Thursday, 27 February 2014

Doctor defamed online by spurned patient

A well respected ophthalmologist at a Chengdu hospital was slandered online by a patient who claimed that he was unethical and had discriminated against her daughter. In an 'exposure' on an online forum, the female patient said her daughter had been refused treatment by a Professor Liu, who discriminated against her because she was a single mother and yet he consented to treat other patients who were less deserving than her. On a popular social media site the woman said the professor had no ethics and she warned that he discriminated against common local people. The post stirred up a lot of angry debate about the ethics of the doctor.
However, when reporter from Sichuan Online followed up at the hospital he heard a very different story. The staff said the woman was impolite and demanded treatment despite not having registered at the hospital. Also she had no medical records and her case was not urgent. A patient from Yunnan was seen instead as their case was urgent and because they faced extra expenses if the case was delayed until the following morning.
Professor Liu said he personally intervened after the woman  argued with nurses. He said it was reasonable in a busy clinic to ask the woman to return when she had her medical records. The other case was more deserving. A security camera recorded the woman acting aggressively and knocking over billboards and items on a table in rage.
However, this story was not told online, and the social media site was led to believe that Professor Liu was an arrogant and uncaring doctor with no ethics. His name has been blackened. Nurses and staff at the hospital said he was a caring and hard-working doctor who often stayed until 9pm at night to ensure that all patients in the waiting room were treated.

Beijing to allow doctors to set up independent private clinics

The Beijing health department will for the first time allow doctors to set up their own clinics funded by private investors. At its annual work meeting the health department announced that doctors may now apply to set up private clinics. The new policy will require alterations to the current sustem of doctors remueration and the personnel assigment system for the healthcare system, the department said. It will require changes in the way public hospital departments employ doctors and also changes in work contracts

Nanjing Hospital nurse and doctor injured in attack by top official

by MichaelWoodheadA dispute over male and female patients being forced to share the same ward is supposedly the cause of an attack by a senior Nanjing official on medical staff that left a nurse paralysed.
A nurse has been severely injured in what has been described as a vicious attack by a senior female official who is head of the Jiangsu Science and Technology Institute. The incident occurred on 24 Feb at the Nanjing Stoma Hospital when a young man was brought in for emergency surgery for a bleeding cyst. Because the hospital was full and had few vacant beds, the young man was allocated to a female ward to recover from the operation, and was to be moved to a male ward when a bed became available. However, when he woke from the anaesthetic and realised where he was he called his family and they hurried to the hospital to demand that he be moved to a male ward. When a nurse said this was not possible she was beaten by the mother of the young man. The nurse was beaten with the handle of an umbrella and the attack was so violent that the handle snapped. The nurse received severe injuries to her chicest and was left paralysed in her legs and unable to move. A doctor on duty was also assaulted and severely bruised.
The official is now under investigation by local police. However, the incident has been widely reported on social media sites such as Weibo, with many saying that it is typical behaviour from arrogant and privilege officials. The young man's father is an official in the Nanjing procurator's office and many doubt the injured nurse will see justice for those who attacked her.

Wednesday, 26 February 2014

3 medical tales from China: the good, bad and the fake

by Michael Woodhead

Hospital performance pay system revealed

Hospitals in China are adopting performance-bonus schemes for their staff based on a concept called the balanced scorecard (BSC) according to an academic paper in the Health Policy and Planning. Researchers from Jinan in Shandong did a literature search and found details of 90 hospitals that had adopted the scorecards for staff as a way of improving performance, staff motivation and patient satisfaction. The hospitals typically compiled the score cards on a monthly basis at a department level and the score systems were usually linked to increasing hospital revenue.  A scorecard might also measure parameters such as operations management (eg bed utilisation), patient satisfaction, learning and attitude to work. The score card-based bonuses were generally well accepted and had become an important part of the staff income, the study found.
(Some interesting facts revealed in the study: China has around 20,000 hospitals, but hospitals receive only about 10% of their operating costs through government subsidies. And medical salaries are low, only about 12% above average earnings.)

Shanxi Hospital swindling exposed

A hospital in Taiyuan, Shanxi is under investigation for swindling women through 'special offers' for treatments including abortion. The provincial Price Bureau started an investigation of the Yellow River Hospital after receiving complaints from women who said they had been charged much more than advertised and had not received the services promised. In one case, the hospital held a special 'Women's Health Week', during which time they offered a special price of 480 yuan to perform painless abortion and IUD insertion. However, women who used the hospital services said they were charged 4288 yuan, not 402 yuan. Part of the excess fee was for 'educational materials' that were widely available elsewhere and cost just a few yuan. The hospital also offered ultrasound scans for for 10 yuan, but women said they were forced to pay 120 yuan. One woman was told she needed magnetotherapy and microwave therapy, for which she was charged almost 10,000 yuan, but no doctor had recommended them. A spokesman for the hospital said the women's health price offer was only available during a certain period and the women in question had treatment outside those dates.


Rat poison kebab death: the fake hospital rumour

A story doing the rounds on Weibo claims that a 12-year-boy has died in a Hangzhou hospital after eating a  rat poison-tainted meat kebab bought from a street stall. The post purports to come from a  doctor at the hospital, who said the boy had a massively increased prothrombin time (known as an INR) of 150. The usual range is around 2-3. The post has been widely circulated, with many netizens commenting that it shows yet again that food in China was unsafe. However, when a reporter contacted the hospital he found there had been no such patient. A doctor said he had heard the rumour being attributed to many hospitals in China, most of which proved to be fake. However, he said there had once been a genuine case of rat poison-tainted food ingestion at the 301 PLA Hospital, but had not been fatal. It was true that rat poison could cause bleeding problems because it was based on the blood thinner warfarin. His general advice was that truth or rumour, it was best to be prudent about eating food from street stalls.

Human-to-human transmission of H7N9 reported in Shandong family cluster

by Michael Woodhead
A probable case of human-to-human transmission of H7N9 avian influenza has been reported by researchers in Shandong province investigating a family cluster of the infection.
A 36-year-old man who developed the infection in April last year in Zaozhuang seems to have transmitted the H7N9 virus to his four year old son, according to Dr Liu Ti and colleagues from the Shandong Provincial Center for Disease Control and Prevention. Writing in the journal BMC Infectious Diseases, they describe the case histories of the family cluster, and conclude that the son had no exposure to poultry as a source of infection but had prolonged contact with his sick father.
The father became infected with H7N9 avian influenza in mid April, possibly from being in proximity to poultry markets, they found. He had no close contact with poultry but there were poultry farms and markets in the area where he lived, the found. The "index case" developed a severe fever and sought medical help. His son became infected seven days later, but he had no exposure to poultry as he remained at home with his sick father before the father was hospitalised with pneumonia. The son had prolonged, close contact with his father, including eating together, and he also became infected with H7N9 and was hospitalised. Both father and son eventually recovered from H7N9 infection and were later discharged from hospital.
“The infection of the index case probably resulted from contact with environmentally contaminated material. For the son, the probable infection source was from the index case during unprotected exposure, but the possibility from the environment or other sources could not be completely ruled out,” the researchers said.
“Though it is difficult to ascertain the infectious source for the two cases, the emergence of H7N9 clusters requires urgent attention because of the possibility that a change in the epidemiological character could spread more easily among people,” they concluded.

