The largest criminal activity in the German pharmaceutical industry
Use anti-cancer drug loopholes to scams
German National Institute of Health (Robert-Koch-Institut) and The German Cancer Registry ZfKD publishes a report on the cancer status in Germany every two years. According to reports published many times, as Germans are living longer and longer, one in two people in Germany will be diagnosed with cancer in their lifetime.
According to the 12th report published in 2019 (2015/2016), there are currently about 1.7 million people living with cancer in Germany. They are all patients diagnosed in the last 5 years. 500,000 new patients. This figure has doubled compared to 40 years ago. Germany's statutory medical insurance company spends 7 billion euros on oncology drugs each year, of which 3.8 billion euros are used for injection drugs.
From this point of view, cancer drugs are a huge market, so what is the market situation? This article gives a detailed report on this market with examples.
4dac0a#Germany status report ZytoService should be shipped for money
There are three pharmacists in Hamburg, they are Enno Scheel, Thomas Detlef Boner and Thomas Hintz. In 2002, the three of them were in their 40s, when they worked together to open a pharmacy called Antares Apotheke. Antares is a red supergiant star in the banking system and the 14th brightest star in the night sky.
With their keen professional sensitivity, the three of them discovered that there is a huge shortage in the anti-tumor drug market. Cytostatic agents used as chemotherapy are expensive drugs. The price of a dose can range from one hundred euros to ten thousand euros, and a cycle of treatment can reach 100,000 euros. They are called "golden drugs" in the German pharmaceutical industry. ".
As long as certain professional conditions are met, the pharmacy can prepare chemotherapy injections for cancer treatment. Chemotherapy injections are prepared in the laboratory using powdered medicines and sterile solutions according to the patient's weight, body surface area and blood test indicators.
The three of them decided to set up a factory to replace the preparation of pharmacy laboratories with industrialized large-scale production of chemotherapy drugs. The three went as they pleased and established a limited liability company named ZytoService in Hamburg. Zyto is taken from the first four letters of the term Zytostatika, a cytostatic injection. Service means service. As the name suggests, the company provides services for formulating cytostatics. We will call it Zyto service company below.
In 2006, the company obtained a pharmaceutical license and began to prepare chemotherapy injections for other pharmacies. So far, it has seven laboratories with a total area of 3000 square meters and 26 workbenches. It is one of the most modern GMP sterile laboratories in Europe. The company's main products are anti-tumor drugs, antibiotics, parenteral nutrition and medical aids. In 2017, its operating income reached 240 million euros.
2019 Company entrance At 9 o'clock in the morning on December 17, 2005, a large number of police cars with flashing blue police lights suddenly appeared on the road where Zyto Service Company was located. The Hamburg Prosecutor’s Office and the police station dispatched a total of 6 prosecutors and 480 police officers to search the Zyto service company, medical practitioner’s clinic, pharmacy and the suspect’s private residence on this day.. This operation can be called the largest economic investigation in the history of Hamburg.
According to the procuratorate’s announcement, a total of 58 locations were searched that day, and about 1,000 paper boxes filled with written documents, about 100 mobile phones, computers and memory cards were collected. The suspect involved 9 doctors and 3 pharmacists. There are a total of 14 people, including a teacher and two general managers of the pharmaceutical company.
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The reason for collecting evidence da
4 This company bribed doctors and pharmacists on cytostatic drugs and cheated insurance companies, causing losses of at least tens of millions of euros in the insurance industry. The insurance company TK alone lost at least 8.6 million euros in 2017.The separation system of medicine and medicine in Germany has a long history
Chinese people who have lived and seen a doctor in Germany know that unless emergency treatment and accident injuries are caused at night, weekends and holidays, usually the doctor is not directly to the hospital. It is to go to the medical practitioner's clinic.
If you compare China's medical system, you can compare the countless medical practice clinics in Germany to a huge outpatient network. They constitute the most important part of the German medical supply system. Just like the principle of dispersing a large number of people from the main railway station to countless small stations for diversion, the work efficiency is much higher than that of everyone crowding together.
And in China, about 70% of the medical workload is in the outpatient department of the hospital. A system like Germany avoids congestion in the outpatient part of the medical supply. In contrast to China’s three-tier and ten-tier hospital system, medical resources are concentrated at the top of the tall, making it difficult to implement “graded” medical treatment.
In Germany, if you need to dispense medicine, the doctor will give the patient a prescription based on the condition, and the patient will take the medicine to the pharmacy on the market with the prescription. The patient pays a small handling fee to the pharmacy when taking the medicine, and the pharmacy settles the medicine fee with the insurance company. This separation system of medical and pharmaceuticals in Germany originated in 1241. On May 23 of that year, the first pharmacy in Germany, Lion Pharmacy, opened in the central square of Trier. According to the records of the Trier City Archives, Fridricus, the butler of the archbishop of the city, handed over the business license to the pharmacy on this day.
