godfather of surgery

Chapter 1339 If you can't play, then flip the table!

The World Health Organization headquarters building.

In the conference room, representatives from health departments, top medical schools, and pharmaceutical giants from various countries spoke in hushed tones, the atmosphere subtle and tense.

Tang Shun sat by the window, looking at the agenda booklet in front of him that read "Preparatory Meeting of the International Alliance for Translational Medicine". The booklet was thick, with the WHO's iconic blue and white cover, and the pages were densely packed with the agenda for two days.

To his right sat Professor Mannstein, and around the oval table sat more than thirty people, representing the power and knowledge landscape of the global medical community: the National Institutes of Health, the European Medicines Agency, the Africa Centres for Disease Control and Prevention, several top medical research centers in Asia, and chief scientists from pharmaceutical giants such as Pfizer, Novartis, and Roche.

Simultaneous interpretation equipment was placed in front of each person, with headphone cords neatly coiled on the table. Six high-definition screens were installed on the walls of the conference room, currently displaying the WHO logo and the name of the meeting.

“Everyone is here.” Dr. Anderson, the meeting chairman and deputy director-general of the WHO, tapped the microphone, his voice carrying throughout the room via the high-quality sound system. He was a Swede in his sixties, his gray hair neatly combed, his eyes behind gold-rimmed glasses scanning the room. “Let’s begin.”

The first two hours of the meeting went remarkably smoothly. Tang Shun introduced the core framework of the system regulation theory; his presentation was clear and logical, and his meticulously crafted slides transformed complex theories into easily understandable concepts. The screen displayed a dynamic model of the human body systems, with different colored lines representing the interactions of systems such as the immune, metabolic, nervous, and microbiome—like a symphony orchestra that needed a conductor, not a soloist.

Professor Mannstein then supplemented the data with validation data from Europe, presenting results from clinical trials conducted at three medical centers in Berlin, Paris, and Zurich. Dr. Ngozi from Africa shared a case study of initial applications in resource-limited areas.

The participants nodded frequently, and their questions all revolved around technical details: data collection frequency, algorithm optimization, and adaptive adjustments for different populations. The Japanese representative inquired about the application prospects of system modulation in an aging society; the Indian representative was concerned about the costs of large-scale implementation; and the Brazilian representative raised the possibility of modulation specific to tropical diseases. The discussion was lively and professional, resembling a purely academic exchange.

Until the tea break ends.

“I would like to raise a fundamental question,” said the white-haired elderly man sitting opposite Tang Shunzheng. He was Dr. James Horton, the former director of the National Institutes of Health and now the chief scientific advisor for a multinational pharmaceutical company. His voice was calm yet powerful, instantly drawing everyone’s attention.

The atmosphere in the meeting room subtly shifted. The previously relaxed, professional discussion gradually froze, replaced by a more serious, even slightly confrontational, atmosphere. Several representatives adjusted their postures; some took off their glasses to wipe them, while others unscrewed bottled water and slowly sipped.

Horton adjusted his glasses, a gesture he'd made countless times, almost a signature move. "Professor Yang's theory is undoubtedly insightful," he said cautiously and precisely, "but it's based on the premise of 'system regulation.' My question is: how do we define the boundary between 'regulation' and 'interference'? When you simultaneously modulate multiple systems—immune, metabolic, neural, and microbiome—how do you prove that this isn't a dangerous, uncontrollable systemic disturbance?"

The question was highly technical, hitting the core of systems medicine theory. Everyone held their breath, waiting for Tang Shun's answer.

Tang Shun did not answer immediately. He picked up the water glass in front of him and slowly took a sip.

“Dr. Horton has raised a question that is both philosophical and technical.” Tang Shun’s voice was calm, a stark contrast to Horton’s. “Before answering, I’d like to tell you a story.”

He recounted the treatment process of a nine-year-old boy named Lele. The boy suffered from a complex autoimmune disease, and traditional treatments—including three immunosuppressants and a biologic—had consistently failed to be effective. The child lost 30% of his weight, needed to take 17 medications daily to try to control his symptoms, and his quality of life was severely impaired.

“When we first met Lele, he could barely walk, and his joints were swollen like balloons.” Tang Shun pulled up a photo with his face blurred. “We stopped all medications and started over.”

He showed data charts, but not the smooth, perfect cure curves; instead, he presented raw data—real data full of ups and downs, relapses, and unexpected reactions. “Look here,” Tang Shun pointed to a data trough in the third week after treatment, “Lele’s inflammatory markers rose instead of falling, which would be considered a failure in conventional thinking. But our further analysis revealed that this was because the immune cells were ‘relearning’ to recognize normal signals.”

He pulled up a dynamic simulation: "Just like when tuning a piano, the strings first make a piercing sound before they can find the accurate pitch. Lele's body is being recalibrated, and this process takes time and requires us to endure the temporary 'deterioration'."

