. During this process, none of the media, government, and capital conducted in-depth investigations on him, and none of them conducted a comprehensive inspection of the drugs he purchased. Now this report is tantamount to letting the media and various stakeholders slap themselves in the face. The media that participated in the creation of this myth did not follow up on the matter, resulting in this report not getting the attention it deserved. The current follow-up is difficult.
3. "Isn't Lu Yong purchasing a regular generic drug?"
Lu Yong has purchased two kinds of drugs successively. We can see that when he purchased the first one, Veenat produced by Natco in India, he used the method of sending money to the other party. But after eating for seven years, he suddenly switched to Imacy, produced by Cyno, not only to promote it on the platform, but also to buy bank cards online for patients to raise funds to buy. Lu Yong was arrested because of the online purchase of bank cards. And now, Lu Yong is cooperating with Cyno and Yunnan Pharmaceutical Factory. This project is said to have invested over 100 million yuan.
And is Cyno compliant? 1. As a pharmaceutical company, sell medicines directly to individual patients. 2. The receiving bank information changes every week. 3. It is not available in local pharmacies in India and cannot be found by the Food and Drug Administration. 4. The production license is non-compliant and expired. 5. Several Indian slow-grain experts have confirmed that they have never heard of it. 6. One thing not mentioned in the report is that this is not a secret in the slow particle circle at all.
Next, in response to the misunderstanding of most ordinary people about this matter and this report, make an answer:
1. "China's Dallas Buyers Club."
This is not a Chinese version of the Dallas Buyers Club story. Or rather, a variant of the Dallas Buyers Club story. Most people may not know the antecedents of Lu Yong's story, and have not read the full text of the report carefully. It is also because this matter has undergone many reversals, and most people are still in the previous stage of the last reversal, thinking that Lu Yong is a hero who buys cheaper Indian generic drugs in an environment where Chinese patented drugs are expensive. That's not the case, so please stop characterizing this as "China's Dallas Buyers Club."
2. "Lu Yong purchased generic drugs. Do you understand the difference between generic drugs and patented drugs? That's not called fake drugs."
Patented drugs, generic drugs, and generic drugs of Cyno Company purchased by Lu Yong are three different things. See the original report:
Lu Yong's story is built on Gleevec's generic drug. Gleevec is the first molecularly targeted anticancer drug in humans, which has increased the five-year survival rate of chronic myeloid leukemia patients to more than 90%. Drugs are also an astonishingly profitable business. The annual sales of Gleevec from Novartis in Switzerland is nearly 5 billion US dollars, continuing the strategy of high premium. box. For cancer patients, they have no choice. The generic drug is the same as the original drug in terms of dosage, efficacy, etc. The only difference is that there is no patent. India's 1970 "Patent Law" gave up intellectual property protection for pharmaceutical compounds, and domestic companies began to mass-produce generic drugs, which quickly developed into a pillar industry. Months after a drug is launched in the United States, cheap generic versions can be found in India.
In fact, it is very common in the chronic disease patient circle to purchase generic drugs produced in India for treatment. Generic drugs are also a very large and mature industry in India. Specific to the drug Gleevec, there are many generic drug brands that are legally produced and have the same efficacy. The generic drugs produced by the Cyno company purchased by Lu Yong are illegal drugs produced illegally in India, and their active ingredients are much smaller than the original drugs after testing. In other words, Lu Yong purchased illegal drugs in generic drugs, which were indeed fake drugs.
3. "Because it is expensive to buy patented drugs in China, why can't you buy cheap generic drugs? Even fake drugs."
As explained in point 2 , there are a lot of regular and legal Gleevec generics that can be bought in India, produced by at least a dozen pharmaceutical companies, some of which are top pharmaceutical companies in India. In addition, the information that has not yet been updated in the report is that through negotiation with these formal manufacturers, the price of the regular generic drugs that Chinese patients with chronic granulation can buy on behalf of them has also dropped to about 250 per box . The counterfeit medicine that Lu Yong purchased on his behalf was 200 boxes, which has long lost its price advantage. However, due to Lu Yong's monopoly position in the field of purchasing Gleevec generic drugs, many patients are unaware and unable to purchase regular and cheap generic drugs through other channels.
