In the film Dying to Survive, a peddler of fake health supplements in Shanghai comes across an unbeatable business proposition: selling unlicensed generic drugs from India to China’s booming population of cancer patients who cannot afford the approved drugs. When someone asks the businessman, Cheng Yong, if he wants to be a hero, he laughs. “I don’t want to be a saviour. I just want to make money.”

The relatively low-budget dark comedy has become one of the most popular films in China in years, bringing in almost 2.5bn yuan (about £285m) since its release on 5 July, which already makes it the sixth highest grossing film in China ever.

Based on the true story of a man who, after getting diagnosed with leukaemia, imported unapproved cheaper drugs for himself and other cancer patients, the film has prompted a national debate about the country’s healthcare system that has reached the top levels of the Chinese government.

On Wednesday, the Chinese premier, Li Keqiang, ordered regulators to speed up price cuts for cancer drugs, something the government has been trying to do for years.

“If there is one cancer patient in a family, that family will devote all their resources to them. Even the entire extended family will need to help,” Li said, according to Chinese state media. “Cancer has become the number one threat to people’s lives and health. We need to do whatever we can to save the patients and relieve their families’ burden. We need to solve this problem as soon as possible.”

Many Chinese cancer patients have been importing and prepping their own drugs. Many have gone into debt paying for treatment. Last year, government data showed that 44% of families in poverty had been impoverished by an illness in the family.

The inspiration for Cheng Yong was a textiles trader from the eastern province of Jiangsu named Lu Yong, who was diagnosed with chronic myeloid leukaemia in 2002. He began importing a generic version of Glivec, patented by Novartis, for himself and other patients. He was arrested in 2013 for illegally distributing the unapproved drug, but was acquitted in 2015 after an outpouring of public support.

Lu’s lawyer, Zhang Yupeng, says the film is helping to raise awareness of the issue of unaffordable cancer treatment.

In May, China removed import tariffs on cancer-related medication, and in May and June, China’s state council held meetings on ways to lower the prices of cancer drugs. In some provinces, such as Jiangsu, Glivec is now covered by the national insurance.

Authorities no longer prosecute sellers of unlicensed drugs if the amount is small and the drugs have not caused any serious side-effects, according to Gao, who has taken on other similar cases. “In the past you would be charged as long as you sold prohibited drugs. So authorities are making changes,” he said.

The film, labelled China’s Dallas Buyers Club by some, has also been hailed for its social realism and portrayal of Chinese society in all its contradictions. It features protests and clashes between ordinary citizens and law enforcement. Other characters include a pole dancer whose daughter is sick and a priest who hawks the contraband in his church.

“Among China’s many awful movies, this film stands out as vastly superior,” one reviewer said on the Chinese microblog Weibo. “It shows the struggles and humanity of ordinary people under unjustified laws, and the pain you feel but often can’t say aloud in those situations.”

Additional reporting by Wang Xueying

https://www.theguardian.com/world/2018/jul/19/cancer-drug-film-prompts-china-speed-price-cuts

Every news story about cancer research should come with a health warning: believe the hope, but not the hype. Good headlines are quick and catchy, good science is steady steps taken on a complicated issue over a long time. If a new treatment is still being researched, it could be metaphorical miles and actual years away from getting into the hands or bodies of patients. As blogger Kay Curtin, who has advanced melanoma, puts it: “The media tend to pick one line on a report and run with it, but they do not draw attention or highlight that it’s just a potential benefit, or the fact that many of these are just proven in a petri dish or a mouse and very often do not prove effective when tested on humans. It is cruel to existing patients to make claims with misleading headlines.”

One of the best ways to deal with cancer is to divide and conquer, based on as much knowledge as we can get of how individual tumours work. Treating all cancers from the same part of the body equally isn’t good enough – you must match the right patient with the right treatment.

As Dr Justine Alford, senior science information officer at Cancer Research UK, explains: “As science continues to reveal more about cancer, we’re starting to think of it in a different way, as we know that two tumours affecting the same part of the body won’t necessarily behave in the same way. Some will be more aggressive; some might be resistant to one treatment, but respond to another. Our understanding of these unique features of different tumours has helped to produce one of the most exciting areas of research for all cancer types: personalised medicine.”

Prostate cancer, according to Dr Robert O’Connor, head of research at the Irish Cancer Society, has in recent years “seen the greatest revolution in terms of new agents”. One huge step forward was the use of radiation to reduce the impact of prostate cancer that spreads to bones. Another was the development of better diagnostics, including PSA tests, which mean that most men are diagnosed while their prostate cancer is still curable. The jury is still out on the ideal timing of treatments, but researchers at the University of Birmingham found this summer that giving a drug earlier saved more lives.

