Sunday, 31 August 2014

The Lancet devotes an issue to China

The Lancet this week has China has its theme, and includes many interesting articles on a wide range of topics around medicine and health in China. 

There's a huge amount of material there and I don't really know where to start in reporting it all. The articles cover everything from China's medical education system, the challenge of non-communicable diseases and even a couple of clinical research articles on pulse oximetry for screening newborns for cardiac disease. For me, the most interesting article is one on the recent change of course in China's health reforms to put emphasis on private hospitals. The authors of the review, from Oxford and Harvard universities, say this move is a retrograde and negative step that will run counter to many of the other recent reforms that aim to encourage equity and more efficiency in China's user-pays hospital based system.

The Lancet also includes several articles on the theme of preventing chronic diseases such as obesity - a very timely issue as China becomes more wealthy and starts to see the same lifestyle diseases such as diabetes that are already so common in more developed countries.

For me the other interesting section in this China-themed Lancet is the letters page. There are several letters from doctors in China commending the journal for highlighting the problem of violence against medical staff in China - and all put the blame on the underfunded health system and overworked doctors. On a related theme, doctors in China also lament the drop-off in applications for medical school - few young Chinese want to become doctors these days, as it is seen as a difficult and dangerous job that requires many years of study for little reward.

And any coverage of the medical situation China would not be complete without comment on the difficult status of organ transplantation. Quite a few doctors take issue with a recent Lancet article claiming that 'a new era' in organ donation is about to begin. They point out that China has about 200,000 require an organ transplant but there are only about 2000 donors. Read the full article to find out why.

My only criticism of the Lancet China issue is the too-deferential interview with China's health minister Li Bin, who gets to trot out all the claims of progress with reforms, without really being challenged about the many problems and contradictions with them. Oh, and the omission of any coverage of primary care [or lack thereof] in China ...

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