Monday, 31 December 2012

Shanghai cord blood bank claims successful treatment in hundreds of patients

Shanghai Cord Blood Bank has collected 20,000 samples
A five-year-old boy with a serious blood disease is expected to receive an umbilical cord blood transplant today, setting a record of 200 cord blood transplants — an increase of 47 percent — in the city this year.
The patient, surnamed Zhang from Jiangxi Province, had a fever of unknown origin in September. After a 10-day treatment with antibiotics was ineffective, the local hospital found he had acute and severe aplastic anemia.
The disorder is a result of a patient’s bone marrow not making enough new blood cells.
The boy was transferred to Shanghai Children’s Medical Center on October 11 for treatment. Doctors helped him find a matched donor from the China Bone Marrow Bank.
“However, the donor refused to get an additional health check, which is a must for a transplant,” said Zhang Jiaqin, an official at Shanghai Cord Blood Bank. He said a donor’s privacy is protected.
The boy was transferred to Shanghai No. 1 People’s Hospital for treatment in November.
Failing to find a matched donor from the bone marrow bank, the patient’s family turned to Shanghai Cord Blood Bank and found a matched sample in mid-December.
Umbilical cord blood, collected during a baby’s delivery, and donated bone marrow are both used for blood and immunity disease treatment. The key factor is stem cells, which develop into other types of cells. Stem cells from umbilical cord blood are less mature than those from adult bone marrow, less prone to rejection and more active in developing into other cells.
Shanghai Cord Blood Bank has collected over 20,000 samples and has fulfilled over 600 transplants since being established in 2004, making it a key supplementary service.
Source: Shanghai News

Orphans to get free medical care

Orphans in Fujian, Liaoning and Hainan, as well as Tibet and Ningxia will be covered for critical illnesses
Nearly 30,000 orphans received health insurance contracts to cover the treatment of 12 critical illnesses on Monday.
"It's our best new year gift for the children and I hope more people can join in our efforts to help them," said Dr. Heidi Hu, managing director of the China Children Insurance Foundation (CCIF).
Orphans from the provinces of Fujian, Liaoning and Hainan, as well as Tibet and Ningxia Hui autonomous regions, are benefiting from the expansion of a joint insurance program sponsored by the Chinese Ministry of Civil Affairs (MCA) and the CCIF.
The insurance, paid for with donations, will be accessible for one year starting from Jan. 1, 2013. It is designed to benefit children of poor families and MCA-registered orphans under the age of 18.
Each child is insured for 100,000 yuan (16,091 U.S. dollars) at a premium of 50 yuan a year.
The 12 major illnesses covered by the insurance program include malignant tumors, illnesses requiring organ or stem cell transplants, acute kidney failure, aplastic anemia, acute hepatitis and infantile paralysis.
Since the insurance program was launched in July 2009, the CCIF has distributed nearly 650,000 insurance contracts to children in 20 provinces and regions, from the quake-hit southwestern province of Sichuan to the plateau areas of Qinghai and Tibet.
"It's the third year we have been able to offer such insurance to orphans in Tibet, Fujian, Liaoning and Ningxia. For those in Hainan, it's the second year," Hu said.
Hu said the organization received more small-scale donations this year, mainly through the Internet. Previous years' donations were mainly made by large enterprises.
"We opened a donation center on Taobao, China's version of eBay, this year to expand our search for donors. It has really helped to keep our project sustainable," Hu said
"We will continue to work with civil departments across the country to search for possible insurants and renew our beneficiary list every year. Our current goal is to help all 712,000 registered orphans in China," Hu said.
To guarantee transparency in the insurance program's operation and management, the doctor said all donation-related information can be checked and verified online at baoxian.cctf.org.cn, a website hosted by the China Children and Teenagers' Fund, the parent foundation of the CCIF.
Source: CCIF

AstraZeneca invests in R&D into Chinese herbal medicine

AstraZeneca will fund Shanghai research into Herba Leonuri
AstraZeneca has signed a research collaboration with Fudan University, a leading Chinese academic institution in cardiovascular disease research.
The research agreement focuses on pre-clinical studies to understand the mechanism of action of leonurine, a compound derived from Herba Leonuri, a herb used as a traditional Chinese medicine.
Understanding the role of leonurine in cardiovascular diseases such as chronic heart failure, ischemic stroke, and atherosclerosis may ultimately help in the development of novel medicines.
With over 100 million people with heart disease, China is the ‘diabetes capital of the world.’ Cardiovascular diseases are a major complication of diabetes; about 65 percent of people with diabetes die from heart disease and stroke.
“We’re delighted to be collaborating with AstraZeneca, a world-leader in biopharmaceutical innovation,” said Principal Investigator for the research at Fudan University, Professor of Pharmacology and Dean of the School of Pharmacy, Dr Yi-Zhun Zhu. “Understanding the structure and properties of natural substances may open doors to potential drug targets and provide innovative pathways to explore in the fight against major health burdens including cardiovascular disease,” he added.
Under the terms of the agreement, Fudan University scientists will work in collaboration with teams from AstraZeneca’s Cardiovascular and Gastrointestinal Innovative Medicines group over the next two years.
“Partnering and collaborating with scientists, biotech companies and best-in-class academic institutions like Fudan University brings our Asia R&D strategy to life by helping us harness the increasing levels of innovation we see coming out of China and other emerging markets,” said Dr. Steve Yang, AstraZeneca’s Head of R&D for Asia and Emerging Markets.
Source: Asian Scientist

Beijing hospital staff accused of using ambulances for personal errands

by Ernest Kao
Beijingers claim that ambulances are being used by hospital staff for private trips
With sirens wailing, a Beijing ambulance headed for the hospital was not rushing a patient back at all. It was returning from a noodle restaurant where staff members had dinner that night.
It was Friday evening in Beijing and along Haidian Dong San Jie, an ambulance could be seen hurtling down the street – the vehicle's blue and red lights flashing and sirens wailing.
The ambulance from the Beijing Emergency Medical Centre in Haidian was not rushing a sick or injured patient to the hospital, however. In fact, it was not carrying any patients at all.
The ambulance crew was heading back from dinner at a nearby noodle restaurant. Onboard were other hospital staff, all dressed in their white medical coats.
A netizen who claimed to be in the area snapped a photo of the ambulance as it returned to the hospital and reported the incident on his Sina Weibo account @BG2RHY.
“I frequently see ambulances from the Haidian hospital parking lot drive over to a restaurant for meals. They will then turn on their sirens and head back to the hospital. I’d like to ask 1) aren’t these ambulances under the management of the hospital? 2) Are these acts even allowed?”
His post spread across social media, sparking debate over emergency-staff work ethics and non-compliance issues.
As of Monday morning, the thread “should [drivers] give way to ambulances?” has been trending on weibo, racking up more than 7.8 million mentions and  more than 3,300 shares.
“So even doctors lack ethics and discipline now...this is sad,” wrote one user on weibo.
The Haidian hospital acknowledged the incident and launched its own investigation.
"Only in the case of an emergency would the use of a siren be permitted...ambulances are not 'privilege cars' and any private use would prompt investigation," one hospital official told the Beijing News on Sunday.
The hospital announced its findings at a news conference on Monday and, on its official weibo account, said the ambulance crew would be handed the “appropriate punishments”.
The Haidian hospital does not have a cafeteria, and staff members frequently went out to dine at nearby restaurants.
Beijing’s emergency services have become the subject of much public attention recently, especially after a woman died in the back of an ambulance in early December, when a supposedly short three kilometre trip to the hospital took more than 40 minutes in the city’s manic rush hour traffic.
Source: SCMP

Sex hospital opens in Wuhan for infertile couples

Despite the plethora of sex videos and DIY tomes on the art of conceiving, some couples face huge problems when it comes to having babies. Now an enterprising hospital in Hubei has introduced its "second nuptial chamber" to aid those affected.
Each room in the Songziniao hospital in Wuhan, Hubei province, comprises 538 square feet of matrimonial bliss - red lamps, sex toys, automatically adjustable double bed and diagrams.
Sex-skill videos, nurse and air hostess uniforms are available on request.
Huazhong Normal University sex professor Peng Xiaohui highlighted the magnitude of the problem.
He once treated a couple who failed to conceive after three years of marriage. The reason - the husband had mistaken his wife's belly button for her privates.
A session in the nuptial chamber does not come cheap - couples will have to fork out 880 yuan (HK$1,093) per night.
Source: HK Standard

Clinical news from China: Journal Watch

Researchers from Shandong University identify the enteroviruses responsible for  causing hand foot and mouth diesease in children (PLOS One).