Tuesday, 25 February 2014

Today's medical news: an idiot and 'special care' patients

by Michael Woodhead
"Medical staff are incompetent and deserve to be cut with a knife" - that's the opinion of TV personality Wang Mudi who is described as a Guangdong TV finance news presenter and producer. He made the remarks on Weibo after  he took his girlfriend to a hospital to have treatment for a skin allergy. Mr Wang took his "Little Bunny" to have an IV  'infusion' (the Chinese cure for everything - oral drugs are seen as inferior) for the rash on her hands. Unfortunately, the nurse at the hospital took four attempts to find a suitable vein for the IV line, causing the girlfriend much pain and distress. Wang complained online to his 370,000 followers about the nurse's insolent attitude and said he would like to chop someone with a knife. His remarks drew a lot of negative feedback online in light of recent attacks on medical staff - including he killing this month of an ENT surgeon in Heilonjiang. Wang later apologised on Weibo and tried to justify his remarks by saying the nurse had been chatting away to someone else and didn't seem to care - and didn't apologise either. However, doctors and nurses said Wang's remarks encouraged attacks on medical staff and he wasn't fit to be on TV.

From 'red envelopes'  to 'special needs'
Following on from my post about red envelopes and the culture of bribery and connections in Chinese medicine yesterday, the business magazine Caixin has a timely feature on China's "special care patients" - a euphemism for super rich. The article describes how most hospitals have a special wing for the wealthy, in which money can buy you a luxury private room complete with big-screen TV, plump cushions and an attentive nurse - and of course attended by the top surgeons. The VIP medical suites are thriving and they are one of the main ways that public hospitals can make money. A State Council decree in 2009 ordered them to take up no more than 10% of a hospital's beds, but critics say the VIP sections of hospitals are unlikely to be cut back. Caixin quotes Xu Shuo, deputy chairman of the Chinese Medical Doctor Association, as saying the suites are a symbol of the growing wealth inequality in China and will eventually have to close - or become a bridge between public and private medicine. However, critics say the private wings are simply too lucrative for both the hospitals and the doctors who work in them to disappear.

And in other news:

She's back ...
Mianyang's Corridor Doctor whistleblower Lan Yuefeng is featured in ChinaSmack. The site provides some pictures of the strike and public protest by her former colleagues who objected to her criticisms of the hospital from which she was sacked. Interesting comments from Chinese netizens and also western readers, most of whom side with the 'whistleblower', even though the staff say she is an attention seeker.

Smog and superbugs
Meanwhile, the smog continues in Beijing - and a story in the local news says that a Tsinghua University research team has found more than 1,300 species of microbes in it. Most of the bugs are harmless, but a small number are pathogens, according to the report.

Abandoned babies
And in Guangzhou, authorities are to announce new rules to deal with the "malicious abandonment" of babies after a dead baby was left outside a recently constructed "baby hatch" in the city, it is  reported. The baby hatch was set up by authorities to accept abandoned infants.  An autopsy will be carried out on the dead baby and if it is found to have had disease, the parents could be accused of intentional homicide, police say.

Beijing respiratory wards overflow with smog-related illness

by Michael Woodhead
The heavy smog that has hung over Beijing for days has seen many patients turn up at the city's hospitals with respiratory complaints. The Sino-Japanese Friendship Hospital was overflowing with patents on infusions yesterday and respiratory specialists said the worst was yet to come. The infusion room, where patients are given IV infusions was 100% full and there was an overflow 'ward' in the outside corridor where camp beds had been set up to cater for the extra patients and their families. Doctors said most of the patients had conditions such as pneumonia. The director of respiratory medicine at the hospital, Dr Lin Jiangtao said he expected the problem to worsen over the next week as the adverse effects of the smog tended to be delayed. The patients most affected were those with chronic obstructive pulmonary disease, asthma and heart disease, he said. The accumulation of pollution particles in the lungs tended to cause bronchoconstriction and chest tightness and other breathing difficulties, he said. The exact mechanism was not clear but China was now starting studies to investigate this process, he said.
Authorities in China said this week that one seventh of the country was covered in the thick smog and it was expected to last for about five days.

Monday, 24 February 2014

Why the ban on "red envelopes" for doctors won't work

by Michael Woodhead
China's National Health and Family Planing Commission (NHFPC) this week announced further restrictions on the use of red envelopes or 'hongbao' (bribes) by doctors. 
From May, both patients and doctors will have to sign an official undertaking or contract within 24 hours of hospital admission, stating that neither side will give nor receive red envelopes, money, gifts or other inducements as part of the treatment process. A ministry spokesman emphasised that the doctor-patient agreements are part of a wider contract in which the doctor also pledges to respect the patient's autonomy, privacy and informed consent, and the agreement requires the clinician to do his or her utmost for the patient. Conversely the patient pledges to respect the medical staff, scientific medicine and to act in an orderly and civilised manner. The ministry says phone complaint lines will be set up to allow authorities to be notified of any infringements of the agreements. They say the new contracts are intended to clean up the medical system, create a professional medical system and to build harmonious doctor-patient relationships.
However, the proposals have been met with cynicism and doubt from those working within the healthcare system. A Xinhua journalist interviewed several doctors, nurses and hospital managers and was told that the plans were unrealistic and unworkable.
A manager at a major hospital said that on the surface, public and private hospitals already prohibited the giving or receipt of 'red envelopes' but the use of favours and connections was a common practice under the surface.  "What doctor would dare to say that he had never received favours, especially the surgeons!" he said. "The red envelope system is an invisible system and a piece of paper from the health ministry isn't going to change it," he said.
Some patients said they believed they had to give small tokens of appreciation to be able to get to see a doctor or to see the best doctor - and also to ensure that the doctor did their best. But doctors interviewed by Xinhua dismissed these claims, saying they would do a good job for all patients and were unlikely to do poor work just because gifts had not been received. However, doctors did admit off the record that guangxi - 'connections' - played an important role in getting prompt and good treatment. They said junior doctors worked hard and had many patients to see, and it was unlikely that red envelopes would make a difference to the way they worked. If a doctor actively solicited red envelopes then that was clearly immoral and he deserved to be caught and punished they said. However, in their clinical practice doctors said they observed that patients and families often wanted to give tokens of appreciation after the treatment was successful - was it normal or wrong to accept such gifts if they were given with gratitude? One doctor said such gifts could be anything from 200 yuan to as much as 10,000 yuan, and he had once been offered a car worth 200,000 yuan by an elderly man whose life he saved.
The main influence over doctors was not from strangers giving bribes but from 'acquaintances' who squeezed them for favours, he said.
Top specialists were much in demand, and it was common for them to give priority to 'friends' who had connections, he said. This kind of favouritism didn't mean that doctors literally had money put in red envelopes or even deposited into their bank accounts - it was more subtle than that. Such favours for connections usually were repaid in kind, he said. He knew one example where a surgeon helped a well connected man and in return the doctor's son was able to gain entry to a good university. How would the new ban on red envelopes prevent something like that?
Another common area of favouritism was in private and personal 'extra' treatment. It was not uncommon for doctors to do 'private calls' and give private clinics for those who could afford it - and for those who could do them favours. This kind of 'private practice' meant that those who did not have money or connections missed out, of course.
The doctor said this kind of thing happened because there was simply a shortage of medical specialists and resources. "There are too many patients and not enough highly skilled doctors.  China has 20% of the world's patients but only 2% of the medical resources, and no law about red envelopes will change the situation until that imbalance is fixed. It's the system that is the problem, not corrupt doctors," he said.
A nurse said that the new regulations would stop the visible giving of gifts, but that wasn't a common occurrence anyway. "Who of us in hospital depends on red envelopes?" she laughed. "It's the unwritten rules that need to be changed," she said.

