Thursday, 28 February 2013

Baidu and government partner to combat fake medical information online

by Liau Qun Ying
Chinese search engine Baidu and the China State Food and Drug Administration (SFDA) have partnered to fight fake medical information online.
Baidu will display results from China State Food and Drug Administration in medicine-related searches.
A Sina Tech report Monday said SFDA opened up three major databases to Baidu, which will offer three new search functions for certified drugs, the wiki entry of a medicine's instruction manual, and certified Internet drug stores.
The three major databases SFDA allowed access to include the SFDA drug database which has information of about 180,000 local and important medicine, instruction manuals for 6,000 over-the-counter drugs and Chinese traditional medicine, and the database of Web sites certified to sell drugs online.
The report said users can search for information on drugs via Baidu using the medicine's brand or generic names, as well as approval number. The search results will include information from SFDA'S database.
In addition, when users search for online drug stores, Baidu will show a "certified" tag next to online stores which have been certified to sell drugs. SFDA's database of instruction manuals for medicine also will be included in Baidu's Wiki, the report added.
It noted that Baidu since 2010 had worked with various government organizations, including SDFA, to fight fake information online. The search giant said it busted 201 businesses promoting counterfeit drugs last year.
In 2011, Baidu and other Chinese search engines were slammed by a state television station which alleged the search engine promoted Web sites which offered counterfeit drugs.
Source: ZDNet

Morphine underused as analgesic because of Opium War stigma war

by Zhao Xu in Beijing
Despite its benefits as an analgesic painkiller, morphine finds few backers among doctors because of its opium war associations.
Morphine, a medicine recommended by the World Health Organization as the most effective treatment for severe and chronic pain, is still widely viewed in China as something that people should avoid at all costs, even if they are suffering miserably and have a clinically estimated life expectancy of no more than a few months.
"The key word is addiction," said oncologist and pain-control expert, Liu Duanqi.
However, this is not addiction in the common sense of the word, but one that, according to Xu Guozhu, former director of Peking University's National Institute on Drug Dependence, "dragged the Middle Kingdom to its knees more than one and a half centuries ago and has punched fear deep into the hearts of all her citizens ever since".
"Leaf through any Chinese history book and the First Opium War of 1840 marks the beginning of the country's contemporary history, the beginning of a vast nation's seemingly incessant humiliation at the hands of foreign powers and its long, tortuous and blood-stained road to revival," said Xu, referring to a conflict triggered when British merchants dumped large quantities of opium on the Chinese coast and its subsequent confiscation by concerned Chinese officials.
The war ended in a crushing defeat for the Qing court, whose drug-emaciated subjects were scoffed at by the victors as "the sick men of the East".
By all evidence, that vicious plume of smoke has long dissipated, but the specter remains. And morphine, as a close relative of opium - both are derived directly from the resin of the opium poppy, with the former being "purer and stronger", according to Xu - has endured its "fair" share of suspicion, dread, and plain disgust.
Except that it's all "pure misperception", said Xu, who has personally monitored the clinical tests of nearly 50 types of morphine-based drugs in China, both imported and locally manufactured.
"Clinical observations show that pain itself is capable of putting up the most powerful defense against any potential addiction," he said. "In other words, patients who take morphine for pain relief are much less likely to get hooked than those who do so recreationally, for fun."
One example is the US involvement in the Vietnam War between 1961 and 1973, during which morphine was given extensively to wounded US soldiers. Signs of addiction were later found not in those for whom the medicine was intended, but in their fellow soldiers who had managed to procure the drug with the objective of getting "high".
"Staying away from pain with morphine's help does not mean letting yourself come dangerously close to the claws of addition," said Xu. "The WHO has whittled down the addiction rate for patients using morphine to less than 0.06 percent - the number speaks for itself about the absurdity of rejecting the medicine."
The severity of the issue first rang alarm bells for Chinese policy makers in the early 1990s, as the country began to adopt the WHO's Three-Step Analgesic Ladder in Cancer Pain Relief, a document published in 1986 with the aim of legitimizing and thereby increasing the prescription of morphine, especially among cancer patients in the globe's less developed regions.
It's a battle both Liu and Xu have joined, as they led the charge and pushed the frontiers forward, slowly but consistently, for two decades. Ground has been taken and victories claimed. In 2011 - the latest figures available - the total medical consumption of morphine in China reached 1,100 kilograms. That's roughly 0.79 mg per person, more than six times higher than the number for 1999, and nearly 400 times that of 1980, when per capita morphine consumption in China was a mere 0.002mg.
One milestone breakthrough came in 1998, when the Health Ministry scraped the upper limit capping the total amount of morphine a cancer patient is entitled to during the entire process of treatment. Another followed two years later, when all Chinese hospitals were granted unlimited access to morphine, based on need instead of the number of beds in their wards, as was previously stipulated.
Read more: China Daily

Wednesday, 27 February 2013

Medical conferences expensive, repetitive and over-commercialised

by Hera Hui
Medical conferences and related events occur frequently throughout China. Attending a high-level academic meeting can help Chinese doctors build relationships with their peers and improve their professional capabilities. But what types of conferences benefit these busy professionals? Do Chinese doctors find time to attend academic meetings, and what do they believe the purpose to be of these events?, the largest Chinese online academic portal, conducted an Internet-based survey asking, "What academic conferences are you anticipating attending?"During the 1-month survey, 2162 valid responses were collected and then reported. Of those who responded, 58.0% were doctors located in tertiary hospitals, 27.6% in secondary hospitals, 11.4% in primary hospitals, and the rest were in other settings
In regard to professional titles, about one fifth of respondents were professors or associate professors (5.4% and 17.9%, respectively), two fifths (39.9%) were attending doctors, and the rest were residents and interns (29.5% and 7.3%, respectively). Over half (59.9%) of the participants had a service experience of 6 years or longer; 31.6%, 1-5 years; and 8.5%, less than 1 year.
Academic conferences are important venues for continuing medical education (CME). The survey shows that most respondents (62.3%) take part in 1-3 academic conferences every year, whereas 19.5% of the respondents attend 4-6 academic conferences annually. Notably, 14.8% of the respondents attend more than 6 academic conferences annually, which means that they participate in such events almost every 1 or 2 months on average. Only 3.4% of the respondents "never attend"
When answering the question "What is considered the optimal duration for an academic conference?", 86.5% of the respondents favor 2-3 days, while 39.2% and 47.3% prefer 2 days and 3 days respectively. Only 4.7% of the respondents think that 1 day is enough, and 8.8% chose "4 days or more".
 A short event often is less informative, whereas a prolonged meeting can overwhelm the audience and make it difficult to arrange daily activities.
The respondents were asked to select which sponsors of academic conferences were most trusted and to choose as many as applied. As shown in the survey, the vast majority (91.1%) of the respondents prefer to take part in conferences held by academic societies/associations, hospitals/departments, and colleges/scientific research institutes (accounting for 45.5%, 31.2%, and 15.2%, respectively). Only 8.1% of the respondents are more interested in events sponsored by advertising/exhibition companies
Symposiums/workshops are most welcomed by doctors because they are more focused and targeted. On the contrary, about one third (34.2%) of the respondents prefer to attend national academic conferences. In keeping with academic globalization, a notable 17.6% of doctors show interest in international academic meetings. Few doctors are interested in local academic conferences and commercial events (6.6% and 0.6%, respectively).
Respondents were asked about their major purpose for attending academic events. They were allowed to choose any answer choice that applied. Most (86.8%) respondents choose "academic exchange" as their main purpose for attending academic meetings. Also, 76.2% of the respondents are willing to learn about new technologies and new products at such events. Academic meetings also can serve other functions: 47.5% of respondents attend to obtain CME credits and 31.3% go for social networking
Normally, CME credits play an important role in academic conferences. However, more than half (55.6%) of the respondents clearly expressed that they will attend academic conferences that offer no CME credits, while 39.4% chose "it depends" and only 5.0% insist that they will not attend an academic meeting without CME credit.
An interesting question, then, is whether doctors from different tiers of hospitals have different attitudes toward academic conferences that do not offer any CME credit. The survey shows that up to 58.1% of the respondents from primary hospitals will not attend, while only 6.3% and 4% of doctors from the secondary and tertiary hospitals, respectively, chose this option, which may be explained by the fact that doctors in the secondary and tertiary hospitals have more access to CME credits. Therefore, meetings that highlight CME credits may be more popular among doctors from primary hospitals.
As shown in the survey, most (78.4%) respondents attended academic conferences with a registration fee below RMB 1000 yuan, 20.9% have participated in events with a registration fee of RMB 1001-3000 yuan, and only 0.7% attend those with an RMB of 3001 yuan or above
In reply to the question "Are you willing to attend academic conferences at your own expenses?", only 24.0% chose "yes"; 28.2% chose "no," and 47.8% replied "it depends".
To 87.1% of the respondents, an "acceptable self-paid expense" is "below RMB 1000 yuan"; 12.7% chose "RMB 1001-3000 yuan," and only 0.2% selected "RMB 3001 or above"
The medical sciences have become more specialized in recent decades and so have the academic conferences. Are doctors in China satisfied with their domestic meetings? The survey respondents were invited to score the overall conditions of the domestic academic conferences using a 10-point system. The results showed that scores below 5 accounted for 20.8%, scores of 5-7 for 67.1%, and scores of 8 and above for only 12.1%
In a list of "areas for improvement," the options selected most frequently included repeated topics, commercialisation, high charges, limited interaction, and poor organizsation capability.
On the basis of the feedback from the respondents, meeting sponsors in China may consider: (1) enhancing academic inclusiveness and encouraging academic debates; (2) linking academic lectures with real-world clinical practice; (3) avoiding out-of-date information; and (4) improving the registration and receipt processes, finding a balanced point between academia and commercialization.
Source: Medscape