About 60% of children have high levels of pyrethroid insecticides in the blood, possibly because of the use of mosquito repellants, according to a study by researchers from Fudan University, Shanghai. (Chemosphere).

Water supplies and soil near farms in China contain high levels of antibiotics such as sulfonamides, tetracyclines, fluroquinolones, macrolides and trimethoprim, a study from the Guangzhou Institute of Geochemistry has found. (Science of the Total Environment).

The diagnosis of Parkinson’s Disease can be differentiated from essential tremor in Chinese patients by assessing sense of smell and ultrasound abnormalities of the substantia nigra, say researchers from the Department of Neurology at Ruijin Hospital, Shanghai. (Translational Neurodegeneration).

Cryptococcal meningitis is relatively uncommon but highly fatal disease in China, according to researchers from Shijiazhuang. They say clinicians should consider the infection as a potential cause for pediatric meningitis in children, particularly boys from rural areas, who have had contact with birds/bird droppings or saprophytes and in children who did not receive prompt medical attention.
(BMC Infectious Diseases).

Central venous catheter-related bloodstream infections are more likely to occur in intensive care patients who have multiple lines and in those who have already been treated with antibiotics prior to having a line inserted, a study from the Chinese Medical University in Shenyang has found. (Journal of Critical Care).

Honey from Zhejiang contains toxic levels of arsenic, a study conducted by the Zhejiang University of Technology, Hangzhou has found. (Food and Chemical Toxicology).

Some men with HIV in China have antibody responses that neutralise a wide range of HIV subtypes, suggesting it may be possible to develop a ‘broad spectrum’ anti-HIV vaccine.
(PLOS One).

Saturday, 29 December 2012

From Omaha to Shaanxi: US doctors help develop rural health

by Paul Goodsell
US doctors on exchange in Shaanxi says Chinese doctors are just as knowledgeable, but work in a different system
Hooked to an IV, Zhu Qingli sat on a wooden bench and watched television in an outpatient room in a small hospital deep in the Chinese countryside.
The 28-year-old, wearing a basketball jersey and shorts in the purple and gold of the Los Angeles Lakers, was getting treatment for bronchitis. His once-heavy cough was gone and he was feeling much better, but he still needed a few more days of antibiotics.
The hospital was primitive by U.S. standards, with cracked concrete walls and ill-fitting doors in the outpatient room. But the young man's treatment was more modern and sophisticated than it would have been in this rural area even a few years ago — partly because of training provided by Nebraska doctors.
China's leaders have been open to such help because they want to modernize the country's health care system and reduce the wide gap in medical services that exists between the country's rich cities and its poor rural areas.
“Take every disparity in the United States and multiply it times 10, and you've got China,” said Jeffrey Harrison, a family medicine professor at the University of Nebraska Medical Center.
But in the past three years, China has poured $125 billion into an overhaul of its health care system. Rural doctors in Xunyang and other remote areas are better trained than they used to be, and rural hospitals are getting better equipment.
China's efforts have been aided by UNMC physicians like Harrison who have traveled to China or welcomed visiting Chinese doctors and professors who go to Omaha to learn about primary care medicine and rural health strategies.
“We do family medicine and primary care and rural health pretty well,” Harrison said.
The UNMC effort in China is partly altruistic, reflecting doctors' desire to educate and improve care. But it also is driven by the self-interest of Nebraska and its university.
Deeper ties with China — also including student exchange programs — open the door to joint research projects and other collaboration that help UNMC, university officials say.
More broadly, as Nebraska makes more connections with China, they open doors to better trade opportunities in agriculture, irrigation systems and other Nebraska goods and services.
“At the 30,000-foot view, we're there because it's good for the state of Nebraska,” Harrison said. “The Chinese are very relationship-oriented. They're going to buy goods from their friends.”
In fact, UNMC's work stemmed from contacts made during Nebraska trade missions to China. And during Gov. Dave Heineman's trip there last summer, officials formalized an extensive partnership that has been developing between UNMC and Chinese academic institutions.
UNMC officials are good ambassadors for the state's economic development efforts in China, said Joe Chapuran of the Nebraska Department of Economic Development.
“It makes us stand out,” said Chapuran, who organizes the state's trade missions.
For rural doctors in Xunyang and elsewhere in Shaanxi province in central China, the Nebraska connection involves UNMC doctors who have gone to China to teach about primary care and about developing relationships with patients.
In China's health care system, people with ailments typically go to large hospitals, take a number and wait to see a specialist rather than starting with a family doctor. They don't always see the same physician on repeat visits, and they often get little ongoing, preventive care.
UNMC has been providing guidance to the Chinese on how to shift to a family medicine approach.
The Chinese government has been retraining its rural doctors. Doctors from far-flung parts of Shaanxi province are brought to the capital city of Xi'an for four months of classroom work followed by eight months of observing experienced physicians in modern hospitals.
Typically, eight UNMC professors have gone to Xi'an annually since 2008 to give lectures and training in family medicine and rural health care. Starting in 2010, the faculty members also have gone to Shanghai.
“The students get very excited because they know they have American doctors to help them,” said Chunli Wu, a nurse who was trained in the U.S. and is coordinator of the rural doctor training program in Xi'an.
At first, Harrison said, he and his colleagues thought they would be teaching medicine to the Chinese doctors they instructed. But they were soon humbled to realize that the Chinese were just as proficient as the Americans in medical knowledge.
“They do the same things we do. They know the same things we know,” Harrison said. “It's just teaching them a different system, that this is the model of care we use.”
Dang Giangrong, a rural doctor from another city who has been through the program, said the UNMC doctors gave him a new approach.
“To be patient with them,” Dang said. “To treat them not as a disease, but as a whole. They showed me how to talk with the patient nicely, and also educate the patient.”
Zhang Li An, who heads the Ganxi Central Medical Care Center in the outskirts of Xunyang, said the retraining efforts have made a difference at his hospital, a nearly four-hour drive from Xi'an on twisting mountain roads.
When Zhu Qingli came in with his bronchitis, Zhang said, his doctors talked to him about his lifestyle. They are trying to determine the cause of the illness, not just provide treatment.
In addition, he said, they were able to do a chest X-ray using modern equipment that the government upgraded recently.
Even so, he said, rural health care in China remains less advanced than in bigger cities.
“We still have a long way to go,” Zhang said.
Source: World Herald

Officials use loophole to retain 'unfair' free medical treatment

by Alice Yan
Officials to be reimbursed for losing access to free treatment
Civil servants in the eastern city of Nanjing will lose their privileged access to medical treatment next week, making it the last city in the Yangtze River Delta to implement a reform launched by the central government 14 years ago in an attempt to assuage public concerns about the unfair benefits given to officials.
The "free medical treatment" scheme, introduced in the early 1950s, allowed civil servants to receive assistance at public hospitals for little or no cost.
Unlike the employees of businesses, whose medical insurance contributions are deducted from their salaries each month, officials didn't have to spend anything.
Ordinary urban residents on the mainland have to pay about a third of their medical bills, while farmers living in rural areas have to meet half of their hospital expenses.
The central government said in 1998 that all civil servants should relinquish "free medical treatment" and instead join the basic medical insurance scheme used by the employees of urban businesses, making the same contributions and receiving the same level of benefits.
However, local officials in a quarter of the mainland's 31 provinces, municipalities and autonomous regions, and more than 300,000 officials in central government departments, are still hanging on to their unfair benefits.
Nanjing's 200,000 local officials will forfeit their "free medical treatment" cards next month and join the urban employees' basic medical insurance scheme, Modern Express reported following an announcement by the city government. Two per cent of each official's monthly income will be transferred to their insurance account and the department they work for will contribute another 9 per cent of their monthly income to the account.
On the surface, the medical treatment that Nanjing officials receive will be no different from that given to ordinary employees, as claimed by the authorities. But a remark by a senior official paints a different picture.
Chen Jianning , deputy director of Nanjing's human resources and social security bureau, was quoted as saying that besides the basic medical insurance scheme, officials were also entitled to join an additional medical insurance scheme, meaning that most of the money officials pay for medical treatment will be reimbursed.
Officials in many other cities, including Beijing and Tianjin , receive similar favourable treatment. One official from Beijing's municipal human resources and social security bureau who tried to explain the rationale behind the arrangement said it was designed to ensure that civil servants' medical benefits were not reduced under the reform.
The "free medical treatment" enjoyed by government officials has long been criticised by analysts as an unfair privilege. Some officials have even been rumoured to have used their "free medical treatment" cards to acquire free medicine for relatives.
The average medical expenses of a Beijing resident in 2009 were 4,200 yuan (HK$5,150), but the average expenses of a Beijing official were triple that. The capital implemented the reform of officials' medical insurance at the start of this year.
In Guangzhou, city authorities budgeted 1.4 billion yuan this year for the medical expenses for officials, but only allocated 615 million yuan to subsidise hospital visits by 2.1 million farmers, Yangcheng Evening News reported in June.
Civil service jobs, known as "iron rice bowls" on the mainland, have long been highly sought after because they offer stable, long-term employment, better medical insurance and higher pensions. Officials get pensions at least twice as big as other retired workers in their city, without having to make any contributions to a pension scheme at all.
In some affluent cities, a thousand applicants can compete for one civil service job.
With reform of officials' medical insurance benefits being introduced sluggishly and half-heartedly and pension reform stalled, the "iron rice bowl" is likely to maintain its allure for some time to come.
Source: SCMP

