Guangdong to trial family doctor service

China's southern Guangdong Province, one of the richest regions in the country, will initiate a family doctor service starting next year on a trial basis, local health authorities said.
The move is to encourage people to have medical care at grassroots medical institutions and reduce the pressure on hospitals in cities.
The provincial government is expected to experiment the service at county-level next year. The service will cover all streets and villages within five years, according to a provincial health and family planning commission statement on Wednesday.
A family doctor, or family physician, is devoted to the continuing and comprehensive health care for individuals and families across all ages.
The family doctor service will be based on the general medical practitioners service in urban community and rural township clinics. They will initially serve the elderly, pregnant, disabled, children and those with chronic diseases and then extend to all people in their areas, according to the statement.
The doctors will provide basic medical care as well as health consultations.
Coastal Guangdong Province, with a population of more than 100 million, is leading the country in economic development with a per capita gross domestic product of 54,095 yuan ($8,818) recorded in 2012.
Source: Global Times

Chinese Alzheimers research may be example of academic 'black market'

by Margaret Munro
Some of Canada’s top brain specialists have apparently been duped by shady operators in China.
The Canadian doctors approved and recently published a scientific report on Alzheimer’s disease that came from a “flourishing” academic black market in China, according to a report released Thursday.
“China’s publication bazaar,” as it is described, allows unscrupulous scientists to pay big money — up to  $26,300 — to become authors of scientific papers they didn’t write.
They don’t do any experiments or research either, according to the report in the U.S. journal Science that adds a creative, if disturbing, twist to research misconduct.
“It’s new to me,” says Dr. Robert Chen, at the University of Toronto, who is now investigating the origins of the suspect Alzheimer’s report.
It surfaced last year in China’s “flourishing academic black market involving shady agencies, corrupt scientists and compromised editors — many of them operating in plain view,” according to Science. It says that several scientific papers advertised under “authorship for sale” by Chinese brokers and editing shops have later appeared in established journals — including the Alzheimer’s report published this year in the Canadian Journal of Neurological Sciences.

Chinese government acts to improve 'second rate' rural medical insurance plan

Early in November, Chen Ping arrived in Beijing on what was likely to be her last trip to the capital.
The 52-year-old stayed just two days - long enough for her to say a heartfelt farewell to the doctors and nurses in the oncology department of the Chinese PLA General Hospital who have been treating her breast cancer for eight years.
Chen, who comes from a small village in Jilin province, wanted to express her gratitude to the medical staff for helping to extend her life.
She told the staff she was grateful to have lived long enough to see her sons grow up. However, as her illness is now in the terminal stages she has decided to stop receiving treatment.
One man Chen particularly wanted to see was out of town, so she was unable to say a last goodbye to Liu Duanqi, former director of the hospital's oncology department, who supervised her treatment.
Liu, looking tired after a working trip to Gansu province, said of Chen: "She's a peasant woman with a rural hukou (household registration). That means the only public medical insurance available to her is the New Rural Cooperative Medical Scheme."
The hukou system effectively ties a person to their place of birth and registration. It usually means that they are ineligible to claim social benefits or medical insurance if they receive treatment outside the place where they are registered.

Poor rural infants to be screened for PKU, thyroid and hearing disorders

China will start screening for three major diseases among infants in poor rural areas next month, said the National Health and Family Planning Commission here on Friday.
The free screening targets phenylketonuria, congenital hypothyroidism and hearing disorder and will cover about 490,000 rural newborns in 200 poverty-stricken counties of 21 provincial regions, said a commission statement.
Those who are diagnosed with the diseases will receive treatment and medical assistance from the state, according to the statement.
Phenylketonuria, also known as PKU, is a metabolic genetic disorder that can lead to learning disability, seizures and other medical problems. If patients can be diagnosed at an early age and get proper treatment, the symptoms may not develop and they can have a normal life.
Congenital hypothyroidism is another metabolic disorder under which an infant is born with a severe deficiency of thyroid function. Early diagnosis and treatment can prevent growth failure and mental retardation caused by the condition.
The central government will allocate a special fund for this program, 120 yuan (19 U.S. dollars) for each infant, the statement said.
Additionally, the commission will dispatch free dietary nutrition supplements to infants from six to 24 months in 300 poor counties so as to reduce incidence of anemia and stunting.
Source: China Daily

