Dying to Survive: A Dark Comedy About Smuggling in Cancer Drugs from India

文/黃茵茵 譯/孟潔冰

“Over the years since I became ill, the drugs have cost me my home and bled my family dry. Sir, can you tell me which family doesn’t have a patient, and can you guarantee that you’ll have a lifetime free of illness?”

[2] The words are spoken by an elderly Chinese leukemia1leukemia 白血病。patient to a policeman confiscating her smuggled cancer drugs in the movie Dying to Survive, which opened nationwide on July 5. It won acclaim when it debuted at the Shanghai Film Festival in June and raked in a record $200m in its opening weekend on a budget of just $15m.

[3] Based on the true story of a businessman who became a savior for hundreds of leukemia patients struggling to pay for expensive imported drugs,it’s a rare example of a domestic movie that dares to tackle the cruel realities of middle-class life in China—in this case,the extraordinary lengths families go to in order to obtain life-saving medicines.

“我生病吃藥這些年，房子吃沒了，家人被我吃垮了。領導，誰家能不遇上個病人，你就能保證你這一輩子不生病嗎？”

[2]在7月5日全國上映的電影《我不是藥神》中，一位患白血病的中國老太太對收走她走私抗癌藥的警察說了這番話。這部影片在6月的上海國際電影節上首次放映就贏得好評，憑借僅有1500萬美元的制作成本，創下首映周末2億美元的票房紀錄。

[3]這部電影改編自一個商人的真實故事，他成為了數百名難以負擔昂貴進口藥的白血病患者的救世主。作為國產電影少有的典范，本片敢于觸及中國中產階級生活的殘酷現實——在這種情況下，患者家庭為了得到救命藥而費盡心思。

No ordinary drug lord

[4] Dying to Survive tells the story of Cheng Yong, a peddler of oils intended to cure erectile dysfunction, who is approached for help by a leukemia patient who can’t afford the fictional Geliening,a Swedish drug that costs some 40,000 yuan ($6,032) a bottle. The patient asks Cheng to procure the generic version from India, which costs just a fraction of the price.

[5] After realizing the enormous profits to be made, Cheng puts together an unlikely team of smugglers—including a mom who’s stripping to pay for her daughter’s leukemia treatments, and a priest. The film draws its lighter moments from Cheng’s irate reactions to his encounters in India, where he travels to buy the medicine. Cheng is played by Xu Zheng, a well-known Chinese comedic actor who co-produced the film with Ning Hao, a director known for making low-budget comedy films.

[6] Cheng’s character is based on the true story of Lu Yong, a textile trader who was diagnosed with leukemia, and spent more than $80,000 on Gleevec,a very effective treatment that wasn’t covered at the time under national health insurance. Manufactured by Swiss pharmaceutical firm Novartis, it cost the equivalent of $32 for a single pill. Lu located a generic substitute in India—and then helped get it to at least 1,000 other leukemia sufferers in China.

不平凡的藥神

[4]《我不是藥神》講述了程勇的故事，他是出售壯陽印度神油的商販，有位白血病患者由于買不起“格列寧”而找到他求助，這種虛構的瑞典藥物每瓶售價高達4萬元（約合6032美元）。這位病人懇求程勇從印度代購仿制藥，因為仿制藥的價格只是原廠藥的零頭。

[5]在看到賺取巨額利潤的商機后，程勇組成了不可思議的走私團隊，包括為了給女兒支付白血病治療費而跳脫衣舞的單親媽媽和一位神父。在前往印度買仿制藥的過程中，各種遭遇讓程勇大發脾氣，也構成這部電影中輕松幽默的片段。中國著名喜劇演員徐崢飾演程勇，他和以制作小成本喜劇片出名的導演寧浩共同擔任了本片的監制。

[6]程勇的角色改編自陸勇的真實經歷，這位紡織品企業老板被診斷出患有白血病，他服用格列衛的費用高達8萬多美元，這種藥物療效很好，當時卻沒有納入全國醫保范圍。瑞士諾華制藥公司生產的格列衛在中國的售價約為每片32美元。陸勇在印度找到了替代的仿制藥，后來至少幫助中國的1000名白血病患者買到了這種藥品。

[7] The unapproved drug was considered counterfeit under Chinese law, and in 2014, Lu was arrested and charged with selling fake drugs. During his more than four months in detention, some 300 leukemia patients petitioned for his release. Lu was freed in 2015, with the prosecutor noting that he had never personally pro fited from the sales. After his story came to light, many drew parallels with Dallas Buyers Club—the 2013 film about a man who sells unregulated AIDS drugs to fellow HIV sufferers.

