Doctors reveal the shady “super-class” treatment of tumor treatment is helpless or profitable?
Our reporter/Li Mingzi Du Wei “Zhang Yu, a medical oncologist at the Third Hospital of Beijing Medical University, reflects on the shady tumor treatment by his real name” is still under investigation. Zhang Yu said in an article that Lu Wei, deputy chief physician of General Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, performed unnecessary NGS gene sequencing on patients, prescribed inappropriate chemotherapy drugs, and recommended ineffective, expensive, and illegal NK treatments (1) A series of behaviors such as cell immunotherapy), which caused the patient’s cost to increase tenfold but died earlier. Regarding several controversial issues during the diagnosis and treatment, Ma Rong, the eldest daughter of the deceased patient Ma Jincang, and the doctor Lu Wei were interviewed by China News Weekly. How to seek medical treatment for advanced gastric cancer that has metastasized? Ma Rong did not expect that the progress of medical treatment to Shanghai Xinhua Hospital would be so fast. On the afternoon of July 1, 2020, Ma Jincang, accompanied by his wife and daughter, flew from Qinghai to Shanghai. Earlier, Ma Rong only told him that there was a tumor in his stomach, and he did not explicitly say it was a “malignant tumor.” Ma Jincang’s attitude towards “seeking a doctor” was very complicated and he was instinctive to survive, but he was also worried about hearing “There is no other way.” “It’s best to go back to my hometown for chemotherapy”. On the one hand, Ma Rong encouraged his father to “visit relatives” because his sister Ma Jincang was treating stomach cancer at Xinhua Hospital. On the other hand, Ma Rong asked his aunt’s cousin to tell Ma Jincang’s condition to his aunt’s attending doctor Lu Wei, and Lu Wei listened to it. Later, he decided to let Ma Jincang come to the hospital for treatment the next day. At about 8:40 am on July 2nd, Ma Jincang walked into Xinhua Hospital. Ma Rong’s aunt (ie Ma Jincang’s sister) was discharged from the hospital on the same day. His father Ma Jincang was admitted to the hospital. He lived in the same bed as his aunt and was admitted to the Department of Orthopedic Surgery of Xinhua Hospital. The tenth floor. Ma Jincang was diagnosed with gastric cancer a month ago. Ma Jincang, who almost never went to the hospital, was notified that he was in advanced gastric cancer the first time he was “hospitalized”. The diagnosis at the Affiliated Hospital of Qinghai University showed “gastric malignant tumor”, as well as secondary liver malignant tumors and lymphatic secondary tumors. Malignant tumors, hypertriglyceridemia, hydrocele, etc. Because there is already metastatic cancer, the gastroenterologist recommends that you don’t need surgery and go directly to the oncology department for chemotherapy. Ma Rong was worried that local hospitals had limited conditions and misdiagnosis. He entrusted him to seek medical treatment in a third-class hospital in Beijing. The PET-CT examination once again confirmed the previous diagnosis. At the time of the Beijing epidemic, doctors in Beijing advised them to “go back to their hometown for chemotherapy. The cost of treatment in Beijing is high, not to mention that the beds don’t have to wait until when.” Ma Jincang heard that chemotherapy is very painful and uncomfortable, so after returning to his hometown of Haidong City, Qinghai Province, he did not go to the hospital for conventional chemotherapy. Instead, with the help and recommendation of relatives and friends, he tried some folk remedies. They even drove more than 300 kilometers and spent 40,000 yuan to buy a “small party”, “it turned out to be fooled.”
Regarding the Ma family’s motives for seeking medical treatment, Ma Rong explained, “Whoever does not yearn for birth, as far as the daughter’s affection for his father is concerned, even if the doctor says that there is a genius doctor on Snow Lotus Mountain, as a family member of the patient, I will look for it.”
