Mastering the Sword Manual, sweeping across the globe

"What do you mean by making only professional judgments?" Sister Zhao pressed.

"If a consultation is needed, send the medical records over and they will provide professional advice... They can also accept patients who need to be transferred to other hospitals, but they don't get involved in anything else."

"It's just about not taking the blame," Director Sun stated bluntly, crossing his arms over his stomach and scanning the room. "Everyone here knows the actual situation: these people meet the admission criteria, and there's no reason for the medical professionals not to admit them. They pay for everything themselves, don't use medical insurance, and don't use up medical insurance funds. As for beds, our hospital currently has plenty of room. Since it doesn't affect patients in the area, turning them away wouldn't make sense."

"Once you come, you are a patient. Doctors are like parents; this is our duty."

The air in the meeting room relaxed a bit.

The head nurse leaned back in her chair, a slight upturn at the corners of her mouth.

Xiao Chen closed the folder, then opened it again, unsure whether to applaud, and finally just nodded vigorously.

"However, let's be upfront about the unpleasant aspects first," Old Zhou spoke again, his voice this time deeper than before. "We're a neighborhood health center, and everyone knows our limitations. We don't have an operating room, an ICU, or a pathology department. The only things we have to offer are a few ventilators and monitors that the city distributed last year. We have limited experience with some treatments, such as immunotherapy combined with chemotherapy. If we're unsure about something, we shouldn't force it, and there's no need to force it."

"This is also a rare learning opportunity. If you find any abnormal drug reactions, imaging changes that do not meet expectations, or complications that cannot be handled by existing equipment, report to the higher-level hospital immediately. Don't be afraid of losing face."

"Just one sentence: Don't do anything reckless. Admission criteria, medication plans, referral procedures—follow the rules exactly, without a single mistake. Xiao Chen, print out the flowchart today and post it on the wall. How to record medical records, how to sign informed consent forms, how to implement each step."

"There's also the issue of fees. These patients all receive subsidies and pay for everything out of pocket, mostly the highest-end options... But each case needs to be handled individually. If it's a small favor and you can do without charging, try not to. For offline catering, if the patient or their family needs to pay for certain items out of pocket, try to direct them to affordable restaurants."

After the meeting, Lao Zhou went downstairs to check on the patients, carrying a thermos.

The inpatient department of Huimin Street Health Center is located behind the outpatient building. It is an old-fashioned three-story building with a terrazzo finish that was popular in the 1980s, and several ivy plants are climbing on the corner of the wall.

The ward was small, with a dozen or so rooms and four beds each. The sheets were newly changed, blue and white striped, and stiffened from being exposed to the sun.

The window at the end of the corridor was open, and a breeze blew in, causing the "Smoke-Free Hospital" sign on the wall to sway slightly.

When Lao Zhou entered the innermost ward, the patient on the bed by the window was sitting up and drinking porridge.

This was a middle-aged man in his forties, with dark skin and prominent cheekbones; he was clearly not a local.

His wife sat on the edge of the bed, holding an enamel bowl, and spoon-feeding him food.

"Dr. Zhou," the woman quickly stood up and called out in Mandarin with a heavy southern accent when she saw Old Zhou come in.

"Sit down, sit down, don't get up." Old Zhou waved his hand, walked to the bedside, looked at the nursing record hanging above the bed, and then looked down at the patient. "How are you feeling today?"

"Much better." The man spoke up, his voice a little weak, but his words were still clear. "I had a check-up yesterday, and the doctor said the results have gone down."

"Good, good," Old Zhou said, tucking the thermos under his arm and taking out a stethoscope from his white coat pocket. He warmed it up before placing it on the patient's chest, listened for a while, and then moved it to a few different spots. He nodded with satisfaction. "Your breath sounds are much clearer than last week. You're recovering quite quickly... But don't rush to discharge yourself. Observe for at least another two weeks."

The woman listening nearby had tears in her eyes. She reached for a thermos on the bedside table, turned her back to pour water for her husband.

Old Zhou asked them a few more questions about their food and accommodation. The woman said that the neighborhood committee had arranged beds for them at the temporary resettlement site behind the building, free of charge, and there was even hot water.

Old Zhou nodded, but as he walked to the door, he remembered something and turned back to look at the couple.

They were very close, the woman's hand resting on the back of her husband's, their fingers intertwined, quiet and still, like two old photographs glued together by time.

He walked out of the ward with his thermos cup and stood in the corridor for a while.

Outside the window, several family members were hanging clothes to dry in the yard, and a child was squatting on the ground drawing a crooked sun with a twig.