13 clinical research centres launched with $16 million funding

In a Lancet editorial published today, Yang Zhe, Deputy Director-General for the Department of Science and Technology for Social Development, Ministry of Science and Technology, China, says the launch of the National Clinical Research Centres program will see 13 new clinical research centres launched with  initial funding of $16 million:

 "Over the past 5 years, China has increased its investment in scientific research by 20% annually, with funding of more than US$160 billion (1 trillion Renminbi) in 2012. In the Outline of the Twelfth Five-year Plan for National Economic and Social Development, the State Council declared that overall 2·2% of gross domestic product will be spent on scientific research. The Chinese Government's funding for medical research has increased accordingly, resulting in notable achievements. However, investment differs between biomedical and clinical research. In 2011, government funding for biomedical research was about $1 billion (6 billion Renminbi), but only $250 million (1·5 billion Renminbi) for clinical research. The investment in clinical research has lagged at a time when such knowledge is needed to address China's many health challenges—the growing burden of non-communicable diseases, soaring health-care costs, a rapidly ageing population, and changes in health behaviours and local environments.

Free abortions suggested for Beijing students

A representative of the Beijing Municipal People's Congress has suggested that public hospitals should either provide free abortions for students or charge nominal fees.
The representative, named Wei Aiming, timed his proposal to coincide with the onset of winter vacation. Chen Suwen, a doctor at the Beijing Obstetrics and Gynecology Hospital, admitted that the number of students seeking abortion peaks every year after school holidays.
Wei said that if public hospitals can offer abortions for free or for less than 100 yuan, it will help students to avoid having to choose cheap private hospitals and the increased risk of future complications.
Source: ECNS

Pregnancy screening program set up in western and inland provinces

A program to help pregnant women get better healthcare and prevent birth defects has been launched.
The program plans to establish 22 training centers in 11 central and western provinces to improve ultrasound diagnosis, especially by doctors in far-flung areas.
Initiated by the China Medical Foundation and Samsung Electronics, the program was launched in Guiyang, capital of Guizhou province, in early November.
Pregnant women in these areas will have better facilities and diagnosis, said He Pijie, director general of the China Medical Foundation.
Statistics from China's Birth Defects Prevention Report in 2012 shows that nearly 150 out of every 10,000 infants had congenital defects in China. The report also indicates that birth defects not only cause disability but also become a leading cause of death among Chinese infants.
"Especially in China's central and west regions, the lack of fundamental equipment and doctors with proper experience are causing even higher death rates for infants," He explained.
Source: Peoples Daily

Cockroaches bred by pharmaceutical companies for hepatitis drugs

Wang Fuming spends 8 hours every day with cockroaches — millions of them. He even dines on them, fried, in the belief they can cure his stomach disease.
Although the insect incites feelings of disgust and dread for many people, the 43-year-old businessman in Shandong province has pinned high hopes on them.
Inside two concrete buildings near an elevated highway running through Jinan's Changqing district, Wang keeps as many as 10 million cockroaches in sheets of cartons that resemble battery cages on a hen farm.
Wang supplies cockroaches to pharmaceutical companies, who use them as medicinal ingredients. Scientists say certain parts of a cockroach can enhance a person's cardiovascular functions as well as combat hepatitis B.
The price of dried cockroaches, on average, reaches 150 yuan ($25) per kilogram and farms are steadily spreading in Shandong, Jiangxi, Yunnan and Sichuan provinces.
The largest farm, which occupies more than 2 hectares and has an annual production of more than 1 billion American cockroaches, is owned by a pharmaceutical company in Xichang, Sichuan province.
Source: China Daily

Sperm donor clinics are big business in Shanghai

For many young men in Shanghai it sounds an ideal way of making money while enjoying themselves. The Shanghai Municipality Human Sperm Bank pays up to 5,000 yuan ($821) to donors and hundreds of hopefuls arrive at the bank every week.
They head to the northern branch of Renji Hospital on Lingshan Road where, on the third floor, they will find the reception desk and entrance decorated with cartoons of cheerful sperm.
But it's far from cartoon fun in reality. Li Zheng is the director of the Shanghai Municipality Human Sperm Bank and he said the bank had two big problems. "The quality of the sperm offered is not good and there are not enough suitable donors."
Of the thousands of volunteers the bank sees every year, only 15 percent qualify as donors and 10 percent of these men will drop out after being accepted.
Ten years after it was established there are only around 5,000 sperm donations being stored at Renji at present although several thousand women have been impregnated. It's even more problematic in other parts of China where sperm banks only hold a tenth of this number of donations.
Source: Global Times