At this moment, Ma Rong’s cousin found a new way. At that time, cousin Ma Rong, on the recommendation of his classmates, visited Lu Wei’s special needs clinic through an online consultation platform. After a few days of treatment for the aunt who also suffered from stomach cancer, her mental state and appetite improved.
In this way, under the recommendation of his cousin, Ma Rong took his father on the road to seek medical treatment again.
Should I do NGS sequencing and what should I do?
It takes no more than 1 hour from Ma entering the warehouse to receiving NGS gene sequencing.
At about 8:40 in the morning on July 2, after Ma Rong and his mother arrived at the hospital with his father, Lu Wei called Ma Rong and her cousin to a conference room. Ma Rong recalled that at that time Lu Wei asked her: “Is there no other hospital? Accept?” Ma Rong nodded in response. Later, Lu Wei told her: Your father’s condition is very serious and it is impossible to cure it, but according to my plan, it is no problem to live for three years. Work hard to live to five or six years.
This is the first time Ma Rong has heard from a doctor how long his father can live since his father was diagnosed. At least there is a glimmer of hope. In the conference room, Lu Wei instructed Ma Rong to “have a checkup later, people have just contacted.”
Later, a person who called himself “Manager Wu” hurried over, called Ma Rong to the safety exit of the stairs, stood in front of the window and took out the POS machine, and brushed away Ma Rong 18,600 yuan. The swiping voucher shows that the time is 9:29 on July 2nd.
Ma Rong recalled that at that time, Lu Wei called the nurse to draw blood from his father, but no one was in charge. Only one trainee nurse helped to draw two tubes of blood, which was later packed in plastic bags by “Manager Wu”. Ma Rong didn’t understand why he needed an institution other than the hospital for testing and secretly traded. His cousin told Ma Rong: “My mom did the same at the time. The results will be available a week later.”
“At the time, I couldn’t even call the name of the genetic test. After the blood was drawn, I asked Dr. Lu Wei, and he told me that it was a genetic test to find chemotherapy drugs faster. At the time, I didn’t say that a puncture should be done, nor did he say. You can take the organization for testing, I think it can be done just by drawing blood.” Ma Rong said in an interview.
However, Lu Wei explained to China News Weekly that he informed patients of the pros and cons of choosing blood and organizing tests. Lu Wei explained that when the patient came, there were multiple liver metastases from gastric cancer, multiple lymph node metastases in the abdominal cavity, and a huge metastatic lesion on the left clavicle. After taking musk for a month, it should be because the tumor was not controlled. The abdominal pain was severe and the pain was grade 6-8. , Can not eat, affect sleep. Therefore, the patient is reluctant to do another gastroscopy biopsy, and he cannot force it. The reason why NGS sequencing is done is to avoid ineffective treatment. The principle of helping patients choose a genetic testing company, Lu Wei said, is that the report can be understood by patients, the genes tested are more complete, and the results are reliable, but the price is relatively low.
However, Zhang Yu said in an article published on Zhihu that the NGS results of blood draws have almost no reference value. According to the routine, it is more accurate to detect the pathological tissue slices of the gastroscope used in the diagnosis of patients. In an interview with other media, Zhang Yu also added that the current clinical work found that NGS sequencing is extremely inaccurate in sensitivity to chemotherapy drugs and can only be used to screen targeted drugs instead of chemotherapy drugs. At the same time, the accuracy of NGS is very related to the collection of materials, especially for gastric cancer. It is very irresponsible to use blood for NGS. In the NCCN (National Comprehensive Cancer Network) gastric cancer clinical practice guidelines, this “liquid biopsy” is more used in patients whose disease has progressed and it is difficult to obtain tumor tissue samples. It is used in the CSCO (Chinese Society of Clinical Oncology) 2020 version of gastric cancer diagnosis and treatment. In the guidelines, it is listed as the third type of evidence, which is the lowest level of evidence.