[8] In the Chinese movie, Cheng starts off looking to make money but gradually develops compassion for the patients. At one point, Cheng stops smuggling because of the risks involved. When a patient commits suicide because he can’t afford to pay his medical bills, Cheng resumes procuring the Indian drug for Chinese patients—but no longer pro fits from it.

A rare mirror to China’s problems

[9] The issue of huge out-of-pocket drug costs is one many moviegoers in China will recognize. Some 40% of the country’s healthcare spending is on drugs, a far higher share than in many countries. About a third of healthcare spending falls on individuals.

[7]依照中國法律的規定，這種未經批準的藥物屬于假藥，陸勇在2014年因涉嫌銷售假藥而被逮捕。在他被拘留的4個多月里，大約有300名白血病患者請求釋放他。由于檢察官認定陸勇本人未從銷售仿制藥中獲利，他在2015年被釋放。在他的故事曝光后，許多人將其和《達拉斯買家俱樂部》相提并論，這部2013年上映的電影講述了患有艾滋病的男主人公向病友出售未經批準的艾滋病藥物的故事。

[8]在這部國產電影中，程勇最初是為了賺錢，但是逐漸對病人產生了同情。有一次，程勇因為卷入風險而停止走私。等到有位病人因為無力支付醫藥費而自殺后，程勇重新開始為中國患者購買印度仿制藥，但是不再從中牟利。

中國問題的罕見寫照

[9]巨額自付藥費的問題會得到很多中國觀眾的認同。在中國醫療衛生支出中，藥品的費用占到了40%左右，這個比例遠遠高于許多國家，而個人自費支出大約占三分之一。

[10] Last year, China announced plans for reforms to reduce the drug burden on patients and cover more vital drugs under national insurance. Patients taking Gleevec, which began to be covered last year, now only pay around 20% of the sticker price. As of this year, China added a slew of patented drugs from multinationals to its national health insurance plan, securing massive price reductions(paywall2paywall付費門檻。) in exchange for covering them. And even as China exchanged threats of trade tariffs with the US this year, it scrapped tariffs on imported cancer drugs from May 1. Previously import taxes varied from 3% to 6%.

[11] China’s state medical-insurance administration announced in June that it had invited ten foreign and eight domestic drug companies for “negotiations”in a bid to drive down prices. On July 10th the food and drug authority said it would speed up approval of foreign drugs. Bruce Liu of Fudanin, a healthcare consultancy in Shanghai, predicts that cinema-goers’ spirited reaction will prompt the government to include more drugs on its public-reimbursement scheme.

[10] 2017年，中國公布了醫改計劃，以減輕患者的醫藥費用負擔，將更多的重點藥物納入國家醫保范圍。格列衛在去年開始納入醫保，服用這種藥品的病人現在只需承擔20%左右的藥費。到今年為止，中國在國家醫療保險計劃中增加了大量跨國公司生產的專利藥物，以大幅降價為條件把這些藥品納入醫保目錄。盡管今年中美兩國相互要加征關稅，但是中國從5月1日起取消了進口抗癌藥的關稅，此前進口藥稅率從3%到6%不等。

[11] 2018年6月，中國國家醫療保障局宣布，邀請10家外資藥企和8家內資藥企進行“商談”，以降低藥品價格。7月10日，國家食品藥品監督管理局表示將加快外國藥品的審批速度，上海醫療咨詢公司復旦光華的董事總經理劉宇剛預測，電影觀眾的熱烈反響將促使中國政府把更多藥物納入公共報銷范圍。

[12] On Douban, Dying to Survive has a rating of 9/10 from over 100,000 users. In addition to applauding its heartwrenching depiction of life for China’s cancer patients, viewers admired the film for its courage to go beyond the commercially-driven blockbuster fare that fills China’s big screens.

[13] “We often hear people asking why China can’t make movies that change society, like South Korea and India,” wrote Douban user Xu Ruofeng.“We need more writers and film makers to confront the problems of society, and make more films with a conscience.” ■

[12]在豆瓣上，10多萬用戶給《我不是藥神》打了9分（滿分為10分）的高分。除了為本片對中國癌癥患者生活令人揪心的描寫喝彩，觀眾還欣賞這部電影超越充斥中國大銀幕的商業大片的勇氣。

[13]“經常聽到有人問，為什么中國拍不出韓國和印度那樣改變社會的電影?！倍拱暧脩粜烊麸L寫道，“我們需要更多的創作者和電影人站出來直面社會問題，拍攝更多有良知的電影。” □