Beijing doctor claims to have cure for bone necrosis caused by corticosteroids

Most people think about the respiratory system when they think about SARS. Chen Weiheng knows it can also affect the pelvis.
The 50-year-old doctor and director of the China Academy of the Chinese Medical Sciences' Wangjing Hospital has spent the past decade treating patients with pelvic bone necrosis caused by the hormone therapies used to treat SARS and the necrosis often causes the affected pelvis to collapse.
Chen had focused on avascular necrosis of the femoral head (ANFH) since 1991. ANFH occurs when bone tissue dies and the bone often collapses due to a lack of blood flow to the top of the femur. This has happened to many SARS survivors who received hormonal treatments.
The doctor has used a myriad of treatments and much research to slow the cellular death of his patients' hips. He has employed surgery, intravenous infusions of traditional Chinese medicine, arterial injections, Western drips, DNA analyses - anything he can to maintain skeletal integrity.
He has saved hundreds of patients from losing their joints to metal replacements.
Source: China Daily

Now for the hard part: reforming city hospitals

China's ongoing medical reform has already entered its most difficult stage, Minister of Health Chen Zhu has said.
He made the remarks at the launch of the China-World Health Organization Country Cooperation Strategy 2013-15.
The strategy outlines a medium-term framework for cooperation between the Chinese government and the WHO to improve the health and well-being of Chinese people.
"By 2015, when all county-level hospitals are reformed, the program will be expanded to large city hospitals, which will be very difficult," Chen said.
As China has nearly achieved universal healthcare by covering about 95 percent of the population under some form of health insurance, reforms to public hospitals will be on top of the working agenda, he said.
The essence of the reform is to cut public hospitals' financial dependence on drug sales, a mechanism that easily results in excessive examinations and prescriptions, health policy experts said.
Zhang Liming, deputy director of the WHO collaborating center for primary healthcare in Shanghai, said the reform is aimed at improving public access to affordable medical care at public hospitals.
"Public hospitals should serve as a base providing essential healthcare to the people rather than a profiting institution," he said.
However, finding a proper way to compensate them is crucial, Zhang pointed out, proposing government support.
According to Chen, by the end of the year, about half of the nation's county-level public hospitals will be reformed and for that, the government would largely subsidize their operation.
At present, 70 percent of the nation's population, mainly farmers, get medical care at county-level hospitals, the Ministry of Health said.
Given that county-level hospitals are relatively small and totally subject to the control of health administrations, "they were chosen as the starting point of the reform", explained Wu Ming, assistant director of the Peking University's Health Science Center.
"The reform will surely reach large hospitals in cities by 2015 when all county-level ones finish it," Chen vowed, urging more support from large hospitals for the reform.
As sporadic experiments, several major hospitals in cities such as Beijing and Shenzhen launched the reform in July, previous reports said.
Under the pilot program, the long-established 15 percent markup on drugs was scrapped while the fees for seeing the doctor were raised.
"That's more like a restructuring to the insurance payment pattern," Zhang explained.
In fact, the government didn't pay extra for the change, he added.
"The annual revenue of large hospitals usually amounts to hundreds of millions yuan, and that's impossible for the government to absorb," he said.
Huang Jiefu, vice-minister of health, said the success of China's medical reform lies in medics' hands, thus it's important to find ways to compensate their potential losses and encourage their enthusiasm for work.
Source: People's Daily

Retired doctors urged to work in rural areas

by Laurie Burkitt
China is encouraging doctors to come out of retirement and work in rural areas as part of an effort to tackle a health-care disparity between wealthy cities and the much poorer countryside.
The move is one of a number of initiatives outlined by China's health minister to revamp a health-care system that reinforces the social inequalities now threatening the country's economic growth and stability. China offers progressive medical facilities in large cities such as Beijing and Shanghai, for those who can afford it, but still struggles to provide basic care to large portions of the rural population.
Many medical professionals prefer living in cities, fueling the disparity. On Tuesday, Health Minister Chen Zhu said the ministry is boosting incentives, such as free education, to entice physicians to work in less developed regions.
The ministry is also rolling out a new examination system that will lower the standards required for doctors who aim to work in villages, Dr. Chen said at a briefing with representatives of the World Health Organization on China's health-care reform. Retired doctors from large public hospitals will be invited to return to work in primary-care facilities around the nation, he said. He didn't outline specific details for the new examination system or the programs for retired physicians.
Doctors working in public hospitals follow the national retirement regulations, with men retiring at 60 and women at 55. Private hospitals can hire or retain doctors beyond those age limits.
Health officials will also increase efforts to create more county hospitals and primary health facilities in the countryside to take the strain off large urban hospitals, Dr. Chen said. "This is a critical year" for health reform, he said, adding that there is now more expectation among the general public for better health care.
The world's most populous country is in the midst of one of the largest health-care overhauls the world has ever seen. China has spent $125 billion in recent years to extend public health-insurance coverage to 95% of the population.
The yawning gap between the country's rich and the poor, most obviously between its city and rural dwellers, is an issue facing China's new government that takes power in March at a meeting of the National People's Congress. The median household income of city residents was 28,000 yuan, or roughly $4,500, in 2010, nearly triple that of rural counterparts, according to China's Southwestern University of Finance and Economics.
The rift threatens to unhinge the country's growth and ignite social unrest. And it is widely playing out in the country's health system.
Health officials announced years ago plans to expand hospital networks across China, but village and rural dwellers are still traveling often thousands of miles across the country to city hospitals where they seek treatment when treatment back home either isn't available or isn't up to par with city standards
The result has been overcrowded city hospitals, where the sick spend days, even weeks, waiting for appointments in overflowing waiting rooms.
China's central and western regions remain the country's largest weak spots, said Wang Jin, a partner in consultant firm McKinsey's health-care group in China. "There has been recent investment in those areas and other rural areas, but historically there has been such a deep gap there that the government is still catching up," Ms. Wang said.
While much of the emphasis has been on improving the quantity of hospitals and doctors in rural areas, future leaders will be tasked with a need to improve the quality of care, Ms. Wang said, noting that many rural doctors' skill sets limit their ability to operate on patients and treat certain diseases.
Health officials are also aiming to improve the reimbursement rate for rural families dealing with critical and catastrophic illnesses, Dr. Chen said, adding that the country's national insurance has reimbursement rates of around 70% for rural citizens, but the other 30% is often a huge burden.
Dr. Chen also said that it is expanding sales within counties of pharmaceuticals on China's essential drug list, a list of Western and traditional drugs that cover diseases such as cancer and that are subsidized by provincial governments.
Source: WSJ

HK doctors face official obstacles to running clinics in Shenzhen

by Ernest Kao
Hong Kong general practitioners operating clinics across the border have been facing many difficult challenges despite a huge market for quality medical services in China.
Complex bureaucracy, arcane regulations and operating costs even higher than Hong Kong's have been weighing heavily on private medical practices in Shenzhen - like the one belonging to Wu Wei. The Hong Kong doctor set up his clinic there three years ago.
But Shenzhen’s Health, Population and Family Planning Commission has suspended Wu’s practice for “poor business management” and ordered the clinic to "rectify its problems by March 31", the Southern Metropolis Daily reported on Tuesday.
Wu’s practice provided a range of services including traditional Chinese medicine, gynaecology, dentistry - even cosmetic surgery. Wu was contacted by reporters at the Daily, but staff at his clinic said the doctor had been away since the beginning of the Spring Festival. They did not know where he was.
Wu opened his Luohu clinic in 2010 and was one of the first Hong Kong GPs to capitalise on new Closer Economic Partnership Arrangement (Cepa) rules. These allow medical service providers from Hong Kong to tap the mainland market and enjoy "national treatment” in setting up wholly-owned or joint medical institutions.
The aim was to develop a market in Guangdong for quality Hong Kong-based medical services for China's rich.
Hong Kong-based Dr Wong Chi-ho told the South China Morning Post that although there was still a large market for Western and Chinese medical services on the mainland, operating and start-up costs were still too high.
“Moving up to the mainland will still be the trend, but doctors must be prepared to spend a lot of money for new equipment and meeting the regulations of local authorities,” he said.
Wong says he is one of the few Hong Kong GPs left in Shenzhen and alternates from his Shenzhen and Tuen Mun clinic throughout the week. He was the first Hong Kong doctor to obtain a licence to practice western medicine in China and opened up his clinic last May.
“Some of the current medical practice regulations for hospitals may not be suitable for private clinics,” he added.
Private clinics charge about 500 yuan (HK$620) for a single consultation in Shenzhen, about three to five times more than hospital outpatient departments.
Source: SCMP