The chief physician of the Department of Oncology of a third-class hospital in Beijing told China News Weekly that at present, it seems that NGS examinations are more suitable for patients with advanced stages. Of course, different tumor types have different requirements. For advanced patients, such as targeted therapy, there are mutation sites after tumor recurrence, and there are a few percent of genetic changes. Through testing, finding special drugs for the changed sites can sometimes have miraculous effects. Generally, when chemotherapeutic drugs are used in the clinic, we do not completely follow the NGS test results. NGS has relatively little reference significance, and there are more references to NGS for targeted drugs and immunotherapy.
NGS is usually detected by tissue or blood draw. “But sometimes, for example, after recurrence, the tissue is not available and it is not suitable for puncture. Then the blood is used to replace the tissue. Some tumors have been studied accordingly, and the consistency of blood and tissue in some tissues reaches 70%- 80%. When tissues cannot be taken, replacing tissues with blood NGS also has certain reference significance. I suggest that patients should be punctured. After the tissues are formed, blood will be drawn for testing at the same time, so that the accuracy rate will be higher.” The Chief Physician of the Department of Oncology of the Top 3 Hospital said.
Is there any recommendation for NK therapy?
“Whether to recommend/guide patients to adopt NK therapy” is the biggest controversy in this incident.
Lu Wei told China News Weekly that for NK therapy, “My family and I talked about the principle. They learned about it from other sources and then came to consult and decide. I didn’t take the initiative to introduce it, and they certainly did not only consult me. A person is indeed not recommended by me, and I did not stop it out of hope that my life can be effectively prolonged.”
But Ma Rong recalled, “When I heard it for the first time, I couldn’t remember the word NK. This was introduced to us by Dr. Lu Wei.” Ma Rong, who had already returned to work in his hometown on the morning of August 1, After receiving a WeChat call from Lu Wei, suggesting to give Ma Jincang “strengthen (treatment)”, Lu Wei said on the phone: “In the beginning, work hard and add a NK cell therapy. For him, recovery is better and easier. It produces results, especially when he has insufficient immunity and poor digestion of tumors.”
Before that, on the evening of July 29, Ma Rong’s mother asked her on WeChat, “I have a 30,000 yuan needle, do you want to get it?” Ma Rong felt that the cost was too high and did not agree.
However, Ma Rong insisted that the first time he heard “NK cell therapy”, it was Lu Wei who said that because he was worried that asking twice would make the doctor unhappy, so he recorded the sound and planned to listen carefully after hanging up. NK pin”. Ma Rong remembered that at the time, Lu Wei explained patiently on the phone, “Chemotherapy is a policeman, NK injection is a mercenary, and tumor is a thief. It is equivalent to the police and mercenary fighting the thief together.” Lu Wei also mentioned on the phone that his After a patient received NK injections, the lesions disappeared. “Lu Wei said that NK works well, but it is very expensive. It costs 50,000 yuan per injection. I sympathize with us from afar. It can be cheaper, but don’t say he introduced it. Yes. He said on the phone that he would send my cousin the contact information and address.” Ma Rong said.
After hanging up, Ma Rong received a document introducing NK treatment from Lu Wei, which included the name of the company “Shanghai Jiakang”. Ma Rong thought at the time, since the doctor recommended it, let his father try it. In an interview with “Medical Circle”, Lu Wei explained that before accepting Ma Jincang and his sister, he had received another pancreatic cancer patient. This patient had received NK treatment. After further treatment at Xinhua Hospital, the tumor The index dropped exponentially and was discharged smoothly. The company providing NK treatment is “Shanghai Jiakang”. The actual controller is Xu Yibing. Xu Yibing and him met at alumni gatherings. This pancreatic cancer patient had experience in the same ward with sister Ma Jincang during chemotherapy. “They learned about NK therapy during the chat, come and ask me.” Lu Wei said that he told Ma Jincang’s sister and son the principle, and told that this is not a standard treatment, and it is more expensive, it is only in the experimental stage, and may not be effective. Afterwards, Ma Jincang learned that NK treatment for patients with pancreatic cancer was free, so they asked them to help communicate and reduce the cost.
