Taking Stock of My Gains in Medicine in 2019

On the last day of 2019, I decided to take stock of my own gains in medicine over the year. I want to write this article in two parts: one on my gains in medical research, and the other on my findings from studying China's medical system.

First, let me talk about my gains in medical research.

Over the past year my workload increased considerably compared with the year before. The number of patients I saw rose by about 30% over 2018, so I had the chance to explore several cancers more deeply than before. Unfortunately, however, most of the cancer patients I saw were already late-stage or end-stage patients who had long undergone various other Chinese and Western treatments, so the overall therapeutic effect was not good.

My effective treatment rate is only about 30%, and the successful cases in which patients were treated to a tumor-reduced or tumor-free state are even fewer, under 10%. For most patients, treatment can only achieve the goals of maintaining survival with tumor, slowing the growth of the tumor, prolonging the patient's life, and improving quality of life.

Of course, overall, according to the current average level of world medicine, that is about all that can be achieved for late-stage cancer.

I publish these figures in the hope that in the new year, when new patients turn to me for help, they will face this reality squarely, not hold unrealistic expectations of me, and seek care with caution.

I have successfully treated some cancer patients. Among certain cancer communities, many people are exaggerating my results by passing on distorted accounts, which leads some patients to come with expectations that are too high and places great psychological pressure on me. That is why I keep speaking out myself; I do not want patients to regard me as an almighty divine doctor—I do not have such great magic powers.

In the days ahead I will continue to walk and explore the road against cancer, though I may still not achieve a high effective rate that satisfies either patients or myself. Even so, I will not stop exploring; the human cause against cancer needs people like us to keep going and pave the way for those who come after. The lessons of my failures can be drawn upon by later generations, and the experience of my successes can also serve as a reference for them.

Over the past year I kept up my writing on popular medical science, essentially publishing one article a day, roughly three hundred articles over the whole year. I am fairly satisfied with my own perseverance; for a middle-aged person to do what I have done truly requires extraordinary resolve. That I could successfully overcome inertia and keep writing original science articles—this, I believe, is beyond most people. Even a full-time writer may not produce as many words in a year as I have.

When my son was in the first year of middle school, he once wrote an essay saying that after his grandmother died of illness, his father developed an idea different from Lu Xun's—that curing the sick and saving lives mattered more than writing.

Actually it is not quite like that. I have kept writing while persisting in treating the sick, because I feel that curing the sick and writing are equally important.

I keep writing within a certain circle, aiming to raise everyone's understanding of disease, of medical care, and of death. As my clinical experience grows richer, my understanding of the profession of doctor deepens. A doctor not only has the responsibility of curing and saving, but also the responsibility of helping people overcome the fear of death and easing the pain of bereavement. Just as the classic epitaph of Dr. Trudeau says, the nature of a doctor's work is "to cure sometimes, to relieve often, to comfort always."

In addition, in this era of severe emotional confrontation between doctors and patients, there should also be doctors who, like me, step forward and truthfully and rationally write out the voice of physicians so that all sectors of society can hear it—so as to increase the public's understanding of doctors and of medicine and improve the doctor-patient relationship. At the same time, it lets those in power see the difficulties doctors face, so that in medical reform they may take doctors' feelings into account and create a better medical environment.

China's annual outpatient volume is 9 billion visits. Without a good medical environment, everyone is affected. Medicine is a matter of the people's livelihood; birth, old age, illness, and death are the four great themes of life, and all four are closely bound up with medicine. Over the past decade China's medical environment has been deteriorating, and this trend should be checked.

Checking this trend is the responsibility of every one of us. Doctors have a duty to educate the public, and the public has a duty to raise its scientific literacy and its understanding of medicine. The medical community also has a duty to adopt industry self-discipline measures, casting aside colleagues who damage the medical environment and purifying itself.

That is the purpose of my uninterrupted popular science writing.

In 2019 I also published many of my empirical prescriptions. These are formulas that have shown actual clinical effect in my practice; although their efficacy is not one hundred percent, they have indeed helped many patients, and I have made them all public without reservation.

Some readers have told me that they used my empirical prescriptions to solve their problems. I am very glad of that. In the years ahead I will continue to explore cancer treatment; whenever a safe and reasonably effective empirical formula emerges, I will continue to make it public.

As for formulas that are not very safe and require close observation by a doctor because they carry risk, I will continue to monitor their use and not publish them casually, so as to avoid harming patients who blindly try to save themselves. The core of medicine is safety and efficacy, and a physician's duty is to balance both.

For thousands of years, excessive conservatism in Chinese medicine has hindered its development. I will not take secret formulas to my grave; in the end, every formula I create that is proven effective and highly safe will be made public.

Next, let me write about my reflections on studying China's medical system.

As a researcher fighting cancer with Chinese medicine, my writing on medical research in Chinese oncology may be understandable to everyone. But writing on the study of the medical system—perhaps some people will not understand.

China is about to enter a peak period of cancer outbreak; it is estimated that in the future one in every three citizens will die of cancer. Relying solely on doctors' research in medical skill cannot solve this social problem; the government needs further reform of the medical system to properly address a problem that will affect nearly every Chinese family.

Because I often try to prescribe medicines that patients can reimburse through medical insurance, in order to lighten their economic burden—after all, cancer patients need long-term treatment and their families are under heavy financial pressure—I pay close attention to medical insurance policy.

No matter how good one's medical skill, without the support of medical insurance policy, treatment for many cancer patients will still be interrupted for economic reasons. So after practicing medicine for a long time, I unconsciously began to pay attention to these issues and to study China's medical problems. I hope to raise my own voice, urging the state, when reforming the medical system, to see what a grassroots practitioner like me has observed and thought during clinical practice, and to respond to our call when formulating medical reform policy.