Thursday, 21 February 2013

New rules for rational antibiotic use in China

by Xiao Yonghong and Li Lanjuan
On Aug 1, 2012, China formally implemented a decree issued by its Ministry of Health on administrative regulations for clinical use of antibacterial agents. This ruling defines all aspects of antibiotic use in hospitals, including selection, procurement, prescription, use, monitoring, and legal responsibility, and is the strictest regulation yet for antibiotic management in China. The major purpose of the new regulations is to ensure rational use of antimicrobial agents.
China has extensively reformed its health-care system, which is expected to ultimately give all citizens access to basic medical care. To achieve this aim, the current profit-orientated philosophy in public hospitals should be completely abandoned, and administration of drugs, including antimicrobial agents, should be rationalised. Irrational long-term use of antibiotics allowed by current hospital managements strategies in China has generated antibiotic-resistant bacterial strains, despite the health-care authority releasing several sets of guidelines during the past 10 years to promote rational use, including principles for clinical use of antibiotics (2004), a national formulary (2008), and guides for hospital drug therapeutic committee (2002). Bacterial resistance is now a major problem in China.
In a national survey, 60% of isolates of some species were drug resistant, including meticillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing Escherichia coli, quinolone-resistant E coli, and carbapenem-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii.  Rational use of antimicrobial agents and the implementation of other methods to prevent resistance from worsening have become crucial.
The recently introduced regulations for antibiotic use incorporate the internationally accepted notion of antimicrobial stewardship, and include some administrative requirements tailored to the Chinese health-care system. The regulations also include specific instructions for leaders of medical institutions who are responsible for the rational administration of antimicrobial agents, for establishing an effective antibacterial drug-management system, and for forming a working group composed of infectious disease physicians, pharmacists, microbiologists, and managers. Medical institutions must ensure that antibiotics are classified as non-restricted, restricted, or special-grade. Physicians and pharmacists need specific training in antibiotic prescription before they are granted different levels of prescribing privileges depending on their professional title. The health-care authority will set administrative goals for institutions, review of antibacterial drug prescriptions, regularly publish information about antibacterial drug use in hospitals, commend physicians who closely follow the regulations, and impose penalties on medical staff who violate them.
The regulations also encourage medical institutions to explore alternative strategies to improve the rational use of antibacterial drugs, such as diverse antibiotic use, active intervention for antibiotic use, implementation of clinical guidelines, and hospital infection control. At the same time, pharmaceutical companies should implement a standardised drug-promotion procedure and stop attempting to increase drug sales for economic incentives. Medical institutions need to regularly report the use of antibacterial drugs to the health-care authority. To improve the administration of antibiotics, institutions that seriously or persistently violate the regulations will be appropriately penalised by the authority, by means such as downgrading the hospital to a lower level of classification, and dismissing the leaders of the institutes involved. Medical staff who seriously violate the regulations could lose permission to prescribe antibacterial drugs, have their professional qualification revoked, or even be prosecuted if their actions have serious consequences.
To promote the implementation of these regulations, in 2011 the Chinese Ministry of Health initiated a 3 year campaign with a special task force in antibiotic management. By strict implementation of these regulations and the introduction of legal penalties, the rational use of antibiotics in public medical institutions can be enforced quickly and efficiently. Although these steps are appropriate to reduce antibiotic use in the current Chinese health-care system, long-term management of the strategies needs more planning and the establishment of a sustainable back-up system such as antibiotic stewardship professionals, guidelines, ongoing staff training, and procedures for identifying illegal practice. Unfortunately, antibiotic sales in high-street pharmacies are not within the legal jurisdiction of the regulation.
Source: Lancet Infectious Diseases

Hospitals banned from linking doctor's income to prescribing and investigation fees

The Chinese government on Wednesday released a guideline on its basic medicine system that forbids hospitals from linking doctors' incomes with their patients' medicine and medical exam expenses.
Some hospitals link doctors' pay with revenues earned through medication sales and exam fees, creating greater economic burdens for patients in some cases.
The guideline, released by the health and reform office under the State Council, or China's cabinet, is intended to consolidate and improve the basic medicine system and offer solutions for problems related to local-level health care reform.
The guideline also calls for efforts to teach medical staff to use basic medicine properly, as well as encourages non-governmental local medical institutions to use medications that are on the basic medicine list.
The guideline also calls for quality inspections for basic medicine and the implementation of electronic monitoring during the medication production process. It also asks for inspection results to be released to the public regularly.
Source: Xinhua

Wednesday, 20 February 2013

N95 masks must be worn continually to protect against respiratory infection

by Michael Woodhead
N95 respirator masks must be worn continually by healthcare workers if they are to be effective in preventing transmission of respiratory infections, a Beijing study has shown.
In a randomised clinical trial of 1669 hospital staff in Beijing in the 2009/2010 winter, healthcare workers used either medical masks; N95 respirators continually or targeted use of N95 respirators while doing high-risk procedures or barrier nursing.
The study showed that the rate of respiratory illness was highest in the medical mask users (17%), followed by the targeted N95 arm (12%), and the N95 arm (7%).
Bacterial respiratory tract colonisation in subjects with respiratory illness was highest in the medical mask arm (15%), followed by the targeted N95 arm (10%) and lowest in the N95 arm (6%).
The researchers from the Beijing Center for Disease Prevention and Control say that targeted N95 use is no better than wearing a medical mask and that continuous use of N95 respirators is more effective against respiratory illness than intermittent use of N95, or medical masks.
"Most policies for healthcare workers recommend use of medical masks alone, or targeted N95 respirator use ... this study provides further data to inform occupational policy options for healthcare workers," they conclude.
Source: American Journal of Respiratory and Critical Care Medicine

Ministry of Health clarifies that 'bulk billing' free treatment scheme will only be a pilot

China’s Ministry of Health denied a statement that a medical payment system that allowed patients to pay after treatment will be introduced nationwide, but confirmed that the system was encouraged to promote in pilot regions.
The pilot system reveals a change in China’s medical payment system – hospitals will pay the fees under related policies for patients first and settle the accounts with the medical insurance then.
Earlier, state-run China Central Television reported that the ministry will introduce the system of “Pay after Treatment” in hospitals across the country this year.
But Jiao Yahui, head of the ministry’s medical management division, said on Tuesday that the system will only be promoted in some qualified pilot regions.
Under the new system, patients, especially those suffering extreme conditions, will receive treatment first. Hospitals will pay the fees for them first and repay by medical insurance later. After the treatment, patients will only pay the part that is not included in the medical insurance.
Currently, most Chinese citizens must pay their bills and apply for a reimbursement covered by medical insurance, usually more than 70 percent of the total treatment fees, Xinhua News Agency reported.
Jiao said the “Pay after Treatment” system was first tested in a hospital in Beijing in 2009. Now more than 20 provincial regions are carrying out the pilot programs in local hospitals, Xinhua said.
Jiao said the new system will not be adopted nationwide in the short term due to an immature social credit system and insufficient medical insurance in the country.
Some patients may "disappear" without paying treatment fees after leaving hospital, which has created risks for the hospitals, according to Jiao. Hospitals will not be able to get the money back if patients don’t buy any medical insurance, Xinhua said.
But in coastal wealthy regions, hospitals won’t face such risk. Medical insurance departments, instead of hospitals, will pay in advance for patients who have bought medical insurance, the 21st Century Business Herald reported.
An unnamed director with the medical insurance department of a major hospital in Shanghai told the paper on Tuesday that the department will allocate one twelfths of the annual amount of medical insurance to the hospital every month and the money can totally cover what patients need.
The paper said the above system of payment in advance by medical insurance department can support the “Pay after Treatment” medical payment system. But it hasn’t introduced in most regions of middle and west China.
Zhu Hengpeng, head of the Center for Public Policy with the Institute of Economics of Chinese Academy of Social Sciences, believes that the reform of medical payment system is just a technical matter, what matters the most is the reform of the medical service supply system, the paper reported.
Currently in China, public hospitals have monopolized the medical service, it’s hard for the new payment system to work, Zhu said.
Source: Morning Whistle

Tuesday, 19 February 2013

Dengue fever controls insufficient to prevent outbreaks in Guangdong

Dengue is spread from infected visitors by Aedes mosquitoes that thrive in Guangzhou
by Michael Woodhead
Dengue fever outbreaks in Guangdong are not due to endemic infection but are being triggered by imported cases that slip through inadequate border controls and poor local hospital surveillance, researchers have found.
Despite fears that dengue was re-emerging as an endemic disease in Guangdong, researchers from the Guangzhou Center for Disease Control and Prevention have traced the source of three recent outbreaks in the region to travellers arriving in Guangzhou from Vietnam, India and Tanzania.
A 2009 outbreak was straced to a Chinese man who returned from a trip to Vietnam, the report in PLOS One. Two other outbreaks in 2009 and 2010 were traced to visitors from India and Tanzania, the latter resulting in almost  80 cases of the disease in the city. Using genetic analysis of the dengue virus, the researchers showed that the strains were not like the endemic strain seen previously in China but were similar to strains seen internationally.
The outbreaks of dengue infections mostly occurred following the monsoon season, when the climatic factors (temperature and humidity) remained conducive for Aedes mosquito breeding. Most of the patients were in the age group of 21–50 years, which is contrary to the popular belief that dengue is a paediatric disease.
The outbreaks occurred because the dengue fever cases were initially misdiagnosed, which is understandable as initial symptoms are often non-specific and viraemia may be below detectable levels. Outbreaks of dengue in Guangzhou are also promoted by Cantonese habit of culturing water plants and keeping water for watering flowers, and environment were suitable for the breeding of  dengue carrying Aedes albopictus mosquitoes.  Also, there is a lack of local self-awareness of the need to protect against dengue, the researchers say.
The researchers are critical of the half hearted measures taken by local government to identify imported dengue cases and reduce the local transmission.
The Guangdong dengue control program includes a network of rapid diagnostic laboratories, and fever screening at international airports using infrared thermal scanners. However, febrile passengers suspected of having dengue virus infection are not detained at the airport nor required to complete the “Dengue Survey Form”, and only provided with a mosquito net, which is rarely used.
"These findings underscore the importance of early detection and case management of imported case in preventing large-scale dengue epidemics among indigenous peoples of Guangdong," they conclude.
Source: PLOS One