Chinese people with diabetes have poor insulin injection techniques

by Michael Woodhead
People with type 2 diabetes have poor insulin injection techniques that cause bruising, bleeding and lumps in the skin, a Nanjing study has found.
A survey of the injection techniques of 380 patients with diabetes from 20 centres across China found that their injection techniques with insulin pens were poor and they often re-used single use needles.
The survey found that 36% of patients had lipohypertrophy (fatty lumps under the skin) and 57% of patients had bleeding and bruising, and abdominal lipohypertrophy at injection sites. The re-use of single use needles was a major factor in lipohypertrophy, and there was also a link with rolling the insulin pen while pulling out the needle after injection.
"The bleeding and bruising at the injection sites may be associated with suboptimal absorption of injected insulin. Improved education in optimal insulin injection technique, including reducing needle reuse and correct rotation of injection sites should be emphasized, the researchers concluded..
The study was conducted by Lou Qingqing  and Ji Jiajia at the Jiangsu Province Hospital, Nanjing. The findings are published in Current Medical Research and Opinion.

Sunday, 23 February 2014

Heavy rainfall and floods to blame for resurgence in leptospirosis in China

by Michael Woodhead
An outbreak of leptospirosis in Sichuan in which six people died shows that the disease spread by water contaminated with rat urine is far from eliminated in China.
The 26 cases of leptospirosis reported in Lezhi country east of Chegdu in 2010 were analysed by researchers from the Department of Medical Microbiology and Parasitology, Institutes of Medical Sciences, Shanghai Jiaotong University School of Medicine.
They found that the cases were caused by the parasite that is typically spread from rats to humans via the urine and other hosts such as domestic dog and cattle. The researchers noted that local farmers in Lezhi collect rainwater in the farm land for rice plant. And in the harvest season, men and women, old and young all work barefooted in the farm land. 
The infection is caused  by a spirochaete bacterium and signs of the disease may vary from mild fever and jaundice to very severe and often fatal kidney, liver, and heart failure.
The leptospirosis outbreak coincided with periods of heavy rainfall and flooding they noted.
"This outbreak has reminded us that leptospirosis should not be neglected, especially during flood season," they concluded.
They reported their findings in the Biomedical and Environmental Sciences journal.

Tuberculosis in China often resistant to most drugs: researchers sound the alarm

by Michael Woodhead
The emergence of strains of tuberculosis that show multiple resistance to almost all available anti-TB drugs is causing great concern among Chinese clinicians.
A  study of more than 200 patients with tuberculosis in Harbin has found that one in four patients had tuberculosis that was resistant to at least one drug, and more than one in twenty had extensively drug resistant tuberculosis (XDR-TB) that was untreatable by commonly used anti-TB drugs such as isoniazid, rifampin, ethambutol, streptomycin, ofloxacin, and kanamycin.
Dr Yang Ying and colleagues from Harbin University of Science and Technology found that 26.3% of tuberculosis patients had isolates that showed resistance to at least one drug, while multidrug-resistant TB (MDR-TB) was seen in 6.8%of patients (3% of newly diagnosed patients and 22% of previously treated cases).
"The results of this analysis of drug resistance in Mycobacterium tuberculosis reflect the situation in a local hospital and indicate that the morbidity related to TB, especially MDR-TB, is still a serious health problem. Thus, the timely detection of drug resistance is of great importance to optimize treatment and to direct infection control measures to block the transmission of MDR-TB."
The results are published in the International Journal of Infectious Diseases.

Saturday, 22 February 2014

China's medical internship scheme starts in 2015 - but it comes at a price

by Michael Woodhead
From 2015, all Chinese medical students who wish to become a full doctor must complete a three year internship scheme at a hospital, the National Health and Family Planning Commission has announced. 
The aim is to give all medical graduates in China a practical grounding in all clinical areas, and to achieve consistent standards for medical practitioners across China. The scheme will mean that once medical students have graduated they will obtain an internship at a hospital and do standardised training in various rotations such as surgery, psychiatry and paediatrics as well as receive additional training in areas such as communication with patients. During the three years the interns will have assessments and exams that they will have to pass to gain a licence to be a full doctor.
The plan will bring China into line with most other countries that have medical internship systems, but Chinese medical students are not happy. They say the new internship scheme will add another three years to an already lengthy medical training - and will also mean three more years of penury. At present, the competitive education system means that most medical students have to complete a Masters or even a PhD in order to obtain a training place in a city hospital. This takes at least seven or eight years, so would-be doctors now face a training period of at least 10 years  - or possibly 12 years - before they become a fully fledged doctor. And during this long period, students earn little or nothing. Current internship schemes at Nanjing hospitals, for example, see interns earning about 2000 yuan a month - well below the average incomes of other students who have done masters or doctoral degrees. Students say the new internship scheme will mean that the total costs of studying to be a doctor will be at least 150,000 yuan.
"Undergraduate, masters, doctorate  - at least eight years then three years more of training - that means you will be at least 30 before you are a doctor. What about marriage and having children?" said one medical student who predicted that the new system would turn many bright students away from studying medicine.
The internship plan will come into effect in all Chinese provinces from 2015 and the full standardised internship  system must be up and running by 2020, the NHFPC says.
Source: Nanjing News

My top10 medical stories from China for Saturday 22 February

1. Smoking with a water pipe confers a 'profound' risk of chronic obstructive pulmonary disease (COPD) among people in south west China and also carries a high risk from passive smoking, researchers have shown.

2. Patients with pneumonia of unexplained origin should be promptly investigated for H7N9 risk factors such as exposure to poultry and they should also be given pre-emptive antiviral treatment such as Tamiflu, the Beijing health department has ordered.

3. About 85% of Chinese doctors experience burnout, with those who are younger, unmarried and working in emergcncy medicine having the highest risk of serious burnout, a study shows.

4. Fertility clinics in China need to become more patient-friendly as they are perceived as too impersonal and lacking in transparency and respect for patient informed consent, researchers say.

5. The stigma of mental illness in Chinese culture means that patients with schizophrenia often do not understand their medication and are unwilling to take any anti-psychotic medication, according to a study from the Guangzhou Psychiatric Hospital.