Roommate's poisoning meant as joke: medical student

A medical student at Fudan University who was accused of poisoning his roommate to death said at trial today it was just an April Fool's joke.
Lin Senhao, 27, denied having held a grudge against his roommate, Huang Yang, though he thought Huang was self-righteous, the Shanghai No. 2 Intermediate People's Court heard in the ongoing trial.
Lin insisted that he didn't mean to kill Huang. Instead, the postgraduate student said he had planned to just make Huang feel sick since he believed Huang would take only a little of the toxin, which shouldn't have killed him, Lin said.
Lin said he had experimented on rats and many didn't die of poisoning.
Source: Shanghai Daily

China ahead of Canada in treatment of HIV: experts

British Columbia’s partnership with China in the fight against HIV/AIDS highlights not only the progress being made overseas, but also the lack of foresight shown by the Canadian federal government at home, says an acclaimed B.C. researcher.

Julio Montaner, director of the B.C. Centre for Excellence in HIV/AIDS (BC-CfE), accompanied Premier Christy Clark in Beijing Tuesday as she signed a memorandum of understanding between the Chinese Centre for Disease Control and Prevention and the B.C. organization during a trade mission.

In 2011, China became the first country to adopt the BC-CfE’s “treatment as prevention” (TasP) strategy, which involves widespread HIV testing and the immediate offer of highly active antiretroviral therapy to those who test positive. This treatment has been shown to virtually eliminate progression of the disease to AIDS and reduce transmission of the virus by 96 per cent.

The United States, France and Brazil have since adopted the World Health Organization-backed treatment as well, each hailing it as a progressive strategy backed by abundant scientific evidence. Canada, however, has not.

Chinese orphans with HIV are abandoned, say Australian doctors

Australian doctors are campaigning to raise awareness of the neglect of Chinese orphans with HIV.

This Sunday is World Aids Day and general practitioners Dr Julie Mallinson and Dr Sam Vidler (who are husband and wife) of Nelson Bay, NSW,  say paranoia about catching the virus had led to the abandonment of 10,000 HIV positive Chinese children.

"Kids with HIV have the worst time out of all orphans," Dr Mallinson said.

The couple volunteered in Chinese orphanages for 3½ years and adopted daughter Maggie Vidler, 6, a sufferer of HIV. They also started ELIM, a home for affected children, in 2009.

HIV medication has a high success rate and is administered for free in China, but neither hospitals nor orphanages are willing to administer it.

Dr Mallinson said anyone with HIV was turned away from hospitals, children and babies included.

"It can be life saving," Dr Mallinson said.

"If they don't have the treatment most won't live to see their 10th birthday."

She said ELIM aimed to educate orphanages and hospitals that HIV could not be caught by treating someone for HIV.

It also aimed to find short-term foster care for orphans while a permanent adoption was organised.

Nelson Bay physiotherapist Stephen Odgers lived in China for nine months while he volunteered with ELIM.

"Children with HIV in [places like] Africa have a family and community structure that supports them," he said.

"In China, they have no community or family structure."

He said orphanage resources were "very stretched" and so children with HIV were often considered a waste of time, money and medicine and were left alone in isolation rooms.

Mr Odgers, Dr Mallinson and Dr Vidler will hold a charity walk for World Aids Day on Sunday to raise money for medication, tests and essentials for the orphans. 

Source: Port Stephens Examiner

FT article on the perils of China healthcare

With annual sales growth estimated to exceed 20 per cent, many global drug companies regard China as a “must-win” market.

But problems from basic delivery of services across the vast country to rampant corruption, beset the sector. GlaxoSmithKline’s bribery charges brought international attention to the problems. Measured by availability, price and quality, China has a long way to go.

One big challenge for the government is the high cost of so-called generic drugs that have provided an easy way for big multinationals to make profits. In China, the price of branded generic drugs remains high, as hospitals and companies impose a premium for what they claim are higher quality products compared with lower-cost equivalents made by rivals.

“It is a bit of a strange thing to see old drugs priced far higher than you would see anywhere else in the industrialised world,” says Dr Carl Firth, the chief executive officer and founder of ASLAN Pharmaceuticals, an Asia-focused pharmaceutical company.

“The government has been reducing prices on older drugs but the pricing pressure is not as strong as you would see in the west.”

Another issue is a lack of quality healthcare outside the hospital system. Clinics and community physician practices are beset by in­consistent quality and mistrust, so 90 per cent of inpatient and outpatient services are delivered via hospitals, an expensive platform.