Taiwan gives green light to mainland medical tourism

Chinese with NT$200,000 can visit Taiwan for medical treatment
The regulations for Chinese coming to Taiwan for medical services have been eased to increase economic growth and boost the international competitiveness of the medical industry, the National Immigration Agency (NIA) announced yesterday.
The NIA said that Chinese citizens who are over 20 years old and have savings over NT$200,000 or have annual income over NT$500,000 can apply to visit Taiwan for health inspections or medical cosmetology with their relatives and spouses.
Hsieh Li-kung (謝立功), director-general of the NIA, said that this rule from the revised Regulations Governing the Entry Permission to Taiwan Area for the People from Mainland China will become effective tomorrow.
“With this revised regulation, Taiwanese health inspection and medical cosmetology industries will be able to compete internationally,” Hsieh said. “This can also attract more Chinese tourists to visit Taiwan.
“Allowing Chinese to come to Taiwan to enjoy great medical cosmetology services also demonstrates Taiwan's ability and development in the industry.”
According to the NIA, medical organizations can request that travel agencies apply with the NIA for business activities that involve Chinese coming to Taiwan for medical services.
Source: China Post

Blood shortage in China forces patients to turn to black market

The lack of donated blood in Chinese hospitals means patients have to buy it on the black market or get it from relatives
by Luo Jieqi
The tumor was growing, and the family of cancer patient Xia Jianqing was growing desperate.
Doctors at a military hospital in Beijing had warned Xia's family that he would die without the blood needed for a lifesaving operation. But the hospital had no blood to spare, forcing the family out of desperation to shop for blood on the street.


The patient's sister, Xia Guoqing, said they turned to one of the many criminals who roam Beijing hospitals, the local Red Cross of China Blood Center and even city streets offering bags of blood.
The family paid more than 10,000 yuan, she said, and doctors performed the operation.
There was nothing unique about the Xia family's early 2012 experience. Serious blood shortages at hospitals across the country have been pushing patients and their families to buy from illegal sellers every day since at least early 2011.
"Many relatives of patients who need blood for an operation have no choice but to come to us," said a seller who declined to be named standing outside the Red Cross center in Beijing.
Police have cracked down on the underground trade over the past year, arresting increasing numbers of "blood hawkers" in Beijing, Guangzhou, Wuhan and other cities.
Five hawkers were separately convicted of organized crime charges and illegal blood trafficking during the first six months of 2012 in Beijing's Haidian District Court.
And in July, in the largest blood-related trial of the year, the Haidian procuratorate indicted 12 people on similar charges, including men named Wang Haitao and Xue Shengkai whose customers several months earlier had included the Xias.
Authorities say some members of the Wang-Xue gang regularly solicited customers inside hospitals. Others scoured streets and the Internet for people willing to sell blood. Their arrests, which could lead to sentences of up to five years in jail, shut down the business. 
But as long as blood is in short supply and desperate patients are willing, officials say, the illegal trade is likely to continue.
"Do you need blood?" was the question posed by a man in his 30s, sporting a crew cut and a black tote bag, whenever someone passed him in the hallway of a respected, Beijing military hospital in October.
Coping Strategies
Shortages are commonplace in growing cities such as Beijing, Shanghai, Chengdu and Guangzhou. And the problem "is spreading across the entire country," said the director of Tianjin's Municipal Blood Center, Yang Wenling.
Beijing's citywide stocks on November 26 held only about 10,000, 200-milliliter units of blood, officials say, which is only about half of what the city's hospitals need.
To encourage Beijingers to donate, the Red Cross recently rolled out special policies offering preferential treatment to employees of companies and organizations that sponsor blood drives. Any of these employees who need blood would be first in line.
These preferential policies underscore the severity of the blood shortages, which have deepened in recent years. Since October, official websites for health agencies in Inner Mongolia Autonomous Region and Zhejiang Province, for example, have been urging people to donate any type of blood.
The central government's Ministry of Health says the amount of blood used in medical procedures across the country has increased up to 15 percent annually in recent years, far outpacing legal donations. Surgeries using blood rose more than 18 percent in 2010 over the previous year, but blood collections outside the illegal trade increased only 7.7 percent.
Under China's system, blood centers handle collections from voluntary donors. They're supposed to collect enough to meet the demands of hospitals and other health care facilities.
If supplies from pro-bono donations fall short of needs, the national Blood Donation Law encourages patients to organize personal blood sourcing, perhaps by persuading family members, friends, coworkers and neighbors to donate blood through a so-called "mutual aid" project. Few hospitals in China provide personal collection and storage services for people who want to bank their own blood.
Before 2011, mutual aid donations accounted for a small portion of all donations. Most sources were donors who rolled up their sleeves at Red Cross drives or on university campuses, and whose blood was processed, banked and distributed to hospitals on an as-needed basis.
But over the past two years, mutual aid donations have skyrocketed. A doctor working at a military hospital told Caixin that "because of the blood shortage in Beijing, almost every operation in 2012 required a mutual aid donation."
And the mutual aid system's loopholes are wide enough for plenty of illegal activity.
Read more: Caixin

Hospital antibiotic use declines by 6% due to curbs

Report claims antibiotic use fell from 25% to 19%
China's national campaign to crack down on prescription drug abuse appears to be making progress, after figures revealed a drop of 6 percentage points in the use of antibiotics in hospitals from 2008 to 2011.
An annual report by the Chinese Academy of Social Sciences on China's pharmaceutical market showed top-level hospitals in 21 provinces reported antibiotics use dropped from 25 percent in 2008 to 19 percent in 2011.
"The report illustrates the success we've made in the campaign," said Zhu Hengpeng, senior associate of the Institute of Economics, at the Chinese Academy of Social Sciences.
"Antibiotics abuse drives up medicine costs," he added.
The side effects of antibiotics use can lead to more serious problems, including damage to organs, and disorders associated with the body's resistance to disease.
Many Chinese believe wrongly that antibiotics can reduce inflammation, meaning they are often misused to treat maladies like toothaches and fevers, according to experts.
In recent years, China attached growing importance to the issue, and have been urging hospitals to take more care when prescribing antibiotics.
In the latest move, it launched a surveillance system in July to document cases of antibiotic-resistant bacteria at 1,349 large public hospitals across the country.
Media reports have suggested that antibiotics overuse results in about 80,000 deaths in China a year, and could cost 80 billion yuan ($12.8 billion) to treat.
However, officials from the Ministry of Health said no reliable research can prove the numbers.
Elsewhere in the report, figures showed that antibiotics still account for a smaller proportion of drug misuse in China, compared with drugs acting on the nervous system, which increased by 1.6 percentage points in use and drugs for treating tumors, which rose 1.3 percentage points.
Statistics from several city and provincial health bureaus revealed that tumors have now became the top life-threatening disease in China.
In Beijing, one in four deaths was the result of a tumor in 2010, and incidence of breast cancer in Beijing jumped by 130 percent from 2000 to 2009.
Zhi Xiuyi, director of Capital Medical University's Department of Oncology, said that a combination of pollution, stress and modern lifestyles were contributing to the rises.
Apart from drug use, the report also listed the top 10 pharmaceutical companies now operating in China, in terms of market penetration of top-level hospitals.
The global giant AstraZeneca topped the list, half of which consisted of foreign companies.
Source: China Daily