Eight out of 10 women now survive breast cancer, but research won’t be over until no one dies and survivors have a far easier journey. Researchers are trying to find out more about how we might prevent breast cancers, how some become resistant to therapy and how to stop them from spreading.

With the number of cancer survivors in the UK expected to increase by 1 million each decade, “survivorship” – how to live as comfortably as possible with and after cancer – is an important area of research for all cancers.

Lung cancer, however, remains deadly. There are often no symptoms until it has taken over a large part of the lungs or spread to other parts of the body. On top of this, it grows quickly and is sometimes intrinsically resistant to chemotherapy. Other cancers that don’t come with clear early warnings include pancreatic cancer – the Pancreatic Cancer Research Fund says it is“the only cancer that has seen no improvement in [survival rate] over the last 40 years” – and oesophageal cancer, which is on the rise, partly due to obesity and alcohol use. Pancreatic and brain tumours are hard to get drugs into. The brain is surrounded by a very selective gatekeeper called the blood-brain barrier, which normally keeps possible poisons out; while as much as 90% of pancreatic tumours comprises of a dense tissue called stroma, which surrounds the tumour like a shield.

Researchers are looking for kinder, more effective treatments for these cancers, as well as ways to catch them sooner. Innovative ways to get drugs into brain tumours, such as modifying bee venom or adjusting the chemistry of nanoparticles, offers hope. Lung cancer research, much of it at the University of Manchester and UCL, is carving out a better understanding of how the cancer works and how we can treat it better. Meanwhile, both pancreatic and oesophageal cancers had breakthrough discoveries this year when subtypes of each cancer were discovered, meaning they can both potentially be treated with personalised medicine in the future.

Of course, if we already knew the answer, it wouldn’t be research. The greatest challenge, always, is the complex and wily nature of cancer, but there’s no getting away from the fact that finite funds aren’t evenly spread across different cancer types. More people donate towards breast than lung cancer research, partly reflecting the number of people affected by breast cancer and the well-organised advocacy behind it. And according O’Connor, in Ireland, of the tens of thousands of cancers diagnosed every year, less than 200 are in children. However, because childhood cancer is so emotive, many more donations come in for paediatric than geriatric cancers.

In a recent video on Twitter, the charity Breast Cancer Now said that every £25 raised supports one hour of research. It’s impossible to guess at how many more hours will be needed before we can live free of the fear of cancer. The only certainty is that we won’t give up.

https://www.theguardian.com/science/2017/aug/14/cancer-treatment-sorting-the-good-news-from-the-hype

Just in case you haven’t got the message that exercise is good for you, two huge research studies this week shout it louder than ever. Which is just as well, since almost one-third of adults are classified as “inactive”. Exercise is already known to reduce the risk of breast, colon and endometrial cancer (cancer of the lining of the uterus) by between 10% and 40%. Now, a pooled analysis of data from studies looking at 1.4 million adults between the ages of 19 and 98 has found that exercise reduces the risk of an additional 10 cancers, including oesophageal, stomach, bladder and kidney. What’s more, for many cancers, exercise reduces the risk even in overweight people. This is particularly interesting, because the mechanism by which exercise is thought to protect from cancer is weight reduction.

It seems that exercise may work its magic in a variety of ways. Dr Marilie Gammon, an epidemiologist from the Gillings School of Global Public Health in Chapel Hill, North Carolina, who wrote an editorial to accompany the paper in the peer-reviewed journal JAMA Internal Medicine, says that exercise may help to repair DNA when it is damaged by cancer-promoting substances. Exercise may also alter hormone levels and reduce inflammation.

How active you have to be to reduce your cancer risk is unknown. Gammon suggests anything is likely to be beneficial – even taking the stairs instead of the lift.

But why stop at exercise? The second study of lifestyle and cancer, which took data from 136,000 Americans, found that anyone who quits smoking; does two and a half hours of moderate exercise a week; has no more than one drink a day if a woman or two if a man; and keeps to a BMI between 18.5 and 27.5 is likely to reduce their risk of bowel cancer by 30% and breast cancer by 12%.

Get on your bike

So, are you doing enough to reduce your risk of getting cancer? While these studies can’t prove that exercise reduces the risk of cancer – because they only report an observed association – they show a strong link, which is enough for me to get out my bike tomorrow. The fact that you can be overweight and still see a reduction in risk means you can get the benefit whatever your size. Dr Stephen Moore, the author of the JAMA Internal Medicine paper, is reported to run every day. Get moving.

https://www.theguardian.com/lifeandstyle/2016/may/23/dr-dillner-can-exercise-reduce-risk-getting-cancer