Friday, 31 January 2014

China's medical news for Friday 31 January

Breast milk contains high levels of DDT
Breastfeeding mothers in Zhejiang have high levels of DDT in their milk, a study has shown. Researchers said the high levels of DDT found in breast milk were in excess of safe limits and showed that human milk was "grossly polluted". The DDT was thoght to come from seafood in the diet, the researchers said in the journal Environment International.

Shanghai obesity myth dispelled
Shanghai researchers have dispelled the concept of 'metabolically healthy obese'. In a study of more than 211,000 people over 40 i 25 areas of China they showed that  obesity was a risk factor for  CHD regardless of the presence or absence of insulin resistance. The findings are published in the International Journal of Cardiology.

Zinc levels linked to naughty children
Low zinc levels have been linked to behavioural problems in pre-school children in China. A study conducted in 1314 children in Jintan, Jiangsu found that low zinc levels were significantly associated with increased reports of total behavior problems. Living in the suburbs was associated with increased internalizing problems, while higher mother’s education and being female were associated with decreased externalizing problems, the study in the journal Nutrients found.

N95 face masks prove effective
A study of the effectiveness of N95 masks in Beijing has found that they are protective against bacterial colonization, co-colonization and viral-bacterial co-infection. The clinical trial of 1441 hospital staff found the rate of bacterial colonization was 2.8% with N95 mask users, 5.3% in medical mask users  and 7.5% in staff who did not wear any mask. Co-infections of bacteria and/or a virus  occurred in up to 3.7% of healthcare workers and were significantly lower in N95 wearers, the study in Preventive Medicine showed. (NB: See our earlier story that found N95 masks were a poor fit for Chinese faces).

Medicine costs and hospitals
The Economist has an article explaining why China's hospitals are dependent on revenue from drug sales for their financial viability. The magazine says efforts to reduce corruption will be difficult until the system is reformed, as hospital derive 40% of income from commissions on medicines and medical products.

China has psychotherapy boom
Mental disorders have traditionally been a taboo subject in China, but SBS reports that a reality television show Psychological Sessions has been captivating audiences across China. And a researcher says there is now a 'psychotherapy-boom' in China as people have become aware of modern-day stresses and the need for treatment. 

Women don't get a fair go in health
Women face medical discrimination in China as they appear to have lower rates of treatment than men, a study suggests. Published in the International Journal for Equity in Health, the study finds that women have lower rates of hospital admission than men for the same conditions. Women also have lower rates of investigations and shorter hospital stays compared to their male equivalents.

Thursday, 30 January 2014

Health ministry outlines penalties for doctors who accept bribes or kickbacks

translated by Michael Woodhead
Doctors and healthcare staff who accept bribes or kickbacks may receive anything from a warning to being fired, depending on the severity of the offence, according to draft regulations released this week by the National Health and Family Planing Commission.
The draft rules cover the acceptance by staff of bribes such as 'red envelopes' for preferetial treatment. They also apply to medical staff who accept any free or discounted goods such as drugs, medical devices or equipment from suppliers. The regulations cover activities such as accepting unauthorised commissions, kickbacks or rebates from suppliers.
For any medical personnel found to be accepting bribes or kickbacks the penalties include expulsion from the workplace and loss of licence to practice. Other sanctions include demotion, warnings and 'demerits', the NHFPC plan says.
The draft regulations have been circulated to all local health and family planning work units, to medical institutions, hospitals and medical education units. Feedback will be accepted by the NHFPC until 8 March.

China medical news for Thursday 30 January

Blood lead levels still hazardous for Chinese children
Blood lead levels for children have decreased in recent years but are still at unhealthy levels, a study carried out in 11 cities has found. The blood sampling survey of 12 000 children under six years of age found that average blood lead levels dropped by 16% (from 46μg/L in 2004 to 39μg/L in 2010). The prevalence of elevated blood lead levels dropped by 87% (from 9.8% in 2004 to 1.3% in 2010). Factors associated with high blood levels included eating popcorn, chewing fingernails, sucking fingers, being cared for at home or at a boarding nursery, the study in the World Journal of Pediatrics found.

Rise in China's caesarean rates 'alarming'
The overuse of cesareans is rising alarmingly in China and has become a real public health problem, a review by researchers in Beijing has concluded. The current national caesarean rate is near 40%, and there has been a rapid rise of cesarean sections in recent years, say researchers from the School of Public Health at Peking University. Nonclinical factors such as financial incentives for hospitals were considered as the main drivers fueling the rise of cesareans. However the change in health services to focus on specialised care and marginalizing primary care have also played a role, they say in the International Journal of Women's Health.  

Dengue fever changes in Guangdong
The pattern of dengue fever outbreaks in Guangdong is changing, infectious disease specialists have found. The disease appears to be becoming endemic although outbreaks are caused by the milder types of dengue, researchers report. The prevalance varies between 2-5% and serotypes are now more varied, according to the study in PLOS One.

Puberty arrives earlier for Chinese girls
The age of onset of puberty is now at least a year earlier for Chinese girls compared to those of 1984, a study from the Capital Institute of Pediatrics, Beijing, has found. The research in the World Journal of Pediatrics found that the age of onset of puberty for urban girls had decreased by 4.2 months per decade, and that of rural girls by 9.6 months per decade from 1980 to 2004.

Fish pedicures a hepatitis risk
Aqua pedicures where tiny fish nibble away at dead skin on bathers feet may spread blood diseases such as HIV and hepatitis B, a Ningbo newspaper says. Dr Wang Jiahua, a dermatologist at a local hospital, said there were risks of infection, citing a patient whose legs became hot and swollen days after his first fish pedicure.He suggested a one month interval between fish pedicures and antibiotic ointment to protect skin where wounds are found.

Wednesday, 29 January 2014

Seven important items of medical research from China

N95 masks don't work for Chinese faces
The specialised N95 face masks used to protect against infections such as influenza are not shaped to fit Chinese faces and most would fail to prevent transmission because of poor fit and leakage, tests by Wuhan researchers have shown. Evaluation tests on ten different types of N95 mask found that only two performed within acceptable limits to prevent transmission of infections. Performance of some masks was better when users were trained and they were specially fitted, the study in PLOS One showed.
"This study indicated that widely used N95 filtering facepiece respirators in China didn't fit well and can't provide desired protection for respirator users," the researchers concluded.

Malaria from Africa now a problem in China
Malaria has been virtually eliminated in China but doctors now face the problem of treating malaria in Chinese workers who have returned from Africa. In Jiangsu there have been 918 malaria cases and six deaths in the last decade due to malaria imported from other countries. The imported cases make up 12% of all malaria cases and account for all malaria deaths, according to researchers from the Jiangsu Institute of Parasitic Diseases, Wuxi, writing in the Malaria Journal.

No cardiovascular treatment for many Chinese patients
Two out of three Chinese people with cardiovascular disease are still going untreated, a major study has found. Data from of 512,891 Chinese adults showed that 5% had a history of cardiovascular disease. However, of these only 35% had been treated with any cardiovascular medicine for secondary prevention such as statins, antiplatelet drugs or antihypertensives. The findings from a team from Oxford and Beijing universities, are published in the International Journal of Cardiology.

Shenzhen women have high rates of HPV
More than one in ten women in Shenzhen are have HPV serotypes that put them at risk of cervical cancer, researchers say. A study of 4, 413 women measured HPV infection rates and the prevalance was 14%. The high risk HPV types 16 and 18 that are likely to cause cervical cancer were found in 3.5% of women and 1.27% of women, according to the study published in the Asia Pacific Journal of Cancer Prevention.

Avian H7N9 flu virus on way to mutation
The H7N9 influenza virus is genetically much more diverse than previously thought, suggesting that it is reassorting and closer to mutating into a pandemic virus, researchers from the Jiangsu Provincial Center for Disease Control and Prevention, have shown. They report their findings in Nature.

Medical teacher burnout
Staff at medical colleges in China have high rates of burnout, a study from Shanxi shows. Staff who had a love of teaching and those who received praise and recognition were less likey to suffere burnout, according to the study in Archives of Environmental & Occupational Health.