For hospitals and healthcare organisations to make money, they must charge higher prices for pharmaceuticals and other, unregulated, services such as X-rays or scans or prescribe unnecessary drugs, diagnostic or surgical procedures.  

According to Public Finance in China, published by the World Bank, China has two-and-a-half times as many MRI scanners per capita than would be predicted by its GDP.

This led to the conclusion that profit incentives and not patient outcomes may be driving this proliferation of technology. Ironically, this incentive increases the perception that those who can afford scans are receiving better care. Ancillary costs in China’s healthcare system can be very high.

Pharmaceutical prices are controlled by The National Formulary list of medicines. But inclusion in the formulary ensures sales volume. But for lower volume products, avoiding the formulary allows them to be priced higher.

The government introduced an Essential Drug List in 2009, which capped the price of as many as 500 items. According to Barclays, the dream of increasing the availability of essential drugs to primary healthcare facilities has turned into a nightmare, as implementation has focused on price reduction instead of volume, which is not to the benefit of hospitals.

The temptation to game the system has proved too much for even supposedly ethical western drug companies to ignore. Nor is corruption limited to pharmaceutical companies, with the broader healthcare market also under suspicion. 

Read full article at: FT

One in ten pregnant Chinese women have disease that may cause miscarriage or premature delivery

One in every 10 pregnant women with thyroid disease may experience miscarriage, fetal death, premature delivery or problems with their baby’s intelligence without proper diagnosis and treatment, Shanghai medical experts have said.

“Screening of thyroid function before and during early pregnancy is important for early detection and intervention for children’s health,” said Dr Duan Tao, president of Shanghai No. 1 Maternity and Child Health Hospital.

He said a domestic survey found over 80 percent of pregnant women with thyroid disease didn’t get a timely diagnosis that would come from a proper screening for risk factors. Duan recommended more screening of pregnant women for thyroid diseases.

A recently issued guideline has suggested hospitals screen women for thyroid disease within eight weeks in pregnancy.

Source: Shanghai Daily

Chinese women with PCOS have high rates of hypertension and metabolic abnormalities

by Michael Woodhead

One in five Chinese women with Polycystic Ovarian Syndrome (PCOS) have hypertension, almost twice the rate of other women, a study from Shandong has found.

Women with PCOS also had abnormal lipid, insulin and glucose levels compared to women without PCOS according to a study conducted by Dr Shi Yuhau and co-researchers at the Reproductive Medicine Hospital Affiliated to Shandong University, Jinan.

The researchers studies 3396 women with PCOS and 1891 controls They found the prevalence of hypertension to be 19.2% in the women with PCOS, which was much higher than that in the controls (11.9%). After matching for BMI, the hypertensive PCOS group had significantly higher glucose, insulin, and lipid levels than the normotensive PCOS group; these differences were significant.

The researchers said the likelihood of long-term metabolic complications was high in hypertensive PCOS patients.

 “These findings underscore the importance of preventive strategies in women with PCOS in order to prevent hypertension,” they said.

“Cardiac risk factors associated with PCOS have public health implications and should drive early screening and intervention measures. Fasting lipid profiles and glucose examinations should be performed regularly. Treatment of the associated cardiovascular risk factors, including insulin resistance, hypertension and dyslipidaemia, should be incorporated into routine PCOS patient wellness care programmes. These results suggest that it is importance to control weight and blood pressure in women with PCOS in order to reduce their excess risk of future complications. “

Read the full study in: European Journal of Obstetrics & Gynecology and Reproductive Biology

Hospitals banned from rejecting seriously-ill patients

China is prohibiting all hospitals from rejecting or delaying treating patients in critical condition, regardless of the circumstances, the Beijing Youth reported on Tuesday.
The National Health and Family Planning Commission (NHFPC) of China recently issued a guideline regarding the standards of the country's emergency medical system, which said that hospitals need to offer first-aid to patients with serious medical conditions and cannot reject or delay treatment for any reason.
During initial emergency treatment, the guideline states that patients with dire symptoms, like being unconscious or not having a pulse, should be arranged to see a doctor as soon as possible.
The NHFPC said that these medical guidelines only refer to the most fundamental and necessary medical methods in dealing with a patient in critical condition. They do not encompass preventative medical care or subsequent care after a patient's condition becomes stable.
While the commission adds that people can more easily see a doctor with the improved coverage of medical insurance in China, doctors still reject some patients who either cannot be identified or do not have the means to afford the medical fees. Thus, the NHFPC says a non-discerning emergency-response medical system must be established.