Health care for older Chinese people who lose their only child

by Li Yan and Wu Shufang
Over the past three decades, the one-child family planning policy in China has had a substantial role in population control and in boosting the economy. However, it has also brought about a new phenomenon of “childless” older people in China, and this group is expanding rapidly.
In 2011, the number of families who lost their only child across China rose to more than 1 million—a figure that is estimated to reach 10 million by 2035. In a country with a seriously flawed health system, elderly parents are heavily reliant on their children. The death of an only child at a time when parents are unable to have another can cause pronounced psychological trauma, including long-term grief, depression, and anxiety about a lonely old age without an adequate pension or proper health care.
Support from the government is essential in relieving the difficulties currently faced by the childless elderly in China, and the difficulties they face in the future. Such support includes three major aspects. The first is health and social care, including policies to support family care services, better quality nursing homes, and the creation of various community health-care services. The second is economic support. To many of these parents, loss of their offspring immediately means the loss of their only hope of financial security. Although the Chinese Government has begun to schedule plans for providing support to elderly people who have lost their only child, detailed regulations, practical enforcement at the grassroots level, and pension insurance are urgently required. The third aspect is that of spiritual comfort. Several local governments in China have taken steps to act on this; for example, in September, 2012, the Beijing municipal government launched a scheme to provide psychological support at community care centres for the childless elderly, and this scheme now covers around 3900 families in Beijing who have lost their only child. However, the gap in assistance is still vast. The government should increase cooperation with non-governmental organisations in setting up community service centres that can provide door-to-door services for the childless elderly, providing them with psychological care and emotional comfort. Another approach that could be considered by the government is the encouragement of volunteers and training of social workers to offer free psychological consultation and mental health interventions.
Moreover, the media should be encouraged to report on the childless elderly and raise attention to this newly vulnerable group.
Source: Lancet

Who will replace the ageing village doctors who work hard for a pittance?

Believing that their situation will one day improve, village doctors are working tirelessly to better the health conditions of rural areas.
Shi Huaiqing is one of this group of about one million village doctors. 

Shi, 52, hails from the village of Shijiagelao in Luochuan county, near the city of Yan'an in Shaanxi Province. He has been a doctor for 35 years and has been responsible ever since for the village's 268 households. 

The job does involve some risks, considering the increasing number of disputes between doctors and patients in recent years.

"We're afraid of potential risks. Often, I am nervous about taking on a patient even if I am confident I can cure them," Shi said, adding that this definitely has increased the economic burden on villagers since they often have to travel far to town or county hospitals.  

Salaries are low, which is why so few young doctors choose this path as a career. Shi is worried that no one is willing to take his position, including his son.

Shi receives 10,000 yuan ($1,605) a year in subsidies, which is much better than the situation years ago when he and Zhang barely earned 60 yuan a month. But despite this improvement, it is still far from enough. "In some mountainous areas, the subsidies are reasonable to encourage village doctors to keep working but in my county it's difficult," said Shi.

Luochuan county is well-known for its apples that sell internationally. This has allowed local farmers to boost their income, with flash cars appearing around the villages. This has meant that the subsidies for village doctors have paled in comparison to the yearly income of local families. 

If it weren't for Shi and Zhang's wives making extra money working on their apple farms, the two doctors would have trouble supporting their families.

Village doctors have been deemed as heroes fighting on the very frontline of the country's vast healthcare system. However, for decades, they have been officially considered as farmers, with practicing medicine only a part-time job - they are not on the public-owned hospitals' pay rolls and they are not covered by the pension system like other doctors working in the city hospitals.

When healthcare reform was carried out in recent years, which brought greater benefits to rural residents, these doctors seemed to be left behind. Mass petitions by village doctors were reported in many areas across the country, calling for greater respect and equal welfare with urban counterparts. 

When village doctors were invited to meet Li Keqiang in January this year, one made his concerns very clear, namely a lack of training opportunities, inadequate facilities, great risk, low income and no pension.

In truth, the authorities have been trying to address these problems in recent years.

"They made just several hundred yuan a month. If they were treated the same way as village teachers (many included in government pay roll), many problems would have been solved," said Minister of Health Chen Zhu at the annual session of the National People's Congress in 2009 (NPC). 

According to a report by the China News Service on January 25, the Ministry of Health said pilot programs for village doctors under contract will be carried out in some areas, and special subsidies will be provided while a pension system will be established. 

Zhang often drives his car to visit villagers, to make sure they take their injections on time or to carry out physical examinations.

The director of the town's hospital once joked to Zhang that even though his petrol costs aren't covered, he still uses his car for the job, recalled Zhang.

As far as he's concerned, the job requires enthusiasm and patience, but it's all worth it because it places him right at the center of the country's healthcare system, straddling both towns and villages.

These sub-divisions were meant to ensure that common ailments would be handled at the village level, with patients only visiting larger hospitals for more serious problems. 

Zhang graduated from a clinic school in Yan'an after studying three years there. He has been a village doctor since 2000. "Within these years, I've learned a lot but I still need to keep learning to be a qualified doctor," he said.

 Zhang can cure some common diseases such as colds and stomach bugs, but he cooperates with the local town hospital to promote the practice of State-run programs.

Urging villagers to have free medical examinations is a challenge. "Villagers usually value farm work more than their health," he said, adding that it's normal for him to turn to elderly people's children for help to persuade their parents to go to the hospital.

Working hard also takes a toll on doctors' relationships with their families. For Shi, some of his relatives think he does not care about family, as he is often late for relatives' weddings or funerals due to so much of his time being taken up with receiving patients.

Shi's colleague, Shi Shihong who worked in a nearby village, died at the age of 80 before the Spring Festival. His wish was also to improve the condition of retired village doctors.

Gu Linhai, a village doctor who had worked for over 40 years, has been living with cerebral palsy for a decade. Now he only gets 160 yuan a year as a pension, according to Shi. 

Shi said his living conditions are much better than those of his colleagues who work in remote areas of the countryside, and therefore he has no excuse to give up his job, despite accepting conditions too forbidding for most.
Source: Global Times

Monday, 18 February 2013

Chinese medical news from the journals

Almost one in three Staphylococcus aureus strains found in humans by Yangzhou researchers were methicillin-resistant S. aureus (MRSA), with most being hospital-acquired MRSA. The superbugs were also found in food and animal samples. Writing in the journal Foodborne Pathogens and Diseases, the researchers say infection with multidrug-resistant MRSA strains acquired from food, animal, and human sources might also become a significant problem for human medicine.

One in four Chinese people with epilepsy has poor adherence to their anti-epilepsy medication and 70% have only moderate compliance, a new study shows. The reasons for nonadherence included forgetfulness (54%), being seizure-free for a period (49%), and fear of adverse drug effects (28%).
Epilepsy and Behavior.

Rotovirus and norovirus are the two most common causative agents for diarrhoea and vomiting in Chinese infants, a study from southeastren China has found. Rotovirus tended to cause more prolonged, frequent and severe illness and the viruses were seasonal, the study published in Pediatrics Infectious Diseases journal showed.

Smoking is a major risk factor for nonalcoholic fatty liver disease, especially in obese people, a Shanghai study has found. People who smoked and had a high BMI had a nine-fold higher risk of nonalcoholic fatty liver disease, their study in the Journal of Epidemiology showed. Passive smoking was also associated with a  25% increased risk of the disease, say researchers from the Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine.

China has made progress in the prevention and control of major non-communicable diseases but there are still large action gaps in the fight against epidemic non-communicable diseases according to members of the Subcommittee of the Non-Communicable Diseases, the Expert Committee on Disease Control and Prevention established by China’s Ministry of Health.
Global Health Action.

Chinese people who have a more varied diet and especially a diet rich in fruit have a much reduced risk of bladder cancer, a study in Cancer Causes and Control shows

Type 2 diabetes is associated with the increased risk of  liver cancer within five years after diagnosis in Chinese population, researchers at the State Key Laboratory of Oncogene and Related Genes and the Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine have shown.  Writing in Annals of Oncology, they say the finding suggests that hyperinsulinaemia rather than hyperglycaemia is more likely to be a primary mediator for this association.