2041 on Trier The birth of Germany’s first pharmacy Löwen Apotheke (Lion Pharmacy)
Löwen Apotheke (Lion Pharmacy)’s business license
It is said that in 1231, the then Holy Roman Emperor Frederick II (Frederick II, also translated as Frederick II) issued a The regulation "Edikt von Salerno" stipulates that the "separation of medicine and medicine" means that the two professions of doctor and pharmacist must be separated. Doctors are not allowed to make money from medicines given to patients. The task of doctors is to diagnose and prescribe medical treatment. Prescriptions; pharmacists are not allowed to diagnose and treat patients, and medicines can onlySold at the legal price.
This regulation is still in effect today after more than 700 years. In addition to the universal medical insurance system, medical treatment is free. There is no direct economic connection between doctors and patients in terms of medical treatment and medicine (except for non-insurance items for dentists) ), there is no financial relationship between the doctor and the patient. The doctor-patient relationship here is a community of interests for everyone to deal with the disease together.
Emperor of Rome Frederick II (Frederick II)
is another case for chemotherapy drugs for cancer. The doctor's prescription is not directly given to patients, but to pharmacies qualified to prepare chemotherapy injections. The pharmacist in the pharmacy prepares injections in the laboratory with powder and sterile solutions according to the patient's weight, body surface area, and blood test indicators. The prepared medicine is sent directly to the doctor, who then gives the patient a drip.
Whether a pharmacy is qualified to prepare chemotherapy drugs depends on whether it has a special sterile laboratory. There are only about 250 pharmacies in Germany with such qualifications, plus some pharmaceutical companies.
4dac04a# Pharmacy Laboratory The service company has a monopoly in the industry
Not long after the establishment of Zyto Service Company, in 2008, it received investment from the investment fund organization Capiton. With the power of investment funds, Zyto Services established a huge laboratory worth 7.4 million euros. At the same time, they lobbied to exert their own influence on the Federal Parliament and the Ministry of Health. In the 2017 German general election, various political parties launched an election campaign during which the current Minister of Health Jens Spahn visited the Zyto service company. Enno Scheel, one of the founders of
, also established the "National Federation of Prescription Drug Preparation Enterprises" (BRH). 12 prescription drug preparation companies are members of this organization. Enno Scheel is still the chairman of the organization. The organization formulated strict documents and sterile laboratory standards, which made some ordinary pharmacies unable to qualify. Subsequently, according to the provisions of Article 13, paragraph 1, of the German Pharmaceutical Law (AMG), chemotherapy injections and artificial nutrition liquids used by cancer patients Antibiotics and antibiotics can only be prepared by "prescription drug preparation companies" with production licenses, or by compliant pharmacies and hospitals' own pharmacies.
"Enterprise United Prescriptions" "(BRH) President Enno Scheel Press Spokesperson Katrin Kollex
From this perspective, prescription drug preparation companies monopolize this industry to a certain extent. Zyto Services has grown rapidly. Between 2011 and 2017, the company's output doubled and sold 400,000 sets of injections; operating income almost tripled to 240 million euros. In 2016, the Capiton Investment Fund withdrew from Zyto Services, and was joined by the IK Investment Fund. Currently, the New York Teachers’ Pension Fund and the Manchester Public Employees’ Public Fund have invested in the company.
As mentioned earlier, Germany has implemented a system of separating medical care and medicine for more than 700 years. Since the company has mastered the drug link on the one hand, how can it control the medical treatment on the other hand? As the saying goes, fat and water do not leak out, if it can unconsciously combine medical care and drugsAll links are controlled, and letting our own doctors write out prescriptions for their own dispensing factories and pharmacies is not a bigger game of chess.
Acquired a hospital in Hamburg to establish a base camp
There is a Mümmelmannsberg community (Mümmelmannsberg) in the east of Hamburg, and about 18,000 residents live in this 2.8 square kilometer community .
In this community, a quarter of people live on subsistence allowances (H4), and 60% of the housing is social welfare low-rent housing for the unemployed or low-income families. There is a simple two-story building in this area with many practicing physician clinics, and on the second floor there is a community hospital called SKH. In 1990, the hospital still had 82 beds and about 3000 inpatients every year.
However, the hospital is going downhill every day, and there are only less than 1,000 inpatients left in 2012. The hospital announced its closure more than five years ago, but the Zyto service company came to buy this small hospital. At this time, there were only 15 beds left in the hospital. However, don't underestimate this small hospital at a time of crisis. Zyto Services will start from here and launch a "revolution" in the oncology medical market.