As for Lu Wei’s claim that he was once a related shareholder of a company related to “Shanghai Jiakang”, Lu Wei said that during the postdoctoral period, he and Xu Yibing’s company had CTC cooperative research. The transfer of 10,000 yuan, but this is a scientific research contract, not a share, as to why I became a shareholder, I don’t know.”
On August 3, Ma Rong’s cousin, mother and younger brother went to the “laboratory” where Dr. Lu suggested NK injections. On the same day, Ma Rong’s mother told her, “That place looks like a beauty salon.” At that time, NK injections were tested. The manager of the office also told Ma Rong’s mother that if the rich come here for injections, the wrinkles and spots on the face can be removed.
On August 10, Ma Jincang and his sister went to get the first injection of NK. With the help of Ma Rong’s cousin, the laboratory manager said that “you can buy 5 and get 1 free.” Ma Jincang and his sister each had 3 injections. Since then, Ma Jincang received the remaining two NK injections on the afternoon of August 27 and September 18.
On September 27, when Ma Jincang was undergoing a gastroscopy, a doctor sighed that “the stomach was so bad that it was so bad.” At that time, Lu Wei comforted Ma Rong as “nothing (more and more serious).” By October, Ma Jincang’s physical condition was getting worse and worse. Ma Rong couldn’t help but doubt the efficacy of the NK injection. He called Lu Wei again and asked why his aunt and father did not respond after the NK injection. “Lu Wei was angry at the time. He said that he hadn’t said that it was 100% effective. Only 70% was effective. Your dad might be the 30%. After that conversation ended unhappily, Lu Wei told my dad that your daughter didn’t Trust me.” Ma Rong recalled.
Does the surgeon plan the chemotherapy regimen?
In addition to the controversial drug selection and dosage of the second version of the chemotherapy regimen, whether surgeons can lead medical chemotherapy is also a focus of this incident.
On July 15 last year, Lu Wei told Ma Rong that because Ma Jincang was in hospital for too long, he had been complained and introduced them to a private hospital called Zhongda Cancer Hospital for the first chemotherapy. According to the information provided by Ma Rong, the chemotherapy drug at that time was oxalibo + fluorouracil.
According to Ma Rong’s recollection, after the “unpleasant call” in October last year, Lu Wei’s attitude became cold and he changed his father’s chemotherapy regimen at the same time. Starting from the fifth chemotherapy, the patient’s chemotherapy regimen changed to a combination of pemetrexed, anlotinib, oxaliplatin, capecitabine and tamoxifen. At the same time, Ma Jincang on October 3 ” “Intravenous chemotherapy drugs” still write “Lu Wei” in the column of the operating physician.
Regarding the reasons for the replacement of chemotherapy drugs, Lu Wei said: After adopting the first-line treatment plan, the patient’s first 2 cycles of treatment are effective in symptom control, and “you can eat and sleep.” But the blood AFP continues to rise to more than 10,000, and it may be more than 7,000 when it comes. Therefore, during the 2-3 cycle, it is recommended to evaluate with the family members, “The evaluation shows that the liver lesions are in a stable state, and the supraclavicular lymph nodes have disappeared. However, the patient’s symptoms reappear.” After discussing with the patient, the family members said that the patient was young and decided to adopt Individualized treatment plan. Moreover, the patient’s NGS results showed low sensitivity to paclitaxel and high side effects of irinotecan, and then recommended the above-mentioned second-line drugs, referring to the Chinese and English literature and drug principles of this disease. After this, Lu Wei was sent to Hainan without further follow-up treatment. “In fact, the family members only partially implemented this plan. They should have multiple consultations, but the follow-up did not go on.” Lu Wei said.
But Ma Rong did not agree with this statement. “My father took the chemotherapy drugs for a long time, and I bought anlotinib from outside after taking it. Up to now, there are only one or two of each drug left.” Ma Rong said.