6. H. Pylori infection rates are over 90% among people in their thirties in Jiangsu, which may explain high rates of gastric cancer in the region, say researchers from Nanjing.

7. Babies in Shenyang have increased rates of neurodevelopmental deficits because their mothers were exposed to high levels of organophosphorous pesticides during pregnancy, according to a study in PLOS One.

8. Adenovirus has emerged as a significant cause of serious pneumonia in China, with a study showing that 5% of cases are attributable to the virus.

9.  People with tuberculosis are also at high risk of HIV, with rates of around 3% in groups tested in TB patients from Guangxi, Henan and Sichuan, say Chinese researchers.

10. A mediation service for patients involved in medical disputes with hospitals is to be launched in Shanghai and it will be open to patients where compensation claims exceed 30,000 yuan ($2900) regardless of whether the hospital refers them.

A Tibetan fairy tale in Beijing: woman has stroke but has no family to pay medical fees

There was a happy ending for a 19-year old Tibetan woman called Dorje Tso who had a stroke while living in Beijing. The woman was taken into the Xuanwu hospital over Chinese New Year by friends when she showed signs of a severe stroke, which is unusual at that age. Doctors did a CT scan and diagnosed an embolism that required immediate treatment. However, the young woman had no money and no family with her to assent to the treatment while she was in a coma. Doctors tried calling her family in Qinghai but her parents were unable to speak Mandarin, only Tibetan. With only a four hour treatment window, they then desperately tried calling her sister who was in Shenzhen. However, the sister believed the call was a hoax and did not believe the request for medical fees was genuine, but a scam. One of the surgeons then took pictures of the Tibetan patient in the hospital with his mobile phone and texted them as a phone message to the daughter, who eventually agreed to her sister having treatment. Neurosurgeons then operated on Dorje and were able to remove the embolism, after which she made a good recovery.  One of the doctors involved  in the operation told the story on WeChat and it created great interest. One netizen was so moved by the story that he offered several thousand yuan to pay Dorje's medical bills.

Mianyang hospital doctors strike in protest against 'Corridor doctor' whistleblower

The long running saga of the Sichuan 'whistleblower doctor' took another twist this week as her colleagues staged a stop work meeting and mounted a noisy demonstration in Mianyang. They complained that the doctor's widely-aired allegations of overservicing and bad medical practice at the hospital were untrue and had besmirched their reputation. Police were called to the demonstration by medical staff as they became angry and shouted for her to be expelled from the hospital. They said the doctor's allegations had ruined the reputation of the hospital and resulted in it being downgraded, despite an official investigation finding no wrongdoing. Her allegations had also resulted in doctors at the hospital being abused and ridiculed, they said. Her claims of poor medical practice had stuck to individual members of staff who now found it hard to work because patients no longer trusted them, they added.  Dr Lan Yuefeng claimed to have been stood down from her position in the ultrasound department after she refused to agree to overtreatment of patients. She became a media star when she carried on working in a corridor for almost two years after being turned out of her office.

Friday, 21 February 2014

Medical news - seven China links

1. With more than 10,000 new cases of HIV a year, Yunnan is to fund more NGO anti-HIV programs and improve healthcare for people with the infection.

2. New regulations on genome sequencing are to stop clinics ripping off consumers by offering the sequencing as part of routine health checks or to help predict children’s potential abilities, officials say.

3. Malnutrition is still a major problem in some parts of rural China, with one in every five children under the age of five years in poor areas needing better nutrition. Local governments have been set a benchmark of 29 kg per capita meat consumption standard to benefit children in underdeveloped region.

4. Pilot schemes have been set up in 27 provinces to allow rural migrants to claim medical insurance benefits away from their home town.

5. About 13 million deaths from smoking-related illness could be avoided if China adopted WHO recommendations on tobacco control, a paper in the BMJ says.

6. Adverse effects from drugs - and especially antibiotics - are a major health burden for hospitals in China and also cost thousands a of yuan a year for hospitals and patients alike in extra care costs, a study has suggested.

7. Only 9% of boys and 2% of girls in China get the minimum amount of physical activity per week to maintain health, a study carried out in 11 cities has found.

Thursday, 20 February 2014

China's 60 million "left behind" children face neglect and poor mental health

by Michael Woodhead
More than 60 million Chinese children have been 'left behind' by rural migrants who move to cities and these children suffer from neglect and mental health problems, a new study has shown.
Research conducted by Dr Zhao Xue of the Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University has found that almost 60% of children in the rural areas were 'left behind'. This was a much higher number than expected and reflected China's "explosive growth" and shift to urban centres.
The survey of almost 1700 'left behind' children in rural Anhui found that they had higher levels of neglect, higher levels of social anxiety,  lower family function and poor quality of life compared to  children who lived with their parents. The problems were worse for girls perhaps because in Chinese society they have lower status than boys and thus get little attention, receive less physical and emotional support and have worse lives than boys, the researchers said.
However, left behind children tended to have lower rates of physical abuse than children who lived with thir parents. This might be becuse the escaped the "education by sticks" beatings from parents, the study authors suggested.
"These findings suggest that "left behind children' are currently in a relatively disadvantaged situation in Changfeng county and require more help from the local government and society to improve their life environment," they concluded.
The findings are published in Acta Paediatrica.

Shenzhen clinics show over-prescribing of antibiotics can be curbed by removing financial incentives for doctors

by Michael Woodhead
Antibiotic prescribing fell significantly when Shenzhen community clinics severed their ties with hospitals and dropped the financial incentives to prescribe them, a study has shown.
Published in the journal Family Practice, the study by Dr Liang Xiaoyun and colleagues at Beijing Normal University shows that prescribing of antibiotics fell by about 10% when the governance model of community  clinics in Shenzhen's Baoan district was changed by government in 2009. Under the new independent model, doctors no longer received financial incentives for prescribing. After the reform, the number of young children receiving antibiotics decreased by 9%. The costs of antibiotic prescriptions also fell because doctors tended to prescribe cheaper first generation antibiotics instead of more expensive newer drugs. The study authors said their findings showed that "changes in governance structure model can have positive effects on the antibiotic prescribing behaviour of providers. This short-term effect might have an important
implication for community health reform in China."

Wednesday, 19 February 2014

Schistosomiasis in China


Schistosomiasis has been largely eradicated in China but there are still about a quarter of a million people infected and 30,000 Chinese people with advanced disease, a review states. Dr Chen Minggan of the National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, said that before 1950 the infection caused by Schistosoma japonicum was endemic in many parts of China and had a high death rate - sometimes wiping out whole villages. Eradication programs have been successful in most parts of China but there are still areas where the infection persists, especially around the Yangtze river, he writes in the journal Infectious Diseases of Poverty. Some people have acquired the infection from swimming in rivers where the eggs of Schistosoma japonicum are present. Others contract the disease from farm animals such as cows and pigs. While the disease is in decline in humans, animals such as water buffalo still provide a large reservoir for the infection, with at least 1.5 million animals infected. Therefore eradication programs muct now address this problem if the infection is to be completely eliminated in China, Dr Chen writes.