Friday, 15 February 2013

Four million Chinese have untreated mental disability

News findings from a Chinese study indicate there is huge unmet needs for mental health services among Chinese adults with mental disabilities, as well as socioeconomic inequalities in use.
In a study of almost 2 million adults, the prevalence rate of mental disability was 0.81%. From this, it was estimated that about half, or more than 4.2 million adults with a mental disability had never used a mental health service.
People were less likely to use mental health services if they lived in rural areas, had less education and were poor.
Dr Li Ning and co- researchers from Beijing University say mental disability in China has become a significant public health problem. However, few studies have examined utilization of mental health services in China among people with mental disabilities.  "Strategies are needed for enhancing community mental health service systems and reducing barriers to mental health service use in China," they conclude.
Source: Psychiatry Online

All-of-life care policy needed for people with autism

Shanghai needs to provide life-long care for people with autism, according to a political adviser. At present they are only covered by a special education and training network until the age of 18.
Life-long care would offer proper support and help to people with autism and their parents, who worry about their children's future after they are gone, said Yao Jianjian, a member of the Shanghai committee of the Chinese People's Political Consultative Conference.
Yao said there are at least 10,000 people with autism in the city. Autism is the result of a neurological disorder that affects the development of a person's communication and social interaction skills.
Yao said the current legal system only allows for nine years of compulsory education for children with autism from seven years to 16 years old.
There is another two years of vocational training available for those with mild autism.
"After 18, all autism patients have to stay at home, since there is no follow-up care and training for this special group of people, who can't communicate with others properly," Yao said. "Until death, they almost have no social welfare."
Yao said Shanghai has the ability to set up a welfare system covering the whole life of people with autism. "Developed countries such as Japan and Canada ... all have special education and training plans for people with autism, whose welfare continues to improve," he said.
Yao suggests that the city government carry out a detailed study on autism and set up a life-long social service welfare system covering early diagnosis and intervention, rehabilitation, education, employment and care throughout adulthood.
The government should also offer subsidies to the carers of people with autism and give favorable policies to non-governmental organizations involving in the care of such people.
Source: Shanghai Daily

Journal watch China

China has 1.5 million people disabled in road traffic accidents, or one in a thousand, according to a survey conducted by physicians published in the Journal of Public Health.

The high levels of air pollution recently seen in Chinese cities such as Beijing will increase deaths from strokes, according to research at Fudan University, Shanghai. Published in the journal Stroke, a study  carried out in eight Chinese cities found that for every 10 μg/m3 increase in  outdoor air pollution (particulate matter <10 μm in aerodynamic diameter, sulfur dioxide, and nitrogen dioxide) there is a 1.5% increase of stroke mortality.

Anaemia in pregnancy is causing mental retardation in Chinese children, according to a study from western China. The two year follow-up of 850 children born to women who took part in a trial of prenatal folic acid and iron supplementation in western rural China found that children whose mothers had iron deficiency anaemia in the third trimester showed a significantly lower mental development index at 12, 18, and 24 months of age. However, prenatal supplementation with sufficient iron protects child development even when the woman’s anaemia is not fully reversed, the study published in Pediatrics shows.

Sexually transmitted infections are common in prostitutes, a study of more than 3000 sex workers in eight Chinese cities has found. According to the findings published in the journal BMC Public Health, the overall prevalence rates of HIV, syphilis, gonnorheoa and chlamydia were 0.26%, 6.5%, 5.9% and 17%, respectively.

Toxic fungi are present in drinking water supplies in in Xiamen, a study  has shown. Analysis of water samples from four parts of the city found that the mycotoxigenic fungi Fusarium sp., Exophiala sp., and Phialophora sp were present in "with high frequency" in samples. " Some detected strains may directly cause human health problems," say the researchers from Xiamen University.

Wednesday, 13 February 2013

Diclofenac causes 14,000 deaths a year in China and should be banned: researchers

The anti-inflammatory drug diclofenac should be withdrawn from sale in China because of its high risk of cardiovascular adverse effects that may be responsible for 14,000 deaths a year, researchers say.
The call to withdraw the drug comes from UK and Indian researchers who found that diclofenac was still the most popular NSAID drug for pain and arthritis in countries such as China despite having a higher risk of cardiovascular disease.
They called for the drug to be removed the the list of essential medicines because safer alternatives such as ibuprofen and naproxen are available. For China, they estimate that
"The findings  ... have significant implications for public health. In China the age- and sex-standardised death rate from cardiovascular disease is estimated to be 312/100,000 for males and 260/100,000 for females. Diclofenac is the most commonly used NSAID in hospitals in China.  If it were taken by only 1% of China's population of approximately 1.3 billion annually, based on the relative risk calculations from meta-analyses it could cause 14,000 additional unintended deaths. These deaths are preventable - lower risk NSAIDs, including naproxen and low-dose ibuprofen, are widely available and are equally efficacious," they write.
According to the researchers, NSAID recommendations on national essential medicines lists should be based on the optimum balance of benefit and harm and give preference to low risk drugs, in particular to ibuprofen and naproxen.
"Diclofenac has no advantage in terms of gastrointestinal safety and it has a clear cardiovascular disadvantage. Given the availability of safer alternatives, diclofenac should be de-listed from national EMLs. There are strong arguments to revoke its marketing authorisations globally."
Source: PLOS Medicine

Petitioning still plays a role in hospital complaints in China

by Zhang Qian,  School of Public Health, Fudan University, Shanghai
The Letters and Visit (petition) system is a channel for people to express grievances and seek justice, which also applies to hospital complaints.
There is a department for Letters and Visits (LV) in any government at or above the county level, and an Letters and Visits office in any relevant department of the government. Individuals and organizations make comments or lodge complaints to departments and offices of LV at all levels.
The idea of Letters and Visits comes from Mao’s Mass Line directly, but it also root-ed in the tradition “Gao Yuzhuang (to accuse someone before the emperor)” with a history of more than 2,000 years.
People use the Letters and Visits System  driven by the simple trust in governments, especially governments at higher levels, with the hope that leaders will re-turn justice to the people once they learned about their suffering, or simply because there is nowhere else to accept their complaints.
The government values Letters and Visits system more by new regulations and lifting the position of Letters and Visits office. But it’s not the only grievance redressal channel established formally in hospital complaints. There are at least other two out of the hospitals to deal with hospital complaints, which are held by People's Mediation Committee or the legal court. But the Letters and Visits system is still important to people: In Shanghai, about 70% of cases accepted by Letters and Visits in health administration department are related to hospital complaints. We conducted research to find out how Letters and Visits system works in hospital complaints, its advantages and limits, and to explore whether it fits users’ expectation.
We found there were 9,000 complaints at the Letters and Visits office at one city hospital every year. Generally all complaints are accepted. No matter governments of which level the complainant presents to, the case is transmitted to the Letters and Visits office of the government at the corresponding level.
Type I complaints were cases expressing patients’ grievances are transferred to hospital owners. Type II cases were reporting hospitals’ illegal activities are transferred to other departments of BoH according to their statutory functions and duties.
Type I cases were transferred to hospital owners, Type II cases were referred to other departments of the hospital according to their statutory functions and duties.
Investigation were made into important complaints (300-400 per year in Shanghai), which are typical or transmitted from higher level governments.  There is no mechanism for Letters and Visits office to track most case after they are transferred. A report to Letters and Visits office is only necessary for important complaints. The Letters and Visits office can urge a better solution, but it rarely happens. Occasionally the departments or institutions to which complaint cases are referred to do not perform their duties, The Letters and Visits office is meant to report this to the leader of BoH if it occurs.
The Letters and Visits office’s initial response when the case is transferred, is usually within 3-5 days after acceptance.
The report about the results by who handles the case, is generally with 30-60 days.
We conclude that the Letters and Visits system can work as a fallback channel in hospital complaints. It receives complaints through multiple con-tact methods, and transfers to appropriate departments or institutions and plays a coordinating role .
But the Letters and Visits system may not ensure the justice people expected: It works within health system, depends on other channels in handling, and is non-procedural.

Avian H5N1 flu death in Guizhou

One of two people confirmed by the China Ministry of Health to have contracted highly pathogenic avian influenza H5N1 died in a hospital in southwestern city of Guiyang Wednesday morning.
The patient, a 21-year-old woman, died of multiple organ failures in Guizhou Provincial People's Hospital at 9:41 a.m. Wednesday.
Source: Xinhua

Tuesday, 12 February 2013

Antibiotic resistance in China promoted by farm animal feeding practices

Widespread and unregulated use of antibiotics in animal feed in China is causing the emergence and release of antibiotic resistance genes  to the environment, according to a study that found 'diverse, abundant, and potentially mobile antibiotic resistance genes in Chinese pig farm.
Writing in the Proceeds of the National Academy of Sciences, Chinese and US researchers say that antibiotic resistance genes  are emerging contaminants posing a potential worldwide human health risk. Intensive animal husbandry is believed to be a major contributor to the increased environmental burden of ARGs. They say that despite the volume of antibiotics used in China, little information is available regarding the corresponding antibiotic resistance genes associated with animal farms.
Therefore, they assessed type and concentrations of  antibiotic resistance genes at three stages of manure processing to land disposal at three large-scale (10,000 animals per year) commercial swine farms in China. In-feed or therapeutic antibiotics used on these farms include all major classes of antibiotics except vancomycins. High-capacity quantitative PCR arrays detected 149 unique resistance genes among all of the farm samples, the top 63  antibiotic resistance genes being enriched 192-fold up to 28,000-foldcompared with their respective antibiotic-free manure or soil controls. Antibiotics and heavy metals used as feed supplements were elevated in the manures, suggesting the potential for coselection of resistance traits. The potential for horizontal transfer of ARGs because of transposon-specific ARGs is implicated by the enrichment of transposases—the top six alleles being enriched 189-fold (median) up to 90,000-fold in manure—as well as the high correlation between  antibiotic resistance genes and transposase abundance. In addition, abundance of  antibiotic resistance genes correlated directly with antibiotic and metal concentrations, indicating their importance in selection of resistance genes.
Source: PNAS