Pancreatic cancer in Shanghai
The diagnosis and treatment of pancreatic cancer in Shanghai has room for improvement, according to researchers from Fudan University. In a review of management of pancreatic cancer published in Cancer Letters, they report that most patients miss out on the recommended histologically verified diagnosis and the 1-year and 2-year survival rates were 35% and 14.4%, respectively.

China medical news headlines for Wednesday 29th January

Tuberculosis rates fall by 80%
Rates of tuberculosis in Shandong have fallen by 80% in the last decade, a study of 55,000 adults has shown.The prevalence rate of bacteriologically confirmed TB ases was 34 per 100,000 for adults in 2010. However, diagnosis of TB is now more difficult as half of bacteriologically confirmed cases did not present persistent cough, researchers said in BMC Infectious Diseases.

Man arrested for spreading H7N9 rumours
China's internet is full of stories of doctors and medical staff who have died of H7N9 influenza. Social networks such as Sina Weibo, QQ and WeChat have stories circulated by netizens of deaths of medical staff in Shanghai, Tianjing, Shenzhen and Nantong, according to CRI. However, health authorities have branded the stories as rumours and have arrested one man for spreading false information. In one case, a doctor who was named as having died of H7N9 influenza has startled patients by being on duty at hospital.

Shanghai life expectancy is 82
Life expectancy in Shangahi is 82 and a half years old, the Shanghai Health and Family Planning Commission has said. Women have a life expectancy four and a half years longer than, a report in ECMS said. LIfe expectancy in the city is on a par with developed countries but infant mortality including migrant families, rose from 5.04 per 1,000 in 2013 to 5.73 per 1,000.

High alert as H7N9 cases increase
China has gone on to high alert for H7N9 influenza as the number of cases continues to increase. Bird markets have been shut down in Shanghai and quarantine authorities have stepped up monitoring at airports. However, health authorities have played down the risk of a pandemic, saying the infection is not spread by human-to-human transmission. A vaccine against the H7N9 virus is being developed but is not ready for use in humans yet, authorities have reported.

China's can't cope with dementia
People in China are ill prepared to cope with the huge number of elderly people with dementia and Alzheimers disease, according to an article in SCMP. China has almost six million patients with Alzheimer's, 50% higher than a decade ago and twice as many as earlier estimated by the international health community. However, caring for dementia sufferers in China is left to family members with limited or no training and no support from the state.

Red Cross resuscitation ads are wrong
An advertising campaign by the Red Cross that urges Chinese to help those who have collapsed and need resuscitation is technically inaccurate, according to emergency specialists The picture on the ad shows a woman pressing the soft tissue of the patient's neck, which will lead to obstruction of the airway. First-aid practitioners should place their index finger and middle finger on the patient's chin bone, a doctor has pointed out.

Tuesday, 28 January 2014

Act early to stop leprosy, Guizhou expert urges

translated by Michael Woodhead
Leprosy is still a problem in some parts of China, but it can be controlled if detected and treated early enough, an infectious diseases expert from Guizhou has said.
Speakin in International Leprosy Action Week, Dr Li Jinlan of the Guizhou Centre for Disease Control and Prevention said leprosy is still present in poor districts parts of southern China where hygiene standards were low. He said leprosy needed warm and humid conditions to thrive, but it could be controlled if the symptoms were detected early and chemotherapy give. According to Guangming Daily, he urged Chinese citizens to remember the 'Three roots' to leprosy.  The first root is awareness of the the possibility of leprosy, especially in people who have a long-lasting rash, skin lumps, white spots and numbness of the skin. The second factor is to have experienced clinics that can recognise and treat leprosy in a timely way. The third root is to be not afraid of seeking diagnosis and treatment due to stigma. Dr Li said leprosy was often transmitted within families and relatives should arrange for anyone they suspect to have leprosy to be checked out.

China medical news headlines for Tuesday 28 January

Hospital care declines after switch to contract nurses
China's hospitals are no longer employing career nurses but opting for cheaper contract nurses, resulting in inferior levels of care, researchers from the School of Nursing, Sun Yat-sen University,  Guangzhou have shown.  Their study found that hospitals are moving away from the 'bianzhi' system of state-guaranteed lifetime employment to a contract-based nurse employment system with limited job security and reduced benefits. This may adversely affect both nurse and patient satisfaction in hospitals, the study found.

Tamiflu call for H7N9 flu
The increasing threat of H7N9 avian influenza has prompted Shanghai to shut down bird markets after 12 deaths in surrounding areas.  Live poultry trading has been banned in nearby Zhejiang cities, after 49 human H7N9 infections and 12 deaths were reported this month, says the Shanghai Daily.  Meanwhile Zhong Nanshan, director of the Guangzhou Institute of Respiratory Diseases has suggested early and longer use of antiviral drug Tamiflu for H7N9 patients.

Death sentence for hospital attack
The man who killed a doctor at a Zhejiang hospital in a medical dispute has been sentenced to death by a Taizhou court.  The 33-year old man stabbed a doctor to death at Wenling hospital and wounded two other doctors because he was unhappy with surgery to cure a nose problem which he said was causing extreme pain, according to the Global Times.

Boy died after drip infusion
Shanghai authorities are investigating how an allergy-prone boy died after having an IV drip infusion treatment for a cold at a local hospital.  The boys parents allege that the hospital has covered up the incident and switched the infusion packaging to prevent analysis of the fluid used, according to ECNS.

Monday, 27 January 2014

China medical news headlines for Monday 27th January

Premier pledges social security system
In his first press conference as premier, Li Keqiang affirmed the Chinese government's commitment to building a social security system safety net that will include provision of medical care. According to China Daily, the premier said the government should "weave a network that guarantees the basic living of all the people", covering education, medical care, social insurance and housing.

Blood donations dry up at New Year
China is facing severe shortages in blood donations as the usual donors - students - return home for Chinese New Year. Nanning's blood donation centre now has only 300 donors a day but the city needs 4-500 to meet hospital demand, according to CRI. Cold winter weather also deters people from going to blood donation centers or donation buses, health authorities say.

Whistleblower doctor gets her job back
Mianyang's 'corridor doctor' whistleblower who lost her job after complaining about hospital overservicing will be offered her job back after an inquiry, authorities in Sichuan say, according to Global Times. Lan Yuefeng worked in a corridor for two years after protesting about her hospital offering unnecessary treatments and profiteering.

Laowai not using medical cards
Foreigners who work in China now receive social security cards that allow them to access subsidised medical treatment in the same way as Chinese citizens, according to China Daily. However many foreigners are unsure of their entitlements and do not use them, a professor says.

Social security shortfall
New social security laws compel local authorities to provide financial assistance to the needy including those with severe medical conditions and local officials  face legal action if they refuse to provide it, according to the Beijing Review. However,  local authorities say they do not have the personnel to check every single claim for validity.

Outdoor workers get pollution clinics
Shanghai has set up special drop-in medical centres for outdoor workers who are suffering from the effects of air pollution, according to ECNS. The city authorities have also provided 300 medical cards for outdoor workers because of their high risk of pollution-related ailments.

Leaders call for action on H7N9 response
The Chinese vice premier Liu Yandong has called on all local authorities across China to take action to prevent the spread of H7N9 influenza. Local health departments will face punishment if they do not take action on epidemic surveillance and outbreak response plans in areas such as health institutions and schools. Poultry markets in Beijing have not tested positive for H7N9 influenza virus, according to the Shanghai Daily. However Shanghai has now experienced its eighth case of H7N9 avian influenza of the year, the paper reports.

Three medical stories from Chinese language media

Chengdu doctors out of pocket as fundraiser fails to deliver 

Chengdu neurosurgeons are out of pocket to the tune of 60,000 RMB  after they operated on a seriously ill boy whose parents turned to fundraisers to pay the medical bills. The surgeons at the Chengdu Military District Hospital performed an urgent operation on a 9-tear old boy who had inflammation of the cerebral cortex. His parents did not have enough money to pay for the medical bills and they turned to a volunteer fundraiser to help solicit donations. However, at the end of the year the hospital is trying to balance its accounts and has yet to see the funds for the operation. According to the hospital rules, unpaid bills are the responsibility of the doctors who provided the treatment. When contacted by the West China News, the fundraiser Chen Mei said she was  waiting for the paperwork to be done so she could process the donations and provide the funds to the doctors.