Old Zhou unscrewed the thermos and took a sip. The water inside was already cold, but he didn't care.

Today's meeting went fairly well. The higher-ups didn't give a definite answer, but they didn't completely shut the door either. Old Zhou has been working in grassroots health centers for over a decade, and he knows this is already the best possible outcome.

He was about to go to the next ward when he suddenly heard hurried footsteps at the top of the stairs. Xiao Chen ran up with a folder in his hand, his face showing an expression that was hard to tell whether he was nervous or excited.

"Dean Zhou, I just received a notice from the subdistrict office that an expert medical team organized by the Health Commission will be coming to our hospital next week... The team leader is a director of the Department of Respiratory Medicine at the Provincial Cancer Hospital."

Old Zhou was taken aback: "Provincial Cancer Center?"

“Yes, the Provincial Cancer Hospital.” Xiao Chen handed over the folder. “The notice said that they are here specifically to guide the lung cancer treatment work in grassroots hospitals. They also specifically mentioned that they need to pay close attention to the treatment progress of several special cases recently admitted to our hospital.”

Old Zhou took the folder, flipped through it, read a couple of lines, and slowly twitched the corners of his mouth upwards.

The Provincial Cancer Hospital—that's a place Ming-ge goes to almost every day.

Their initiative to send experts down to provide rounds of medical consultations is itself a signal that these grassroots attempts are at least not deviating from the general direction.

Xiao Chen stood in front of him, hesitated for a moment, and asked in a low voice, "Dean, is the higher-ups supporting or opposing our decision to admit these patients?"

Old Zhou closed the folder and patted Xiao Chen on the shoulder: "The higher-ups support us in doing things right."

He tucked the folder under his arm, placed it next to his thermos, and went downstairs to see the patients.

The family members were still hanging clothes out to dry in the yard. The child had finished drawing the sun and was now drawing a crooked bird next to it.

The sunlight shone on the leaves of the Virginia creeper, making them sparkle as if they had just been washed.

163 Respectfully submitted at my own expense

At 5:43 p.m. on Friday, Jacob Mayer finished the last sip of his coffee and was about to shut down his laptop.

A message popped up in the bottom right corner of the screen, from Dr. Zhou, the direct supervisor of ...

Jacob had only been at Novartis’s Basel headquarters for four months as a junior analyst in the Oncology Pipeline Strategic Analysis Group. His superior, Dr. Zhou, was of Chinese descent and usually didn’t talk much. This afternoon, after coming out of a meeting room, his complexion was noticeably different from usual.

Jacob stood up from his workstation and ran into Lena, who was in the same group, in the hallway.

She had joined the company a year and a half earlier than Jacob, and her expression was similar to his, filled with confusion.

"Have you heard anything?" he asked in a low voice.

“I’m not sure,” Lena shook her head, “but there were three black Mercedes parked outside the main gate at noon… The people who got out of the cars didn’t seem to be from the corporate world; they didn’t have that business smile, you know? When we came in, the security guards came in first and scanned the area. I heard someone from the administration say, ‘The Federal Commissioner is also inside.’”

Meeting room C was more crowded than Jacob had ever seen.

All the partitions were open, and at least forty or fifty people were sitting on both sides of the long table. The formal seats were already full, and people in the back had their laptops on their laps, while others simply stood against the wall.

Jacob quickly scanned the name tags of the attendees: Global Head of Oncology Pipeline, President of Asia Pacific, Vice President of Global Public Policy, Chief Economist, Senior Vice President of Global Market Access... Several of these people should have been in New York, Tokyo, or Shanghai, but now they were all crammed into the same room.

On Friday evening, without any prior notice.

Dr. Zhou stood at the front of the long table, one hand supporting himself on the edge of the table, the other hand clutching a thick stack of documents.

The projector is already on, and a line of text is projected onto the screen:

"Blue Priority Projects - Pre-Negotiation Internal Briefing"

"Let me first talk about what has happened in the past 72 hours," Dr. Zhou said, skipping the small talk and speaking almost twice as fast as usual. "On Tuesday, the Director of the Swiss Federal Office of Public Health visited headquarters and had a two-and-a-half-hour closed-door meeting with the CEO. On Wednesday, the Deputy Secretary-General of the Federal Secretariat for Economic Affairs visited and exchanged views with the global market access team. On Thursday, the WHO European representative flew in from Copenhagen."

No one spoke in the meeting room.

Jacob sensed that Lena, who was sitting next to him, was repeatedly tracing the same word in her notebook.