Chinese trial shows clopidogrel better than aspirin for preventing recurrence of stroke or TIA

A relatively short course of aspirin plus clopidogrel immediately after sustaining a transient ischemic attack (TIA) or minor stroke outperforms aspirin alone in cutting the risk for a subsequent stroke, and it does this without a significant increased risk of major bleeding complications, results of a large Chinese trial show.
Results of the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial were presented here at the International Stroke Conference (ISC) 2013 in Honolulu on Feb 8
The CHANCE trial, carried out exclusively in China, is a few steps ahead of a similar trial, the Platelet Oriented Inhibition in New TIA and stroke (POINT) trial, now enrolling mostly in the United States.
However, although CHANCE was a "well done" trial and its results showed "a larger treatment effect," it's important to note that healthcare in China is different from that in the United States, said CHANCE co–principal investigator, S. Claiborne Johnston, MD, PhD, professor, neurology, and director, Stroke Service, University of California, San Francisco.
"Secondary prevention practices are not as robust there as they are in Europe and in North America, and that could have impacted the trial," he said. "Also, usually genetic differences don't matter, but in this case, they might because there are differences in polymorphisms that affect clopidogrel metabolism in Asian populations."
For these reasons, although American neurologists might see the CHANCE trial as a signal to go ahead and use combined therapy, "I think it's wise for us to wait for a confirmatory trial outside of China, said Dr. Johnston, who is also co–principal investigator of the POINT trial.
CHANCE co–principal investigator was Yongjun Wang, MD, professor of neurology and vice-president of Beijing TianTan Hospital, Capital Medical University, who presented the full results here.
The study enrolled 5170 patients at least 40 years of age who had sustained a TIA or minor stroke. Within 24 hours of their symptom onset, they were randomly assigned to 1 of 2 groups: aspirin (1 day loading dose of 75 to 300 mg, followed by 75 mg/day) plus placebo, or the same aspirin regimen plus clopidogrel (loading dose of 300 mg followed by 75 mg/day).
Patients in the combination group were taken off aspirin at 21 days because of the concern that Chinese patients, as with other Asian populations, are at relatively high risk for hemorrhage. "Frankly, that belief comes from epidemiological studies, but the epidemiology may just reflect underlying risk factors and not a true propensity for it," said Dr. Johnston. He pointed out that the studies testing this have not been in the acute period.
The study showed that stroke occurred less frequently in those receiving both aspirin and clopidogrel. At 90 days, the hazard ratio (HR) for survival free of stroke — either ischemic or hemorrhagic — in the combination group was 0.68 (95% confidence interval [CI], 0.57 - 0.81; P < .001).
For the secondary outcome of combined events (stroke, myocardial infarction, vascular death), the HR was 0.69 (95% CI, 0.58 - 0.82; P < .001). The risk for hemorrhagic stroke was the same in the 2 groups (0.3%).
Notably, severe bleeding events occurred at a similar rate in the 2 groups (0.2% in each). Although mild bleeding occurred more often in the combination group (1.2% versus 0.7%), Dr. Johnston noted that these events included nose bleeds. "We did not see a signal that the combination was unsafe."
Both aspirin and clopidogrel affect platelets, but through different pathways. "Together, the 2 are much more powerful than either one alone," said Dr. Johnston.
CHANCE was the first trial to focus on the acute period in TIA and minor stroke, which Dr. Johnston emphasized is not being seen nearly enough in the emergency department. "People with TIA and minor stroke are not coming in acutely or they're calling the office and being seen in clinic," he said. "We need to remind people that this really is an emergency and it should be treated right away."
Asked whether the combination therapy would be an acceptable approach for more severe strokes, Dr. Johnston said it's impossible to know "where to draw the line." The researchers will do more subgroup analyses looking at stroke severity, but Dr. Johnston pointed out that "there was no difference between the TIA and stroke in terms of rates of hemorrhagic stroke or in the efficacy of the combination."
Compared with elsewhere in the world, the risk for stroke is very high in China. "There are a whole lot more strokes in China than there are in the US and even if you add Europe, you still have more strokes in China," said Dr. Johnston.
Because the trial was so large and because standards for clinical research have improved dramatically in China, the CHANCE results are "incredibly important" and should have a major effect on public health around the world, said Dr. Johnston. However, there are important differences between healthcare in China and that in the United States.
For example, Dr. Johnston noted that about two thirds of the Chinese patients in the study had hypertension and less than half were receiving any drug for hypertension during follow-up. Undertreatment, he said, could "certainly" affect the absolute effect size that's seen in the trial.
It's probably wise to await what happens with the POINT trial before changing treatment approaches here in North America, said Dr. Johnston, who is that study's principal investigator. Interim POINT results will be available in May, he said. "That will provide an opportunity to say it's very important to continue POINT or it's not important to continue POINT."
The POINT trial, which is about a third of the way through recruitment, differs slightly from CHANCE, said Dr. Johnston. For example, it includes a higher loading dose of clopidogrel and requires enrollment within 12 hours instead of 24 hours. As well, patients in the combination group continue with aspirin for 90 days instead of stopping at 21 days as in the CHANCE study.
Dr. Johnston pointed out a graph showing times for survival free of stroke for the treatment groups. "Most of the separation in the 2 curves occurs just in the first couple of days, so certainly by 21 days, the curves are almost parallel."
POINT includes mainly centers in the United States, although some sites have been added internationally.
The idea of comparing aspirin plus clopidogrel in a North American trial dates back more than a decade, but the researchers ran into funding difficulties when the drug manufacturer pulled its backing. This, said Dr. Johnston, substantially delayed the start of the trial.
When asked about next steps for CHANCE, Dr. Johnston said the Chinese researchers will look at ancillary studies of biomarkers and subtyping based on vascular imaging. As well, they plan to provide outcomes at 1 year that will include results related to cognition.
Source: Medscape

Monday, 11 February 2013

Nine patients infected with hepatits C at Anhui hospital

Nine  people are believed to have contracted hepatitis C in a hospital in Huainan City, Anhui Province, local health officials said.
Of the 75 patients who underwent dialysis treatment in the city's Xinhua Hospital, nine have been confirmed of hepatitis C infection and another 21 were also tested positive.
Initial investigation reveals that they got infected in the hospital. Further probe is under way to find the cause, Xinhua News Agency reported today.
Source: Shanghai Daily

Crackdown on illegal fertility clinics

A new campaign will crack down on facilities offering illegal assisted reproductive technology services, which put both babies and mothers at risk.
Unauthorized use of the services, surrogate motherhood and the illegal collection and supply of sperm and eggs, as well as the illegal sale and abuse of ovulation induction medicine, will be targeted, the Ministry of Health said.
By the end of last year, there were 358 medical facilities on China's mainland licensed to carry out such services and operate sperm banks.
In Shanghai, there are eight such facilities, including a sperm bank at Renji Hospital.
All the approved facilities face re-evaluation and registration, while the ministry won't approve new applications during the year-long campaign. Any problems found must be rectified, or approval for the services would be rescinded, the ministry said.
The campaign will include a crackdown on the illegal collection and use of human eggs and sperm and the illegal sale of embryos and ovulation drugs. A hotline, 010-82647810, and e-mail account,, have been set up for tips from the public. Checks on facilities will result in a blacklist of any offering illegal services, officials said.
The ministry said China's infertility rate was now between 7 and 10 percent, but some 70 to 80 percent of infertile women could conceive after changing their lifestyle and receiving proper medical treatment.
The technology can help about 20 percent of infertile couples to conceive, officials said. In 2011, around 350,000 people received the services and more than 60,000 previously infertile couples had given birth.
Song Guofan of the Shanghai Health Bureau, said the services are strictly supervised in the city and there had been no cases of illegal use.
Source: Shanghai Daily

Two cases of human H5N1 avian influenza in Guiyang

Two human cases of highly pathogenic avian influenza H5N1 have occurred in the southwestern city of Guiyang, the Ministry of Health has announced.
A 21-year-old woman and a 31-year-old man, who developed symptoms on February 2 and Feb 3, respectively, tested positive for H5N1 virus on Sunday, the ministry said, citing local health authorities.
"They are in critical condition and medical workers are carrying out emergency treatment," the ministry said in a statement. "No epidemiological connections have been found between the two cases."
An investigation did not find the two had contacts with fowls before they fell ill, it said.
People who had close contacts with the two patients have been put under medical observation, but none of them has been found ill so far.
The human-infected highly pathogenic avian influenza is an acute respiratory infectious disease mainly caused by the deadly H5N1 subtype virus. The main symptoms include high fever and pneumonia.
The human case of bird flu is mainly transmitted from poultry to humans and there are no reported outbreaks of sustained human-to-human transmission.
Source: China Daily