Girl in Sichuan has duplicate organs

The People's Daily reports the case of a 13-year old girl who has a congenital disorder that has given her double the number of organs of a normal person. The Guangzhou girl called "Tian Tian" was born with four kidneys, two bladders, two uteruses and four Fallopian tubes. The girl had some fusion surgery when she was an infant but now her kidneys are causing her problems. The excessive organs mean that she has to urinate twenty times a day and she has frequent urethral infections. According to the newspaper report, the girl and her parents have now gone to Chengdu to track down the doctors who did the original operations to ask them to amalgamate the kidney
Her treating doctor Hu Xianliang said the operation would not remove the kidneys but would seek to normalise their function. He said Tian Tian was likely the first such case in the world and was caused by abnormal development of a twin ovum.

 Chinese children can't exercise in smog

A report in the Guangming Daily looks at the warnings from health experts to parents about not letting their children exercise in smoggy conditions. The report quotes a child health expert from the Sports Ministry saying that children should continue to do physical exercise during smoggy periods of bad air pollution but should exercise indoors and avoid heavy aerobic exercise. The long term health risks of inhaling high amounts of pollution during days of heavy pollution should be weighed against the dangers of a sedentary lifestyle, the article says.
Other sports medicine experts have even produced  a manual that shows the best indoor programs for sports and activities for children to do when the weather is smoggy.

Sunday, 26 January 2014

'Shaolin patient' amazes Wuhan doctors (or is it fake?)

A patient at a Wuhan hospital gave medical staff a demonstration of his amazing Shaolin monk like 'wugong' powers after he recovered from a serious jaw injury following a car crash.
The photo was posted by a Dr Wan Qilong at the Wuhan Stomatological Hospital, who said it was of a 37-year old patient demonstrating his martial art skills by balancing horizontally on a table using only his finger. The manouevre is known as "One Finger Meditation", according to the report in Ifeng News. Dr Wan said the patient had suffered a broken jaw in a car accident and had been treated at the plastic surgery and orthopaedic departments of the hospital to recover his function. At first the man known as Chen Mo was unable to open his mouth or eat, and it took him two months to recover his jaw function. He was so grateful to the doctors and nursing staff that he said he would give them a demonstration of the martial arts skills that he had studied since childhood. Just before he was discharged from the hospital Chen Mou demonstrated the "One Finger Meditation" and staff were amazed by his skill. The photo of  his balancing act was posted by Dr Wan on the internet and it has since attracted a lot of comment.

NHFPC issues directive on pharmaceutical price caps and production of essential medicines

translated by Michael Woodhead
The National Health and Family Planning Commission in conjunction with nine other departments has issued a notice entitled: "Correcting unhealthy tendencies in pharmaceutical purchasing and sales and medical services - a special governance work implementation paper."
The notice calls for strict standardisation of medicine purchasing and sales arrangements in order to  reduce the sector's high prices for drugs in the medical compendium.

The NHFPC statement calls for health institutions and agencies to improve and perfect centralised buying systems for pharmaceuticals and high-value medical consumables. Departments should research the best ways to improve pharmaceutical product quality and find appropriate appraisal measures for medicine standards. The notice also requires department to adopt effective measures to supervise and regulate medical treatments and to explore single source purchasing arrangements and tender arrangements. It also suggests that governments adopt pharmacoeconomic evaluation of medical treatments. Steps should be taken to develop a "national central drug purchasing tender price database inquiry system" function. While guaranteeing pharmaceutical quality, practical measures should be taken to reduce artificially high drug prices in tenders, it says.
Published in the Peoples Daily, the NHFPC notice also calls on departments to strengthen supervision of medicine prices,  medical product costs, to monitor production costs and achieve reasonable adjustment in retail prices for medical products. It says measures should be taken to ensure production of low volume but clinically essential medicines at fixed prices while ensuring reasonable profit margins for manufacturers, to encourage the enthusiasm of production enterprises for manufacturing these products.

Saturday, 25 January 2014

Hospital scalpers cleared out from Beijing Childrens Hospital

Six hospital scalpers have been arrested at the Beijing Children's Hospital in Xicheng after an undercover operation by local police.
The scalpers were arrested for trading in hospital admission registration tickets that would-be patients usually have to queue up for hours for in order to be able to see a doctor.
Xicheng police say they mounted an undercover operation, keeping the scalpers under observation for several days in oredr to identify they key figures and to obtain firm evidence of their activities. The scalpers were detained in an 'ambush'.
According to the Beijing Daily, the arrests bring the total number of scalpers detained in the western district of Beijing to 55. The local police commander said tackling the problem of hospital scalpers would help provide an orderly and fair environment for the common people when seeking medical treatment at hospitals. The local people will continue to crack down on these activities to ensure an orderly environment around major hospitals in the area.

China medical news headlines for Saturday 25th January

Bribery and medical profiteering targeted in new campaign
Chinese authorities have launched a major national campaign targeting bad practices in medical services, including excessively high prices for drugs. According to the Global Times the reform campaign will stress better monitoring of drug production and marketing and address inappropriate practices within medical institutions and among medical practitioners. Medical ethics will be further promoted, and bribery in marketing of drugs will be addressed. Deaprtments taking part include the National Health and Familiy Planning Commission. The campaign calls for violators to be identified and cases of bad medical practice to be punished  in a serious way.

STDs a major problem in sex workers
Urgent efforts are needed to tackle the high rates of sexually transmitted diseases among prostitutes in Jiangsu, researchers say. A study of sex workers in Yangzhou and Changzhou found that 15% were infected with chlamydia, 5% had gonnorhoea, 5% had syphilis and 0.2% had HIV infection. The findings are published in PLOS One.

Dietary advice for obese students
Shanghai students should be given dietary advice and better access to health food at school to combat the rising trend in obesity, a political adviser has suggested. According to Shanghai Daily, Chen Lei said 17% of Shanghai school students were obese, three times the national average. Over half of the parents he surveyed expressed dissatisfaction with lunch provided by schools, which often included fried food such as pork and chicken.

Fujian hospital chief arrested for bribery
The president of a hospital in Fujian province has been removed from his post for accepting bribes. ECNS reports that Lu Kaiming, who also served as the vice chairman of the Municipal Committee of the Chinese People's Political Consultative Conference in the city of Sanming, has been detained and investigated for law infringement and serious disciplinary violations. Authorities have confiscated his illegal gains and he will be transferred to a local judicial organ for his alleged crime.

Friday, 24 January 2014

Abbott the latest pharma company to be accused of bribing doctors in China

The US pharma company Abbott has launched an internal investigation after being accused of paying bribes to doctors in China in relation to its nutrition products.
A report in the 21st Century Business Herald says Abbott has been channeling 8-10% of its sales revenue to give to doctors. The claims come from a 'deep throat' source who says the payments to doctors are to promote the use of Abbott Nutrition products. The source also claims that Abbott is working outside the usual hospital products  buying and selling system.
The company has responded by saying it was not aware of any such behaviour, which would be a violation of its own strict code of conduct. Abbott said it was now investigating the claims.
The report says the behaviour was encouraged by Abbott managers in 2012, and the bribery was disguised by being channeled through meal expenses and conference expenses. Larger payments were made through bogus travel agencies for meetings. The report says company representatives also bypassed the usual hospital buying system to provide products direct  via an agency, which meant that doctors could earn larger commissions from sales.
The report says many of the practices exposed were normal for the pharmaceutical industry and the government is now cracking down n these methods, as seen by the investigation into GSK.

Medical news headlines from China - Friday 24 January

China's foray into pharma research hits setbacks
An article in Caixin looks at Chinese pharmaceutical company efforts to develop therapeutic vaccines that will cure hepatitis B rather than just prevent it. This is a potentially lucrative market given that 10% of Chinese have the infection.  However, the R&D efforts of three companies - including a brewery - to develop a hepatitis B vaccine have proved disappointing, resulting in falls in their stock prices. Research efforts for a therapeutic vaccine have been characterised by delays, poor results and concerns about adverse effects of the new products. Some experts have said the vaccines may do more harm than good while others have said that there may no longer be a need for therapeutic vaccines if hepatitis B is prevented by immunisation.

