Dying to Survive was an unexpected megahit at China’s 2018 box office, where it took third place with US$451 million, according to Box Office Mojo. At least part of its success was because it touched on a major social issue. Based on a real incident, the film opened up debate about the pricing of medicine in China, and in particular imported medicine. The medical system has been marketized. The growing wealth gap is creating huge disparities in access to treatment. In 2015, Lu Yong, a leukaemia sufferer, was charged for importing and selling an Indian generic version of an expensive leukaemia drug to patients who could not afford the “real” thing. The patients that he helped petitioned the court in support of him, and this encouraged the reform of China’s drug and medical device approval regime as well as a series of other changes to drive down the prices of medication. The medical humanities are often associated with studying cultures of medicine and the body or improving patient-doctor interactions. But how policy shapes access to medicines and treatment and how policy is shaped by political and philosophical beliefs are also crucial issues that link medical humanities, public health, humanities and social science.
The film narrative follows the core of the real-life story. Megastar and co-producer Xu Zheng plays Cheng Yong, owner of a shop that imports Indian magic oils with supposed aphrodisiac properties. The business is failing, his ex-wife is suing for full custody of his son, and he needs to find money to pay for his elderly father’s operation. Just at this moment, a neighbour who is suffering from leukaemia asks Cheng to bring the cheaper generic version of his medication back on one of his trips to India. Cheng cannot resist the opportunity, and in no time at all he is running a booming but illegal business selling his wares through social media patients’ groups. As the Chinese police begin to investigate, the Swiss parent company Novartis sues the Indian manufacturer of the knock-off drug, and Cheng gets into a dispute with a seller of a fake version of his drug. Under pressure, and saying he is an entrepreneur, he withdraws from the medicine import business and goes into carpet manufacture. But a year later, he discovers his former customers are being exploited and defrauded. The prices of the illegal generic drug are going up, and so he goes back into business. Eventually he is arrested, found guilty, and sentenced. But his former customers line the route as he is driven away and applaud him. A final title card reveals that Lu Yong, whose real story the film is based on, was released and that his story encouraged extensive reform of the Chinese medical system. Indeed, Premier Li Keqiang specifically singled out the role the film had played in the reform process.
Numerous critics noted the echoes between Dying to Survive and Dallas Buyers Club (Jean-Marc Vallée, 2013), the Hollywood film about smuggling HIV-AIDS drugs across the USA-Mexico border. Clearly, the actual stories were different. The significance of the comparison, rather, is that it highlights the global relevance of the issues of drug pricing and availability.
As a film, the final and highly emotional scene of Cheng Yong being paid tribute to by the customers he has helped marks Dying to Survive as a melodrama. In melodramas, much of the emotion is generated by a narrative pattern that we can characterise as “too little, too late” or “too much, too soon” or, in the case of a rare happy ending “just in the nick of time.” Cheng Yong is being taken off to jail, so at first it seems this is a “too little, too late” tragedy. But the final title that reveals he was released early suggests maybe this display of support turned out to be “just in the nick of time.”
Furthermore, behind the emotion in melodrama is always the question of what the right way to behave is in a secular modern world. This question is what distinguishes the narrative pattern of melodrama from, for example, the suspense of a horror film or a thriller. In Dying to Survive, Cheng Yong learns that it is more important and more personally fulfilling to sacrifice himself for his customers who cannot afford the licensed versions of the medicine than making money as a carpet manufacturer. This then provides the audience with the release of redemption.
Dying to Survive was directed by Wen Muye, who graduated from the Beijing Film Academy. It is by far his biggest box office success so far, and is shot in classic Hollywood realist style. As an actor, Xu Zheng often plays roles where his moral status is unclear, as is the case here. Together with other films like Only Angels Wear White (嘉年华 Jia Nian Hua, Vivian Qu 文晏, 2017), Dying to Survive marks the recent re-emergence in China of mainstream commercial films in the realist mode that address serious social issues.
In Dying to Survive, the ethical questions opened are all around the ethics of access to medicine in a market economy.
Clifford Chance, “China’s Blueprint for its Pharmaceutical Sector,” 14 October 2019, (https://www.cliffordchance.com/briefings/2019/10/china-s-blueprint-for-its-pharmaceutical-sector.html)
For a perspective on the American situation: David Alvaro, Emilie Branch, and Cynthia A. Challener, “Balancing Ethical and Fiduciary Responsibilities in Drug Pricing,” Pharma’s Almanac, 12 March 2019, (https://www.pharmasalmanac.com/articles/balancing-ethical-and-fiduciary-responsibilities-in-drug-pricing)
Gordon G. Liu, China’s Healthcare System and Reform (Cambridge: Cambridge University Press, 2017).
Sabrina Qing Yuen Luk, Financing Healthcare in China (New York: Routledge, 2019).
Jiwei Qian, The Rise of the Regulatory State in the Chinese Health-Care System (Singapore: World Scientific, 2017).
