godfather of surgery

Chapter 1286 The Most Luxurious Medical Negotiation Team
The strategic meeting room on the top floor of BG Group's Washington office.

Michael Harper, Rigow's chief political advisor and a legendary lobbyist who has been working on K Street for thirty years, is pointing a relationship diagram on the wall with a laser pointer.

“Listen up, gentlemen.” Harper’s voice was loud and clear, his suit jacket casually draped over the back of his chair, his shirt sleeves rolled up to his elbows. “There are seven key figures in this FDA building who will decide the fate of K therapy, three of whom have known us for over twenty years, but this time it’s different…”

The laser red dot stopped on several names in the center of the map.

“The new director of the Center for Biologics Evaluation and Research (CBER), Elena Watson, is a technocrat left over from the Obama era; she only cares about data. Robert Chen, the deputy director of the Center for Drug Evaluation and Research (CDER), is a second-generation Chinese American; he is both sensitive and cautious about technology from China.” Harper paused. “The most troublesome one is David Miller, a special advisor in the FDA Commissioner’s office. He is an old classmate of the Senate Majority Leader and a staunch defender of traditional pharmaceutical interests.”

At the long table in the conference room, the government affairs team, legal counsel, and director of scientific affairs from BG Group looked solemn.

“Miller has already given the gossip,” Harper continued, pulling up a summary projection of an encrypted email, “He believes that the approval of the K therapy needs to be extremely cautious because the possibility of national security risks due to technology transfer cannot be ruled out.”

"Absurd!" Dr. James Wilson, BG's new Chief Scientific Officer, couldn't help but slam his fist on the table. "This is pure medical technology! All of Professor Yang Ping's papers have been published in open journals and can withstand any scrutiny."

“Doctor, this is Washington,” Harper calmly interrupted him. “The word ‘national security’ can crush any scientific argument. What we need is strategy, not anger.”

Li Gaoyang's image appeared on the side screen. He looked more haggard than at the press conference, but his will to live seemed even stronger.

“Harper,” Rigley’s voice came through the speaker, slightly hoarse, “I need a timeline. In the most optimistic scenario, how long will it take for clinical trial approval?”

Harper paused for a few seconds: "Under the conventional pathway, the FDA's average review time for breakthrough therapies is six to eight months, but if there is political resistance, it could drag on for more than a year, or even longer."

Li Gaoyang on the screen closed his eyes.

A year? His attending physician, Johannesson, told him privately that at the current rate of tumor infiltration, he might only have 9 to 12 months left.

“We don’t have a year.” When Li Gaoyang reopened his eyes, he said with a desperate resolve, “Activate Plan B.”

“Plan B is very risky,” Harper warned. “By bypassing the standard review process and going through the ‘expanded compassionate use’ and ‘special emergency use authorization’ pathways, we need political backing at the White House level. This would leave us with huge favors and completely enrage the FDA’s technocratic system.”

“My life can’t wait for the bureaucracy,” Li Gaoyang said firmly. “Contact our allies in the Senate and initiate the legislative process for the Breakthrough Medical Technologies Emergency Use Act. At the same time, submit a special request to the White House Office of Science and Technology Policy to designate K therapy as a ‘national security-related medical emergency.’”

The meeting room fell silent. Everyone understood what this meant: it meant linking individual healthcare needs to the national strategic agenda.

However, Rigoyan and his family have the power to do so, provided that his family supports him, and it is clear that his family is now willing to support him at all costs.

"This will plunge BG Group into a political vortex for the next decade," the legal advisor warned in a low voice.

"If there is no future, what is the vortex?" Li Gaoyang's image disappeared.

Harper took a deep breath and turned to the team: “Okay, ladies and gentlemen, cheer up, we need to accomplish three things within a week: First, organize an academic hearing with a Nobel laureate on stage to prove the value of K therapy to the scientific community; second, contact patient advocacy organizations to create public pressure; third, and most importantly…”

He pulled up a list containing the names of more than twenty senators and representatives.

"To launch the 'Medical Hope Initiative,' we need at least fifteen members of Congress to publicly endorse expedited approval processes. Remember, the focus is not on Republicans or Democrats, but on members of Congress with seriously ill family members or whose districts have large medical centers."

The lobbying machine is running at full speed.

BG Group's helicopters frequently shuttle between Washington, New York, and Boston, bringing top neuro-oncologists, bioethicists, and even former FDA officials to attend closed-door briefings.

At the same time, a meticulously planned media campaign was launched simultaneously—The Wall Street Journal published an in-depth report by a senior medical journalist, the New England Journal of Medicine published a rare editorial calling for "review based on science rather than geopolitics," and CNN broadcast a special program called "The Cost of Waiting," interviewing several late-stage patients who could not access experimental treatments.