Private investors in hospital must tackle local government
Another feature in Caixin  takes a look at the recent relaxation of rules that allows private investment in public hospitals. It uses the example of a Chinese pharmaceutical company that tried to buy a stake in two hospitals in Kunming. The article concludes that the local governments which control the hospitals have the power to make or break an investor's plan and stand as the biggest barriers to the kind of public hospital reform advocated by the central government.

Red envelopes still needed for medical care
An editor at the China Daily admits he had to use guanxi and "favours" to get a hospital bed for his father after he suffered  a stroke in Beijing. In his article, Bai Ping says it is extremely difficult to get a hospital bed in Beijing because many people come to the capital from outside in the hope of getting superior treatment in the city's hospitals. Bai Ping says his family now faces huge medical bills and they feel themselves at the mercy of doctors over treatment and costs that they do not know much about.

Unvaccinated China faces grim flu season
China faces a serious flu season because of low levels of immunisation, infectious disease specialists have predicted. The influenza virus is much more active this year and there are three major strains of the flu virus: H1, H3 and Influenza B, according to Feng Zijian, deputy director of the Chinese Center for Disease Control and Prevention (CDC). China's flu vaccination rate remains at 2 to 3% of the population each year, lagging far behind 27% in the US. Low vaccination rates are thought to be due to a general lack of awareness among the Chinese public about the dangers of influenza, as well as concerns about the safety of domestic vaccines, according to the Shanghai Daily.

Trains should have medical facilities
Long-distance trains should provide on-board health facilities, according to China Daily. Many passengers become sick on long distance journeys that can last 2-3 days in China, but they cannot get off the train because their ticket will become invalid. Some long-distance trains have infirmaries but the medical service on trains cannot meet serious emergencies. The railway authorities, therefore, should assign medical professionals to the infirmaries and stock them with as much emergency medicines as possible.

Wenling doctor killer in court
The man accused of attacking and killing a doctor at the First People's Hospital of Wenling in Zhejiang province in October has appeared in court charged with murder. Lian Enqing, 33, is suspected of stabbing to death Wang Yunjie, 46, and severely wounding two other physicians, according to China Daily. It is believed he was unhappy with a surgery done on his nose at the hospital. 

Thursday, 23 January 2014

From the journals ... five China medical study links

1. The prevalence of resistance to linezolid in China is 11% in multidrug-resistant (MDR) tuberculosis cases and as high as 60% in cases of extensively drug-resistant (XDR) tuberculosis, a study from the Respiratory Diseases Department of the PLA General Hospital, Beijing has found.

2. Pregnancy maybe a risk factor for clinically severe influenza in young women infected with the H7N9 virus - case report from the Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing.

3. Vaccination means measles is a step closer to eradication in China, study from WHO Regional Reference Measles Lab, at China Centre for Disease Control and Prevention, Beijing shows reduction in co-circulating lineages of endemic genotype H1 viruses.

4. Lyme disease is different in China: a study from Heilongjiang shows that the causative organisms for Lyme borreliosisis tend to be a different type of  B. burgdorferi sub-species from those seen in US and Europe, predominantly B. garinii.

5. Only 19% of Chinese patients with type 2 diabetes perform self-monitoring of blood glucose with the recommended frequency, and one in three never do self monitoring, according to a study in the Chinese Medical Journal.

Rabies on the increase in China as pet dog ownership rises

by Michael Woodhead
Cases of rabies are increasing exponentially in China as more dogs are kept as pets, a study from Henan shows.
Dr Li Guowei and co-researchers from the Zhengzhou Center for Disease Control and Prevention say that rabies was unknown in Henan until the 1960s, and there were only about 10 cases a year until the year 2000. However, since then the number of cases of rabies has increased exponentially each year, with more than 100 reported in 2005 . The researchers say the rise in rabies has paralleled the increase in pet ownership as China became more wealthy. About one in four cases is in children who may have been bitten by domestic dogs, the article in Emerging Infectious Diseases notes.
Most patients died within two days of being exposed, and three patients who died had received rabies vaccine after being bitten by dogs.
The high cost of rabies vaccine and the lack of prompt treatment were related to many additional deaths, the researchers said.
“The severity of rabies and its increased incidence present a public health threat, and appropriate control strategies in Henan province are needed. A new rabies control system should be established that includes cooperation of the various health care sectors to provide protection to the public,” they conclude

WHO says H7N9 flu situation changing but still not high risk

A WHO analysis of China’s latest H7N9 avian influenza outbreak shows that that cases are trending slightly younger, with a lower case fatality rate, according to CIDRAP News.
The latest risk assessment by WHO found that the average age in the latest surge of H7N9 was slightly lower than the first wave: 52 years compared with 58 years. H7N9 is still striking males more frequently than females, and the case fatality rate is not as high as the outbreak's first wave, but H7N9 infections are still marked by rapidly progressing severe pneumonia. Tests on the H7N9 virus have not shown resistance to neuraminidase inhibitors such as oseltamivir (Tamiflu). And while most cases are linked to exposure to infected live poultry, the recent death of the doctor from Shanghai shows that continued vigilance is needed, the WHO said.

Medical headlines: Violence against doctors in Xian | Family doctors unpopular | New Year depression

Violent attack at Xian hospital injures five staff
Five doctors and nurses have been injured and a Xian hospital severely damaged in an attack by irate relatives of a patient who died, Xinhua reports.
More than 20 people with iron bars burst into the fourth floor of the Xi'an Municipal Central Hospital to assault medical staff and causing damage including smashed windows and breaking furniture and fittings.
The violent incident was probably the result of a dispute between the hospital and relatives of a patient with meningitis who died in the hospital earlier. The doctor treating the patient is reported to be severely injured, and other medical staff members suffered bruises. Police are investigating the incident.

Family doctor system proves unpopular in Shanghai
The pilot family doctor system in Shanghai offers patients more contact with doctors for everyday illness, but many are reluctant to use the service, the Global Times reports. In a long article the Times says the new system is popular with older people with chronic diseases but is being bypassed by younger people with acute illness who want immediate access to a hospital and all its expertise. Doctors working as family practitioners also say they are losing heir skills by being away form the hospital environment.

New year blues
Many Chinese people are suffering from a malaise of lethargy and depression around the Chinese New Year period, the Global Times reports. Psychiatrists say it is quite common for Chinese to experience "year-end syndrome" when they feel tired, anxious and socially withdrawn. The condition is partly psychosomatic and may be worsened by the stress of returning home and the dark days of winter, doctors say.

Wednesday, 22 January 2014

Today's China medical news headlines

More than half a billion Chinese have health cards. At the end of 2013, 540 million Chinese people, or roughly 40% of the population, had social security cards, which are mainly used to pay for medical expenses.It is hoped to expand numbers to 800 million cards by 2015, according to the Shanghai Daily.

Doctors in Beijing will be allowed to work in private hospitals as well as public ones under new regulations being drawn up by the National Health and Family Planning Commission.
At present doctors are restricted to working in only three local hospitals, according to China Daily. The city's health bureau says lifting the restrictions is aimed at encouraging doctors from top public hospitals to work in private medical institutions, attracting more patients to these institutions and thus alleviating the workload on large hospitals.

China may see human-to-human transmission of the H7N9 bird flu virus on a limited scale the WHO representative to the country has said. But there is no evidence that the virus will become sustained or widespread among humans, Bernhard Schwartlander said, according to the Beijing Daily.

"Since October, only one cluster was detected where human-to-human transmission might have occurred. We continue to expect only sporadic human cases," Mr Schwartlander said.

A Shanghai hospital has donated 'free' plastic surgery to a poor 16-year-old girl who survived the devastating Wenchuan earthquake of 2008. According to Shanghai Daily, the Shanghai Huamei Plastic Surgery Hospital gave Li Wenqian a free operation to separate her ring finger and little finger on her right hand, which had grown together after injuries she received when she was buried under debris for nearly 10 hours after the earthquake.

China is setting up a national health data network advisory group to make better use of population and public health information, CRI reports. A team of 28 experts from fields including medicine, demography, engineering, mathematics and law will provide suggestions for strategy, policy and planning based on population and public health data, according to the National Health and Family Planning Commission.

The New England Journal of Medicine is to expand its presence in China through the Wolters Kluwer publishing group and Ovid, according to a press release.