Clinical news in brief - from the journals

In 'grassroots' hospitals, knowledge about Parkinson's disease - its diagnosis and management - is very limited for both neurologists and patients, a study from the West China Hospital in Chengdu has shown. Neurologists lacked knowledge of non-motor symptoms, differential diagnosis, therapeutic strategy and appropriate indications of surgical treatment, although they were familiar with the motor symptoms of the disease.

Adenoviruses cause 10% of cases where children are hospitalised for severe diarrhoea in China, according to a study from the Capital Institute of Pediatrics, Beijing.

More than 95% of people in Jiangsu have inadequate levels of riboflavin in their diet, putting them at risk of anaemia, a study has shown.

High levels of arsenic in seafood - and especially shellfish - pose a risk to human health, researchers from Shandong have warned.

People with epilepsy who have been seizure free for at least two years may be able to come off their anti-epilepsy medication, neurologists in Chengdu has shown. In a study of 162 patents with epilepsy who slowly tapered off their medication, 23% had a recurrent seizure and had to re-commence medication.

Ovarian cancer is relatively uncommon in China and rates are in decline, a review by the Henan Cancer Research and Control Office has concluded.

Tuesday, 18 February 2014

Doctor bludgeoned to death by "revenge killer" former patient angry over nose job

by Michael Woodhead
The head of the ENT department at Qiqihar Beigang Hospital in Heilongjiang has been bludgeoned to death by an 18-year old youth who was dissatisfied with the treatment he received from the doctor.
According to Chinese media reports the young man surnamed Qi entered the hospital brandishing a 50cm steel pipe, which he used to bash in the face of Dr Sun Dongtao. A doctor who witnessed the attack said the young man bashed Dr Sun so violently in the face and throat that he was not recognisable. Despite receiving immediate treatment the 45-year old doctor died. The suspect was apprehended by police, who found he was a local high school student who had recently undergone treatment on his nose by Dr Sun but was dissatisfied. Police said he developed a deep feeling of resentment against Dr Sun and sought revenge.

Breaking news - China medical news in brief


by Michael Woodhead
Genetic sequencing to reveal inherited traits such as high risk breast cancer gene BRCA1 has been banned in China until adequate standards can be set, the Beijing News reports. The order was made by the China Food and Drug Administration (SFDA) and the National Health and Family Planning Commission. An official said DNA sequencing was being promoted by some clinics and companies at the costs of thousands of yuan to detect conditions such as cancer, but the testing technology had not been authorised or verified and the charges not standardised.

Rural patients with dementia or depression have death rates three to four times higher than those of their urban counterparts, a study from Anhui has found.

A shortage of blood group O supplies in Beijing has caused the cancellation of elective surgery for many patients. The Beijing Daily reports that a 47-year old man who required cardiac surgery had his operation postponed because there was no blood group O available, only the more common B group. The man's family tried to donate blood but they found they were all group B. A return to the man's home town to try find donors from friends and family also proved unsuccessful. The man and his family resorted to placing adverts in the Beijing newspapers to try solicit blood donations. Doctors said the New year period was always a time of blood donor shortages as the traditional sources of blood donation - students - went home for extended periods.

Chinese people are subject to far too many useless, dangerous and wasteful medical tests in routine check-ups, an article Global Times claims. Citing the experiences of a visiting US physician, the Times asks why so many tests such as X-rays are offered as art of compulsory regular medical check for employment and other purposes when there is little scientific evidence to support them. Chinese clinicians agreed, putting much of the blame on private clinics which they said offered 'warmer service' but which exaggerated the risk of illness and the need for investigations. Clinic staff often act more like sale people than doctors and they offer unnecessary tests to an unwary public who do not have the medical knowledge to make an informed decision, the experts said. One group  has estimated that the health checks market will be worth 300 billion yuan ($49.44 billion) by 2020.

Will China go bust with new major illness medical insurance scheme?


By Michael Woodhead

In a major feature in today's Beijing News, health economists warn that China faces many problems in widening its medical insurance schemes to cover serious and catastrophic illness. These schemes will cover major illnesses such as cancer where the large medical expenses can often result in families falling into penury. Serious disease medical insurance schemes are currently being pilot tested in 27 provinces and 130 cities, but experts say the existing schemes are very varied in their operation, have mixed results and are often poorly managed, with little commitment from local authorities. The Chinese State Council has recently recommended that implementation be speeded up and has ordered all provinces to have serious illness medical insurance pilot programs up and running by June.
At present, almost 290 million Chinese people are theoretically covered by such catastrophic illness schemes that have funds of more than 600 million yuan. Under existing medical insurance programs the reimbursements for serious illness are meagre and not enough to cover even the most basic costs of treatment. The average reimbursement for urban residents is 258 yuan and for rural residents it is 148 yuan. Health economists say there is a danger that if not managed effectively, a more extensive insurance scheme could simply be like "throwing a cup of water on a blazing woodcart". They point to the widespread 'leakage' in the current medical insurance schemes, in which little of the government funding actually gets to benefit the patient. When the government introduced widespread basic health insurance a few years ago the funding was absorbed by hospitals and practitioners who inflated their fees and carried out unnecessary treatments that would attract reimbursements from the government funds.
Therefore experts say that any new scheme must come with strict supervision and conditions to ensure that providers and insurers do not abuse the scheme. Otherwise there is a danger that any such national scheme would become a bottomless pit into which money was poured but with little benefit.
They say current pilot schemes have proved disappointing, with many of them being incomplete and incompatible with other schemes in neighbouring areas. Many still offer inadequate reimbursement to patients with serious illness and many are underfunded to provide sufficient benefits.
There also needs to be provision for rare and expensive to treat illnesses such as Gaucher's Disease, they warn. Without this, patients and their families will still face ruinous expenses when someone becomes ill.

