“Dying to Survive”: How a Dark Comedy Exposed China’s Healthcare Paradox
When Xu Zheng’s gritty drama Dying to Survive (2018) grossed $450 million amid Chinese censors’ initial resistance , it didn’t just break box office records—it ignited a national conversation about pharmaceutical ethics that ultimately influenced healthcare reforms . More than a tearjerker, director Wen Muye’s masterpiece dissects the moral quagmire of survival capitalism through the lens of a flawed antihero. Here’s why this film deserves global attention.
I. From Profiteer to Martyr: Cheng Yong’s Subversive Hero’s Journey
Xu Zheng’s Cheng Yong begins as a comically pathetic figure—a divorcee selling male potency supplements in Shanghai’s back alleys. His transformation into a “medicine smuggler” for leukemia patients follows Joseph Campbell’s monomyth structure but with distinctly Chinese twists:
- Refusal of the Call (Act 1): Cheng initially rejects helping patients, sneering: “I’m not the Buddha—saving lives isn’t my job.”
- Supernatural Aid (Act 2): The “magic elixir” here is generic Indian Imatinib, priced at 1/20th of Novartis’ patented Gleevec .
- Atonement (Act 3): Cheng’s final act of selling drugs at a loss mirrors Confucian ren (benevolence), transcending legalistic morality.
Unlike Western biopics that sanctify their protagonists (e.g., Dallas Buyers Club), Cheng remains ethically ambiguous. In one haunting scene, he counts blood-stained cash while patients chant “Long live Yong God!”—a deliberate juxtaposition of martyrdom and profiteering.
II. Cinematic Realism: Vermilion Tides and Symbolic Color Palettes
Cinographer Wang Boxue employs color as narrative language:
- Red dominates early scenes (neon brothel signs, Cheng’s sweater) representing danger and moral compromise.
- Blue permeates hospital sequences, symbolizing bureaucratic coldness—note the azure-tinted police interrogation room.
- White emerges in the finale: Cheng’s prison uniform and snowfall during his prisoner transport signal spiritual purification.
The film’s most visually daring sequence—a surreal protest where patients remove masks to reveal necrotic faces—directly challenged China’s censorship norms regarding collective action imagery .
III. The “Medicine Tribe”: Microcosm of Reform-Era Inequality
Supporting characters embody specific societal fractures:
- Lü Shouli (Wang Chuanjun): A migrant worker turned patient leader, his suicide by hanging with scarves parodies the Red Guard’s ritualistic fervor.
- Liu Sihui (Zhang Yu): The pole-dancing single mother represents rural-urban displacement—her final whisper (“Tell them I’m going home”) critiques hukou system failures.
- Father Cao (Yang Xinming): The pious priest who rejects smuggled drugs, then dies from cerebral hemorrhage, symbolizes organized religion’s impotence against systemic injustice.
These intersecting narratives form what sociologist Yan Yunxiang calls “the underbelly of China’s economic miracle” .
IV. Ethical Dissonance: When Law Kills More Than Disease
The film’s central conflict—patent law vs. survival rights—parallels global debates from South Africa’s AIDS crisis to Martin Shkreli’s Daraprim scandal. Director Wen cleverly humanizes abstract policy through:
- Medical Jargon as Poetry: Patients recite drug names like mantras—”Imatinib, Nilotinib, Dasatinib”—transforming clinical terms into lifelines.
- Bureaucratic Satire: Officials debate “intellectual property protection” while patients cough blood in hallways, recalling Brechtian alienation techniques.
- Legal Paradox: Cheng’s trial for “disturbing market order” (a real charge in China’s 2014 generic drug crackdown .
VI. Global Relevance: Why Western Audiences Should Watch
- Universal Healthcare Debates: With 18% of Americans rationing medications due to costs , Cheng’s dilemma resonates beyond China.
- Anti-Hero Archetype: Cheng’s moral complexity offers an alternative to Hollywood’s simplistic savior narratives.
- Censorship Breakthrough: The film’s success despite sensitive themes signals shifting creative freedoms in Chinese cinema.
VII. Cultural Aftermath: From Screens to Policy
The film’s impact was seismic:
- Public outrage pressured China to include 17 anticancer drugs in national insurance in 2018 .
- A real-life “Cheng Yong” emerged—Lu Yong, the leukemia patient whose lawsuit inspired the film, now advocates for patent law reforms.
- State media co-opted the film’s message, with People’s Daily praising it as “a mirror for socialist core values” —a fascinating case of grassroots art being absorbed into official discourse.
Conclusion: More Than a “Chinese Dallas Buyers Club”
While Western comparisons are inevitable, Dying to Survive transcends imitation through its unflinching gaze at systemic complicity. The closing scroll text—“China has included 95% of patented drugs in medical insurance”—feels both triumphant and ominous, reminding us that individual heroism shouldn’t bear healthcare’s moral weight.
For global viewers, this film isn’t just about China—it’s a biopsy of capitalism’s cancerous contradictions, performed with Xu Zheng’s surgical precision.
-Availability: Streaming on Netflix with English subtitles.*