Why an 8-year-old girl uses “viagra” to survive

On September 5, 8-year-old Xiaoya unexpectedly became popular on the Internet. A video with over 8 million views. Xiaoya walked timidly to a large drug store in Zhengzhou and told the pharmacist that she would buy “sildenafil”.

Sildenafil is commonly known as “Viagra”. Traditionally, this is a medicine for treating male erectile dysfunction. The pharmacist thought that something was wrong, and stopped Xiaoya from asking who to buy “Viagra” for.

“I’m using this medicine. This medicine can cure my illness.” Xiaoya replied timidly.

In a strange look, Xiaoya’s mother appeared, “Viagra is Xiaoya’s life-saving medicine.” She explained with tears that Xiaoya is a patient with pulmonary hypertension. Taking “Viagra” can help relieve the pressure on the pulmonary blood vessels.

Pulmonary hypertension is often referred to as “cancer in cardiovascular disease” and is also referred to as “blue lips” because patients’ lips are often blue. Without treatment, the average survival time of patients is only 2.8 years. Cheung Chi Cheng, a distinguished professor of the Yangtze River Scholars and Fuwai Hospital of the Chinese Academy of Medical Sciences, previously stated publicly that conservative estimates estimate that there are about 5 million patients with pulmonary hypertension in China, and only 20,000 to 30,000 have received treatment.

Long-term drug treatment can significantly improve the survival rate of patients with pulmonary hypertension, but more than just Xiaoya’s drug costs and examination fees have been hollowed out over the years. They reluctantly turned to the cheaper Viagra.

Bad “birthday gift”
The nightmare started when Xiaoya was 3 years old. Xiaoya was hospitalized for suspected encephalitis. After various examinations, local doctors found that Xiaoya had mild heart disease, and the pulmonary artery systolic blood pressure was much higher than normal.

On the referral of the doctor, Xiaoya’s parents took her to Wuhan Asian Heart Hospital. On her third birthday, Xiaoya received a terrible “birthday gift”-idiopathic pulmonary hypertension.

Pulmonary hypertension patients are easily fatigued, unable to perform high-intensity exercise like normal people, and can not be tired. Xiaoya can only go out by “car”-sitting in the mother’s folding trailer. Because of prolonged hypoxia, each of their walks is extremely difficult. Often accompanied by a wheelchair and an oxygen generator, shortness of breath after a short movement, this is a real life portrait of patients with advanced pulmonary hypertension.

“Pulmonary hypertension drugs can change the fate of patients.” Jingya Cheng, Xiaoya’s attending doctor, said that as long as the medication is continued, many patients can survive with high quality. Cheng Jiangtao, chief physician of structural heart disease at Fuwai Huazhong Cardiovascular Hospital, said frankly, “The key is to keep up with the medicine. But China currently does not have original drugs for treating pulmonary hypertension, only imported drugs and generic drugs.”

Eat “blue pills” just to save money
Since 2014, Xiaoya has tried many targeted drug combinations.

“Miracetam, 29,980 yuan per month; Leoazepam, 8,000 yuan per month; Anrisentan and Bosentan, 5385 yuan per month; Injected remodullin, about three per month, 10,000 yuan . There are also two or three drugs in combination. “Xiaoya’s mother treats these expensive life-saving drugs like several treasures.

However, none of these targeted drugs have entered health insurance in Henan Province. Xiaoya’s parents tried their best to get her daughter to take imported targeted medicines at first, but later the economy was really tight. When she saw some patients rely on Viagra to delay the illness, she had to help Xiaoya also eat the relatively cheap Viagra. Sildenafil is 126 yuan per capsule, which should be taken three times a day. Nevertheless, one month later, the cost of medicine also needs more than 3,000 yuan.

Cheng Jiangtao said that sildenafil tablets can help Xiaoya relax the pulmonary arteries and reduce pulmonary vascular resistance. After taking the drug, reactions such as blushing and heartbeat may occur. In general, the side effects are not great and can be tolerated, but it should be taken under the guidance of a doctor.

Talk about the total cost of seeing a doctor over the years. Xiaoya’s mother passed it with “inestimable”. Behind this, the family took their children to Beijing, Wuhan, and Zhengzhou to see doctors, buy medicines, review, and treat again and again.