Chinese people with HIV hope to see end of health certificate discrimination

translated by Michael Woodhead
Chinese people with HIV can now look forward to a longer life thanks to antiviral medication but they face terrible discrimination in employment because they are barred from having a health certificate.
An article in Guangming Daily Health News this week describes the plight of one young women, Ting Ting, who lost her job as a restaurant manager when she tested positive for HIV. Ting Ting says that until her diagnosis she had enjoyed a good career in the restaurant business because of her hard work, determination and friendly character. She was promoted from waitress to restaurant manager and things looked good for her until she went to get the routine 'health certificate' for employment. As part of the process she had a HIV test which proved positive. She was refused a health certificate in line with government policy and immediately lost her job. She fell into despair and was contemplating suicide as she had no way to support herself. However, she received some support from a HIV support group and eventually pulled through her suicidal phase. However, she still faced the problem of employment, and for the last few years has survived through a series of casual labouring jobs. Due to government regulations she is not allowed to work in food or health industries that require a food industry health certificate'.
Ting Ting says she knows of some HIV positive people who have bought fake health certificates on the black market, but is not willing to do this.
A spokesman for the HIV support group says they do not oppose routine HIV tests done for employment purposes as this is one of the main ways in which HIV cases are detected in China. However, he says it is time to stop discriminating against people with HIV in employment. The medical advice is clear - there is no reason why people with HIV cannot work in industry sectors such as food and shops, the only barrier is the government regulations. And now he is hopeful that these discriminatory rules will be dropped in 2014. he points to the fact that people who are hepatitis virus carriers are now allowed to have a health certificate for employment. Since the transmission risks for hepatitis and HIV are the same  there is no logical reason why people with HIV should be denied health certificates, he says.
He understands that local governments will consider proposals this year to overturn the rules on HIV and health certificates, and she says this is long overdue. People with HIV should then be able to integrate with society.

Tuesday, 21 January 2014

Today's China medical links

An inside look at a Guizhou hospital 
What's it really like getting treatment at a Chinese hospital? How much does it cost, how do patients pay and what happens when you run out of money? Ashish Jha, an associate professor of health policy and management, Harvard School of Public Health, has a great blog post at KevinMD on the nitty gritty of patient care. How do pateints get seen? How doctors manage patients (much more conservatively and slowly) - all based on a visit to the Huaxi District People’s Hospital in Guiyang.

Blood supplies drying up
In the China Daily, blood donations in Beijing have been falling slightly for three consecutive years, and legislation is needed to ensure supplies, according to Ge Hongwei, director of the testing department of the Beijing Red Cross Blood Center. She says the amount of blood used has been increasing by about 15 percent annually in China, widening the gap between supply and demand.

Get me out of here!
A British traveller, Sammy Corfield, blogs about his nightmare experience with various hospitals and doctors  in Zhejiang, when he went seeking treatment for chronic diarrhoea.

H7N9 flu death doctor hailed as hero for continuing to work while sick

translated by Michael Woodhead
The Shanghai doctor who died of H7N9 avian influenza is being hailed in the Chinese media as a hero for continuing to go into work despite being sick.
The 32-year old Zhang Xiaodong who worked as a surgeon in the emergency department of the Pudong New Area Renmin Hospital, died on the 18 of January from pneumonia complications of H7N9 infection.
In an article published today, his colleagues said he was a hardworking doctor who worked in a very busy and understaffed department and did not want to let his colleagues down. They said it was extremely exhausting working in the surgical department and it was not unknown for a surgeon to perform five appendix removal operations in one shift.
On the 16th of January Dr Zhang came into work feeling feverish and insisted on staying at work despite feeling sick. The next day he felt worse and had an 'IV infusion' before resuming his work on his shift. However, his condition quickly deteriorated and he became critically ill and was taken to intensive care. He was put on a ventilator when he developed chest pain and breathing problems. A CT scan showed that infection had invaded many lobes of his lung. The top experts of the hospital were called in to oversee treatment and Dr Zhang received the best drugs available, according to a local newspaper, The Morning Times. However, despite the efforts to save him, Dr Zhang died without making a recovery.
His colleagues said Dr Zhang would not have wanted to miss a shift because the lack of staff meant one of the other doctors would have had to have done a 24 hour shift to cover for him.
Dr Zhang left a wife who was seven months pregnant. The hospital has filed a report of industrial injury and his family will receive compensation.

Sexual re-orientation clinics in China: AFP has the story

Sexual re-orientation clinics to convert gay people back into heterosexuals are doing booming business in China, according to an article by AFP from Beijing (no byline) .
The clinics use electric shock therapy on men while watching gay porn to try 'program' them against being gay. Sounds like the plot of the Tom Sharpe novel Indecent Exposure.
The article says 'conversion therapy' is a lucrative industry in China, with at least five clinics claiming to offer “sexuality adjustment” through various means, including hypnosis, drugs and electric shock therapy. One of them is the Haiming Psychological Consulting Centre in Beijing which offers electric shock treatment -- in 30-minute sessions every few days. Other clinics are reported to offer less severe 'treatments' for homosexuality such as counselling and antidepressants, claiming that homosexuality is changeable in people for whom it was not “innate”. One gay man who went to a clinic under pressure from his father said he was told to wrap an elastic band around his hand and hurt himself if he fantasised about gay sex.
The article adds that such clinics are now being opposed by LGBT groups in China, who say they “deeply damage homosexuals’ physical and mental health, and worse infringe on their self-respect”.

Monday, 20 January 2014

Another study shows Beijing's air is bad for heart health

The thick smogs that blanket Beijing and other Chinese cities have been thought to have adverse effects on respiratory health, but now a study shows they also do terrible things to the cardiovascular system.
Doctors from Peking Union Medical College have found there is a strong association between combustion-related air pollution and blood pressure. During  2012 they monitored pollution levels and personal levels of "black carbon" on five consecutive days in patients with metabolic syndrome in Beijing.
In a paper in the journal Hypertension, they report that exposure to high levels of black carbon was associated significantly with adverse cardiovascular responses. A one unit increase in personal black carbon during the previous 10 hours was associated with an increase in systolic blood pressure of 0.53 mm Hg and diastolic blood pressure of 0.37 mm Hg. They also found that carbon had adverse effects on autonomic function. "These findings highlight the public health effect of air pollution and the importance of reducing air pollution.

Shanghai doctor dies of H7N9 avian influenza: human-to-human transmission?

by Michael Woodhead
The H7N9 influenza-related death of an emergency department doctor in Shanghai seems to contradict the Chinese government's claims that the infection is only being transmitted from animals to humans and poses little risk of a major outbreak or pandemic.
The Chinese website ECNS reports that a 31-year-old doctor at  the Pudong New Area People's Hospital was one of three deaths from H7N9, two of which were in Shanghai and one in Guangzhou.
The doctor is said to have died of pneumonia and respiratory failure on Saturday after being infected with H7N9 avian flu virus.
The other case were a 77-year-old male farmer, Shanghai's seventh H7N9 bird flu case so far.
The deaths follow a claim by China's National Health and Family Planning Commission  on Friday that a large-scale H7N9 epidemic is unlikely because there is no human-to-human transmission.
"The virus is still spreading from birds to human, and the chances of large-scale human H7N9 infection are slim," the NHFPC statement said.
"Current cases are scattered, and no mutation of the virus has been identified so far that could affect public health," it said.
There have been 199 cases of H7N9 influenza and at least 45 deaths in China so far, and there are now about 4-5 new cases reported per day in China. The number of cases is also expected to increase as over Chinese New Year as it is the peak winter season for flu and people travel en masse and live poultry is bought and sold for family celebrations.
Update: The first probable  human-to-human case of H7N9 in China was reported in the BMJ in July by Qi Xian and colleagues at the Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing.

