After being separated from my family, I became a darling of the military region thanks to my medical

the same day.

New York, Manhattan's Upper East Side.

Outside the floor-to-ceiling windows of the Mayo Clinic's New York office, bare trees in Central Park sway in the winter wind.

Graham Harrison sat behind a mahogany desk, on which lay a magazine turned to the middle page.

The cover is bright red, with Chinese characters printed vertically, and a blue stamp from the editorial department in the lower right corner.

Chinese Journal of Surgery

Next to it were English summaries from Williams Airmail and the complete record of the Cavendish surgery.

Harrison is 57 years old, president-elect of the American College of Cardiac Surgeons, and the youngest chief cardiac surgeon in the Mayo Clinic in 40 years.

He had a clean-shaven chin, wore gold-rimmed glasses, and had a Harvard Medical School graduation ring on the ring finger of his left hand.

He has read the English abstract for the third time.

After watching it for the first time, he took off his glasses and rubbed his temples.

After watching it a second time, he stood up, walked to the window, and stood facing Central Park for five minutes.

I watched it for the third time.

He sat back in his chair, picked up the phone on the table, and dialed a number.

After three rings, the call connected.

"Richard, it's me, Harrison."

On the other end of the phone was Richard Clarke, editor-in-chief of the New England Journal of Medicine, who was a classmate of Harrison at Harvard and had been friends with him for thirty years, playing golf together.

"Graham, long time no see. You still owe me the bet for those eighteen holes from last game—"

"Richard, I'm going to send out an open letter."

There was a pause on the other end of the phone.

"What type?"

"A letter to the editor, of the nature of an academic commentary, concerning a newly published cardiac surgical procedure."

Richard's voice became serious.

Which one?

"The Chinese journal *Chinese Journal of Surgery* published a special issue last month featuring a radical resection of tetralogy of Fallot via the apical approach, along with a completely new protocol for autologous pericardial valved conduit. It was sent by Williams from London, along with a surgical record of a British aristocratic child."

There was a few seconds of silence on the phone.

"I know this piece; Williams sent me a copy too. Lynn has already finished translating it, and I've read the whole thing."

Richard's tone slowed down.

"Graham, what are you saying?"

Harrison did not answer the question.

He glanced down at the diagram spread out on the table, a hand-drawn illustration of the apical incision, in red and blue, with lines so clean they didn't look like they were drawn by hand.

His gaze lingered on the picture for two seconds.

"Richard, what do you think of this technique?"

"You go first."

Harrison leaned back in his chair.

"From a purely technical point of view, this approach design is impeccable. I have gone through it three times and cannot find any anatomical flaws."

"Then why did you write an open letter?"

"Because the fact that we can't find the loopholes is the biggest problem in itself."

Richard didn't respond, waiting for him to continue.

"The special issue from China only presented data from eleven surgeries, with the longest follow-up period not exceeding three months. There was no randomized controlled trial, no multi-center validation, and the five-year survival rate was completely unavailable."

Harrison tapped his fingers on the table.

"A completely new approach, coupled with a self-made pipe material that has never been internationally validated, is being promoted globally with an extremely limited sample size. This is unacceptable in any established academic system."

There was a moment of silence on the other end of the phone.

"Graham, are you sure you're discussing academic norms?"

"What do you mean?"

Richard's voice calmed down.

"What I mean is, Williams made it very clear in the letter that the anatomical reconstruction drawn by that Chinese doctor with a pencil was more accurate than the 3D reconstruction that Brompton spent half a million pounds on. The Cavendish family's children were given a death sentence by seven top centers around the world, but she saved them all by herself."

Richard paused for a moment.

"You and I have both been cardiac surgeons for thirty years. Tell me, can you do it?"

Harrison didn't say anything.

He stared at the hand-drawn picture on the table for a long time before speaking.

"I can't do it."

He admitted it very frankly.

"But just because I can't do it doesn't mean I can't question it. On the contrary, it's precisely because this procedure is too perfect that I must stand up and demand more rigorous verification."

His voice turned somber.

"Richard, if we say nothing and young doctors all over the world imitate this procedure, what if those self-made tubes start having problems in the third year after surgery? What if the one percent failure rate is masked by the small sample size?"

"By then, whose patient will be dying?"

There was a long silence on the phone.

Richard finally sighed.

"Send the manuscript over, and I'll arrange for it to be published in the next issue. But Graham, there's something I need to remind you of."

"explain."

"Once you send this letter out, the whole world will think that the American cardiac surgery community is targeting China. No matter what your original intention was, you can't control the political interpretation."

Harrison closed the Chinese magazine that was spread out on the table.

"I know."

He picked up his pen, unscrewed the cap, and wrote the title on the blank paper in front of him.

Cautionary recommendations regarding the promotion of techniques that have not undergone international peer review.

He wrote very slowly, stroke by stroke, with the rhythm of stitching on an operating table.

Two hours later, the three-page handwritten manuscript was swallowed by the fax machine and sent towards Boston.

Forty-eight hours later.

This open letter appeared in the latest issue of the New England Journal of Medicine.

Signed: Graham Harrison, Chief Cardiac Surgeon at Mayo Clinic and President-elect of the American College of Cardiac Surgeons.

The letter posed three questions in extremely restrained language.

First, is the sample size of eleven surgeries sufficient to support the clinical promotion of a completely new surgical procedure?

Second, there is a lack of data to support the mid- to long-term patency and calcification rates of autologous pericardial valve conduits.

Third, in the absence of international multicenter randomized controlled trials, does elevating single-center experience to industry standards align with the fundamental principles of evidence-based medicine?

In the final paragraph, he wrote: "We respect any country's exploration and breakthroughs in the field of medicine, but scientific progress should be based on repeatability and rigorous verification, rather than being swayed by other factors."

This statement makes no mention of any nationality.

But everyone who reads it knows what he's talking about.

On the morning that Reuters' medical section reprinted the letter in full, it was snowing in Geneva.

In a small conference room on the fourth floor of the WHO headquarters building, three senior committee members sat around an oval table with Ye Zhen's nomination file in front of them.

One of the committee members adjusted his glasses and placed a printed copy of the NEJM open letter on top of the file.

"Ladies and gentlemen, I suggest that we postpone this nomination and resume the evaluation process after the controversy has subsided."

Another committee member flipped through the materials in his hand.

"A proposal personally signed by Dr. Mahler, and we're just going to reject it outright?"

"It's not a rejection, it's a postponement. Pay attention to the wording."

The third committee member remained silent, looking at Harrison's open letter on the table and tapping his fingers lightly twice on the surface.

"Notify the Chinese side."

He said.