4. "The medicines purchased by Lu Yong are insufficient, but a little effect is a little effect. It's better than waiting to die if he can't afford patented medicines?" "If you can spend 200 yuan to eat medicines with 55% of the active ingredients, no Is it worth it?"
Combined with point 3, patients can have legitimate, safe, effective and equally cheap generic drug options.
Moreover, 1. Lu Yong has always claimed that the active ingredients of the drug he advocates are more than 99% similar to the original drug, and the patient does not know the real situation. 2. Some batches of active ingredients are 55% of the original drug, and some are 83%, so should the patient take twice as much medicine or one and a half times? Can medicine be added, subtracted, multiplied and divided like this? 3. Taking medicine indiscriminately brings uncontrollable effects. The article has already mentioned Dr. Jiang Qian's report that the follow-up monitoring of patients taking Indian generic drugs is poor, mainly because the source of the drugs is unknown. You can check the status of Dr. Jiang Qian in the slow-grain circle, she is "the first sister of slow-grain".
Then I can finally talk about the significance of this report in terms of news writing and raise some questions for journalists:
- In the capitalist-oriented modernity, in the past few years, the writing of special articles or so-called investigative reports has become more and more "story-based" or even "image-based". It seems that whether a topic can be passed, Whether a news event is worthy of being written, whether it can become a "popular", and whether it can be adapted into a film and television drama has become the most worthy basis for consideration. Journalism has long since lost its justice.
- In the process of Lu Yong's purchasing of generic drugs, being deified, repeatedly being proposed by the National People's Congress, and being made into a movie, why did not one of the more than 150 media across the country conduct an in-depth investigation? ! Compared with the investigative reports such as "The Great Xing'anling Murder Case" that successfully attracted a lot of attention when a murder case occurred during the reporting process, the efforts made by "The Doubtful "Chinese Medicine God" are obviously far more worthy of attention. It is a true detective-like investigation of the truth, a discovery of the truth. The hardships and courage involved not only transcend the identity of a "journalist", but also make investigative reporting regain (or restore) the highest mission and value it can have in today's era. Looking at the non-fiction writing in China in the past ten years, this report can be regarded as a milestone. Because it is not only a non-fiction writing that re-examines the facts and rediscovers the truth completely by myself, it can really change the lives of countless people. Writing this report is itself a movie, the Chinese version of Focus.
- This is a report that truly tests the conscience and choices of journalists. Due to the professionalism of the author of the report, the report could have been written more "attractive", but "The Suspicious "Chinese Medicine God" still chose to present all the evidence from a rational and objective perspective. Not quite as dramatic as the non-fiction writing that's popular at the moment, which also makes the coverage seem very tame. After the report came out, the collective silence of many authoritative media made this report not get the attention it deserved. Yes, this report cannot be adapted into a film and television, and even the biggest stumbling block of "Chinese Medicine God"; this report is not "good-looking" enough, not "full of controversy", and cannot be regarded as unreasonable in terms of storytelling and writing techniques. Discuss hot topics that are popular in fictional writing; because of the brilliant shaping of Lu Yong by other media before, journalists dare not slap themselves in the face. Yet it lives up to the highest value news and journalists can have.
To sum up, the exposure of the "hero" Lu Yong in the report "The Suspicious "Chinese Medicine God" is just the beginning of a battle. As for how far it can go, whether it can really arouse the attention of the whole society, and whether it can really save the lives of tens of millions of patients with chronic granulocytosis, it must be up to you, an unrelated ordinary person, to continue to push it forward.
After this answer is written, there must be many questions and discussions, which is not important. Because whether we can get more power to pay attention to and follow up on this matter, even if it is questioned or even overturned, will make the facts clearer and make the problem of medicine clearer. This is the focus of this answer.
Whether criticizing or agreeing, I hereby express my gratitude as an ordinary person who knows a thing or two about this matter.
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