Friday, 28 December 2012

Wuhan researchers develop oral vaccine for rabies

Affordable vaccine may help prevent rabies deaths in China
by Michael Woodhead
Researchers from Wuhan have helped develop a new vaccine for rabies that is based on the virus that causes kennel cough.
Publishing their research in the Journal of Virology, scientists from the State-key Laboratory of Agricultural Microbiology at the College of Veterinary Medicine, Huazhong Agricultural University, Wuhan say that untreated rabies virus infection is fatal and the disease causes 55,000 deaths a year. They note that vaccine and post-exposure treatment are effective in preventing rabies, but rabies vaccination and treatment have not been widely used in developing countries due to the high cost.
To try develop an effective and cost effective rabies vaccine they tried a new approach by using Parainfluenza virus 5 as a vaccine vector.  They note that Parainfluenza virus 5 is thought to contribute to kennel cough and kennel cough vaccines containing live PIV5 have been used in dogs for many years.
Therefore they tested a PIV5-vectored rabies vaccine in mice. A recombinaint PIV5 encoding RABV glycoprotein (G) (rPIV5-RV-G) was administrated to mice via intranasal (IN), intramuscular (IM) and oral inoculation. They found that  a single dose of the new vaccine was sufficient for 100% protection when administrated intranasally. The intramuscular route also provided very robust protection (90%-100%) against rabies. And intriguingly, the mice vaccinated orally with a single dose of vaccine showed a  50% survival rate, which is comparable to the 60% survival rate sen with the attenuated rabies vaccine.
"This is first report of an orally effective rabies vaccine candidate in animals based on PIV5 as a vector. These results indicate the rPIV5-RV-G is an excellent candidate for a new generation of recombinant rabies vaccine for humans and animals and PIV5 is a potential vector for oral vaccines," they conclude.
Source: Journal of Virology

Smoking fines double as Shanghai cracks down on tobacco

Smokers were fined more than $50,000 last year
The Shanghai city government has fined individuals and businesses 313,505 yuan ($50,267) over the first nine months of this year for violating the city's smoking regulations, the local health promotion authority announced at a press conference on Thursday.


The total was almost twice the amount the government fined over all of last year.

 As of the end of September, four regulation enforcement authorities conducted 230,531 inspections and fined 77 individuals and 179 public spaces, according to the Shanghai Municipal Health Promotion Committee. 

Under regulations introduced on March 1, 2010, smoking is prohibited in 13 types of public places, including hospitals, schools, museums and libraries, as well as on public transportation. The maximum fine for an individual violation in public spaces such as hospitals and schools is 200 yuan. Businesses can be fined as much as 30,000 yuan for failing to prevent smoking on the premises.

 Authorities at the district level have been enforcing smoking regulations more strictly this year at Internet cafes, restaurants and entertainment establishments - places where violations were most prevalent, said Gu Xiping, a press officer with the Shanghai Municipal Health Promotion Committee. 

According to the regulations, restaurants and bars larger than 150 square meters with more than 75 seats must confine smoking to designated areas. These establishments must also post no-smoking signs and remove items related to smoking, such as ashtrays, from non-smoking areas. 

The committee has also seen an increase this year in public involvement with the enforcement of the regulations. The number of volunteer inspectors had increased to 1,855 as of September, up from a total of 1,170 last year, according to the committee. 

"To raise public awareness about these regulations, we will continue to run promotion campaigns next year. We are also going to learn from the successful experiences of Hong Kong and other overseas cities," said Li Zhongyang, vice director of Shanghai Municipal Health Promotion Committee. 

"We hope that local residents will have more self-discipline and consider their own health and the health of other people when it comes to smoking," Li added.
Source: Global Times

Beijing hospital senior doctor critical after stabbing

Stabbing victim was vice president of Pinggu District Hospital
A vice president of a hospital was slashed by an unidentified man near the hospital in Pinggu district, Beijing Thursday morning, local media reported.
At around 6am, Wang Jianyun, vice president and chief physician of the Pinggu District Hospital, was attacked on his way to the hospital. While investigation is still ongoing, police suspect two men attacked Wang before escaping by car.
A witness said a group of old men playing the shuttlecock found Wang bleeding and rushed him to the hospital for emergency treatment.
Police cordoned off the area and obtained footages from surveillance cameras overlooking the road. It is still uncertain if the video images are clear because it was still dark outside when the doctor was stabbed.
Hospital staff refused to comment on Wang's condition, citing employee confidentiality, but reports indicated that Wang suffered multiple wounds in his lungs. He is now in the intensive care unit after a surgery.
Source: Sina English

One child policy exacerbates diabetes epidemic in China

First borns gain more weight and gain it faster, which may create an epidemic of diabetes in China
Diabetes in China, which is emerging as a major health issue in the country is probably being aggravated by its one-child policy, experts observe.
The Chinese Government said that about 100 million families have just one child, which translates into an equal number of first borns, a status that researchers are finding may be linked to conditions that raise obesity risk, Chong Yap Seng, a scientist at Singapore’s National University Hospital, said.
Dr Chong and colleagues in Beijing and Southampton, England, are studying the biological mechanisms that have conspired with diet and lifestyle changes to produce 92.3 million diabetics in China, almost four times as many as in the United States.
Chong said that first borns gain weight faster and are bigger as adults, a trajectory that increases obesity risk and may explain why China’s diabetes prevalence has more than tripled in a decade, the report said.
Sales of diabetes medicines in China will expand 20 percent a year to reach 3.2 billion dollars by 2016, consulting firm IMS Health said, it said.
The one-child policy was introduced in 1979 to curb a population growing 1.4 percent a year and to promote prosperity, it added.
According to the report, some exceptions to the policy are allowed, such as permitting rural families to have a second child if the first is a girl. Those who can afford to can have a second or third baby by paying a fine.
Rising numbers of diabetics, though, are costing China’s economy 26 billion dollars annually in medical care and lost productivity, according to the International Diabetes Federation.
The prevalence of diabetes in China, a nation of 1.34 billion people, is 8.8 percent, the report said.
The U.S. has a diabetes prevalence of 9.3 percent and 24.1 million sufferers, according to federation estimates released last month.
Within 18 years, China is projected to have 130 million sufferers of Type 2 diabetes, the form of the disease in which the body stops responding properly to the hormone insulin, according to the Brussels-based federation.
The disease is already killing 1.2 million Chinese a year because of kidney failure, heart attack and other associated conditions, it said in a recent report.
A 2010 study by researchers in Brazil, Britain and Italy published in PLOS One found that birth order is associated with increased body mass, higher levels of fat and metabolic risk in young adult men in Brazil, the report added.
Source: Healthcare Asia

Rich doctor scorned for being unfilial son

A high-earning doctor in south China who refuses to support his ill mother is facing fierce backlash in the country that traditionally values filial piety. 
Yang Xiaomin, an associate professor at Hainan Medical University and a doctor with HMU's Affiliated Hospital, has refused to provide 1,500 yuan ($240) a month to cover his septuagenarian mother's medical costs and daily expenses.
Yang refuses to be his mother's caretaker, saying he "cannot afford to hire a nanny."
When his sister stepped in to take care of their mother and asked for money to help cover the costs, he refused even though the sum is only about one-seventh of his monthly salary.
Yang has suggested sending his mother, surnamed Li, to a local nursing home, threatening to sever all ties with Li if she doesn't.
"I have devoted my whole life to bringing up my son. I can't believe he would treat me like this," Li sobbed.
Yang's behavior has angered netizens and sparked a widespread discussion on the state of morality in China. One media report about the case has been forwarded more than 1,800 times on Twitter-like Sina Weibo, with irate netizens lashing out at his disrespectful behavior.
"He doesn't deserve to be called a human being!" wrote Weibo user "buqieryu."
"This is unbelievable! How do you expect someone with low moral standards to be a good doctor?" wrote "yuanshanyouwu."
Since the case began circulating on Weibo, Yang has been suspended from his positions at HMU and the hospital.
This, however, is not the only case that has drawn Chinese people's attention to the topic of filial piety recently. Earlier this month, a 91-year-old mother was beaten by her son and daughter-in-law and kicked out of her family's home simply because she wanted to have a bowl of porridge instead of noodles, her staple food for the past 22 years.
Another case of parent abuse was exposed via Weibo, in which a centenarian, surnamed Jiang, was living in a pigsty in Guanyun County, Lianyungang City, in Jiangsu Province.
Jiang, whose five sons and three daughters were supposed to take turns caring for her, has been living with pigs for the past three years. One of her sons insists that Jiang wanted to live with the pigs.
These cases reflect the disappearance of the traditional value of filial piety in a country with a fast-growing economy, said Xia Xueluan, a professor with the Department of Sociology of Peking University.
"In China, there are many who ignore the moral value of showing filial piety to parents, such as those often seen in property disputes with their parents," Xia said.
China is going through economic and social restructuring. Amid these changes, many are chasing money and leaving behind traditional Chinese values, including those regarding family relations, he said.
The government needs to do more work in moral education, especially in a graying China where filial piety is disappearing and senior citizens face lots of psychological problems, he added.
China's population is rapidly aging. By the end of 2011, 185 million people in China were aged 60 or above, and the number is expected to further rise to account for about 30 percent of China's total population of nearly 1.4 billion by the middle of this century.
The Chinese government has been increasing people's awareness of the importance of helping the elderly and restoring the traditional value of filial piety. In July, the Standing Committee of the National People's Congress, the country's top legislature, reviewed an amendment to China's Law on the Protection of the Rights and Interests of the Elderly for the first time.
The amendment added an item that asks sons and daughters to go home often to see their aging family members, which gained strong support from the Chinese people.
But Xia said this is far from adequate.
"In addition to laws and regulations, the government should boost traditional morality education. It should also consider moral standards when selecting government officials and thus, drive them to set good examples for the general public in terms of morality," he said.
Source: Xinhua

