by Xinyang (Sally) Zhai
As the most-populous developing country, China has lots of livelihood issues. One of the most significant problems is that some medicines are too expensive for ordinary people to buy. When life-saving pills get too expensive, seriously sick people have to do everything they can to raise money and buy the medicine they need to live. When desperately-needed products are super expensive, black markets have great opportunity to expand. The movie called Dying to Survive portrays the birth and growth of a black market for medicines in China, shows the complexity of the black market, and raises lots of thought-provoking questions like how black-market medicines are developed and distributed and whether every black market is bad.
Dying to Survive describes the process of a shop owner turning into a dealer of black-market medicines. In the movie, a poor man named Yong owns a small shop. The pressure of paying rent, paying his father’s hospital expense, and divorcing his wife leads Yong to follow a suggestion of a patient who has chronic myeloid leukemia: buy cheaper Indian medicine that has the same effect as the expensive Chinese medicine and sell it to Chinese patients. In the beginning, Yong buys Indian pills at the price of 500 Yuan per bottle (US $70) and sells them at 2000 Yuan per bottle (US $280). Patients compare the price of Yong’s Indian pills with the Chinese pills price of 37,000 Yuan per bottle (US $5180), and they are attracted because they can afford the Indian pills. Yong earns large profits from his smuggling operation, and he is called “the God of medicine.”
A couple of months later, a counterfeit Chinese medicine with the price of 2000 Yuan per bottle appears in the market. Patients feel sick after taking the counterfeit pills, and the police start to monitor the market for fake medicines. Zhang, who is the biggest seller of the Chinese counterfeit medicine, hides from the police. He finds and threatens Yong and buys Yong’s whole stock of Indian pills for two million Yuan, which means he becomes a very rich person, and he spends that money operating a garment factory.
After Zhang monopolizes the source of Indian pills, he raises the price to 20,000 Yuan per bottle. People start losing the ability to buy medicines. One of Yong’s friends kills himself because of hopelessness; lots of people die because they cannot afford expensive pills. More and more people beg Yong to restart his business selling Indian medicines. Yong is moved, and he begins selling them again with the price of 500 Yuan per bottle.
A half year later, the police begin inspecting the medicine black market. Another of Yong’s friends dies has a car accident while drawing the police’s attention away from him. India’s government shuts down the medicine factory under pressure from the Chinese factory that makes the expensive pills. Yong volunteers to buy the Indian medicines from the regular Indian market for 2,000 Yuan and sells them to Chinese patients with the cost of 500 Yuan. In the end, Yong turns himself into the police. When he is sitting in the car on the way to jail, all the patients and their families stand on both sides of the road, watching him being sent away. Three years later, the government releases Yong early because his smuggled medicines helped a lot of patients and because of his good behavior in jail. The medical system had improved since his arrest, and more and more patients with chronic myeloid leukemia received help and support from the government.
In the movie, the Indian manufacturer of Yong’s medicine has cheap labor and raw materials, producing “a generic drug manufactured for the poor through the ‘compulsory licensing system’ initiated by the Indian government. It is recognized by the World Trade Organization as a direct bypass of patent rights.” In a word, the company spent little money on producing the medicine. In general, from the supply side of medicine black markets, the cost of producing medicines and profit are related. With a low-cost product as we see in the movie, the company can make a profit from the difference between the cost and selling price.
Compared to the medicine in India, those medicines that the Chinese government sells are indeed costly. However, the higher cost makes economic sense. People usually think that medicine is expensive because of the greedy pharmaceutical companies and the government. “All these factors contribute to increasing the price of a drug, but one very important factor often gets entirely overlooked: Drugs are expensive because the science of drug discovery is hard. And it’s just getting harder.” My father, who has been a surgeon for over twenty years, told me that the price for those lifesaving medicines is set based on all the expenses used to develop and produce the pills. In the research article called Innovation in the Pharmaceutical Industry: New Estimates of R&D Costs, researchers randomly chose 106 kinds of new medicines from 10 medical factories. Statistics suggested that the average R&D cost of these pills is 2.87 billion dollars based on the economic situation in 2013, and the average R&D time is about ten years. And the specificity of anti-cancer drugs, like the Chinese medicine in the film, requires even more money and time than other medicines.
Expensive R&D causes the exceedingly high price of lifesaving medicine, and it also influences peoples’ decisions about which medicines they can buy.
From the demand side of the medicine black-market, the ability of people buying medicines and the necessity of the product play crucial roles. In the movie, one bottle of Chinese medicine is 37,000 Yuan, and one bottle of the Indian pills is only 2,000 Yuan. It might be possible for people to buy less than ten bottles, but taking those pills is a long-term process. When patients need more than ten bottles, they can’t afford the rest of them. That kind of medicine is necessary for patients with chronic myeloid leukemia, and they have to depend on it to stay alive, so cheap Indian pills with the same effect become a more long-term, good choice for them.
In real life, many medicines are exceptionally expensive but necessary for treating specific rare diseases. In the U.S., for example, Actimmune costs 52,321 dollars. It is the treatment “for osteopetrosis and chronic granulomatous disease, a rare disorder that causes the immune system to malfunction.” For another example, Daraprim is “commonly given to AIDS and transplant patients to prevent infection.” Sixty pills of Daraprim costs 45,000 dollars, and that’s a reduced price. Mylapet is the only option to control “leptin deficiency in patients with generalized lipodystrophy,” so people don’t have other choices to save money if they have this disease. The price for Mylapet is 4,213 dollars per small bottle, and a patient should take 10 bottles. All these kinds of medicines are expensive.