Source: CRI

Beijing to monitor health effects of smog

Beijing will start monitoring the effect of smog on residents' health this week, said the city's health bureau in its Sina micro blog account on Monday.

The city's center for disease control and prevention will set up monitoring stations in 11 communities to monitor air quality, and will dispatch professionals to test air samples on a regular basis.

Also, the city's authorities will collect data from hospital medical records to determine the relationship between the smog and the health of residents.

In October, the National Health and Family Planning Commission asked health authorities in 16 provinces or municipalities, including Beijing, to monitor and report the density of PM2.5 and its impact on health.

Source: China Daily

OGTT reveals high rate of diabetes in hypertensive patients - Beijing study

by Michael Woodhead

There is a high prevalence of diabetes and newly-detected diabetes among Chinese hypertensive outpatients, Beijing researchers have shown.

About one in four hypertensive outpatients had concomitant diabetes, and approximately one in three cases were newly detected , their study found.

Dr Wang Wei and co-researchers at the Beijing An Zhen Hospital, Capital Medical University and the Beijing Institute of Heart, Lung and Blood Vessel Diseases say that additional testing of 2-hour plasma glucose with an oral glucose tolerance test (OGTT) should be added to fasting plasma glucose (FPG) assay to improve the detection rate of diabetes, especially in elderly patients.

In a study of 4942 patients attending hypertension outpatient clinics in 46 hospitals in 22 provinces of China, the researchers measured fasting plasma glucose in all patients and also did 2-hour plasma glucose testing in those without a history of diabetes.

The study found that the prevalence of diabetes was 24% (both previously and newly diagnosed cases). Among the 1202 patients with diabetes, one third were newly detected. In patients aged <45 years, 53% of cases of diabetes were newly detected. Of the 417 cases of newly detected diabetes, 55% were identified using FPG tests and the remaining 45% by 2-hPG tests. More than a quarter of patients with newly detected diabetes had FPG <6.1 mmol/L and 16.5% had FPG <5.6 mmol/L. Among the elderly patients, 32.4% had normal FPG (<6.1 mmol/L) and 24.5% had optimal FPG (<5.6 mmol/L).

The detection rate of newly diagnosed diabetes was higher in patients with low educational level, low level of medical insurance, obesity and high triglycerides.

The researchers say that currently only the fasting plasma glucose assay is routinely used in China because of its technical convenience and low cost. However, they say their findings show that adding 2-hour plasma glucose to the routine FPG assay would increase detection rates by 4.5%, and by more than 6% in the elderly.

Source: BMJ Open

New NGO set up to defuse hospital-patient disputes

An NGO was established in Beijing to provide free consultation and mediation services for medical disputes.

The NGO, Beijing Jinghan Medical Disputes Mediation and Law Support Center, has a professional team of 60 specialists, including lawyers and medical experts.

These experts, who have no employment or financial inks to hospitals or patients, will provide free consultation or mediation over medical disputes to patients.

A voluntary team was also set up to supervise the operation of the center, with volunteers including legislators and political advisors.

Experts said that the current official mediation over medical disputes was time-consuming.

Source: Beijing News

Mainland medical graduates should be used to overcome Hong Kong doctor shortages

by Dr Feng Chi-sun

There is a serious shortage of doctors in Hong Kong and it affects mainly public hospitals. Based on the frequently cited figures, more than 90% of inpatient services are performed in public hospitals, where fewer than 50% of our doctors work.

Since it takes years to train a doctor, the obvious quick remedy is to hire overseas doctors. When Hong Kong was a British colony, all Commonwealth doctors are eligible to practice in Hong Kong; non-Commonwealth ones had to take a qualifying exam. After the handover, all foreign medical graduates have to take the exam, which is notorious for its level of difficulty, with a pass rate of 10% or less.

It's no wonder we continue not to have enough doctors in public hospitals, and waiting time for elective surgeries takes months and years.

To solve the shortage problem, Hong Kong's Hospital Authority has come up with a solution that some argue is flawed. It is giving limited license to selective non-local medical graduates so that they can practice in public hospitals without taking the exam. The candidates must speak Cantonese and hold a valid medical degree. Fair enough. But that's where the transparency and accountability of the selection process ends. By picking candidates based on their paper credentials and not by a more objective method, such as test scores, the authority is inclined to admit only medical graduates from world-renowned schools from Western countries, and exclude those from less prestigious ones, especially those from the mainland.