China healthcare: huge market, huge risks for western multinationals

by Barry S. Cohen
It's little wonder that multinational health care companies (MNCs) may be salivating at the opportunities in China:

1) By 2016 China is expected to be the second-largest drug market, forecast to reach nearly $165 billion that year

2) During the next several years the Chinese drug market is supposed to grow at a rate of 15% to 18% a year compared to little or no gains for the Western countries

3) Growing affluence is permitting many Chinese to pay out of pocket or pay high insurance deductibles to gain access to innovative Western medicine

4) China needs new drugs to treat higher than average incidences of hepatitis B and neck and head cancers. China also has growth potential for drugs to treat arthritis, diabetes, osteoporosis, high blood pressure, high cholesterol, depression HIV/AIDS.

However, all that glitters may not be gold. The chance of a recession as well as internal politics could make it difficult for the multinational pharmaceutical companies to make strong headway into the Chinese market. Nowhere in the world are the pressures greater to expand access to better health care while at the same time controlling costs.

Examples abound. One policy decision eliminated differential pricing on approximately 100 drugs MNCs sold into China. For nearly two decades, these drugs had benefited from special pricing as part of an agreement between the Chinese government and the pharmaceutical industry. Furthermore, a blind bid and tender process reduced prices on some drugs by up to 90%. MNCs watched as domestic Chinese pharmaceutical companies bid prices down in an effort to use volume gains to offset collapsing margins.

Despite the caution flags, large MNCs continue to devote substantial resources to cracking the Chinese market. Both Pfizer and GlaxoSmithKline have made major moves to re-orient sales resources away from developed economies towards China. Eli Lilly and Novartis , among others, have opened new R&D facilities in China, primarily in Shanghai. And given the country's mammoth diabetes problem, Sanofi is moving deeper into the country. The company's Lantus insulin product is estimated to have 17% of the Chinese market.

Large pharmaceutical companies hoping to stake a claim in China may be eyeing two of the country's largest medical research testing companies as a vehicle to gain entry. Both WuXi PharmaTech  and ShangPharma have been mentioned as possible takeover targets.

Even insurance company WellPoint has announced its entry with the hopes that it can develop a private healthcare insurance business. And medical device companies like Boston Scientific, Johnson & Johnson and Medtronic are also aggressively expanding into China. For more information about stocks in this space, our real time trading reports help investors identify opportunities before they happen.
Source: MSN Money

Chinese students sent to Nebraska to study medicine

Yang Hu is one of a select few students sponsored to study medicine in the US
by Paul Goodsell
Yang Hu is one of the first Chinese students chosen to enroll in the special program at the University of Nebraska Medical Center.
Going to an American medical school is more than a great opportunity for Yang. The program she joined is also a source of pride for UNMC and an example of the med center's growing international reputation.
While thousands of Chinese students already are at American medical schools for doctoral programs, research or short-term clinical rotations, the UNMC program is different. Only in Omaha does the Chinese government pick up the tab for its students to earn a four-year U.S. medical degree or a similar professional diploma in fields like pharmacy or physical therapy.
Besides bringing in tuition revenue, university officials say, they hope the students will establish relationships with UNMC that could lead to future research partnerships and other ties with China, the economic powerhouse that is expected to continue its rapid growth and increasing influence in the coming decades.
“These students will be leaders of Chinese health care,” said Jialin Zheng, a UNMC professor who heads UNMC's Asia Pacific Rim development program. “They will be ambassadors to future collaborations.”
For now, however, they are merely 20-something students wrestling with rigorous coursework, language challenges and an unfamiliar culture.
Yang and her fellow Chinese students have had to adjust to a different educational system and adapt to the American approach to health care.
They have stared blankly at American restaurant menus, worn costumes to Halloween parties and spent Thanksgivings with new Nebraska friends.
One is exploring Christianity after growing up as an atheist. Several have learned to drive.
The experience has “really helped me to broaden my horizon,” said Xin Zhang, a 26-year-old physical therapy student from Xi'an.
Xin and Yimei Huang, a pharmacy student from Chengdu, started at UNMC in 2011. This year, Yang and Lei Yu from Chengdu both entered the medical school.
The scholarship program is one element of the Shanghai-U.S. Health Science Initiative formalized in August when Nebraska Gov. Dave Heineman was in China on a trade mission. UNMC officials describe the broader pact as one of the most extensive partnerships between U.S. and Chinese academic institutions.
UNMC Chancellor Harold Maurer said the med center has ties with China that are envied by top U.S. universities. At a recent meeting with leading U.S. medical schools and the Chinese government, he said, “it was clear that UNMC is probably one of the best known U.S. institutions in China.”

Other schools such as Duke University asked the Chinese about why they were working so much with Nebraska, Maurer said. The answer: UNMC takes good care of its Chinese students and teaches them well. In addition, the Chinese noted, it doesn't cost as much to go to school in Nebraska.
With the new program, university officials have begun slowly, carefully selecting students for their English language ability and above-average test scores.
When fully implemented, there will be 10 new students arriving in Omaha each August — two in each of five areas: medicine, pharmacy, physical therapy, dentistry and nursing.
Read more: World Herald

There can be no real health reform without political reform

by Yanzhong Huang, Senior Fellow for Global Health
In April 2012, the director of the State Council Health Care Reform Office announced that targets set in the three-year plan for China's health-care reform had been accomplished on schedule.
There is no denying that the reform has led to expanded health insurance coverage and increased provision of public health services—it has also contributed to the strengthening of grassroots healthcare institutions. However, there has been at best mixed success in reforming the essential drug system. The past year was supposed to be a year of deepening health-care reform. The government selected about 300 pilot counties and cities for reforming public hospitals, which is considered the most important component of healthcare reform. It also announced plans to raise the reimbursement level for catastrophic illness to more than 50 percent, which is an important step toward reducing the share of out-of-pocket payments to 30 percent by 2015. Despite this, the reform has not fundamentally solved the problem of access and affordability. The officially stated 95 percent coverage rate contradicts the fact that more than 200 million migrant workers are actually not covered in China. Meanwhile, disintegrating business ethics and lack of regulatory capabilities have made food safety an unpredicted concern in China.
Driven by the need to maintain legitimacy and to stimulate domestic consumption, the new Chinese leadership is expected to commit to the building a social safety net in the coming years. For health-care reform to succeed, the new leaders have to demonstrate significant progress in reforming the public hospitals and make health care more affordable. In the absence of fundamental changes in public hospitals' financing and management structures, health-care costs will likely continue to increase rapidly. This could be exacerbated by population aging and the growing burden of chronic noncommunicable diseases (NCDs). Today, more than 80 percent of the mortality in China is attributed to NCDs, which is significantly higher than the world average (63 percent). So far, the government has not adopted a proactive approach to addressing NCDs and their risk factors (e.g., tobacco use). Sustained government funding for the healthcare sector is also threatened by local public financing problems. Local governments, which provide the lion's share of government health spending, still do not have the incentives and capabilities to effectively implement important reform measures. A fundamental overhaul of China's health sector therefore entails reforming China's archaic political system.
Read more: Council on Foreign Relations