At this moment, Rigoyan was lying in a VIP ward at New York-Presbyterian Hospital, maintaining contact with various parties through encrypted lines. His headaches and dizziness were becoming more and more obvious, but his eyes were becoming brighter and brighter.

“Father, is it worth it?” he asked his father. “We are dragging the whole family into a political quagmire.”

Old Li sat high on the edge of the hospital bed, his eyes filled with worry. He held his son's hand with astonishing strength: "My child, nothing is more important than life. A family is made up of one vibrant individual after another, and we will not abandon any of them. Since our ancestors set foot on this land more than two hundred years ago, why have we all strived so hard to achieve what we have today? The purpose is to make us and our descendants freer, happier, and have more choices. Now, there is a high wall between your life and death, and we have the ability to break it down, not only for ourselves, but also for all those who have been sentenced to death by 'process' and 'time'."

“But I’m worried about time…” Li Gaoyang sighed.

Old Li shook his head: "Don't worry, Harper will buy you time. Money can't solve all problems, but it can solve most of them, including buying you time."

……

While preparations were underway for the hearing in Washington, the headquarters of Ruixing Group welcomed the highest-level international pharmaceutical delegation in its history.

They formed an alliance, booked an entire floor of the Nandu International Conference Center, and brought more than 100 people with them, including technical experts, legal advisors, market analysts, and a translation team.

The meeting was held in the largest circular conference room at Ruixing's headquarters. On either side of the long table, the camps were clearly divided: on one side was Ruixing's core team led by Huang Jiacai, consisting of no more than ten people; on the other side was a large joint delegation, seated according to region and company, creating an imposing atmosphere.

“Mr. Huang,” said Friedrich Schneider, CEO of a German pharmaceutical giant and the spokesperson nominated by the joint delegation, speaking first with a strict German accent, “Thank you for taking the time to meet with us. We represent the major players in the global pharmaceutical industry and hope to have a constructive dialogue with Ruixing regarding global cooperation on K therapy and X-2 technology.”

Huang Jiacai nodded slightly, his dark gray suit impeccably tailored: "Welcome to China Southern Metropolis. Ruixing has always been open to constructive dialogue."

“Let’s get straight to the point.” Mark Thompson, from another American pharmaceutical giant, took over, his American directness evident. “Our six companies have reached a preliminary agreement and formed a joint proposal.” A hardcover proposal booklet, five hundred pages thick, was pushed in front of Huang Jiacai. The cover, in gold lettering, read: “Joint Framework Agreement on Establishing a Global Commercialization Alliance for K-Therapy and X-2 Technology.”

Huang Jiacai did not immediately open the document, but looked at the representatives present: "Before discussing the specific terms, I would like to confirm a premise: Have you all read and understood the 'Global Framework for Inclusive Benefits' principle statement that we issued earlier?"

A brief, subtle silence fell over the meeting room. Schneider cleared his throat: "We've reviewed the document. While some of the ideas are insightful, a more flexible approach may be needed in business practice."

"For example?" Huang Jiacai asked.

“For example, tiered pricing,” Pierre DuPont of the French pharmaceutical giant continued. “Mr. Huang, we understand your intention to benefit low-income patients. However, pharmaceutical research and development requires huge investments, and without reasonable expectations of returns, the entire innovation system will be unsustainable. Our joint proposal puts forward a more sustainable model: implementing market pricing in developed countries and injecting a portion of the profits into a special fund to subsidize patients in developing countries.”

"What is the ratio?" Huang Jiacai asked in great detail.

"The initial suggestion is 10%-15% of the profits of developed countries."

Huang Jiacai shook his head slightly: "According to our calculations, to truly achieve global accessibility, at least 30% of the profits need to be redistributed. Moreover, I noticed that your plan defines developed countries very broadly, including some countries with a per capita GDP of over $20,000 but weak healthcare systems."

Kenichi Sato, a representative of the Japanese pharmaceutical giant, spoke up at this point, his tone gentle but his stance firm: "Mr. Huang, pharmaceutical cooperation is not just a matter of pricing. Each of our six companies possesses unique advantages: a distribution network in Europe, market control in the Americas, production and process optimization capabilities in Asia, and a presence in emerging markets. If Ruixing cooperates with us as a whole, we can bring K-therapy and X-2 to every corner of the world in the shortest possible time."

"What exactly does 'overall cooperation' mean?" Huang Jiacai pressed.

Schneider leaned forward: "We propose the formation of the 'K-Therapy Global Alliance,' with Ruixing holding a 30% stake as the technology provider, and the six of us jointly holding the remaining 70%, responsible for global commercialization. The alliance's board of directors will consist of representatives from seven parties, and major decisions will require at least five votes in favor."