The difference between an ethnic Chinese from a Canadian medical school and one from a Chinese medical school is the family background. But, unlike family wealth and prestige, medical knowledge is acquired and not inherited. Regardless of their undergraduate medical education, all doctors have an equal chance of being nurtured into a highly competent healer. Doctors learn most of their skills at the postgraduate stage.

Perhaps, a better way for the Hospital Authority to deal with the shortage crisis is to recruit Cantonese-speaking non-local medical graduates from around the world, and lower the entry bar for them to start working in Hong Kong by easing the exam to a level at which the pass rate is at least 50%. The way the current exam is structured, it is suitable only for fresh graduates, but is counter-productive to our goal of recruiting competent doctors. Many of the candidates have already had a few years of practice experience in their own fields, and might have forgotten many didactic facts in other areas. Is there really any need for a future ophthalmologist to also have indepth knowledge of gynecology?

And like in the US, they could start work as an intern, and are allowed a full license only after years of training and passing a more advanced exam in their specialty.

The approach used by the Hospital Authority in picking candidates to work for them is problematic because it is whimsical and non-transparent, and easily perceived to be discriminatory or having a hidden agenda. It invites criticism and possibly lawsuits.

Most of all, the pool of potential medical geniuses is much bigger on the mainland than the small group of Cantonese-speaking doctors who graduated from Western countries. Hong Kong will lose out if this valuable human resource is not tapped.

The author was a consultant pathologist for the Hong Kong government and St. Paul's Hospital before his recent retirement. He was a lecturer at the Medical Faculty of the Chinese University of Hong Kong and a diplomate of the American Board of Pathologists.
Source: China Daily

Rankings show China's ten best hospitals

China’s top three hospitals are the Beijing Union Medical College Hospital, West China Hospital, Sichuan University and the PLA General Hospital according to the latest rankings for China’s Best Hospitals released this week.

The rankings, compiled by selected by the Institute of Management at Shanghai’s, Fudan University are based on  a combination of factors such as quality of care, research capability and clinical technology.

The rankings are also decided by a panel of clinical experts and scholars from 30 clinical specialties, the National Committee of the Chinese Medical Association and the Professional Committee of Municipalities. 

Fudan Universtiy’s Professor Gao Jiechun  said the hospitals on the list should be considered as China’s specialist centres for clinical diagnosis and treatment of difficult diseases and specialist training centres.

China’s Annual Best Hospitals Ranking (2012) 

1 Beijing Union Medical College Hospital

2 West China Hospital, Sichuan University

3 People’s Liberation Army General Hospital

4 Shanghai Jiaotong University Affiliated Ruijin Hospital

5 Xijing Hospital, Fourth Military Medical University

6 Huashan Hospital , Fudan University

7 Zhongshan Hospital , Fudan University

8 First Affiliated Hospital of Sun Yat- Sen

9 Peking University First Hospital

10 Tongji Medical College

Source: About China

Elderly Beijingers miss out on free flu vaccine

by Michael Woodhead

Most elderly people in Beijing are failing to take advantage of the government’s program of free influenza vaccine each winter, research shows.

Only 44% of people over 60 had influenza vaccination during the seasons from 2008 to 2011, according to a survey of almost 2500 elderly Beijing residents published in the BMJ Open journal this week.

The vaccination rates over three seasons were consistently below 50%, which is well below the WHO target of 75% for annual seasonal influenza vaccination for the elderly, said Dr Zheng Yang and co-researchers from the Institute for Infectious Disease and Endemic Disease Control at the Beijing Center for Disease Prevention and Control (CDC).

The low uptake of flu vaccine occurred despite the government policy to offer the vaccine free of charge to all vulnerable populations including older people via community health centres, the researchers said.

Analysis of the figures showed that flu vaccination was more likely among people living in rural areas of Beijing, people with a lower level of education and those who perceived themselves to be unwell.

“Influenza vaccine coverage in Beijing still remains suboptimal. Further work needs to be undertaken to ascertain whether the method of distributing the vaccine is adequate and whether health professionals are appropriately promoting the vaccine,” the researchers concluded.

“ Education efforts should continue to highlight the need for the vaccine among individuals who are at risk from the disease and its associated complications,” they added.