This year I clearly felt that the prices of medicines covered by medical insurance are rising sharply. The most typical example is Xihuang Wan from Beijing Tongrentang. Last year the price of Xihuang Wan (3x10g) dispensed at designated medical-insurance hospitals was still 334 yuan a box; this year it has risen to about 1,200 yuan. Commonly used anti-cancer drugs such as Compound Cantharidin Capsules are also going up in price. Our government keeps talking about lightening the economic burden on cancer patients, but in reality patients' financial burden is increasing, and all sorts of new charges have appeared during hospitalization.

The real reason behind this is that medical insurance funds are strained. So why are medical insurance funds strained?

On one hand, treating chronic diseases like cancer costs too much money, and medical insurance funds are limited. For each patient with a major or serious illness, the money spent may be more than they could earn in a lifetime, so most patients with cancer and other major diseases can only rely on medical insurance funds for relief.

Our country is a developing nation, and the medical insurance fees we can collect are very limited. I once saw online rural young people in some places cursing the government for charging them a few hundred yuan a year for the new rural cooperative medical insurance, feeling it was simply robbing them. But once they fall ill, they feel that the medical department should provide services free of charge, and even hope to consume hundreds of thousands or millions in medical resources themselves.

One can see how great the resistance to our health work is. Most people want universal free medical care, hoping to receive high-quality free treatment without paying anything themselves. Many people long for China's nearly free medical services of decades ago.

I am someone who lived through the early era of cheap medical care, and I know full well how catastrophic the consequences of that early cheap care were.

For example, today we use disposable needles for injections; when I was a child, injections were given with shared needles. In the clinic, they would boil a needle in an aluminum lunchbox and call that disinfection.

Today, among Chinese people born in the 1970s and 1980s, hepatitis B is especially common; many people's hepatitis B was transmitted just that way.

In some villages in Zhumadian, Henan, because people sold blood to supplement their household income, the blood stations used shared needles in collection, with the result that nearly the whole village contracted AIDS. Do we really want to return to that era of cheap medicine? As someone who was infected with the hepatitis B virus through a shared needle, I shudder when I think about medicine in the 1970s and 1980s.

I was born in the countryside. When I was small, there were not many people over seventy in our village, and almost no one over eighty. Now there are quite a few people over ninety, and the seventy-year-olds in rural areas mostly still work the land; the average life expectancy of our residents is rising sharply. Stroke patients who could not be rescued in the past can now mostly be saved.

So the cheap medicine of the past came at the cost of people's health and longevity. The level of medical and health care at that time was poor; today people want both a high medical standard and low medical costs—this kind of thinking is selfish and deeply problematic.

Humans' natural life span is only thirty-eight years; modern people are striving to extend average life expectancy, but each additional year of average life expectancy requires enormous investment of medical resources. We cannot on one hand wish to live long and on the other wish to give nothing.

Few people in our country donate to causes related to the national economy and people's livelihood, such as health care; few wealthy people are willing to make charitable investments in medical research. China's basic medical research lags behind that of developed countries, and much medical equipment and medicine must be imported from abroad at high intellectual-property fees. All of this raises the cost of modern medicine.

If we want to enjoy high-quality medical services, we need to put in more effort.

Another major reason for strained medical insurance funds is the failure of medical system reform: corruption runs rampant in the medical field, and weevils are profiteering from the disasters of the sick.

Our government has grown accustomed to a paternalistic management model; it is still "big government, small society." No wonder Chinese citizens always have the mentality of giant babies, expecting the government to solve all their problems—because the government has grown used to taking everything on.

China's medicines adopt a government centralized bidding model, and this model has led to a great deal of corruption. In the past it was said that a medicine would not be sold without ten times the profit; now it is even worse. Some commonly used medicines, which private hospitals purchase for a few cents a vial, cost ten or twenty yuan a vial when procured through government centralized bidding.

Moreover, the government centralized bidding model has also caused a flood of safe-but-ineffective yet hugely profitable drugs into the medical system; it would be a wonder if these drugs actually cured disease.

Ordinary people spend more and more money, yet their illness is not cured; whom should they resent if not the doctors? When doctors swore the oath of medicine in medical school, they could never have imagined that after taking up their posts they would become "wage earners" for certain vested-interest groups and tools for amassing wealth.

For a long time, our government has been unwilling to fully devolve power in medical affairs, unwilling to put power into the hands of the doctors themselves. In fact, if power were truly placed in doctors' own hands, with millions of doctors competing for their own careers, Chinese medicine would instead enter a state of healthy development.

Today, medical corruption is an undeniable fact. This is not the corruption of one or two people, but of millions of medical workers who have joined in. Because they cannot decently earn enough to feed their families, large numbers of medical staff are forced onto this chain of interest—and the victim, of course, is Chinese medicine.

In this environment, almost no one in our country is quietly doing medical research. I hope our government takes this problem seriously, and I hope our people take it seriously too, daring to demand back the power that belongs to them and urging the government to reform. I especially hope that our colleagues on the medical front will bravely stand up, say no to unreasonable institutions, and change the status quo.

This year, as I ran around dealing with some personal affairs, I at one point felt so frustrated that I wanted to give up. An elder of mine once said to me: your own affairs still have to be fought for by yourself. I have benefited greatly from those words.

I offer that same sentence to everyone: our own rights need to be fought for by each of us. If we sit by and watch a bad system erode our vital interests, whom can we blame?

I have been struggling and have never stopped. In the future, I personally will unhesitatingly strive for my own rights, and will never allow any unreasonable institution or person to interfere with my freedom or violate my rights. This society has boiled many people like frogs in warm water, but fortunately it has not boiled me.