Tang Shun raised his head and looked directly at Horton: "So to answer your question: the boundary between regulation and interference is not defined by us in advance, but dynamically defined by the feedback of the system itself. Our role is not to impose a 'correct state,' but to provide a series of gentle adjustments, observe how the system responds, and then guide it to find its own equilibrium point."

He paused, giving the translators time to finish their work. "The core of our theory is not that the therapist sets a so-called standard, but that the body can find its own balance. We simply guide it, allowing this self-regulating process to occur."

“It sounds wonderful,” Horton said, unmoved, his expression unchanged. “But how can you prove that you’re guiding things toward ‘more stable’ rather than ‘more vulnerable’? Lele is better today, but what about five or ten years from now? Could this complex, multi-system intervention sow the seeds of long-term risks we are unaware of?”

The question goes deeper, touching on the most fundamental dilemma in medicine—the test of time.

“We cannot prove it.” Tang Shun’s answer caused a stir in the conference room, and several representatives exchanged surprised glances. “Just as we cannot prove that any long-term medication is absolutely safe. Medicine is essentially about making decisions amidst uncertainty. What we can do is establish a more refined monitoring system, conduct lifelong follow-ups on patients, and make all data public, including those from failures.”

He pulled up a table showing the ongoing long-term follow-up project. "For this case, the traditional treatment regimen couldn't even achieve stability for a few days. Why should we demand that a new therapy be stable for five, ten, or even more years? To be realistic, to determine whether a new regimen is an improvement, we need to compare it with the old method on the same baseline, rather than demanding that the new method do everything perfectly when the old method can't do anything."

These words were direct and forceful, leaving Horton speechless for a moment, his face turning ashen. A low murmur filled the conference room, a cacophony of conversations in different languages ​​mingling in the headset.

Without waiting for Horton's response, Tang Shun pulled up another set of data: "In fact, we have been conducting long-term follow-ups. You see, this is Lele's follow-up data. We have tracked more than 300 biomarkers and established a unique 'health baseline trajectory' for each person. When their system deviates from this trajectory, we can detect it earlier and intervene earlier."

Professor Mannstein then chimed in: "This is precisely why we need to build alliances. Systems medicine is not the patent of any one team or country; it requires global collaboration to establish unified data standards, safety protocols, and ethical frameworks. Otherwise, we will repeat the mistakes of the Three Kingdoms incident."

Horton paused for a moment, tapping his fingers lightly on the table. When he spoke again, his tone had softened, but his stance remained firm: "I understand your vision, but medical progress requires caution. An overly radical theory, if promoted too early and too widely, could cause far more harm than good. History is replete with such lessons; think of the early failures of gene therapy or the unexpected side effects of certain targeted drugs."

“Therefore, we need a 'tiered certification system'.” Tang Shun opened the last chapter of his proposal, the culmination of months of preparation by him and his team. “Not all doctors can implement complete systemic intervention programs. Junior certified practitioners can only perform basic monitoring and simple interventions; advanced certification requires two years of training and passing real-case assessments. The alliance will provide an open-source educational platform and decision support tools, but each practitioner's responsibility for patient decisions will be independent and clear.” A detailed certification flowchart was displayed on the screen: from online courses to simulation training, from clinical internships to independent practice assessments, the entire process requires at least 1500 hours of specialized learning. “We are not advocating a simple therapy that everyone can use, but rather establishing a new medical profession that requires specialized training, just like cardiology or neurosurgery.”

The meeting lasted seven hours, with only a short lunch break in between. The debate extended from theoretical levels to practical details, and from ethical considerations to economic impacts.

As Dr. Anderson announced the end of the first day of the conference, Lake Geneva outside the window was shrouded in twilight. Mont Blanc in the distance was bathed in gold by the setting sun, and the lights of the boats on the lake illuminated a tranquil scene.

"The first day went fairly smoothly." Mainstein and Tang Shun walked side by side toward the hotel, their shadows stretching long on the clean sidewalks of Geneva. "Houghton's questions were sharp, but at least they were discussed within an academic framework. There were no personal attacks, no politicized remarks, which is a good sign."

Tang Shun frowned slightly and slowed his pace. "It's going too smoothly. Someone like Horton won't be satisfied with just asking a few questions. Every question he asks is carefully designed. On the surface, it's an academic discussion, but in reality, he's guiding the conversation in a direction that benefits him."

"You mean he's testing our weaknesses?" Mainstein asked thoughtfully.

“It’s more than just a probe,” Tang Shun shook his head. “It’s more like gathering information. Did you notice his assistant taking notes the whole time? Not meeting minutes, but targeted notes. What are they preparing?”