Private hospitals target China's growing middle class

by Sylvia Pan, United Family Healthcare
A decade of economic growth has created an ever-expanding middle class in China. With a better education background and bigger disposable income, they have become a major force as consumers in pursuit of a better way of life.
Yet the explosion of this vigorous and demanding class, combined with the problem of having the world's fastest-growing aged population, has also led to higher expectations regarding healthcare.
Before the 1990s, China's public medical institutions used to be the first, if not the only choice for most consumers, but through personal contact with foreign healthcare facilities when traveling abroad, and the changing concept of health management, today's emerging middle class has new requirements for medical services.
They want to be more involved in the decisions made regarding their care and prefer a personal, private physician rather than a doctor they are unlikely to see a second time from a roster of rotating faces. They also expect clean, well-maintained facilities, efficient systems and courteous medical staff.
The desire for more respect, privacy and dignity in care services is prompting changes in the healthcare business model, one that moves away more from a passively accepted public management system to that of private institutions offering more diversified medical services.
Over the past six years, spending on healthcare in China has grown by 19 percent. Between 2006 and 2009, total annual healthcare spending more than doubled to $251.8 billion (185.6 billion euros). It is estimated it will exceed $705 billion by 2015.
However, China's current healthcare system is mainly composed of large public non-profit hospitals and only a few private institutions. These big hospitals are generally less sophisticated in their management systems and have a weak organizational structure, simple financial management and limited planning and organizational control, according to a report by PricewaterhouseCoopers (PwC).
The report says most hospitals are not yet true corporate bodies with self-controlling and self-stimulating mechanisms. They are not operated under the normal business principles found in international hospitals, so their ability to respond to market and social demands is limited.
The healthcare system structure in China is such that the hospitals are not sufficiently aware of the need to strive for a competitive and quality service, the report adds. Many medical institutions have lower staff levels and are less efficient than those found internationally.
For years China's public health sector has experienced severe growing pains. Many feel public hospitals are overrun with patients, some of whom have to wait for days just to see a doctor, far less to get a full consultation.
Many complain that seeing a doctor in a Chinese hospital is like working on the assembly line - you talk with doctors for three to five minutes, receive the test results, get the prescription and then pay for medicine and other costs.
In 2010, the ChinaCare Group, one of China's leading international healthcare consultancy firms, published a survey of more than 1,000 people classified as middle class from three big cities .
It found that more than a quarter of the patients were dissatisfied with the public health system. Reasons most commonly cited were long waiting periods, poor physical conditions and the attitude of staff members.
Such a system obviously can't meet the healthcare expectations of the burgeoning middle class, who want a full and proper consultation with a doctor.
Many even hope to be able to build up a relationship with a regular family doctor who can give them treatment and advice based on family members' medical history. Family doctors are common in many countries, but rare in China.
However, the Chinese government is aware of the diagnosis. In response to increasing pressure on the public healthcare system and desire by the emerging middle class for private care, curbs on foreign investment in medical institutions have been lifted.
Foreign investment was limited to 70 percent until November 2010, when the government announced that these restrictions would be gradually lifted.
From January last year, full foreign ownership was allowed, and investment was "encouraged" in China's 2011 Foreign Investment Industrial Guidance Catalogue.
Furthermore, China's 12th Five-Year Plan (2011-15) dictates a clear, supplementary role for the private sector, with the aim of raising standards of care and addressing the growing healthcare needs of middle and upper-middle class Chinese.
Today's Chinese consumers are neither complacent nor compliant, and live in an environment where rapid change is the norm. China's growing urban middle class has become sophisticated and demanding, with requirements such as customer-friendly healthcare and environment, and options to receive patient-centered healthcare.
Note too that Chinese consumers' disposable income stretches further than in developed countries. Affluent Chinese are mostly concentrated in large cities, such as Beijing, Shanghai and Guangzhou, and these are considered the prime markets. But the real spending power lies within the young and massive urban middle class.
As a result, China's healthcare system needs to accelerate its reforms to meet the needs of the growing urban population. Currently, a large gap exists between the demand for these services and their availability.
United Family Healthcare, the first private hospital in China opened in 1997, tries to meet the changing requirements of consumers by adopting an appointment system with a one-on-one service to protect the privacy of patients.
Private hospitals like UFH that previously aimed to serve foreign residents and visitors, are now finding that the more affluent among the Chinese middle class prefer to pay more for their healthcare.
However, these private hospitals, most of which are foreign-owned and joint ventures, are run on a small scale. The average joint-venture hospitals have less than 50 beds, and according to the PwC report, there is not enough capacity to meet the healthcare needs of the growing middle class.
Though the costs of private hospitals are higher than in the public healthcare system, and government health programs and Chinese insurance policies rarely reimburse them, we see that more Chinese consumers are willing to cough up for treatment, because for patients, it means shorter waiting times, ostensibly better doctors, modern technology and international standards.
Source: China Daily

Life sentence for Harbin teen who killed doctor

A Harbin court on Thursday upheld the life sentence handed to a teenager convicted of killing one medical worker and injuring three others in a high-profile hospital attack last March.
Li Mengnan, 18, appealed after being found guilty of intentional homicide and sentenced to life in prison by the Intermediate People's Court of Harbin, capital city of northeastern China's Heilongjiang Province, on Oct. 19.
His appeal was heard by Heilongjiang Provincial Higher People's Court, which upheld the original ruling.
A life sentence was the highest penalty that could be meted out to Li, who was under 18 years of age when committing the crime, according to Li's lawyers.
The original verdict also ordered Li to pay more than 680,000 yuan (108,108 U.S. dollars) to the victims' families in compensation.
Li's case was among a string of hospital attacks seen in recent years in China, amid strained patient-doctor relations in the country. Chinese patients often accuse doctors of rushing consultations and prescribing excessive medicines, while doctors have complained about overwork, low pay and being frequently misunderstood.
On March 23, 2012, Li stormed into the First Affiliated Hospital of Harbin Medical University and randomly attacked four medical workers with a knife after believing the doctors at the hospital had refused to treat his spinal disease, the initial ruling said.
Wang Hao, a 28-year-old intern of the hospital, was stabbed to death, while three others suffered injuries.
Source: Sina

Yunnan Baiyao remains on sale despite finding of toxic ingredients

Traditional Chinese medicine Yunnan Baiyao has not been recalled on the mainland despite Hong Kong health authorities claiming to have discovered "undeclared" poisonous ingredients in some batches of the product and ordering it to be taken off shop shelves.
The Department of Health of Hong Kong announced on Tuesday that it had tested samples of capsules, powder, plaster, aerosol and tincture of Yunnan Baiyao distributed by wholesaler Fung Wah (Hong Kong) Co, and found they contained "undeclared aconitum alkaloids".
"According to the products' registration details and the Chinese medicine literature, the ingredients in the products cannot account for the presence of aconitum alkaloids as detected," said the department in its statement.
According to the statement, if used improperly, aconitum alkaloids can "cause discomfort, such as numbness in the mouth and limbs, nausea, vomiting and peripheral weakness, and even lead to life threatening conditions such as breathing difficulties and cardiac arrhythmia".
Produced by Yunnan Baiyao Group, a medicine maker in Yunnan province, the product is a well-known traditional Chinese medicine that is effective in stopping bleeding and treating pain in muscles and joints caused by bruises and rheumatism.
The department said although it has not yet received any reports of users suffering adverse effects from the product, it ordered the recall.
Yunnan Baiyao Group confirmed in an online statement on Wednesday that such products contain aconitum alkaloids, but the toxicity is "greatly reduced" after "unique methods of preparation".
The medicine is still available in pharmacies in Beijing.
Three stores in the capital's Chaoyang district said they are still selling the medicine over the counter.
"It has always been a solid seller and sales have not been affected," a saleswoman at Hedantang Pharmacy said, adding that she had not heard the news of recall in Hong Kong.
The discovery of the poison has ignited heated public discussion because the ingredients of Yunnan Baiyao are not readily available.
A Yunnan Baiyao tincture purchased in Beijing, one of the products whose samples have been found to contain aconitum alkaloids in Hong Kong, has written on its instructions that its ingredients are "nationally classified", but advises against use by pregnant women and people allergic to alcohol.
The government classified the medicine's formulation and the way it is processed in 1956, and more than 100 million people have used the medicine in the past decade, the company said in a statement.
The State Food and Drug Administration has graded the medicine as "level one" TCM to be protected by the government, and its formulation and preparation are classified until August 2015.
But the administration said it has asked the company to revise the medicine's instructions and keep a close watch on reports of adverse reactions. The administration has also warned the public to only use the medicine under a doctor's instruction.
A Notification Letter for a Statement on a Dietary Supplement, that a California-based distributor filed to the US Food and Drug Administration in June 2002, named the ingredients of a product called Yunnan Baiyao Ding, which claimed to be manufactured by the Yunnan Baiyao Group.
The statement did not include aconitum-related ingredients.
On Jan 17, Luo Qiulin, a lawyer, filed a lawsuit in Hunan province against Yunnan Baiyao, claiming that the company infringed on consumers' dignity and their right to know.
However, Huang Jianyin, undersecretary-general of the World Federation of Chinese Medicine Societies, said it makes sense for Yunnan Baiyao Group to classify its ingredients in order to protect its intellectual property rights.
"The national regulations justify it, and if other medicine makers got its formula, they may make generic medicines and harm the company," he said. "If consumers don't trust Yunnan Baiyao, they can switch to replacements."
With regard to its ingredient statement to the US, Huang said domestic medicine makers need to adjust to laws in other countries in order to get into markets overseas.
In an online survey conducted by Sina, more than 8,600 Internet users said they would use the product despite the incident, accounting for 51 percent of the people polled. Nearly 30 percent said they would not use the products of Yunnan Baiyao.
Source: China Daily