Germany has the world's oldest universal medical insurance system, its origin can be traced back to Bismarck's 1883 "Sickness Insurance Law". In order to effectively reduce the national medical insurance premiums and the additional costs of social insurance in people's salaries in the long term, the German government implemented medical system reforms in 2003.
Since 2004, in addition to the clinics of practicing doctors and the joint clinics of two or more doctors, practicing doctors who have a contract with the social security system can open a comprehensive multi-disciplinary medical center (full German name: Medizinisches Versorgungszentrum , Abbreviated as MVZ), that is, doctors from different departments who have contracts with the social security system can get together to open a medical center, and the medical center can also hire doctors who have no contract with the social security system.
In Germany, dentists can directly settle the patient's treatment costs with the insurance company, while doctors in other departments settle the patient's treatment costs with the Practicing Physician Association, which then settles with the insurance company. MVZ Medical Center looks like a hospital on the surface, but it is completely different from a hospital in terms of system. After
SKH Community Hospital was acquired by Zyto Service Company, it served as the parent company and began to establish medical centers in this city and other cities across the country. So far, it has a total of 15 medical centers distributed throughout Germany, and it is said that it will expand to 30 in the next few years.
In Germany, in addition to the separation of the medical and pharmaceutical industries, Germany also issued a regulation in 2012 that pharmacies and pharmaceutical factories (such as Zyto Service Company) are not allowed to establish medical centers. Medical centers only It is allowed to be established by medical practitioners and hospitals that have a contractual relationship with social security (see Volume 5 of the Social Law). But who is the real behind-the-scenes boss of the medical center is not clearly stipulated by German law and the Ministry of Health. Obviously there is a legal loophole here, and Zyto service company takes advantage of this loophole.
The journalists of the North German Radio and Television Station NDR and the German "Die Zeit Online" (Die Zeit Online) of the German-Guangxi Federation have spent a lot of time and money investigating how Zyto service company exploited legal loopholes. According to media reports, the investigative expenses they invested are equivalent to the price of a mid-to-high-end car.
In Germany, if doctors want to open a personal clinic on their own, they need a special license, which is equivalent to a contract with an insurance company that can insure patients. Localities have controlled the number of such licenses. One is to prevent too many doctor clinics from appearing in a certain place, and the other is to ensure a stable income for doctors. If a practicing doctor in a clinic approaches his retirement age, he can transfer his license at a price, usually for a transfer price of about 60,000 Euros.
Zyto service company has a layout throughout Germany
Mysterious personnel related to Zyto service company’s background will look for oncologist clinics to retire all over Germany, and then visit the house and make a sum of hundreds of thousands of euros. The price (approximately 800,000 euros) is to buy the clinic and ask the medical practitioner to transfer the license to them.
Theclinic will be changed to a medical center after the transfer, so that the licensed doctor can be employed in the future medical center. The salaries of hired doctors will not be very high, but with the expansion of medical center business income, doctors can get more money.
How to expand the income of the medical center? That is to rely on a lot of prescriptions for cancer drugs. Some doctors will accept their conditions, transfer their licenses, and sell their clinics. The original clinic was transformed into a branch of the SKH Community Hospital mentioned above-the medical center.
The oncology drug prescription issued by the medical center will fly to the Zyto service company, and the formulated drug will be returned to the medical center for patient use. In this way, Zyto Service Company monopolized the prescription of oncologists. So far, 15 such medical centers in Germany have the background of Zyto service company.
Of course, this background must be hidden and cannot be made public. Then how to conceal it?
According to the author's survey, in the first quarter of 2017, an investment company named ZytoService Investment was incorporated in Hamburg with a registered capital of 25,000 euros. The Enno Scheel and Thomas Detlef Boner families mentioned at the beginning of the article each hold 11.6% of the shares, 74% of the shares are owned by an international investment company in Luxembourg, and 2.5% of the shares are senior executives from Zyto Services and SKH Community Hospital hold.
About 9 months later, this newly established company changed its name to Alanta Investment, and then the investment company established a company called Alanta Health Group in Germany. ), Zyto Service Company and SKH Community Hospital are 100% owned by Alanta Health Group. The 15 medical centers distributed throughout Germany are 100% SKH community hospitals.
Therefore, people will not easily see the relationship between Zyto Service Company and 15 medical centers. Through several bewildering "turns" of the above companies, the relationship between Zyto Service Company and 15 medical centers has become no longer transparent.
where the SKH04 community hospital is located
If we say that the development of the above-mentioned events did not bring adverse effects to the patients, the patients still received the treatment they deserved. But things may not be as simple as the general clinic has nothing to do with the pharmacy. Because the doctor at the medical center would think that the more and more expensive the medicine he prescribes to patients, the more rebates he will get. Therefore, patients will get overdose medication, which will have a great negative impact on patients' health.