He glanced at it; she traced it three times before stopping. The word was "lung cancer."

“The second thing,” Dr. Zhou turned a page, “is that the Chief Financial Officer has approved the initiation of a global cash flow withdrawal procedure. Over the next two weeks, at least $500 million will be withdrawn from the operating cash flow of the three major markets of North America, Europe, and Japan, and $300 million will be withdrawn from other markets in the Asia-Pacific region. The initial cash pool will total $1.8 billion. At the same time, the group has notified major credit rating agencies that this figure may be further increased to $3 billion, depending on the progress of subsequent negotiations.”

“1.8 billion,” a senior analyst sitting in front of Jacob repeated the figure in a low voice, “more than our oncology pipeline’s total expenditure over the past three fiscal years.”

“The third thing,” Dr. Zhou turned to the next page of the document, looked up, and glanced at everyone present, “is that each of your names has been reviewed by your respective department heads before being included in this meeting. This project is classified as ‘blue priority’ within the group. Under this classification, all work related to this project takes precedence over all other business, including the advancement of all Phase III clinical trials and the market maintenance of all existing marketed products.”

After saying this, Dr. Zhou paused for a few seconds to allow everyone to process what he had said.

"Over the next two weeks, we will begin formal negotiations with the Tai Yang Medical Security Bureau. Your task is to complete the following preparatory work within the next seventy-two hours."

The screen switches to the next page, revealing a densely packed list of tasks.

Jacob's fingers flew across the keyboard, and the more he memorized, the faster his heart raced.

"First, the tiered calculation of the scope of authorization and capital investment. The standard contract framework provided by Dayang is: the more capital and resources we provide, the larger the geographical scope of the authorization and the more comprehensive the indication development rights will be. The financial modeling team needs to provide three plans within 48 hours: the lowest scope of authorization, covering only the core European market; the medium scope of authorization, covering Europe, North America and Japan; and the highest scope of authorization, exclusive global commercialization rights. Each plan corresponds to a different level of capital investment and equity structure, and must be accurate to the million-dollar level."

"Second, the legal justification for the joint venture structure. DaYang requires the establishment of a joint venture project company within the authorized region, with DaYang Medical Insurance Center holding no less than 51% of the shares. The legal team needs to submit a preliminary assessment of the legal feasibility of this structure in major markets such as the EU, the US, and Japan within 72 hours. It is particularly important to note that there are already seven partners within DaYang's territory, and our shareholding in the joint venture will be shared with these seven companies, with a total percentage not exceeding 39%. In other words, we are being squeezed onto the same shareholder agreement with seven DaYang companies that we have never met before."

"Third, a global supply chain restructuring plan. The synthesis route of the active ingredient of this drug has been preliminarily validated internally, and the raw material cost is about one-third of that of existing drugs with the same target, but the production capacity is far from sufficient. The supply chain team needs to submit a global production capacity layout plan as soon as possible, including the selection of raw material production bases, the transformation of formulation packaging lines, and the establishment of a cold chain logistics network."

When I returned to my workstation, the Rhine River outside the window had already been swallowed by the night, with only a few scattered lights remaining on the opposite bank.

Jacob opened Teams and found that the analytics group's chat had accumulated hundreds of unread messages during the meeting.

The latest post was from Lena: Does anyone have an English translation of the "Drug Price Management Measures" issued by the Da Yang Medical Insurance Bureau last year?

Jacob flipped through the policy review documents he had prepared before, dragged the files into the dialog box, and then got up to go to the break room to make himself a cup of instant coffee.

He knew he wouldn't be going home tonight.

The negotiations lasted for three days.

Jacob was certainly not qualified to enter the negotiation room; he was merely a junior analyst in the analysis team, working in the support group outside the negotiation room: standing in front of his laptop, updating the financial model, calculating the profit impact, and assessing the net present value of different authorization ranges based on the latest terms transmitted from the front.

For those three days, he and the other five analysts in the team hardly left their workstations.

On the first day, the scope of the authorization was determined at the negotiating table: Novartis obtained exclusive commercialization rights in the three major markets of Europe, North America, and Japan, with an initial investment of US$1.8 billion, which could be increased to a maximum of US$3 billion depending on the progress of market expansion.

The equity structure was finalized the following day: Novartis and seven partners in Da Yang would share no more than 39% of the equity, Da Yang Medical Insurance Center would hold 51% of the equity, and the 10% equity of the poverty alleviation fund would never be diluted.