Wednesday, 6 February 2013

Cardiac rehabilitation message runs counter to beliefs

by Wang Hongyi
Don't just lie down after heart surgery, cardiologists say. They tell Wang Hongyi in Shanghai that moderate exercise will speed recovery.
Shanghai businessman Zheng Yongchao looks fit and refreshed upon returning from his trip to Sanya on tropical Hainan Island. Few would suspect that the 45-year-old had suffered a serious heart attack and had a surgery just three months ago. What made him recover so quickly, Zheng says, was the two-month-long cardiac rehabilitation program he took up after surgery. Under professional supervision, such rehab programs can help patients like Zheng recover from heart surgery and even procedures, such as stenting and angioplasty, says Wang Taoli, a cardiac rehabilitation doctor with Shanghai Delta Hospital and Clinics.
Under this comprehensive approach, doctors provide education and counseling services and help heart patients establish physical training plans, improve their physical fitness and lower the risk of future heart problems, Wang explains.
"Many patients think they should stay at home and avoid any physical activities after the surgery. They're totally wrong," Wang says. "Actually exercise is the core part of the whole rehabilitation."
During the two-month program, Zheng had performed moderate exercise, such as working out on a treadmill and riding a stationary bicycle.
"Above all, the program has helped me establish a healthy lifestyle. Doctors told me what to eat and what not to eat," Zheng says.
Now the businessman has resumed his work routine and enjoys traveling during his spare time.
"I feel much better, physically and spiritually," he says.
According to the 2011 China Cardiac Disease Report, the death rate for patients who have cardiac rehabilitation therapy is 20 percent lower than for those who don't. The admission rate for a second hospital trip can be reduced by 30 percent.
"Cardiac rehabilitation is an important part for heart disease and stroke patients' recovery in Western countries, but it's much underutilized in China," says Hu Dayi, one of the country's top cardio physicians.
China recorded more than 330,000 heart-intervention surgeries in 2011, according to the report. But Hu says that patients' awareness of cardiac rehabilitation is very low.
"When a car breaks down, it needs repair. But it's more important to maintain it after the repair. The same for a heart problem. People only know they have to have surgery on their heart, but ignore the importance of heart rehabilitation," he says.
Yan Jing, president of Zhejiang Hospital in Hangzhou, says his hospital set up one of the country's first cardiac rehabilitation centers in 1999. But the daily visit is about 10.
Though 20 percent of cardiac patients receive rehabilitation now, compared to 4 percent in 2004, such programs suffer from limited medical resources and personnel, as well as poor education and publicity, according to Liu Changping, a medical management expert in Shanghai.
"In China, it's rare to see medical institutions and professionals for cardiac rehabilitation," says Liu, who is also managing director of Shanghai Delta Hospital and Clinics.
Liu's hospital is a Sino-US joint venture, which is known for its cardiac rehabilitation programs.
China now has 40,000 rehabilitation professionals, which is a tenth of the number needed to properly serve the country's 1.3 billion population, according to experts.
Despite being a crucial part of prevention for chronic diseases, cardiac rehab is not covered by medical insurance, which makes it a financial burden for many patients, Liu says.
Heart disease and strokes have emerged as the top killers worldwide. In China, about 230 million people suffer from cardiac disease, which means two in every 10 Chinese are heart patients.
The more people know about the benefits of a rehab program, the more likely they are to try it, says Sidney Smith, president of the World Heart Federation.
Last June, a program to help train more rehabilitation professionals was launched in Beijing. Jointly supported by the American College of Sports Medicine and Focal Point in China, the program will encourage patients to increase physical fitness for better recovery after surgery.
Source: China Daily

Doctor detained over outbreak of hepatitis C infections

A doctor has been detained after 95 people were hospitalized suspected of being infected with hepatitis C at a clinic in Northeast China's Liaoning Province, local health authorities said Tuesday.
The doctor, surnamed Xue, working as a surgeon at the clinic in the city of Donggang, was detained by local police on February 2 and is being investigated, according to sources with the city's health bureau.
A statement from the municipal health authorities said 120 patients who had received injections at the privately-run clinic were traced and screened for the infection of hepatitis C.
As many as 95 of them are suspected to have been infected with the disease, which the World Health Organization says can lead to cirrhosis of the liver and liver cancer.
The clinic has been ordered to close. A further investigation is underway, the sources said.
Local authorities launched an investigation after receiving a tip-off on January 28.
Source: Global Times

Tuesday, 5 February 2013

Chinese trial will answer question of whether to treat pre-hypertension

There's an air of impatience clouding the 2013 International Conference on Prehypertension and Cardiometabolic Syndrome. Most patients diagnosed with higher-than-optimal blood pressure will go on to develop hypertension, but there are no good data to suggest if or how this can be averted.
That frustrates experts gathered here, some of whom say they can't wait for results from ongoing clinical trials—they are proceeding with low-dose pharmacological treatment in select high-risk patients.
"If we wait for the evidence, we'll all be buried before the evidence is in," Dr Flavio Fuchs (Hospital de Clinicas de Port Alegre, Brazil) pronounced. "Four out of five prehypertensives will be hypertensive by age 60. . . . For my [prehypertensive] patients, I am offering the option of using low-dose drugs if they are close to becoming hypertensive."
Dr Stevo Julius (University of Michigan, Ann Arbor) put it more bluntly: "If your brother had prehypertension, you would treat him."
But Dr Yuqing Zhang (Fu Wai Hospital, Beijing, China) pointed out that it is not just the question of drug efficacy in high-normal BP, "we also need to answer the question of cost-effectiveness, because the incidence of hard outcomes is very low in these subjects, maybe 7% per 100-person years. So much lower than in those with established hypertension—this is an area where we really need to get some answers."
Zhang is one of the investigators in the largest ongoing trial in this area, the Chinese High Normal Blood Pressure (CHINOM) trial. The study has finished enrollment of 10 689 patients with blood pressure in the range of 130-139/85-89 mm Hg and at least one other cardiovascular disease risk factor (but no established diabetes, renal or hepatic dysfunction, or history of stroke or CVD).
Presenting an overview of the study here, Zhang explained that patients are being randomized to one of three parallel treatment groups: telmisartan 40 mg, indapamide 1.5 mg, or, in the third group, placebo or a combination pill of hydrochlorothiazide 12.5 mg, triamterene 12.5 mg, dihydralazine 12.5 mg, and reserpine 0.1 mg. The primary end point of the study is combined CV events (nonfatal stroke, nonfatal MI, and CVD death), while a secondary end point addresses new-onset hypertension and new-onset diabetes.
While the first results are still several years away, baseline characteristics of study subjects are already revealing. For example, he noted, 70% of subjects enrolled actually have more than one CV risk factor, with metabolic syndrome being the most common. More than three-quarters of participants are overweight or obese, 42% have high triglycerides, and over one-third have a family history of hypertension.
"This is not a benign population," he said.
Importantly, Zhang said, a family history of stroke is more than twice as common in the CHINOM cohort as a family history of MI (12% vs 5%).
Investigators plan to do an interim analysis when they've accumulated 100 events; they are just shy of 90 now, Zhang said.

Price gouging at 'first class' hospitals

by Guo Jun
Recently, media reports have again concentrated on insiders' revelations about the inflated prices of medical testing at hospitals.
In the past few years, China has put a lot of efforts into medical reforms such as reducing the price of medicine and enhancing the role of district hospitals.
However, there's one more thing missing - medical testing that is not affiliated with any one hospital and could provide independent and adequate diagnoses for patients and doctors.
A few years ago, I needed to have an MRI scan as part of the treatment for my cervical spondylosis, an arthritic condition.
I went to a local triple-A hospital, a first-class hospital in China. It had two types of equipment, with 800 yuan ($128.6) and 1,100 yuan testing fees needed respectively.
Feeling it was too expensive, I went to a second-class hospital and did the testing there, which cost me only 380 yuan.
A doctor from this second-class hospital told me that first-class hospitals can set prices for medical tests by themselves, while the others have to do it under the supervision of the local price bureau. Such double standards are revolting.
Nonetheless, quite a number of patients choose to go for first-class hospitals because they believe that only these hospitals have advanced medical equipment.
In the US, patients would go to see family physicians first. Some physicians open a clinic together or those specializing in the same field collaborate.
These clinics don't have advanced testing equipment or laboratories. But doctors need medical data to prove that their diagnoses are correct.
The way that Americans solve this problem is by setting up independent medical testing institutions that are able to provide necessary tests for all patients.
As these institutions are independent professionally and economically, they are neutral toward all clinics, and it is also good for the updating of equipment and the improvement of personnel quality.
In China, hospitals are classified by three grades. All the most advanced testing equipment is given to first-class hospitals.
When patients who go to ordinary hospitals need the equipment for testing and diagnosis, they have to re-register with first-class hospitals. 
China can learn from the US experiences, and try to establish independent testing institutions. This can increase the diagnosis skills of doctors from district hospitals.
In this way, doctors can also learn whether they have made the right judgment of an illness, thus improving their medical skills.
Meanwhile, it could enhance the trust of patients in district hospitals and raise their confidence in doctors.
Moreover, big hospitals would dare not to make medical equipment detection a means to generate revenue.
Of course, some special fields and treatment means can be limited to first-class hospitals.
However, an authoritative testing institution is bound to improve the medical skills of doctors from other hospitals and help ease the crowding in larger ones.
The author is a professor with the Harbin Institute of Technology.
Source: Global Times