What is more insidious is that the patient died due to overdose of the drug, making it impossible for others to find out the real cause of death. On the one hand, the patient suffers from pain due to chemotherapy. The patient will lose hair, vomit, swell or numb the hands and feet, pruritus all over, exhaustion, sweat, and dry mouth; on the other hand, the doctors secretly earn a lot of money. . Professor Wolf-Dieter Ludwig, oncologist and oncologist of the German Medical Board of Doctors, said in an interview: "In order to increase the profits of the company, doctors prescribe expensive drugs that are not necessary for treatment, which is dangerous for patients. Only. Cell inhibitors and antibiotics in doses exceeding the actual required doses will bring profits to the company.”
With the emergence of medical centers related to Zyto Services, other pharmacies in the area where the medical center is located will be overnight The doctors in the medical center never got prescriptions anymore, even though the doctors who sold the clinics had been cooperating with the local pharmacy for many years, all the prescriptions of those doctors flew to the Zyto service company in Hamburg. Those pharmacies had also invested in the establishment of expensive sterile laboratories because they had to obtain the qualifications to prepare chemotherapeutic drugs.
Just a few weeks ago, the German Bundestag debated the topic of private investment in the establishment of medical centers. When the federal government reluctantly stated that it was ignorant of the background of the approximately 3,200 medical centers in Germany, the left party proposed to establish a transparent registration system for medical centers. The Federal Senate also proposed that in the future, only the hospital can establish a medical center in the area where it is located, and the various subjects owned by the medical center are already available in the hospital. The German Congress of Doctors also requested in a resolution that strict rules should be established for medical centers and that doctors' treatment decisions for patients must be decoupled from economic interests.
The author went to the Zyto service company on December 20, 2019. There are already two security guards at the entrance of the company. Strangers are not invited to enter. That is, on December 20, Alanta Health Group, the parent company of Zyto Service Company, stated on its official website, “For us, the first priority is to provide high-quality services to all patients. This is what we always guarantee. , And will continue to be guaranteed in the future. We cherish the freedom of treatment that all oncologists have. We have never interfered or prevented the freedom of treatment. The medical center associated with the SKH Community Hospital is medically Completely independent, we firmly believe that physicians and medical staff will provide patients with the best services according to the current effective treatment guidelines." They continue to state that "Alanta Health Group’s business model is fully in compliance with applicable laws, in particular, all medical centers are approved through legal procedures. Therefore, we believe that all allegations are meaningless. We will work with the prosecutors. The officer communicates with the competent department. We firmly believe that all charges will be dropped."
The photo on the company website
Chinese pharmaceutical companies bribed doctors on a large scale
Because it is a Chinese-language media, readers have more or less Chinese background. After reading this, it would be incomplete if the reader compares this scandal in German medicine with the Chinese medical circle and concludes that the world is generally black. The Zyto service company incident is still in the investigative stage. Whether it violated the law is still pending investigation by the procuratorate and the court's ruling. In China, it is another situation.
In China, medical representatives have been bribing doctors for 20 years. It has been popular for many years and is a well-known way of selling medicines in the industry.
In the early 1990s, a new profession-"medical representative" emerged. This was a popular profession at the time, and many medical graduates applied for the job and made a lot of money. Where did the money come from? It is the so-called bribery that is condemned so hard in China today.
Medical representatives need to go to major hospitals every day to communicate with doctors and introduce their new products. Every time a doctor prescribes a corresponding medicine to a patient, the medical representative can get a corresponding rebate, and the doctor himself can also get a certain rebate. This sounds like a win-win situation. The more medicines introduced by medical representatives are used by doctors, the more money the doctors and medical representatives will pocket.
Of course, the wool is on the patients, so for a long time, the price of medicines has increased, especially imported medicines. Because the drug price itself not only represents the basic costs of R&D, manufacturing, logistics and management, but also includes rebates from doctors and medical representatives. This kind of mutually beneficial culture between medical representatives and doctors has lasted for more than 20 years. It has been mixed in various bribery fields in China's industries, but it is on par with other industries because of the same corruption, and it doesn't feel bad. And after a long time, I feel that this is the normal habit of the pharmaceutical industry.
Until February 7, 2017, an official document issued by the State Council put the medical representative to the test, which has always been controversial. The General Office of the State Council promulgated the "Several Opinions on Further Reforming and Improving Policies for the Production, Distribution and Use of Drugs" (referred to in the industry as "Pharmaceutical State Article 17"), which clearly requires medical representatives to only engage in activities such as academic promotion and technical consultation, and not to undertake drug sales tasks. His untrustworthy behavior will be recorded in his personal credit record. The publication of Article 17 of the State of Medicine means that medical representatives willSeparated from sales. The domestic "medicine for medical treatment" mechanism has penetrated into the medical system, and drug revenue has become the most important source of hospital funds.
Reposted from China Business Daily
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