Doctor’s embarrassment: medication beyond the instructions
For the use of sildenafil in the treatment of pulmonary hypertension. Ordinary people may find it strange. In fact, the “main effect” of sildenafil that is now well known is nothing more than inadvertent insertion.

Sildenafil was originally developed as a drug to treat coronary heart disease, and recruiting volunteers for clinical trials did not work well, but when the pharmaceutical company Pfizer intended to withdraw the remaining trial drugs from the subjects, male volunteers Unwilling to take it back. The scientists then stumbled upon the drug’s “unexpected effect” and turned it into a worldwide “viagra”. Since then, research has found that the drug can also dilate pulmonary blood vessels, so it has become a targeted drug for patients with pulmonary hypertension.

It is embarrassing that although sildenafil has been approved for marketing in Europe, America and other countries for many years, and is recommended as a first-line drug in the diagnosis and treatment guidelines of pulmonary hypertension, China’s clinical diagnosis and treatment guidelines also recognize this practice. But in China, its indication is only “male erectile dysfunction” (hereinafter referred to as ED). In other words, the treatment of pulmonary hypertension belongs to “over-the-counter medication”.

Because the dose of “Viagra” in China is set for the treatment of ED, for patients with pulmonary hypertension, it is often necessary to take one tablet in 4-5 servings.

In China, the reasons behind sildenafil’s lack of indications for increasing pulmonary hypertension are complex.

An informed doctor revealed that in 2005, after Revatio (a brand name for indications for the treatment of pulmonary hypertension) of sildenafil was launched in the United States, Pfizer, a multinational drug company that developed the drug, once germinated to market this product in the Chinese market. The idea of ​​a drug, but at the time, the Chinese medical community didn’t know much about this particular cardiovascular disease. In addition, the addition of indications requires pharmaceutical and clinical research to be conducted in accordance with drug registration management measures and related technical guidelines, and approved by the State Drug Administration. The large investment in clinical trials, coupled with the low incidence of pulmonary hypertension, has shown little incentive for pharmaceutical companies when the expected profit is uncertain.

Make more patients affordable
The reporter found it in Baidu’s “Pulmonary Hypertension”, and found that there are some patients who seek cheap medicine to continue life like Xiaoya.

Jing Zhicheng learned that in many countries or regions, medicines for treating pulmonary hypertension are included in medical insurance. He has seen many patients rush to Beijing from other places with great expectations, but can only be disappointed to leave because of economic distress-although they clearly know that the hospital has medicines that can be treated, they can survive the medicine.

The good news is that countries and businesses are working to make more patients affordable.

In August 2018, the first domestically produced generic drug Anlipsentan was approved for marketing. At present, 5 provinces have included it in the medical insurance reimbursement catalog. Media sources for the drug maker Howson Pharmaceuticals said that if patients use the drug normally, through “buy three get three free” charity assistance, the patient’s monthly cost is 1200 yuan to 2400 yuan. The cost is reduced by about two-thirds compared with taking the original medicine.

In December 2018, the Medical Insurance Bureau of Inner Mongolia Autonomous Region officially included pulmonary hypertension into the coverage of special chronic diseases in basic medical insurance clinics. Drugs include bosentan tablets, anrisentan tablets, treprostinil injection, and iloprost for inhalation. The solution will save patients nearly 40,000 yuan each year. Inner Mongolia has also become the first province in the country to include most of the medications for pulmonary hypertension in the medical insurance catalogue.

Zhejiang, Jiangsu, Tibet, Shandong, Ningxia, Hunan and other provinces and regions have also included individual pulmonary hypertension drugs in the local medical insurance catalog.

On September 14, Xiaoya’s mother told reporters that Xiaoya’s heart failure has now been controlled. Xiaoya can go to school, but she can’t take physical education classes, and she can’t exercise vigorously.

On the “easy fundraising” platform where Xiaoya’s mother initiated crowdfunding, a patient commented that Xiaoya was a beautiful girl with big eyes and long eyelashes, but she must be accompanied by the disease at the same age. “I hope you will recover soon , Don’t fight pulmonary hypertension for the rest of my life. “