The meeting room fell silent, everyone watching Huang Jiacai. This was a meticulously designed plan that acknowledged Ruixing's technological dominance while ensuring the collective control of the traditional giants through its shareholding structure and voting mechanism. More importantly, it bound the six companies together, forming a united front against Ruixing.

Huang Jiacai remained silent for a moment, glanced at the cover of the proposal in front of him, then raised his head and calmly swept his gaze over each of the representatives present.

“Thank you all for your sincerity,” he said in a low voice, but every word was clear and distinct, “but Ruixing cannot accept this proposal.”

The air in the conference room suddenly froze.

"Why?" Thompson couldn't help but ask. "This is already a huge concession. Under normal circumstances, the technology licensor can only get 15%-20% of the revenue!"

Huang Jiacai did not answer directly, but turned to his assistant: "Secretary Huang, please distribute the materials we have prepared to everyone."

Thinner copies of the document were distributed to each representative. The cover read: "Global Roadmap for K-Therapy and X-2 Technology (Inclusive Framework Implementation)".

“Before I reject you, let me explain Ruixing’s proposal.” Huang Jiacai opened the document. “First, regarding the cooperation structure: we will not sign any exclusive agreements with any company or consortium. Instead, we will establish an open partnership program, and any qualified company can apply to join.”

The delegates began to whisper among themselves.

"Secondly, regarding commercialization: Ruixing will establish a wholly-owned subsidiary, 'Global Health Solutions Company' (GHS), to be responsible for the global licensing management of K-Therapy and X-2 technology. Partners can obtain regional or domain licenses through GHS, but all licensing agreements must comply with the unified inclusive framework terms."

"Third, regarding pricing and accessibility: We will establish a transparent global pricing database, and all authorized prices and actual prices paid by patients will be made public. At the same time, we will cooperate with organizations such as the World Health Organization and the Global Fund to establish a special assistance mechanism to ensure that low-income patients are not excluded."

Huang Jiacai paused, his gaze sharpening: "Fourth, and most importantly—technology control. The core intellectual property rights, production process standards, and treatment quality control of K-therapy and X-2 technology will be completely controlled by Ruixing. Partners can participate in promotion, distribution, and localization, but cannot get involved in the core technology aspects."

“This is unfair!” one representative couldn’t help but say. “It means we bear the market risks but don’t have control over the core technologies.”

“But you have gained access to next-generation treatment technologies,” Huang Jiacai calmly responded. “According to our assessment, if K therapy is fully rolled out, the market share of traditional cancer treatment drugs will shrink by more than 30% within the next five years. Not cooperating means being eliminated; cooperating means transformation.”

He looked around: “I know you are all used to being in control, but this time is different. This is not a battle for market share within the existing market structure, but a fundamental transformation of the healthcare model. In the face of change, no one can maintain their original control.”

Schneider's face turned ashen: "Mr. Huang, do you realize that if our six companies unite to boycott, the promotion of K therapy in the European and American markets will be extremely difficult? Without our channels, without our medical insurance negotiation capabilities, without our physician education system, even the best technology will be difficult to implement."

“I understand,” Huang Jiacai nodded. “But I also realize something else: if Ruixing concedes today and accepts the joint control plan, then this technology will ultimately become a luxury enjoyed by a few. This is not Professor Yang Ping’s original intention in developing it, nor is it Ruixing’s purpose in promoting it. At the same time, I want to tell you all that the world is vast, and you are not the only capable partners.”

He stood up, walked to the window, and turned his back to the delegation: "Ladies and gentlemen, I would like to share some data: According to statistics from the World Health Organization, more than 30 people die from malignant brain tumors every year worldwide, 70% of whom die in developing countries. Most of them will never have access to the latest products from any of the companies represented here today. Note that this is only for brain tumors. I'm sure you are already well aware of the global cancer statistics."

Huang Jiacai turned around, his eyes piercing: "K therapy may not be able to save everyone, but if it can advance healthcare equity even by a small step, then it is worthwhile. This is why the inclusive framework is non-negotiable."

A long silence fell over the meeting room.

For the first time, cracks appeared in the united delegation's lines—Japanese representative Sato looked thoughtful, German representative Schneider frowned, and American representative Thompson looked angry but had a darting gaze.

“We need time to discuss this,” Schneider finally said.

“Of course,” Huang Jiacai nodded. “But I must remind everyone: the recruitment of partners for the Inclusive Finance Framework will officially begin in two weeks. At that time, we will announce the first batch of authorization standards and evaluation procedures, and all applicants will be treated equally.”

The meeting was suspended and the joint delegation retreated to the next room for emergency consultations.

The moment the door to the next room closed, the pent-up argument erupted.