According to the law of demand, the higher the price is of a product, the lower demand people will have for that product. While facing such expensive medicine, if there is another cheaper medicine to treat the disease, although it may be from the black market, it will still be a preferred substitute that people are more willing to purchase. The demand for the medicine from the regular market will decrease, and the need for the pills from the black market will increase, and then the black market has the opportunity to exist, develop, and extend.
Also, the connection between supply and demand significantly affects the development of the medicine black-market. In the film, when Yong starts his dealing business, he divides his customers into different groups by different hospitals and asks one of them to be the representative of the group. When his customers want to buy Indian drugs, they need to tell their hospital-representative how many bottles they plan to buy. Each representative from the different hospitals gathers the numbers and tells Yong how many bottles of pills they need. Then Yong smuggles the Indian medicines and he hands out these medicines to these representatives, who then sell them to specific customers. In this way, it was convenient for Yong to manage all the patients who needed pills and all the Indian pills that he brought into China. Because he only faced those representatives, the chance of him being caught was decreased.
In the movie, the black-market medicine has a tipping point, and the writer Gladwell describes how powerful the connector can be to help one thing reach its tipping point.” People pass on all kinds of information to each other all the time. But it’s only in the rare instance that such an exchange ignites a word-of-mouth epidemic. “ Because the medicine black-mark is illegal, passing information by word of mouth becomes the only useful way to let more people know about the medicine. Those representatives in the movie know lots of people. “They (are) the kinds of people who know everyone,” and as they disperse the information about the advantages of Indian pill; more patients buy them, and the demand side of the medicine black-market expands.
One interesting role of the connector, the main character of this movie, is that his purpose of joining medicine black-market changed during the story. At the beginning of the film, Yong desperately needed money. He said yes to the black market because he knew that it would bring a lot of profit for himself to make a living. After experiencing the death of one of his friends of cancer, another friend’s death in an accident because of protecting him, and the hopelessness in every patient’s eyes after, and after he quits the black market, Yong decides to come back. By the time he starts to sell Indian medicine again, the Indian pharmaceutical factory had already been closed. He showed the kind part of humanity: he bought those Indian pills from normal stores with 2,000 Yuan and sold to those patients with 500 Yuan. In other words, he was helping people buy those medicines with his own money.
What Yong decided to do at the end of the film hardly ever happens in real life. Many people might think that this situation is fake because no one is willing to sacrifice his or her own money for helping so many strangers. Surprisingly the script of this film is written based on a true story that happened in China. The main character of the real story also did the same thing as Yong. This real-life story raises the questions: Is every black market terrible? What about the black market in this story/movie?
The most memorable and shocking line that Yong says is “did he commit any crime just because he strived to survive.” Because those patients wanted to survive so badly, they had to buy medicine to keep themselves alive. Unaffordable Chinese medicine force them to purchase Indian pills and to be the demand part of the medicine black-market. Yong smuggling those drugs helps the patients’ dreams come true that they surviving cancer.
While inefficiency in the market harms the cancer patients, the medicine black market in the movie addresses the inefficiency of the regular market. Black markets often form to address inefficiencies. Places like Montenegro, Balkans, and many other countries in Europe faced the similar issues. These countries were suffering from wars in the 1990s. To make a living, people had to join the supply side of black markets to make money, because that would bring them profit. As a result, the economy of those areas indeed recovered to some extent. “As a consequence of war, sanctions, and corruption in the Balkans during the first half of the 1990s, the states of the former Yugoslavia turned to and nurtured mafias to run the logistics of their military effort.” In other words, crime organizations formed to be in charge of managing society while the government was ineffective.
Looking back to the movie and connecting it with our real life, there are logical reasons for those medicine black-markets to exist. Government and medicine manufacture set high prices for medicine so that they can earn enough money to cover all the expense used to produce the medicine. In order to survive, patients will do anything to stay alive, even buying cheaper illegal medicines from black markets. Sometimes the dealer has to earn the profit to make a living, like what happened in the story and the movie. Moreover, stepping back and thinking more deeply, not all the black markets are bad, like the one highlighted in the film.
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 Li, Xingyu. “Discussion about Dying to Survive.” Interview by author. July 2018.
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DiMasi, Joseph A., et al. “Innovation in the Pharmaceutical Industry: New Estimates of R&D Costs.” Journal of Health Economics, May 2016, pp. 20–33.
“Dying to Survive .” AiJuQIng, 12 July 2018, www.ijq.tv/yingshi/juqing/15249225203269_1.html.
Gladwell, Malcolm. Tipping Point. 1st ed., Little, Brown, 2014.
Jogalekar, Ashutosh. “Why Drugs Are Expensive: It’s the Science, Stupid.” Scientific American Blog Network, 6 Jan. 2014, blogs.scientificamerican.com/the-curious-wavefunction/why-drugs-are-expensive-ite28099s-the-science-stupid/.
Li, Xingyu. “Discussion about Dying to Survive.” Interview by author. July 2018.
Marsh, Tori. “The 11 Most Expensive Drugs in the U.S.A.” The GoodRx Prescription Savings Blog, 28 June 2018, www.goodrx.com/blog/11-most-expensive-drugs-in-the-us/.
Glenny, Misha. McMafia: Seriously Organised Crime. Vintage, 2017.
Wen, Muye, director. Dying to Survive. Alibaba Pictures Group Limited, 2018.
YouTube, China, 2018, www.youtube.com/watch?v=U-h__D07gvs.