Monday, 17 February 2014

"China's Top 10 Hospital" Awards are fake and can be bought for 28,000 RMB

[translated by Michael Woodhead]
China's national broadcaster, CCTV, has exposed a scam in which an official-sounding organisation known as the China Hospital Management Society has been selling hundreds of 'Top 10 Hospital' awards for 28,000 Yuan apiece.
The expose on national television showed that the CHMS had made millions by 'selling' awards and it claimed to have connections with government bodies such as the National Health and Family Planning Commission. However these bodies have now issued a denial of any involvement and have called for a full investigation into the society and its fake awards.
On its webpage (now unavailable) the CHMA claimed to be a non-profit public organisation operating under the auspices of the NHFPC and the Ministry of Civil Affairs.
Just a few days ago the CHMA website was publicising the launch of its "2014 China Hospital Outstanding Manager Award" and also a "2014 Chinese Health Consumer Hospital Satisfaction and Trust Award".  However, it did not say what the requirements or criteria for these awards were, only the closing date for nominations - April 8th.
In January, the CHMA convened a conference in Beijing entitled the "2013 China Hospital Management Science Award Ceremony", the main purpose of which was to award participants with prizes and awards. The conference prospectus states that the society's honorary office bearers hold leadership positions in many important official bodies. Reporters verified these names and the fact that they attended the ceremony in question. A sponsor of the awards commented that these heavyweight leaders required payment  of expenses to attend.
The participation of these 'heavyweights" attracted many other organisations and individuals to attend the awards ceremony.  According to the "Roll of Honour" there were 321 medals awarded. Administrative staff told CCTV that the awards organiser took in more than 10 million yuan per ceremony, and these awards have been offered twice a year for 4-5 years.
According to CCTV, participants who were willing to pay more could get more prestigious awards. Among the ten or so higher awards were the "All-China Top Ten People's Satisfaction and Trust Hospital" award and the "Top 10 Most Trusted Pharmaceutical Company" award.
A CCTV reporter attempted to follow the process of such award by enrolling in the awards system. Despite missing the entry date he received an official confirmation letter, confirming that his 'hospital' had won a "Top 10" award. To collect the prize trophy, certificate and medal he was told he had to pay 28,000 yuan.
There were about 300 participants in the awards of varying sizes. Some received one 'award' , others received several. The organiser said "if you say you are advanced you can be advanced, if you want to be outstanding, you can be outstanding, it can be rubber stamped if you pay more money."
The CCTV report said some winners of the 'awards' auctioned them off to others.
Those who bought the prizes said they had many uses, and could be put on display to fool the public. They said the ceremony allowed them to have their photos taken with the influential 'heavyweights'  who were in charge of important departments and held high office, and would help them win tenders. Others said they bought many smaller awards for 4000 yuan at the ceremony and then sold them on to smaller subsidiary hospitals for a profit.
The  China Hospital Management Society claimed to be operating under the supervision of the NHFPC, but there is no record of it on the NHFPC website. The NHFPC announced that the CHMS was not linked in any way to the department and it was not a legitimate assessment or rating organisation. The department said all bodies that conducted assessments, ratings and commendations in healthcare had to strictly adhere to standards and supervision. The so-called CHMS awards for top hospitals and outstanding performance were all invalid, it declared.

Editor's note: The CHMA appears to be a bogus version of the official Chinese Hospital Association whose website (cha.org.cn) and a list of genuine awards can be seen here. The CHA has published notices warning of the bogus CHMA.

Sunday, 16 February 2014

TCM fails for migraine | Quit advice ineffective | Rural migrants need HIV help

Chinese herbal medicines ineffective in migraine
Chinese herbal patent medicines are used by about 60% of people in China with migraines, but satisfaction rates with the effects are low, and western medicines prove much more effective, a study from Guangzhou has found. In a survey of 219 patients with migraine, researchers found that 58% had used Chinese patent medicines to treat acute attacks, but only 28% reported being satisfied with the results. About 35% reported being unsatisfied. In contrast, about 60% of patients were satisfied with the response they got from western medicines such as NSAIDs for migraine.  The most commonly used Chinese herbal medicines were ones containing L. wallichii, Dahurian angelica root, and G. elata. Interestingly, few Chinese migraine patients used the triptans, which are recognised internationally as being the most effective treatments for migraine, according to the article in Pain Medicine.
 
Quit advice not working
 Smoking cessation counselling is effective for Chinese smokers who have developed COPD but has little influence on asymptomatic smokers, research from Changsha has found. After receiving smoking cessation counselling, smoking abstinence rates at six months were 40% for people with COPD but only 10% for asymptomatic smokers, according to a research group from the Department of Respiratory Disease at the Second Xiangya Hospital, Central South University, Changsha.

Rural migrants missed in HIV prevention
HIV is likely to spread in China via migrant labourers and housemaids, who have low levels of knowledege about the disease and high rates of unsafe sex, researchers from Fudan University in Shanghai have warned. In a survey of 2700 rural migrants they found that more than 40% were ignorant of the facts and risks of HIV, and  6.2% had engaged in high-risk sex in the past 12 months. Only 3% of migrant workers had access to free HIV screening. Writing in BMC Public Health he researchers said migrants must be targeted with tailored educational programs pitched at a level they can understand. Rural migrants should  also be given free condoms and given access to HIV testing and antiretroviral treatment, they urged.

About 50% of pig farmers in Guangdong have hepatitis E

Hepatitis E is endemic in the pig herds of Guangdong, and this is reflected in high rates of the infection among swine herders, a study shows. About 50% of pig farmers in Guangdong show serological evidence of hepatitis E infection, and 38% of the general population have been infected by the disease spread by the faecal route, according to findings published in PLOS One. The epidemiological study of Guangdong people bwas carried out by Dr Liang Huanbin and colleagues at the Ministry of Agriculture Key Laboratory of Animal Vaccine Development, College of Veterinary Medicine, South China Agricultural University, Guangzhou. It found that Hepatitis E infection rates were higher than in surrounding provinces such as Hunan (22%). The study also found that 60-90% of pig herds had the infection, which raised questions about the health risks of pork, the researchers said.

Saturday, 15 February 2014

HIV strain is more aggressive in China - professor

HIV may be more aggressive in China because many infections are caused by a more virulent strain of the virus seldom seen in other countries, Beijing researchers say. Professor Li Taisheng, an infectious diseases specialist at the Harmony Hospital in Beijing say the average time to progression from HIV to immune failure and AIDS is eight years in western countries, but as little as four years in China. The reason for this appears to be a special strain of HIV with a factor known as CRF01, he told the Jinghua Daily. He said a newly published study involving more than 200 HIV patients from across China showed that the more virulent virus was found in almost half of people with HIV.
"CRF01_AE, a predominant HIV-1 subtype in Chinese HIV-1 sexually infected patients, tends to be associated with fast progression to AIDS and advanced immunodeficiency, which might be ascribed to high proportion of X4 tropism. Further investigation of these risk factors may have significant implications to clinical practice and policy-making," his study published in the journal AIDS concluded.

News in brief: Saturday 15 February

China's widespread misuse and overuse of antibiotics needs to be curbed, according to an article published in the BMJ this week. Dr Li Yan who works at Nottingham Trent University in the UK, writes that pressure from patients and perverse financial incentives are just two of many factors that have contributed a high rate of antibiotic use that is ten times higher than that of the US. Antibiotic overuse leads to resistance and causes numerous adverse events, she says. New regulations introduced by the Chinese health department need to be fully implemented, she adds, and there also needs to be a major public education campaign to improve awareness about antibiotics and reduce demand, she suggests.

A Hunan official has been found guilty of selling fake medical licences to six "black (bogus) doctors" who had not passed any medical exams. The records department workers sold the medical licences for 45,000 yuan to people who set up private medical clinics and pharmacies. The official was sentenced to eight months in jail and the medical licences were cancelled, Xinhua reports.

Almost 16,600 Chinese people died of infectious diseases in 2013, with HIV being the main cause of death, the National Health and Family Planning Commission has announced. There were more than 6.4 million infectious disease cases reported, of which AIDS, tuberculosis, rabies, hepatitis and hemorrhagic fever were the most deadly diseases, while hepatitis, tuberculosis, syphilis, dysentery and gonorrhea were the most prevalent, ECNS reports.