Thursday, 27 December 2012

My take on China's health white paper

by Michael Woodhead, Editor, CMN
China has released a lengthy white paper setting out its current health situation, the state of play on health reforms and setting the ambitious target of establishing 'a sound basic medical and health system covering both urban and rural residents by 2020, so as to ensure that everyone enjoys access to basic medical and health services'.
The white paper cites some mind boggling figures: 2,500 billion yuan spent on health annually and 6 billion outpatient visits a year. The country has  2.5 million doctors and 5 million hospital beds, if the figures are to be believed (many of these doctors are public health doctors not working in front line clinical care).
The white paper has a generally positive spin on the health of Chinese people, saying the health system has contributed to increasing life expectancy and is coping with a large increase in hospital stays. It also makes much of the limited reforms to medical insurance, claiming that 95% of people have basic medical insurance and that out of pocket expenses have decreased from 58% to 35% (of what it is not clear).
At least it is honest in acknowledging that health care reform in China is going to be complicated and  arduous, and faces many barriers. My own take on the white paper is that it cites a lot of figures but doesn't really say exactly how the reforms are going to be implemented.
The challenges for China's health system reform fall into four main area: capacity, structure, funding and standards.

1. In terms of capacity, China (like all countries) is facing a large increase in both usage and expectation for healthcare services. Demographics are especially bad for China, which faces an ageing population that is not supported by a younger generation due to the one child policy. Despite having a million hospitals, China does not have the capacity to provide good healthcare to the whole population - especially in regional and rural areas. One of the main reasons is workforce: there simply aren't enough doctors, nurses and other healthcare staff to provide care for a billion people. It has been estimated that China needs 200,000 extra paediatricians, for example. Therefore workforce training and deployment are major issues for China. The white paper also says little about allowing foreign companies and organisations to set up in China and provide health services - this is one way in which capacity (and workforce) could be supplemented.

2. Structure. China's health system is based around hospitals, and this severely limits its capacity to provide care for people with chronic disease, and also to provide continuity of care. China needs a primary care system, and there are some moves in that direction underway already. However, it remains to be seen whether China can really reform its hospital based health system and wean patients away from hospitals. China also needs to look at using other healthcare professionals in wider roles - not barefoot doctors but at the provision of physiotherapists, pharmacists, extended care nurses etc.

3. Funding. If China is to provide a universal healthcare system for all, it is going to need massive funding. The white paper is not clear on exactly how this will be done. It mentions the moves towards new medical insurance schemes, such as the rural cooperative medical insurance system, and also the new pilot programs to cover catastrophic diseases such as cancer. These are commendable moves in the right direction, but it is very early days yet. As with most things in China, there is little transparency or accountability in the health system. The white paper does not say much on how China will allocate funding funding for health, and exactly where it will go. Will there be more money for rural clinics and hospitals? Who will provide the funding at provincial and county level and ensure that funds are directed to clinical services? How will China balance the mix of public and private health cover and how will it set the levels of cover and premiums? In the white paper, China claims an impressive 95% coverage for basic medical insurance. However, this fails to acknowledge that this cover is broad but shallow - it does not cover basic medical care for anyone with a chronic or catastrophic illness. The Ministry of Health may wish to provide medical cover for all, but the real power lies with the Ministry of Finance and with provincial and local leaders who will provide the funding (or not).

4. Standards and quality. China's health reforms will have to tackle the issues of poor and uneven quality in many areas of the health system - from skill standards of practitioners to quality of drugs and medical products and also the wider issue of quality of environment.
The newly affluent Chinese public have increasing expectations of health services, but these are not being met. Many question the clinical and caring skills of doctors and nurses, and there is huge frustration over the 'no pay no care' situation, as witnessed by the violent attacks on doctors and nurses. China needs to ensure that standards are set and adhered to in all areas of clinical care. This also applies to area such as pharmaceuticals and medical products - there have been many well publicised cases of substandard drugs, blood products and food contamination. Often China's response to failings has been draconian - jailing or even executing those responsible. This is not the way to run a modern health system - there is a need for open-ness, professionalism and accountability. The same applies to public health issues such as pollution and food standards. When air pollution levels are deemed a state secret there is little hope of improving respiratory health!

Well, these are just a few of my initial thoughts on the white paper. It has set a hugely ambitious goal of establishing universal, affordable and good quality care for all Chinese. This is commendable and potentially achievable, given China's track record in 'moving heaven and earth' in other areas. However, it will require huge change and will upset many vested interests in  local government, health institutions and businesses. Health reform will also require huge changes in expectations from the Chinese public - they can no longer expect to receive 'walk in' care at a hospital and be provided with a pill (or infusion) for every ill. If the health reforms can get the Chinese public to start seeing GPs by appointment by 2020 and accepting that antibiotics don't cure all fevers then they will have achieved a huge turnaround.

Salt substitution reduces hypertension in Chinese people

Blood pressure was lowered by 4mm after replacing some sodium chloride with potassium chloride
by Michael Woodhead
Replacing regular salt with a potassium chloride-based  alternative may be an effective additional way to lower blood pressure for Chinese hypertensive patients, a study has shown.
Professor Zhou Beufan and colleagues from Beijing assessed the potential efficacy of replacing sodium chloride with potassium chloride for preventing hypertension in patients with hypertension and also in normotensive family member controls.
They conducted a double-blind, randomized controlled trial among 200 families in rural China to establish the two-year effects of a reduced-sodium, high-potassium salt substitute (65% sodium chloride, 25% potassium chloride, 10% magnesium sulfate) compared with normal salt (100% sodium chloride) on blood pressure.
Of the 372 people who completed the study, the mean overall difference in blood pressure between the two groups at the 24-month follow-up was 2 mm Hg for systolic BP and  and 2 mm Hg for diastolic BP. For the people with hypertension, there was a 4mm Hg overall decrease in systolic blood pressure, but diastolic blood pressure was not affected by salt use in the hypertensive group.
The researchers conclude that salt substitution lowers systolic blood pressure in hypertensive patients and lowers both systolic and diastolic blood pressure in normotensive controls.
"Salt substitution, therefore, may be an effective adjuvant therapy for hypertensive patients and [has] potential efficacy in preventing hypertension in normotensive individuals," they say.
Source: Journal of Human Hypertension