Inquiry rejects claims of Mianyang hospital whistleblower

by Michael Woodhead
A local inquiry into a Sichuan doctor's claims of over-servicing and financial irregularities at a Mianyang hospital has concluded that there is no case to answer.
In a story featured prominently in the People's Daily, the claims of Dr Lan Yuefeng have been found to be unsubstantiated by a major investigation conducted by health and disciplinary authorities in Mianyang into affairs at the Renmin Hospital. Dr Lan claimed to have been stood down over her claims that the hospital was driven by income targets that led to overservicing and inappropriate and unethical treatment. Barred from her office in the ultrasound department, she worked in a hospital corridor for almost two years.
However, an investigation by the local health department and party disciplinary and audit committees has refuted all of her allegations, according to the People's Daily.
The investigation found limited evidence of financial performance related targets and income at the hospital, but said these were in accordance with local health department guidelines and were corrected over time.
The investigation found that Dr Lan's claims of inappropriate use of a cardiac pacemaker for profit rather than clinical need were unfounded. The inquiry also rejected claims that there was 'medical chaos' at the hospital and no abnormal growth in servicing or revenue.
The investigator rejected claims by Dr Lan that she had been stood down because she voiced opposition to the inappropriate use of medical procedures such as the use of a cardiac pacemaker.
However, the inquiry did find fault with the hospital in terms of the overall quality of medical treatment, the attitude of staff to patients and the responses to complaints.
The investigation team said staff were lacking in political ideology and more work in this area was needed, especially for Dr Lan, whose political thinking was primitive. Political work needed needed to be strengthened to counsel Dr Lan and also to rectify the problems identified according to the law, it concluded.

Medical research in China: seven samples from this week's journals

China's medical education system is broken
Chinese medical education is not fit for purpose, a review by Dr  Wu Lijuan of the School of Public Health, Capital Medical University, Beijing, finds. Too many students have to get a an additional Masters or even a Doctorate in academic medicine to get a position at a hospital, and miss out on valuable clinical training. At the same time the clinical component of many degrees is not recognised by some institutions and has to be repeated.
Medical Education Online.

Chinese ethnicity protects against pre-eclampsia
A study of of 67 746 pregnant Chinese women found that 1.92% nulliparous women developed pre-eclampsia. The prevalence of mild and severe pre-eclampsia was 1.42% and 0.49%, respectively. The study authors said the prevalence of pre-eclampsia in China was low compared with Causcasians, perhaps due to differences in BMI or lifestyle.
Journal of Human Hypertension.

Allergic triggers in Guangzhou
The main allergic triggers among allergic people in Guangzhou are cow's milk, eggs in younger children and then the house dust mite allergens Der pteronyssinus and Der farinae in later years, a four year observational study has found.
Multidisciplinary Respiratory Medicine.

New cause of hand foot and mouth disease in Guangdong
An unusual enterovirus type, CVA6, has been identified as a new and major serotype associated with an hand foot and mouth disease epidemic in Guangdong.
Essential Microbiology.

Annual health checks urged for rural residents
About two out of three elderly have physical examinations by a healthcare professional at least annually, a survey of more than 1100 people from four provinces has found.However, rural residents suh as farmers were only half as likely to have a regular check up, prompting the study authors to suggest that  government and public health institutions should assist farmers to acquire the habit of having annual physical examinations. "Village doctors should be supported in delivering health information to the elderly in rural areas," they said.
BMC Healthcare Research.

Rats the source of hemorrhagic fever in China
There are about 1.4 million cases of hemorrhagic fever with renal syndrome every year in China and rats seem to be the main reservoir for infection, a study shows.Trends in cases were associated with the local rodent reservoir, climatic factors and socioeconomic conditions suggesting that it may be possible to develop an "early warning system" for the control and prevention of hemorrhagic fever, researchers said.
PLOS Neglected Tropical Diseases.

What are the most cost effective treatments for myocardial infarction in China?
A study from Beijing Anzhen Hospital and Capital University has found the most cost effective treatment for myocardial infarction in China would be optimum use of the four drugs aspirin, β-blockers, statins, and ACE inhibitors in all eligible patients, or unfractionated heparin in non–STEMI myocardial infarction. Other treatments such as reperfusion therapies in eligible patients with STEMI myocardial infarction and clopidogrel would be less cost effective, the study found. Use of all hospital-based AMI treatment strategies together would be cost-effective and reduce the total CHD mortality rate in China by about 10%. 

China's medical news headlines for Monday 20th January

Prenatal tests for syphilis needed
Syphilis and HIV are relatively common infections among pregnant women in China and therefore  prenatal screening programs should include syphilis as well as HIV tests to prevent many more adverse pregnancy outcomes, researhers have suggested.
Their study in Sexually Transmitted Diseases of 20,000 pregnant women  found a 0.07% prevalence for HIV and 0.25% for syphilis; 10% of HIV-positives were coinfected with syphilis.

Shigella common in Jiangsu
Rates of Shigella infection are high in Jiangsu, especially in the more remote far southwestern and northwestern areas of the province, a study shows. Risk factors were not washing hands before dinner and not having access to a safe water source, suggesting that improvements in sanitation and hygiene are needed, researchers said in PLOS One.

Dementia risk high for Chinese women
Mild cognitive impairment is relatively common in elderly Chinese, a study in Xi’an, has found. The survey of 815 people, 60 years and older found that 145 had mild cognitive impairment, giving an overall prevalence of 18.5%. The rates were higher in women (20%) than for men (15%). For women, the risk factors were lower level of educational and lack of religious attendance. "Different preventative measures should be adopted to delay or reverse cognitive impairment among  older men and women," the study authors from the Fourth Military Medical University, Xi’an, said.

Clinical research gets a big boost by Chinese government
China has greatly increased its medical research capacity, according to Zhe Yang, Deputy Director-General for the Department of Science and Technology for Social Development, Ministry of Science and Technology in the Lancet this week. China increased its scientific research by 20% annually for the last five years and set up 13 National Clinical Research Centres in areas such as cancer, cardiovascular disease, neurological disease, respiratory disease, chronic kidney disease, and metabolic disorders

Sunday, 19 January 2014

China's medical news headlines for Sunday 19 January

Hepatitis B vaccine given the all clear

The Shenzhen Bio Kangtai hepatitis B vaccine that was linked to the deaths of 17 infants has now been given the all clear by the Chinese state drug authorities. After an investigation the China Food and Drug Administration and the National Health and Family Planning Commission said the vaccine could be used again as no problems have been found with the hepatitis B vaccine. Authorities tested more than 1300 vaccine samples from six batches that were under suspicion. According to the People's Daily, the CFDA said all samples met the quality standards. The NHFPC said the 17 infant deaths were due to other problems, including severe pneumonia, kidney failure and suffocation.

In Guizhou, retired doctors asked to work in rural clinics

Retired medical specialists in Guizhou are being urged to lend their expertise to rural area clinics, according to China Daily. Professor Sun Fa of Guiyang Medical University told a meeting of the Chinese People's Political Consultative Committee that there were about 600 retired doctors from the province's five top hospitals of whom half were healthy enough to work in rural clinics.
He said they could help the more than 40,000 medical staff in township clinics, many of whom have only medical qualifications from secondary colleges or no degree at all.

Guangdong plans for baby boom

The new two-child family planning policy will not pose a big challenge to public services such as medical care, a top health and family planning official from Guangdong province has said.
Zhang Feng, the former director of the Guangdong population and family planning commission, said 1.1 million to 1.2 million babies are  born in the province each year. and the new policy will see about 130,000 more babies each year. "The baby boom will bring little social impact," he said at the province's annual legislative meeting.

China's smoking ban is unrealistic, says NBC report

A report by Ed Flanagan of the American NBC News says that the recent anti-smoking measures announced by the Chinese government may be as unsuccessful as previous attempts. The article says China has 350 million smokers and the habit is deeply ingrained in society. Previous attempts to curb smoking resulted in "No Smoking' signs being put up but they were widely ignored, says Flanagan. He says the Chinese media have given no details of how the new policy will be enforced. The move also face resistance from the powerful tobacco industry in China, he adds.

 New Yorker profiles China's gene factory BGI in Shenzhen

The New Yorker has an in-depth profile of the gene factory B.G.I., (Beijing Genomics Institute), which is said to be the world’s largest genetic-research centre, located in Shenzhen. The report by Michael Specter says BGI has 178 machines to sequence DNA, and produces at least a quarter of the world’s genomic data. This could help provide new solutions to disease and other areas such as agriculture, he writes.