It is worth pointing out that Lu Wei is not an oncologist, but a general surgeon. A medical oncologist at a top domestic oncology hospital said that such authorization is not allowed abroad, but in China, it is not uncommon for surgeons to perform medical treatments and perform tumor chemotherapy in surgery. Another doctor told China News Weekly that surgeons cannot lead internal medicine treatment plans. As doctors who traditionally dominate tumor treatment, it is understandable that surgeons habitually write some plans for reference. The final internal medicine plan should be decided by multidisciplinary consultation. .
In Ma Rong’s impression, his father’s chemotherapy regimen does not seem to have undergone “multidisciplinary discussion.” Ma Rong recalled that every time she went to Lu Wei’s office to consult her father’s condition, Lu Wei would ask her to wait until after get off work, or after other doctors had left, or she would go into the corridor and say, “I feel he is evasive. The doctor asked him those questions.” Ma Rong said.
Is it a good doctor or a bad doctor?
At the end of October last year, Ma Jincang, who had undergone NK injections and the second version of the chemotherapy regimen, was already thin to the point. At the time, Ma Jincang always said that the back spine hurts. Ma Rong didn’t know that it was cancer pain, or even that his father had bone metastases. Before that, every time he asked Lu Wei about the progress of his father’s condition, Lu Wei said, “Yes. very good”.
Unwilling to reconcile, Ma Rong asked for leave to accompany his father in Shanghai, and on November 1 he went to the clinic of a doctor surnamed Zheng in the Oncology Department of Xinhua Hospital. At that time, the other party had read all the treatment records and told Ma Rong that he and Dr. Lu were in the same hospital. It is hard to say much, but “this treatment is ridiculous.”
After that, Ma Jincang underwent another chemotherapy. Ma Rong had already returned to the Qinghai class. His mother was illiterate, and every time he accompanied his father to see a doctor, he had to ask people around. Ma Rong couldn’t bear the tossing of the old couple, and he also followed the doctor’s advice to “take the old man back to his hometown while he was alive.” On December 24, 2020, Ma Jincang passed away in the arms of his wife at home. In March of this year, sister Ma Jincang passed away.
After the death of the two elderly people, on April 9, 2021, Ma Jincang’s eldest son also wrote a thank-you letter to Lu Wei. The letter stated that during the entire treatment process, “Dr. Lu Wei was very concerned about the treatment of the two elders”, “After the treatment, my uncle’s stomach seldom hurts and the bulge on his neck disappeared.” But Dr. Lu Wei thinks He is in a special condition and the laboratory test results are not satisfactory.” So he adopted a special medication plan, and informed him about the dosage, side effects, and time of taking the medication. The letter also stated, “During the treatment, Dr. Lu Wei never tricked us into spending high prices on treatment, but instead helped us save money everywhere.”
But on the same day, Ma Rong reposted Zhang Yu’s latest article on his Weibo and wrote: “If this will worsen the doctor-patient relationship, then the people really deserve to be deceived, and the world is the power of the strong. The doctors in the big hospital expected that we were from the countryside, and there was no way to get him, so we asked us to get a 30,000 injection of cell needles, giving us hope at a time, letting us down again and again, until Dad was gone. If this is the case, go to death if you get sick in the future, because when you go to the hospital, you will also die.” On April 2 before this, Zhang Yu published an article criticizing Lu Wei for the first time. Regarding the thank-you letter, Ma Rong said, “I don’t know, I didn’t write it.”
“Is NK treatment legal? Will the NK injection be as effective as Dr. Lu Wei said? If it is illegal and ineffective, why do doctors in large hospitals say such things to patients? We only ran from Qinghai to Shanghai for treatment. I only hope that this matter can be investigated clearly. Don’t wrong a good doctor or let go of a bad doctor.” Ma Rong said in an interview that this is her. The final appeal.
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