Family beat doctor and force him to kneel before dead patient's coffin

A medical dispute in Shaoxing took a bizarre turn when the relatives of a man who died of infection in hospital brought his coffin to the hospital and forced a doctor to kneel before it and kow-tow. The gang of family members then beat the doctor severely and also fought with police. Xinhua reports that the family brought the man into hospital suffering from a gallbladder complaint. He initially recovered slightly but then developed a severe infection and died. Family members blamed the hospital for his death and returned to hold a 'funeral' in the hospital reception area. The laid wreaths there and brought the coffin of their father. The family members caused a commotion, shouting and swearing, and they grabbed a doctor who they made to kneel down before the coffin for almost an hour. Then they beat the doctor so severely he required hospital treatment. The assailants also fought with police before they ran off. The incident has generated a lot of comment on social media sites, with some people saying they sympathise with the family but their violent actions were too much. Medical staff at the hospital are outraged and say the attackers must be caught and tried for their 'disgusting and brutal behaviour. Local law enforcement official shave told the family members to give themselves up.

Shenzhen "black doctors" performed unnecessary abortion

A 17-year old Shenzhen women says her healthy baby was aborted by an illegal clinic staffed by unqualified staff (bogus or "black" doctors) who were only interested in making money for doing an operation. The woman went to a private clinic in Shenzen when she had minor bleeding during her pregnancy. The staff there did an ultrasound and told her the fetus was dead and that she should have an abortion. She did so, but was also told she needed additional surgery to have tissue removed. In total she paid more than 4000 yuan. However, her family became suspicious when they noted the 'doctors' at the clinic had the same names as other local doctors. When they investigated further, they found that the doctor who diagnosed' the stillborn fetus did not exist. An investigation by the local health department confirmed this - and found that some of the fake doctors involved in the incident had assumed the names of real doctors who had previously worked in Shenzhen. One doctor who did surgery proved to be genuine, but said she had acted in good faith, accepting the referral and the information from the fake was real. The fake doctors have since disappeared and the clinic they worked at was fined 3000 yuan and given 18 demerit points. The family of the girl complained that this was too lenient.

Hubei group protest forced psychiatric treatment of people without mental illness

People who complain against the government are being forced into mental institutions and given forced treatment with antipsychotics and electroconvulsive therapy, a human rights group in Hubei has told Radio Free Asia.. Liu Feiyue, a spokesman for the Civil Rights and Livelihood Watch says the psychiatric hospital system is being abused and there have been 40-50 cases of forced treatment of healthy people during 2013, in contravention of China's new Mental Health Law, which came into effect in 2013 but is not being implemented on the ground.

Friday, 14 February 2014

"Fake" GPs in Shanghai | 5-in-1 vaccine shortage | Appointments by WeChat: China medical news for Friday 14 February

Shanghai appears to lead China in the introduction of family doctors, but many of the so-called general practitioners (GPs) are fake, says Zhu Shanzhu, the chairman of the Society of General Practice, Chinese Medical Association. In an article in Global Times, Dr Zhu says that Shanghai is on target to have a GP for every resident by 2020, when people will be able to register with a family doctor working out of their local community health centre. However, Dr Zhu says many of the family doctors assigned to the health centres are not true GPs because they are specialists such as surgeons. Shanghai must therefore commit to training doctors in family medicine, she said.

A second death has been reported from the novel influenza strain H10N8 in Jiangxi. According to Shanghai Daily, a 75-year-old man died in Nanchang. Health authorities have urged the public to stay away from live poultry.

Shortages of the popular paediatric 5-in-1 combination vaccine have been reported due to transport congestion and delays ove the Chinese New Year. The imported vaccine, made by Sanofi, immunises against diphtheria, tetanus, pertussis, polio and Haemophilus influenza Type B and costs around 600 yuan for each of the four doses. Parents prefer it over free domestic vaccines because it reduces the number of needles their child has from 12 to four.

Hospitals in Beijing are offering appointments and medical results via WeChat, ECNS reports. The social media service is being offered by 21 municipal hospitals to patients who sign up and obtain a password.

A Shaanxi woman claims one of her kidneys was secretly removed during an operation she had more than 20 years ago. The woman made the shock discovery that she was missing a kidney when she had a hospital scan for back pain. The only possible explanation was that it must have been removed when she had an operation on her ovaries 26 years previously, she told TV reporters. The woman returned to the hospital where she had the operation but they rejected her claims and denied all responsibility for the incident.

A hospital in Hainan is pioneering a new model of "treat first, pay later" care. The hospital in Haikou has dropped the usual registration system in which patients pay a deposit ahead of treatment. the hospital managers say the new system is more convenient, but relies of the trust of patients to pay for their treatment afterwards. Non-payers will be put on a black list and refused further treatment, they said.

A Beijing academic has called on the government to stop the tobacco industry's deceptive marketing of "low tar, less harmful" cigarettes. Professor Yang Gonghuan of the Department of Epidemiology and Statistics, Institute of Basic Medical Science, Chinese Academy of Medical Science, says the claim that low tar cigarettes are less harmful is incorrect. However the slogan is used by industry to encourage smokers to stay with the habit. Writing in Tobacco Control, he urges the government to "stop the execution of this deceptive strategy for tobacco marketing".

And a kidney specialist in Guangzhou has been praised in the Chinese media for continuing to work despite being confined to a wheelchair. Reports say Dr Ke continued seeing 20 patients a day at the PLA 458 Hospital over the Chinese New Year despite having broken her patella and being unable to walk. Patients praised the doctor but she said any of her colleagues would have done the same thing.

Thursday, 13 February 2014

News in brief: clinical studies from China

Measles is now rare in Guangzhou thanks to vaccination, but complete eradication will require vaccination of transient populations who now account for more than half of cases.

People who have a heart attack in China delay going to hospital for more than two hours, often because they don’t recognise the symptoms or their importance.

Chinese people consume dangerously high amounts of salt, with a Yantai study showing that 97% of men and 87% of women had intakes of over 6 g salt per day (mostly from added salt and soy sauce). Salt intake was related to high systolic blood pressure.

More than one in four new mothers in Guangzhou experience post-partum depression.

Compulsory routine infant vaccination with pneumococcal conjugate heptavalent vaccine would reduce pneumococcal disease in China by at least 32%, would prevent 2,682 deaths in the first five years of life and would save $1,190 million.

In rural China epilepsy goes untreated or undertreated in two out of three people with the condition, a Sichuan study has found. One third of people with epilepsy did not know about the disease and had not sought medical help.

The cultural pressure for gay men in China to marry means that their wives face a high risk of HIV and syphilis, researchers from Ningbo say. They found that only one in four gay men always used condoms with their wives, which explained HIV rates of more than 8% in women married to gay men.

Low vitamin A levels are linked to eye cysts (chalazia) in south west China

Weather has an important influence on measles transmission in China, with infection more likely after cold spells and during dry weather.