Saturday, 18 January 2014

The "Corridor Doctor" - whistleblower or crank?

translated by Michael Woodhead
An interesting follow up to last week's story about the female doctor from Mianyang, Sichuan, who ended up working in a corridor of her hospital for two years after being removed from office for raising concerns about overtreatment and profiteering at the hospital.
In a new article, reporter Chen Xi for the Sichuan office of the Peoples Daily describes how he went to the hospital to follow up her claims and find out the background to her sacking and allegations of 'overservicing'. What he heard was a mixture of  good and bad about the would-be whistleblower.
First he spoke to Dr Lan, who said that she had always aimed to be a 'pure' doctor and wanted to be seen as one of  the 'angels in white' (ie female doctors in white coats).
However, when she started working at the Mianyang hospital she found that every activity involved putting generation of income for the hospital first. She said that practicing good medicine was constrained by the pressure to meet income targets. Patients were often admitted for treatment they did not need, and Dr Lan felt this was a breach of medical ethics. When she took her concerns to the director of the hospital, his reply was: "What are you on?"
As we reported last week, Dr Lan was stood down and barred from using her office in the ultrasound department in 2009 after she questioned the use of a cardiac pacemaker in a 53-year-old patient who had varicose veins. She said there was no need for a pacemaker in a patient who had a stable heart rate and who had already been cleared for vascular surgery.
Dr Lan also had another complaint - she said that the hospital had misappropriated thousands of yuan in earthquake relief funds donated in 2008 by Macau to aid survivors from the Wenchuan earthquake. As head of the ultrasound department, Dr Lan learned there was 235,000 Yuan in donations provided to buy a state-of-the-art Colour Doppler ultrasound scanner. However, when the machine was delivered it turned out to be an out-of-date model that was worth only 160,000 Yuan. It was not clear what had happened to the rest of the money donated from Macau. Dr Lan said she was so angry she left the old machine from the warehouse.

When the reporter tried to put these questions to the hospital management, he was told the hospital director Wang Yanming was not available. However, a deputy director, Feng Jianjun, tried to answer some of the questions.
First of all he rejected Dr Lan's claim that a cardiac pacemaker was not needed for the patient with varicose veins. He said it was usual for patients with vascular disease who needed surgery to have an atropine test. If the patient's heart rate was below 90 beats per minute then this indicated that they needed a pacemaker. In the case  raised by Dr Lan, the patient's heart rate was 60 per minute, showing that a pacemaker was clinically indicated, the hospital deputy director said. The pacemaker was needed to prevent the patient from having an adverse outcome during surgery, he said - so how could this be construed as overtreatment or inappropriate treatment?
Dr Lan ridiculed this claim, saying that it didn't make sense for a patient to be sent for tests after they had been deemed as ready for surgery - this was upside down, as pateints were alsways tested before being referred for an operation, she said.

The reporter sought comments on Dr Lan from other doctors at the hospital. An anaesthetist at the hospital said 'overtreatment' was a grey area and even clinical experts often disagreed strongly on what was the most appropriate treatment for a patient. Therefore, Dr Lan could be right or wrong.
Several doctors said Dr Lan was a hardworking and honest doctor, but with a stubborn individualistic streak and an obsessive personality. Some said she was  a loner who did not communicate or consult well with other doctors. One doctor described Dr Lan's self-image as the only 'pure' doctor as naive, while another said she was known to have strong and unbending opinions about subjects outside her area of expertise. A doctor in the obstetrics department said Dr Lan had often seen his patients and made treatment decisions on obstetrics matters that he did not agree with. She did not accept or understand that ultrasound was an ancillary branch of medicine and that it was inappropriate for her to criticise the diagnosis and treatment decisions of doctors outside her area.
Some doctors told the reporter that Dr Lan was the author of her own troubles, and that it was a joke that she chose to 'practice' in a corridor for two years. For this reason she had become know as "Dr Crazy" by some.
In Mianyang, authorities including the local health department said in a statement that they were now mounting multiple inquiries and audits into the claims made by Dr Lan. The inquiries would look in detail at her claims that patients were being overtreated only to generate income and that unnecessary and inappropriate treatments were being regularly used. As part of the investigation, authorities are  to review all CT scans and ultrasounds of patients for the last three years and check whether the treatments matched the diagnosis.

China medical education gets internships | Saving for medical bills | Women have hysterectomies for profit

 China will set up a standardised internship training program in 2015 for medical graduates before they become qualified to be doctors, according to the National Health and Family Planning Commission. Officials said China does not currently have a national standard for training, and training to become resident doctors depends on the hospitals where they are employed, leading to differential medical levels across regions. The new standardised "5 + 3" year training system will ensure that graduates get experience in several branches of clinical medicine before getting a full licence to practice medicine. According to the Global Times, the training bases will first be set up in top level hospitals and some lower level hospitals based on the local situation. They will be subsidized by the governments and central finance.
One of the main reasons why Chinese people save so much is to prepare to pay for future medical bills, a report says. In China, 64% of people surveyed were actively saving for health issues, according to ECNS. Savings rates for health were higher in China compared to other countries surveyed, and Chinese people used diversified strategies in saving for health issues, with local currency, whole life insurance and pure term life insurance among the choices.

And in Taiwan it is claimed that  many of the 20,000 women who have a hysterectomy each year do so to gain thousands of dollars in infertility compensation from the Labor Insurance Fund.
According to the China Post, researchers said Taiwan had the largest percentage of “womb-less women”and this might be due to the lure of  infertility benefits amounting to more than NT$100,000for women under 45 who have a hysterectomy.

Friday, 17 January 2014

Violent medical disputes in China: two stories, two viewpoints

by Michael Woodhead
Two stories in China's media this week illustrate the ongoing problem of medical disputes that turn violent. Doctors and nurses work in fear while patients and families vent their frustration at being treated abysmally by a broken system.
It is only two months since Dr Wang Yunjie was killed by an irate patient at the hospital where he was working in Wenling, Zhejiang. And yet despite the national outrage this incident provoked, doctors at the hospital say they are still facing threats of violence from patients and their families. This week in China News, a 28-year old rehabilitation physician at the hospital, Dr Chen Junrui, recounts how staff have faced further attacks. He says that only a few days previously one of his female colleagues was assaulted by the family of a young boy who died of septicaemia. There was no way to save the boy, the doctor says, but the family would not listen to reason and called in a whole gang of other relatives and friends to berate staff and beat them, he says. A similar incident occurred only yesterday to him, and he was only narrowly able to defuse the situation, he told the reporter.
According to Dr Chen, relations between doctors and patients have deteriorated in the last three years. He says he comes from a medical family and his parents worked at a time when doctors were respected. Now they still talk medicine over the evening meal, but the conversation is all about how unsafe they feel at work.
Dr Chen says he is aware the system does not work well. Some days doctors have to see 100 patients in one shift, and they are often exhausted. But he say patients should not blame doctors and staff for the problems, and should be aware that healthcare workers are trying to do their best. He also blames certain sections if the media for portraying medical staff as corrupt, callous and uncaring.
"Since the killing, security measures have been stepped up and we now have security staff patrolling every half hour. But the main feeling I have at work is a lack of safety," he says.
Another story that has captured the attention of the Chinese media this week shows another side of the story. According to CNTV, a doctor at a Beijing hospital was assaulted by a patient who was bleeding badly but who was refused treatment until he waited in line to register and pay. The man had been drinking when he cut himself badly on a broken bottle. Bleeding badly from a wound, he and a group of friends rushed to a nearby hospital for treatment. However, when he sought first aid from a doctor to stop the bleeding he was told to go to the back of the queue and wait. Enraged, the man kicked the doctor to the floor and his friends also assaulted several security guards who tried to control the situation. The man was eventually arrested by police and taken into custody.
A commentary said the young man's eagerness to get treatment and his frustration at being refused were understandable, but this was no excuse to kick a doctor or for family members to assault and obstruct security guards. The man is now facing a three year prison sentence.