On the third day, the specific implementation standards for the price tiers were finalized.

On the morning of the fourth day, Jacob was woken up by his phone vibrating while he was lying at his workstation.

The screen displays an email from Novartis' global CEO to all employees, with a short title containing only three words: We got it.

On the same afternoon, a global press conference was held at the Basel headquarters.

Jacob stood in the back row of the press conference hall, watching the Senior Vice President of Global Market Access project some key terms of the standard contract onto the giant screen.

The vice president's tie was a little crooked, and his hair was a bit messy, but his voice... anyone could tell he was ecstatic.

Novartis will jointly disclose some contract details of this collaboration with the Dayang Medical Security Bureau.

"First, the pricing logic was set by Da Yang, and we fully accept it."

"At the request of the Da Yang Medical Security Center, the drug prices in the contract should be divided into at least three tiers."

A table was projected onto the screen, showing three price tiers and the corresponding patient types at a glance.

The third tier, the cheapest, is suitable for "perfectly unlucky people" who have no high-risk behaviors, no exposure to risky environments, and no family history of genetic disorders.

The second tier, priced moderately, is suitable for patients who face certain environmental risks but do not exhibit significant personal high-risk behaviors.

Tier 1, Fully Self-Funded: Applicable to patients with a clear history of smoking, alcoholism, long-term sleep deprivation, overtime work, or other self-harm, as well as those engaged in high-risk occupations who have not taken adequate protective measures.

"In other words, pricing tiers and the actual amount patients pay do not depend on market supply and demand, nor on competitors' price anchors. They depend on one thing: how the patient lived before they became ill."

Reporters at the press conference began whispering among themselves, while financial reporters in the back row typed rapidly on their keyboards. Someone raised their hand to ask a question, but was stopped by the person next to them.

“Second,” the vice president turned a page, “the contract involves a special fund. This fund represents 10 percent of the joint venture’s equity, and it will not participate in profit sharing, dilution, or transfer. The sole purpose of this fund is to provide the drug free of charge to patients in low- and middle-income countries who are unable to pay.”

“Third,” the vice president continued, a hint of unease in his voice, “as a reciprocal commitment to obtaining exclusive licenses in the three major markets, Novartis will invest no less than $500 million in its global R&D department over the next three years, specifically for the development of the following technologies…”

He pressed a button on the remote control, and the screen switched to the next page, which displayed a simple list.

"First, a rapid screening technology for smoking history based on real-time respiratory aerosol detection. Second, a rapid detection technology for long-term alcohol abuse based on blood biomarker profiles. Third, a quantitative assessment system for long-term sleep deprivation and overwork based on wearable device data. Fourth, a rapid assessment tool for the cumulative risk of excessive overtime work based on occupational exposure databases and work intensity monitoring."

After the press conference, Jacob returned to his workstation and found that Novartis' official recruitment website had posted a new urgent recruitment notice on its homepage.

He clicked on it, and the drop-down menu showed several job titles he had never seen before: respiratory aerosol point detection technology engineer, blood biomarker researcher for long-term alcohol abuse, sleep deprivation quantitative assessment algorithm engineer, and occupational exposure big data modeler.

Next to each job posting is the same label: Salary increased by 200%.

Required start date: Immediately.

Lena walked by with her now-cold coffee, glancing at Jacob's screen: "The detection technology is developed; the first thing to test is these 200% values."

“Shouldn’t it be us?” Jacob closed his laptop.

"Do we still need to be tested?" Lena smiled.

“You’re right…” Jacob picked up his cold coffee from the table: “Please pay for it yourself.”

164 Wall

The old houses had roofs.

Amar is nine years old. She has a younger brother, Hassan, who is four years old, and a younger sister, Najiya, who is one and a half years old.

The war had already begun when her younger sister was born. Amar remembers that there was no electricity that night, and her mother gave birth to her sister by the light of a flashlight.

Nakia hasn't learned to walk yet because there's no place for her to walk at home. She's too small; so small that Amar can reach both walls at the same time by stretching out his arms.

My current home consists of two slanted walls.

Amar still remembers his old home, a two-story building on the edge of the Jabalia refugee camp.

There's a courtyard downstairs, and a lemon tree in the courtyard.

Every summer, my father would pick a few lemons from the tree, slice them thinly, and soak them in a kettle.

The water was cold and sour, and she could drink half a cup in one go when she got home from school.

My younger brother couldn't speak yet, and he would always chase pigeons barefoot in the yard. If he couldn't catch them, he would sit on the ground and cry.

One day, the little building was gone.