Read the full study at: BMJ Open

China medical research in the journals

No increase in obesity among rural children

There are no signs of an obesity epidemic among rural Chinese children, a study from has shown

Researchers from the Capital Institute of Paediatrics, Beijing, monitored overweight and obesity rates in more than 280,000 children from eight counties in Jiangsu and Zhejiang between 1998 and 2005. They found that the prevalence of overweight was barely changed from 3.7% in 1998 to 3.9% in 2005 and there was no increase in the 0.5% prevalence of obesity.  An increase in overweight/obesity was more likely in boys than girls, especially among those aged over three years. The study also found that the prevalence of stunting decreased dramatically.

Full study: Public Health

IVF conception for 1% of Chinese babies

About one in a hundred Chinese babies is born to women undergoing IVF or other assisted reproductive technology, Beijing researchers have shown. Dr Yang Xiaokui and co-researchers from the Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital analysed rates of ART among 112,403 deliveries from 14 provinces and 39 hospitals. They found the proportion of infants born as a result of ART in China was about 1.013% in 2011, compared to 4% in developed countries. Their study also found an increased maternal complications such as multiple gestation, higher cesarean section rate, low birth weight infants, higher infant mortality in women who conceived with the help of ART, compared with spontaneously pregnant women.
Full study: Fertility and Sterility

Urgent action needed on liver fluke infections in Heilongjiang

Liver fluke infestations are a common and increasing problem in China’s north east province of Heilonjiang, a study from Harbin Medical University has shown.

The infections, which are caused by eating undercooked fish,  were  seen commonly throughout Heilongjiang Province and mainly along the Songhua River, according to Dr Han Su and colleagues from the university. In a review of 4951 outpatients with suspected liver fluke infections the overall prevalence of clonorchiasis was 26%.  Rates of infection increased from 22.5% in 2009 to 34% in 2012. Farm labourers accounted for two thirds of cases and consumption of freshwater fish was the strongest risk factor. Cases of re-infection were common.

“The present study revealed that clonorchiasis remains widespread and prevalent in Heilongjiang Province. An integrated control programme is urgently needed to reduce the public health impact of clonorchiasis in this endemic area.”

Full study: PLOS One

Benzodiazepine use linked to benign brain tumours

Benzodiazepines may increase the risk of benign brain tumours, according to Taiwanese researchers. In a review of  62,186 patients who had been prescribed benzodiazepines, they found that rates of benign brain tumours were more than three times higher in patients using benzodiazepines. The risk of benign brain tumours was dose dependent and increased over time with increasing exposure to benzodiazepines. There was no increase seen in risk of malignant brain tumours, but this may have been due to the low number of such tumours in the study group.

Full study: Journal ofthe Neurological Sciences

SMS reminders improve allergy medication compliance

For patients with allergic rhinitis, a daily SMS reminder is an effective way to improve adherence with intranasal corticosteroid treatment medication and treatment outcomes, according to researchers from the Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital.

In a study of 50 patients with allergic rhinitis they showed that adherence to medication was 60% in the SMS group and 28% in the control group. Clinic attendance and allergy symptoms scores were also better for patients who received SMS reminders.

Full study: International Archives of Allergy and Immunology

Medical corruption is an institutional problem for China

An article by Dr Zhang Yi of the Department of Infectious Diseases, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University in the European Journal of Internal Medicine.

"In the last ten years, medical corruption has become one of the top complaints from the Chinese public. It is an open secret in China that some pharmaceutical companies pay kickbacks to doctors and hospital administrators to boost drug prescriptions. This problem is prevalent in the country and has run rampant in some areas, seriously undermining patients' interests and doctors' professional images.

In early July, the British pharmaceutical giant GlaxoSmithKline (GSK)'s bribery scandal shocked China and sparked widening concern as well as dispute over the country's pharmaceutical sector. It is believed that China's drug market is extremely chaotic with thousands of pharmaceutical companies in existence and the intense competition results in an unhealthy environment. Some companies engage in bribery to raise drug prices, expand sales and reap inappropriate profits. The various forms of malpractices between drug companies and doctors include cash kickbacks, lavish gifts or entertainment, all-expenses-paid trips, ghostwriting services, sponsored supplements in journals and even sexual favors.

Recently, the city of Zhangzhou in southeastern Fujian Province has been hit by a corruption scandal involving all the city's hospitals. It is reported that 1088 doctors and 133 administrators from 73 hospitals of the city were found taking bribes and kickbacks, totaling US$ 3.34 million. Moreover, in Pinghe County of the city, nine out of ten doctors were suspected of taking kickbacks from drug makers or distributors. The Zhangzhou case is just the tip of an iceberg but exposed again the severity of corruption in China's healthcare industry.