China medical news headlines for Friday 17 January

Monitor and treat the best way for hepatitis B

Monitoring inactive chronic hepatitis B carriers is a cost-effective strategy for China, a study shows. The findings published in Hepatology, also show that increasing treatment, monitoring and adherence to therapy are necessary to achieve significant health benefits at the population level.
Shanghai researchers compared the current strategy of not monitoring inactive chronic HBV patients to a monitor and treat strategy which included twice-yearly assessment of HBV and ALT levels. For active HBV cases the researchers suggest treatment with the antiviral entecavir, which evidence shows to be a cost-effective antiviral therapy in China.
The study found that there were 1.5 million adult HBV arriers of HBV in Shanghai, of whom 63% were hepatitis B virus e antigen (HBeAg) positive. The number of active cases of chronic HBV, were 258,139 in the eAg-positive group and 152,384 in the HBeAg-negative group. A monitor and treat strategy would reduce liver cancer by 70% and reduce mortality caused by chronic HBV by 83%, according to News Medical.

China too hard for US generic drug maker

One of the world's biggest generic drug manufacturers has quit China, saying it is too hard to do business there. The US generic maker Actavis has said it will exit China because the business climate is just 'too risky' according to its CEO.
“It is not a business friendly environment,” CEO Paul Isaro is quoted as saying by Bloomberg.

Beijing wants foreign medical city

Beijing is to set up an International Medical Service Zone in Tongzhou District in 2014, Xinhua reports. The 15 square kilometre zone is intended to be a model of medical reform that will integrate social and foreign investment. Beijing hopes the zone will attract doctors and medical experts from Beijing's top public hospitals as well as draw in international medical institutions to set up shop in a healthcare hub. The aim is to have world-class medical facilities, education institutions, medical research personnel, rehabilitation and nursing homes and health management facilities all in one place.

TCM a leading cause of liver failure

Traditional Chinese Medicine is a major cause of acute liver failure in China, according to a report in PLOS One. In a review of 177 Chinese patients with liver failure, 17% had received herbal remedies, and TCM was believed to be a more frequent cause than any other factor, the Global Times reports. Of all the patients diagnosed with acute liver failure 44% developed the condition due to drug or herbal remedy toxicity, and herbal remedies, accounted for more liver failure than paracetamol.

Five Chinese medical studies you should know about in January 2014

Soy bad for men's heart health
A high intake of soy may increase the risk of cardiovascular disease in men, contrary to the well known protective effect seen in women, a study from Shanghai has found.
Habitual high soy food intake over 10g per day was associated with up to a 20% higher risk of incident coronary heart disease in middle-aged and older Chinese men. The researchers said elevated plasma IL-8 and PAI-1 might be potential contributing factors.
International Journal of Cardiology

Chronic kidney disease and metabolic syndrome
In China the prevalence of chronic kidney disease s 4.6% in people with metabolic syndrome and 3.3% in people without metabolic syndrome, a study has found. The risk of chronic kidney disease was 50% higher with metabolic syndrome and the findings suggest an increasing prevalence of chronic kidney disease among Chinese adults with metabolic syndrome, according to researchers from the Department of Endocrinology, The First Affiliated Hospital of the Fourth Military Medical University, Xi'an.
Clinica Chimica Acta

Asthma rarely well controlled in China
Asthma tends to be poorly controlled in China compared to other countries in the region. A study has found that only 2% of asthma patients in China had their condition well controlled compared to 14% in Singapore. Patients whose asthma was not well-controlled tended to use more asthma medications, had more emergency hospital visits and hospitalisations for their asthma, and were more likely to miss days off work or school.
Respiratory Medicine

One in five have mild cognitive impairment
A survey of 10,276 Chinese people aged 65 years or older has found that 21% had mild cognitive impairment, and 6% had cognitive decline that was likely early Alzheimer's disease. Cognitive impairment was more common in rural areas 23% compared to urban areas (17%).Vascular-related mild cognitive impairment was the most common type, according to researchers from the Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing.
Alzheimers and Dementia

HIV screening needed
HIV screening and early identification is badly needed among high risk populations in China such as those with TB, according to researchers from the Shandong Provincial Chest Hospital, Shandong University, Jinan. They found a HIV prevalence of 0.28% among TB-referral patients in Shandong, but noted that HIV/TB co-infection rates are high in regions such as Xinjiang ( 4.5%) and Guangxi (4.3%) due to to high rates of injecting drug use and HIV infection, and most cases presented late as AIDS.
Journal of Infection

Thursday, 16 January 2014

Research requirement corrupts junior doctors, meeting told

translated by Michael Woodhead
Top doctors have called on hospitals to drop the requirement for would-be doctors to take part in medical research to qualify for a position, saying it is a waste of resources and leads to corruption.
At a meeting of the Chinese Peoples Political Consultative Committee (CPPCC) in Guangzhou, leading doctors told the meeting that the academic research requirement was superfluous and prevented front-line doctors from doing useful clinical work.
Professor Hu Xueqiang, head of the neurology department at the Sun Yatsen University 3rd Hospital said academic research was a waste of time for doctors who spent their careers doing surgery and treating large numbers of patients for everyday complaints.
"To work at our hospital young doctors need to have written papers and show they have done some research for their professional evaluation, but we have 50-year old doctors at primary level hospitals who are excellent at their job who have never had to do this. They are steadfast workers, the backbone of the system," he said.
He was supported by Dr Zhai Ziwen, director of the respiratory department at the No 1 Renmin Hospital in Guangzhou, who said: "It doesn't matter hospital you want to work at, the requirements are for research papers. But which primary level hospital needs clinicians with research skills? And anyway, 90% of this so-called research submitted with applications is fraudulent," he said.
Many other doctors at the meeting strongly agreed, with some saying that the academic research requirements led to academic corruption as would-be doctors needed connections ('guangxi') with professors to get a research project. "This diverts funds and resources from real research," they said.
Dr Zhao said there was a need for a more balanced system, allowing major academic hospitals to continue using the current system but also permitting basic level hospitals to drop the requirements for academic research. "The one size fits all system is not suitable for primary level hospitals," he said.
Other doctors told the meeting that the current system was biased against smaller hospitals and was leading to systemic corruption.
Guangzhou deputy governor Lin Shaochun told the CPPCC meeting that he appreciated the depth of the problem and would work towards an effective solution in conjunction with the provincial health department human resources department.
Source: Sohu

Hainan hospital pays doctors based on patient feedback

by Michael Woodhead
At the Renmin Hospital in Hainan's Baoting district, doctors dare not displease the patient because their pay depends on having 'satisfied customers'.  Their pay is linked to ratings given by patients on a 24-item service questionnaire. Items reviewed include the bedside manner of doctors, nurses being on duty and available in the clinic and the standard of cleanliness on the ward etc.
In the admin block of the hospital these appraisal forms are in a huge pile, and divided into 26 clinical departments.
The idea came from a partnership with a Shandong hospital whose staff wanted to think of a way to improve service quality. They come up with the idea of having anonymous questionnaires filled in by all patients. The results of the forms are compiled for each department o a monthly basis, giving administrators a clearer idea of areas where service is rated as good fair or unsatisfactory.
Last year the surgical department, for exampe, scored 100% for its service levels, thus ensuring that staff got all 100% of their bonus pay. The paeiatrics department scored 94%, meaning that staff lost 6% of their pay.
Before the scheme, some staff were fairly lukewarm in the way they welcomed and dealt with pateints. Now they are much more careful and give more attention, in the knowledge that their income depends on giving a good impression, a hospital manager says.
Staff are now seen to be smiling and take the initiative, and they speak to pateints more to explain things, he says.
This new system encourages staff to make improvements and has revolutionised the staff approach to patients. In this way, for example, the satisfaction levels in one child clinic increased from 78% to 98% in just over a year.
Source: Haikou News

Beijing to extend family doctor enrolment scheme

So long as they have a health card and access to a computer, most Beijing residents will this year be able to enrol with a family doctor to get easier access to healthcare. The family doctor scheme that is currently operating in areas such as Fangzhuang and Desheng will be extended to cover most districts of Beijing in the next year according to the local department of health. At present the scheme covers 4 million households and almost 9 million people, according to the Legal Evening News (Fazhi Wanbao).
Under the scheme, residents must sign a contract with the 'health team' at their local community clinic and register with a specific doctor to receive regular appointments. This ensures continuity of care and guaranteed access to the doctor via an appointment system. The advantage of the scheme for patients is that they do not need to go to a large hospital and face long waits to register and bee seen in the outpatient clinics.
According to the health department, the scheme is now extensively used by residents in the initial areas, and the average income for doctors in the scheme is around 80,000RMB, about half the income of doctors working in the tertiary hospital.