End of life care discussion in China

Discussions about dignified dying are no longer a taboo in China
by Zhao Xu
It's been nearly six weeks since her 82-year-old mother died, but Huang Yuan still cringes when she remembers the glimpses she caught of the elderly woman behind the thick glass wall of the intensive care unit. It's a wall that separates, often once and for all, the realm of the living and the immediate, dark corridor leading to the world of death.
"My mother had lost the ability to expectorate. So to prevent her from choking on the phlegm building up in her throat, the doctors decided to place her face down," said Huang, taking long, hard pauses between words as she tried to simultaneously recall but also blunt the painful memories.
"Mom remained there, her head hanging over the edge of the bed and her forehead supported by a cushioned chair. The combined effects of the illness and gravity had given her a swollen face. It was so bad she could barely open her eyes. Moreover, her lips had been constantly acted on by the same forces, to the point that even when she was temporarily restored to her normal, lying position on the bed, they were fixed in a terrible expression, parted, elongated."
The intense suffering was witnessed by the dying woman's seven heartbroken daughters. It sparked a long, often furious, yet ultimately inconclusive, debate among them as to whether their mother was paying too high a price for a chance of recovery so slim that it almost didn't exist.
"What did she want - life or relief from the pain? We are still haunted by that question and will be forever," said Huang.
"Maybe they didn't have to decide and suffer perennial torment over whatever decision they made," said retired cardiologist Luo Diandian. Luo is now a writer whose own experience of her mother-in-law's death, allied to her exposure to Western medical ideas and practices regarding terminal illnesses, combined to make her a strong advocate of so-called Living Wills.
"As the names suggests, a living will is a clear expression of what a person wants and, just as importantly, doesn't want, when it comes to the handling of his or her illness in its very final stage. The core centers on the medical treatment," she said. "For example, a person can specify whether or not he or she will opt for all, or just a certain part of the life-support measures, ranging from being fed by tube and mechanical ventilation, to dialysis and defibrilation."
Two things are emphasized when a person is considering making a will of this kind. First, a living will can be changed whenever the testator wishes, with the final version being the last one made while he or she was still capable of doing so, either in written or oral form. Second, for a living will to be officially valid, the testator must be diagnosed with a terminal illness and a clinically estimated life span of less than six months. In addition, the person must not have expressed any wishes to the contrary.
In some parts of the United States and Canada, the concept of the living will has become so entrenched that it's now considered a basic human right and is legally protected, according to Luo. Although making a will is not compulsory, people are likely to be advised to seriously consider writing one, once they enter adulthood.
So why don't more people embrace this concept and assert control over their exit from the world? The answer is complicated and can be rendered impenetrable by the welter of implications relating to death.
'Bound by sensitivity'
Weng Li, an attending physician at Peking Union Medical College Hospital in Beijing, where Wang's mother spent her last days, wrestles with complexities such as this every day.
"Unlike their Western counterparts, who are legally obliged to tell the full truth directly to their patients, Chinese doctors seem to be 'bound by sensitivity' to conceal the painful reality from their patients, but instead will tell the family members something closer to the truth," conceded Weng. "It's a cultural issue, but when it comes to writing a living will, the underlying contradiction is: How can you ask someone to seriously consider the option, while making every effort to convince him or her that they are not going to die?"
He said that neither the doctors nor the relatives should be blamed. "For the majority of Chinese people, death is still too frightening a thought to face honestly. You might be doing the patient a disservice by plunging them into an ocean of fear where they will simply drown," he said.
Huang, whose father died of gastric cardia cancer in 2008, is a believer in "not telling".
"When the cancer was first diagnosed, we were told to be prepared for his death within six months, but dad lasted another three and half years," she said. "Throughout that time, we never mentioned it and he never really asked. I had the feeling that he had started to sense the deadline approaching, but that wasn't until the very end of his life. Keep him in the dark, or under the sun? It could be both."
In other words, the significance of "the will" notwithstanding, a dying person's often implicitly expressed desire to talk only about survival should be fully respected. And in this case, to be an accomplice in the denial of a hard and imminent truth may be the ultimate demonstration of love, even though it often exacts a tremendous emotional price on those closest to the dying and may deprive both parties of the chance of saying a proper goodbye.
In 2006, Luo set up a website, www.xzyzy.com, and started recruiting volunteers to spread her message. But, despite her continuing efforts, she has only managed to have brochures displayed in one private hospital in Beijing. Refusal is often based on the grounds that such a graphic representation of death, often unsparing in its evaluation of each and every treatment and the potential revival measures required, is potentially offensive and may be at variance with a doctor's mission to save lives.
"When the odds are overwhelmingly stacked against the patient, and death becomes destiny, a doctor's first priority automatically changes from enabling life to easing its end. It's also the time when the doctor should stop being 'aggressive', take a conscious step back and let the patient decide what's the best for him or her," said Liu Duanqi, a former director of the oncology department at Beijing's General Army Hospital, who spent his working life treating terminal cancer patients. "Sadly, in reality, the majority of patients are dragged by their 'ever-dutiful' doctors all the way through their last, physically and emotionally ravaging journey."
There's a tendency to blame the profit motive, because hospitals are often attacked for being driven by financial self-interest, and there's also a fear that some doctors may "persuade" dying patients to undergo harsh, experimental treatment for research purposes, he said.
However, according to Liu, the lack of education about death provided to Chinese medical students is at the heart of the problem.
"Ask a patient whether he wants to live or not and that person will most definitely say yes. But, if you change the question to whether he is willing to endure this or that in order to live just one more week, you might get a different answer. With all their professional knowledge, empathy and skills, doctors can take a guiding role, even from behind the scenes," said Liu.
The reluctance, or possibly inability, of many Chinese doctors to engage patients and their families in sensitive and meaningful discussion about the range of possible choices and potential results often leads to unfounded hope, sudden disillusionment and ultimately anger and despair, according to Liu.
"Despite their general feeling of being wronged, these doctors have, in effect, robbed their dying patients of their last opportunity to make sensible, well-informed decisions," he said.
"And for people with high-level medical insurance, to prolong the process of death at the taxpayers' expense constitutes, for me, a form of social injustice."
The depth of understanding and the courage shown by a person in the face of impending death is the best and most generous parting gift those left behind will ever receive.
Chen Zuobing, director of the emergency department at the First Hospital of Zhejiang University in Hangzhou, East China, knows all about that. His father was diagnosed with terminal-stage peritoneal cancer in July, 2011. After a short, yet intense period of wavering that proved all-consuming, Chen helped his 77-year-old father face the stark reality.
After deciding against chemotherapy, the elderly man left the hospital where his son worked and returned to his home in the countryside. He planted pumpkins and played with the neighborhood children until his deteriorating health prevented him from doing so. Nine months later, in April, he died quietly at home.
"I gave my father the choice and he proved himself a hero," said Chen.
While stressing that she puts quality of life above quantity, Luo insisted that there's absolutely nothing wrong if a person decides "not to become reconciled to the idea of mortality, and to fight to the very bitter end".
"The idea of a graceful death has always been controversial. To me, the commitment to continued existence, no matter how much pain it entails, requires just as much courage," she said. "The purpose of a living will is to fulfill one's last wishes. Any decision that is truly heartfelt is heroic and fully dignified."
Read more: China Daily

Monday, 24 December 2012

China sets up national cancer registries

Registry will allow Chinese doctors to understand trends in cancer
China is setting up a national cancer registry to fully understand the extent of the disease in the country and to help improve cancer prevention policies.
Chen Wanqing, deputy director of the national cancer registry center, under the Ministry of Health, said so far the government-funded project has set up more than 220 surveillance sites across the mainland, covering some 200 million people.
The sites include health institutions, specialized cancer hospitals, research institutions, and public health institutions, he said.
"Accurate cancer registration and monitoring is crucial for effective cancer prevention and control. This new system will involve the gathering of all kinds of cancer-related information," he told China Daily.
He called the new registry a long-term and systematic collection of data about cancer and tumor diseases, which will gather information on diagnostic findings, patient history, treatment progress and the status of cancer patients nationwide.
Qiao Youlin, vice-chairman of the expert board for early detection and treatment of cancers at the Ministry of Health, said the system will be able to gauge cancer trends and patterns from which it will be possible to better allocate resources, improve research and evaluate and improve cancer control programs.
But he added that the project will need the full support of all community-level medical service providers to work.
"Data collected at the grassroots levels represents the most accurate picture of the extent of the disease in China," Qiao noted.
Those currently on the registry are mainly those who hold a hukou (residence permit), but information on the large migrant population is missing, Chen added.
"It's hard to ensure the quality of the data, particularly in rural and run-down areas," he said.
Due to the sheer size of the population, Chen said, it would be hard for the registry to ensure coverage of every area.
"But we can still make a reasonably accurate calculation of the extent of the disease across the country, through quality coverage of regional data," he added.
Various European countries already have national cancer registries, which have managed to gather reliable findings on total cancer numbers.
In the United States, national cancer information is practically guaranteed through the Cancer Registries Amendment Act, which requires all institutions to register the information.
Chen urged medical institutions across China to support the new initiative by reporting cancer cases and any related data to the registry.
According to the Ministry of Health, there are 2.8 million new cancer cases on the Chinese mainland each year and the number is expected to reach 3.8 million within the next decade.
"Cancer has been on the rise, both in terms of incidence and death rate, over the past 20 years," said Chen.
He said that there are also changing patterns in those numbers.
Previously, Chinese were more susceptible to those so-called "poor cancers", such as liver, stomach, and esophagus cancers, according to data so far from the registry.
But as the country's wealth has continued to grow, there are increasing cases of what people call "rich cancers", like lung, breast, and colorectal cancers, he added.
Read more: China Daily