Mainstein's expression turned serious: "You're right, I was too focused on the debate itself and overlooked these details."

The two entered the hotel lobby. The warm, bright light from the crystal chandelier could not dispel the shadows in their hearts. Tang Shun's premonition was confirmed that night, and it came faster and more intensely than expected.

At nine o'clock in the evening, the phone in Professor Mainstein's room rang urgently. It was his research assistant calling from Berlin, his voice filled with obvious anxiety: "Professor, you need to check the New England Journal of Medicine website immediately. They released an editorial today entitled 'Systems Medicine: Old Wine in New Bottles or Dangerous Radicalism?', authored by Houghton and three other heavyweight scholars."

Mannstein quickly opened his laptop and connected to the hotel's high-speed network. The article was already on the website's homepage, accompanied by a complex network diagram of the human body's systems, but deliberately rendered as a chaotic jumble of interwoven lines, visually conveying an implication of "over-complexity and difficulty in control." The article's content was sharp and systematic.

“They didn’t even wait for the meeting to end,” Mainstein said in a low voice. “This was a planned, synchronized action.”

He and Tang Shun immediately reported the matter to Professor Yang Ping, who was far away in China.

“As expected,” Yang Ping said calmly. “Horton’s question at the meeting was just the opening act; this article is the main course. They want to set the tone in the public sphere before we have a chance to fully explain the theory.”

“That’s not all,” Mainstein said anxiously. “The European Medicines Agency suddenly released a ‘position paper on the regulation of complex systems therapies’ today. Although it didn’t name us, it was clearly aimed at us. The paper requires that any therapy involving multi-system interventions must have independent safety verification for each component intervention. This is tantamount to requiring us to conduct phase III clinical trials for each disease, completely ignoring the holistic principle of system regulation.”

Yang Ping felt a wave of disgust. This was not an academic challenge; it was a meticulously planned administrative attack.

“And it gets worse,” Mainstein continued, pulling up another document. “The FDA also updated its guidelines at the same time, expanding the definition of ‘combination therapy’ to include ‘any two or more interventions performed simultaneously’ and requiring data on the individual and combined effects of each intervention. Huang Jiacai learned from Ruixing Medical that several multinational pharmaceutical companies are lobbying Congress to legislate restrictions on ‘unproven systemic therapies’.”

A three-pronged approach: academic scrutiny, tightened regulations, and legislative impetus. This was a cross-border, cross-sectoral collaborative effort, clearly the result of months of meticulous planning. Each component seemed reasonable—academic rigor, patient safety, and comprehensive regulation—but together they formed an almost insurmountable barrier.

"What has been the reaction of our international supporters?" Yang Ping asked.

“Everyone is already organizing a response,” Tang Shun reported. “Dr. Ngozi is preparing to publish a commentary in The Lancet; Professor Kawasaki in Japan is contacting his colleagues in Asia; several research centers in Europe have indicated they will release their positive data. But the other side is moving too fast, and public opinion has begun to shift. The topic of systemic medical risks is rising on Twitter, and some influential medical bloggers are retweeting Horton’s article.”

Yang Ping rubbed his temples. Why is science always so impure?
Why does every genuine innovation involve such a struggle? From Copernicus to Pasteur, from Semmelweis to Einstein, history repeats the same pattern: new ideas challenge the old order, and vested interests fight back desperately.

He paused for a moment, then said something that shocked both Tang Shun and Mainstein: "If they can't play, we'll flip the table."

The two people on the other end of the phone were stunned.

“From now on, the system regulation theory will be withdrawn from countries facing significant resistance,” Yang Ping said calmly but firmly. “The export of related technologies and products to these countries will also be prohibited. This is not our loss, but theirs. If we can’t afford to play, then we shouldn’t play.”

“Professor?” Tang Shun hesitated for a moment. “Wouldn’t this be too extreme? We need international cooperation and global data sharing; these are the foundation for the development of systems medicine.”

“When they use unscientific means to hinder scientific progress, the basis for cooperation no longer exists.” Yang Ping’s eyes were unusually calm. “Sometimes, retreat is for a better advance. Let the patients in those countries continue to suffer from the ineffectiveness of traditional treatments until their doctors, their media, and their patient organizations begin to question: Why are we being excluded from medical progress?”

“But…” Mainstein wanted to say something, but Professor Yang had already made his decision.

"Prepare the statement as I instructed. At the same time, accelerate our expansion into willing countries: Asia, Africa, and parts of Europe. We want to prove that systems medicine can develop, and even better, without the countries that offer the greatest resistance."

The call had ended. Tang Shun and Mainstein exchanged a glance, both seeing the complex emotions in each other's eyes: shock, worry, but also a sense of relief. Perhaps Professor Yang was right; rather than exhausting themselves amidst endless obstacles, it was better to redefine the battlefield.