Since 2009, China has launched an ambitious health care reform. It has committed itself to providing adequate and affordable health care services for its 1.37 billion people. However, exorbitant drug prices have been the center of complaints about China's healthcare system for years. It is reported that a single injection of clindamycin phosphate is sold to patients for RMB 11.5, which is ten times more than its actual cost. More than half of such margins are used to bribe doctors and officials. It is a “hidden rule” in China's medical sector that doctors take bribes and kickbacks which comprise part of the costs of drugs. Although the public are very dissatisfied with the status quo, insiders hold that it is an institutional problem.

In China, it is common for public hospitals to use drug sales to compensate for insufficient government funding, which provides chances for some doctors to supplement their meager incomes with kickbacks from drug companies. It is believed that corruption in China's healthcare industry is fueled partly by the low base salaries of doctors at the country's approximately 13,500 public hospitals, which on average are only 1.19 times higher than those of the rest of the population. A number of physicians and surgeons regard taking bribes and kickbacks from pharmaceutical companies as compensation for their high training costs and high professional risks. However, if doctors in China prescribed drugs for patients depending solely on economic interests, but not on evidence-based clinical practice guidelines, it would be hard to say that patients in China receive the most cost-effective treatments. It is a sad fact that in the eyes of many Chinese people, the term “doctor” is likely to be connected with “prescription abuse”, “excessive examination” or “gray incomes”. The unethical relation between pharmaceutical companies and doctors inevitably damages the doctor–patient relationship and ultimately the whole healthcare system of China.

Therefore, it is imperative for China to step up crackdown on medical corruption. The recent investigations into malpractices between pharmaceutical companies and doctors have shown China's resolve to crack down on corruption in healthcare industry. However, the anti-corruption efforts would not solve the thorny issues if China's health care reform did not go far enough. A comprehensive reform focused on changing the unsound healthcare system is urgently needed. Although we do not agree with some doctors who think it is acceptable to take bribes and kickbacks from drug companies due to low salaries, there should be an appropriate income system to bridge the gap. We deem that medical corruption in China could further be better tackled through decent wages for medical staff, strict conflict of interest rules, effective surveillance systems and severe punitive measures."

Chinese FDA issues reminder on fluoroquinolone safety

China’s national Food and Drug Administration (SFDA) has issued a reminder to clinicians on the potential for adverse effects with overuse and misuse of fluoroquinolone antibiotics.

In a statement released this week, the SFDA said that fluoroquinolones were potent antibiotics but there was a need for prudence in their use because of the risk of adverse effects. The update in the Adverse Drug Reaction Information Bulletin said that the antibiotics may aggravate myasthenia gravis, cause peripheral neuropathy and increase the risk of hypoglycaemia in diabetes.

The SFDA recommended that clinicians adhere closely to prescribing advice for fluoroquinolone drugs, with attention to appropriate indications, dosage, drug interactions, and use in special populations, The SFDA also recommended that  pharmaceutical companies improve the monitoring of adverse drug reactions, and publicise the rational use of the drugs to prescribers.

Source: SFDA

Anger and angst in hospitals where doctors die

There was a time when the words of the Hippocratic Oath meant a lot to Dr. Wen Mei. She'll never forget standing proudly with her classmates, each in a sparkling white coat, and reciting the oath in unison on their first day of medical school.

Wen's idealistic school days are long gone. Like many hospital doctors in China, she's had to change her perspective in the face of harsh workplace conditions, including dangers posed by angry patients, overcrowding that some experts say is behind a patient rage phenomenon in China, and puny salaries.

Now, after 15 grueling years of hospital work and a rising sense of insecurity, Wen says she's thinking about quitting medicine for another line of work.

Read the full article at Caixin

Thais buy small hospitals in China

The Thonburi Hospital Group has decided to buy more small hospitals in China, in Shanghai and Guangxi. The negotiation for their acquisition is expected to be complete by mid-2014, said Dr Boon Vanasin, chairman of the group. 

Boon said his group's investment strategy was to concentrate on buying hospitals outside the country. It does not plan to acquire new hospitals in Thailand because the market it is already too competitive.
The target is to acquire three or four hospitals overseas that have more than 200 beds each year. Thonburi Hospital Group has already invested Bt70 billion in China.
"In general we want to hold at least 50 per cent of each hospital that we have taken over, but we have to wait and see if the Chinese government will come out with any new policy. This is largely dependent on the reshuffle in the Chinese's government," Boon said.

Full article at The Nation