Immunisation halts Xinjiang polio outbreak

Immunisation has helped curb an outbreak of polio that affected 21 people and caused one death
WHO has confirmed that the Xinjiang region is clear of disease after last year's outbreak
China's disease control authorities will continue supporting the Xinjiang Uygur autonomous region to keep the region polio-free, a senior official has said.
Wang Yu, who heads the Chinese Center for Disease Control and Prevention, made the promise at a media event on Tuesday in Beijing to mark Xinjiang's continued polio-free status, which was confirmed by the World Health Organization at the end of last month.
Last year, there was an outbreak of polio in Xinjiang that entered the region from abroad. The 21 cases detected between August and October 2011 resulted in one death, and 17 people, including eight children, were paralyzed, according to the Ministry of Health.
Polio, or poliomyelitis, is a virus that infects the brain and spinal cord, mostly in children younger than 5 years old. One in every 200 cases leads to paralysis, usually of the legs.
"We've learned a lesson and will expand routine vaccinations in the area to avert future outbreaks," Wang said.
He said previous Chinese CDC studies showed that only 60 to 70 percent of Xinjiang residents had been vaccinated against polio, but 85 percent should be vaccinated to ward off an outbreak.
"In some areas the rate could be as low as 50 percent," he said.
In response, "the central government has allocated 160 million yuan ($25.7 million) to improve local public health services", Wang said.
Vaccination agencies will all be equipped with appliances to store vaccines at the necessary low temperatures, he said.
A suspected-case reporting system will be established at local hospitals to detect possible infections as soon as possible, he added.
In addition, border surveillance will be beefed up to prevent polio from entering China from abroad, he said.
According to Luo Huiming, deputy director of the National Immunization Program under the Chinese CDC, the outbreak last year was the first to come from abroad since 2000.
Because Xinjiang borders Pakistan and Afghanistan, where polio is endemic, "it's still at risk of infections, which know no boundaries", Luo said.
"We have to ensure comprehensive polio vaccination in the area to protect people from the disease," he said, adding that greater efforts should be made to raise vaccination awareness, particularly among ethnic groups.
"Thanks to assistance from the WHO and UNICEF, we launched a massive polio vaccination program in Xinjiang and regained the polio-free status within a short time," he said.
Five large-scale vaccination campaigns have been carried out in Xinjiang between September 2011 and April 2012, and at least 43 million doses of polio vaccine were given to children and adults.
According to the WHO, Chinese governments at all levels spent more than 340 million yuan for the response effort.
Michael O'Leary, the WHO representative in China, said that the 2011 polio outbreak showed that no place was safe until the crippling and lethal infection is eradicated worldwide.
With vaccination being the only means of prevention, it's crucial to strive for and maintain high immunization coverage, he added.
Luo Huiming agreed and recalled some difficulties during the massive vaccination campaigns.
Some local people refused at first to get vaccinated because of ethnic traditions, he said.
"Some even confused vaccination with family planning — the two sound similar in Chinese," he said.
"But with great patience we informed them of the importance of vaccination, and most finally said yes," he said, adding that the vaccination programs were free and voluntary.
A 33-year-old Uygur resident of Kashgar, Xinjiang, who gave his name as Parhat, was vaccinated during the campaigns.
"People younger than 40 in southern Xinjiang were advised to get the polio vaccine, so I did. I took the 'sugar pill' vaccine twice for free at the community center since last September," he said.
"Before taking the vaccine, I read and signed the notice about possible side effects after taking the pill. I had a fever after taking the vaccine, but the day after I was fine," he said.
Source: China Daily

Making a million from second hand medical equipment

Golden Meditech bought up old medical equipment from Japanese hospitals and sold it to Chinese hospitals
Kam Yuen occupies one of the largest offices of any chief executive in Hong Kong, on the 46th floor of the IM Pei-designed Bank of China building with views of the harbour and the hills of the city. An exercise bicycle stands behind a leather couch and massage chairs, while gold figures are placed on tables and window ledges. The figures are there for luck. Mr Kam is a great believer in luck, particularly his own.
He might well be, given that he founded two companies, Golden Meditech Holdings and China Cord Blood Corp, both of which are now listed. Shan Weijian, the former rainmaker of US buyout group TPG, has a stake in the first and KKR a stake in the second. Analysts estimate Mr Kam could be worth US$100m, based on his shareholding in Golden Meditech alone.
Mr Kam is the face of the new China, personifying both its strengths and limitations. Like many entrepreneurs, he made his fortune by spotting an arbitrage rather than by coming up with a breakthrough in product innovation or technology.
And while Mr Kam succeeded largely through his own initiative rather than through connections, today he is courted by princelings, and his ties with influential people help his business flourish.
“I have never thought I would not succeed,” he says, waving a cigarette.
Mr Kam, who is 51 though he looks far younger, grew up in Beijing. Ignoring his parents’ wish that he become a doctor, he studied at one of the city’s foreign language institutes. Having failed to learn English, Mr Kam attempted Japanese more successfully.
Upon completing his courses, he joined a metals trading state-owned enterprise, Minmetals, and was sent to Japan in the late 1980s. Tokyo at that time was probably the most expensive city in the world, and as a junior employee
of a Chinese state-owned enterprise, the young worker received a pittance.
“I was paid Rmb70 per month,” he recalls. “I wanted to be more independent.”
So Mr Kam cast about for a more lucrative means to support himself. He soon discovered that Japanese hospitals were constantly discarding medical equipment and replacing working machines with the latest generation of medical equipment – paying waste removal firms good money to get rid of the older models in the process.
The Japanese proclivity to throw out what anywhere else would be considered perfectly respectable goods from cars to couches is well known. But Mr Kam saw the business potential in this proclivity.
He went round to dozens of Japanese hospitals and convinced them to give him their used X-ray, ultrasound and other machines for free and then sold them to Chinese hospitals.
At the time Chinese hospitals had imaging devices that were only black and white; the imported equipment with their superior imaging technology sold very quickly. “There was no colour in China. It made the Japanese feel good,” he recalls. “I made them feel that they were helping China. I became a millionaire very quickly.”
Eventually, though, the magnanimity wore thin and Mr Kam says he was told he ought to begin paying for the equipment he was acquiring at no cost. That was a problem for him because he received local currency when he sold the equipment to Chinese hospitals while he needed yen to pay the Japanese. So he had to come up with something to sell in Japan to earn currency there.
Mr Kam, a devout Buddhist, spotted potential in an unlikely quarter . Japanese temples do not pay taxes and take a huge cut of the proceeds of funerals held there. The young entrepreneur decided to supply marble tombstones to the temples, importing them from China “to fix my foreign exchange problem”.
Golden Meditech describes itself as a leading integrated healthcare company in China, a sector that “needs government support and is in line with government policy”. The founder points out: “I don’t compete with the state-owned institutions. My customers are high end.”
The company includes the first nationwide hospital management operator in China that is wholly foreign owned, as well as a medical devices segment.
During the year ended March 2012 profit after tax dropped 48 per cent to HK$84m, a decline Mr Kam attributes to the volatility of financial markets. Given his own confidence in the business and a sense that current stock prices fail to reflect the intrinsic value of Golden Meditech, he told shareholders in June that he was increasing his own stake to 22.2 per cent.
Like so many companies in China, Golden Meditech is a one-man show. Disconcertingly from the point of view of corporate governance purists, Mr Kam is chairman, chief executive and chief compliance officer. To him that makes perfect sense.
Source: FT

Shortage of vaccines for tetanus and pertussis in China

Shortages of tetanus and pertussis vaccine may affect people living in China
Why is there a shortage of tetanus vaccine in China?
The local manufacturer of Tetanus-diphtheria vaccine (Td) does not plan to continue producing this vaccine, at least until mid 2013, due to low demand of use in China. The low demand is mainly because the China immunization schedule does not include the 10 years booster for all adults. Tetanus vaccine for children is still in the China immunisation schedule. It is offered as DTaP and DT for different ages of children.

What can be done if I had an accident causing open and dirty wounds and I know I do not have tetanus immunity?
[Our hospital] has the tetanus immunoglobulin that our doctor can administer intramuscularly to prevent possible tetanus infection.

What is the reason for the shortage Tdap (Boostrix) vaccine?
Boostrix is manufactured by GSK Belgium. This imported vaccine is discontinued in the China market, but still available globally elsewhere.

How soon are these vaccine shortages going to affect us?
Very soon. Remaining stock of Td vaccine expires on December 23rd, 2012; remaining Tdap (Boostrix) stock expires on January 31st, 2013.

Who will be most affected by the Boostrix shortage?
Adolescents and adults (i.e. parents, siblings, grandparents, childcare providers and healthcare personnel) who have or anticipate having close contact with infants younger than 12 months of age and pregnant women who previously have not received Tdap. US Advisory Committee on Immunization Practices (ACIP) recommends this group of people to be vaccinated against pertussis (also known as whooping cough) with Tdap vaccine (Boostrix), because pertussis causes high risk of pneumonia and death in young infants, especially < 3 months-old if infected.
Source: United Healthcare Shanghai