Wednesday, 12 February 2014

Shanghai hospitals' database hacked and records sold to drug companies

translated by Michael Woodhead
A 'mole' hacked into the databases of three major Shanghai hospitals using wireless laptops and extracted drug usage data that was sold to pharmaceutical company representatives, Eastday reports.
The Huangpu court has found two people guilty of fraud after they downloaded drug data from the three hospitals and sold it for 12,000 RMB to drug company contacts. One of the hackers worked in the technical department of one hospital, the other was a pharmacist. The hacker used a laptop computer while sat in a car in the carpark of the hospitals to hack into the wireless network. They were caught in July 2013 when IT staff noticed unauthorised users extracting data, and traced them to the nearby car park, where they were arrested by police. They were fined 5000 RMB and sentenced to one year in jail.
In the past, pharma companies would sometimes pay hospitals for the drug usage data, but this practice has been outlawed. The hackers made contact with drug company representatives and told them they could sell the information each month for 46 different drugs for 250 RMB per item. They emailed the data to the drug company employee, who will be tried separately for corruption.

China needs to act on overuse of intravenous infusions - BMJ

[Pic: www.news.cn]

Action is needed to reduce China’s massive overuse of intravenous infusions for inappropriate indications, according to an article in the BMJ this week.
The timid steps taken so far by the Chinese government have done little to dent the widespread misuse of IV infusions, with as many as ten billion courses – or eight per person per year – being given, says Yuan Sanying of the West China Hospital, Sichuan University, Chengdu.
She says the government has recognised the problem and has acted to reduce financial incentives for prescribing infusions. However, there is still enormous pressure on doctors to set up IV infusions and the practice continues in most hospitals. Many hospitals even have dedicated infusion rooms, she notes.
Ms Yuan, who works as a nurse in the Department of Liver Surgery, says hospitals look like ‘infusion forests’ during cold weather spells as patients are treated with infusions for common respiratory ailments. And yet doctors acknowledge that most patients don’t need IV medication and could be better treated with oral remedies and rest.
The use of infusions is a major burden on hospital staff, with nurses reporting being overworked and diverted from other tasks as they spend half their working day setting up IV infusions. The Ministry of health has responded by monitoring the number of infusions and by banning some hospitals and doctors from earning commissions from the use of infusions. However, inappropriate is still driven by pressure from patients who believe that they will recover faster if they have an infusion. Doctors and nurses who refuse to provide infusions face getting into disputes with patients and their families, she says. Yuan Sanying says financial restrictions should be extended to all hospitals. She also recommends a public education campaign, similar to the ones that have discouraged the public from using antibiotics for viral illnesses.

Tuesday, 11 February 2014

Illegal Beijing bird markets the source of exported H5N1 influenza virus

A backstreet illegal poultry market stall in Beijing was the likely source of the highly pathogenic avian influenza A(H5N1) virus infection that killed a Canadian visitor, infectious disease specialists have suggested.
In January a 28-year old woman developed H5N1 infection on her return to Alberta after visiting Beijing. She died after developing neurological complications. It was assumed that she had picked up the infection in Beijing but it was reported that she had not had close contact with poultry while in the city.
However, the woman probably picked up the virus from one of many illegal poultry market stalls that exist in Beijing, according to Dr Yang Peng of the Beijing Center for Disease Prevention and Control. In a letter to the Journal of Infection this week, Dr Yang says the Canadian case was only the second such case of H5N1 to be linked to the city. He describes a similar case in which a 19-year old woman developed H5N1 infection and died in 2009. Analysis showed that the H5N1 virus was avian in origin and belonged to clade 2.3.4. The woman had bought a live healthy duck from a street market and she had prepared it for cooking. Dr Yang said poultry breeding and live markets were prohibited in Beijing, but illegal markets had sprung up in the suburbs, and these sold poultry reared in nearby Hubei and Tianjin districts.The stall area where the women bought the duck tested positive for H5N1, according to Dr Yang. He therefore suggested that the recent Canadian case of H5N1 may have occurred after the visitor passed through a street market or stall.
The findings "indicate that illegal and uninspected selling and transportation of live poultry from regions outside of Beijing may have posed a high risk on human infection with avian influenza in the general population of Beijing currently. The enhanced inspection of illegal selling of live poultry, the strict regulation of transporting live poultry from regions outside of Beijing, as well as health education on changing dietetic culture is greatly warranted in Beijing, in order to reduce the risk of infection with avian influenza viruses in the general population of Beijing including visiting foreigners," the letter concluded.
And in another development this week, the full genomic analysis of the Beijing-derived H5N1 case has been published in the Emerging Infectious Diseases. The analysis "provides valuable insight into the presence of mutations that may reflect adaptive changes, altered virulence, and/or transmission phenotype," the researchers said.

Woman needs six stitches after argument with doctor

[Editor's note: there are three shocking things about this story, not just the alleged violence against the woman].

A woman in the Sichuan town of Yibin has needed six stitches for a wound sustained after a fight with a doctor over a dirty cushion. The woman named Chen says she got into an argument with a doctor in the X-ray department after she asked him to swap the cushion on the bench because it had  a bloodstain on it. The woman said that she took her 20-month old son to the hospital for a checkup when he had a cough and cold. When she took him into the X-ray room for a scan, she noticed the bloodstain on the cushion and asked the doctor to change it. However, the doctor refused and said "get on with it". When the woman took out some paper towels and started to clean the cushion, she says the doctor disappeared into  side room. She admitted she swore at him in frustration and then the doctor came back and swore back at her. The argument erupted and she said the doctor struck her on the head, cutting it open and causing bleeding, for which she needed six stitches. The woman said she was eventually faced with a bill for 3000 yuan in medical costs and she is demanding compensation from the hospital.
When the Dr Li was contacted at the Huaxi city Renmin Hospital he gave a different story. he said there were some bloodstains from a traffic accident on the cushion  that he had been trying to clean off, but the clinic was extremely busy and he was under a lot of pressure to examine a waiting room full of patients.  He said the woman called Li had been in an argumentative and volatile mood and had shouted and swore at him before chasing him into the side room. He said he had not hit the woman but had pushed her away after she started brawling with him, and she had fallen and hit her head.
 A hospital spokesman said he could not comment on the matter until a police investigation was completed.

Three things shock me about this story:

1. A dispute over a dirty cushion could result in a violent argument between a female and a male doctor.

2.  A woman would  take her infant with a minor illness like a cough and cold to a hospital and have the child exposed to high doses of radiation with needless chest X-rays.

3. The medical bill for a cough and cold (and stitches) could be as high as 3000 Yuan.

What health stories are Chinese people seeing in their media today?

Here are a few samples of the medical and health stories appearing in the Chinese press today (links are to Chinese language sources):

Beijing has introduced screening for H7N9 in high risk groups such as those working in poultry markets.

Cities have been told to strengthen reform of hospital system, and second-line regional hospitals to introduce reform pilot projects.

Overeating and drinking during the Chinese New year has resulted in a 4-fold rise in hospital treatment for gastric problems.

False rumour spread about Beijing women whose stomach 'exploded' after overeating.

Liaoning woman, 18, arrested and forced to make public confession adn apology for spreading false rumours on Weibo about the death of a person from H7N9 influenza.

Rural children have rates of underweight and growth retardation four times greater than those of urban Chinese children, according to NHFPC.

Violence against doctors in disputes with pateints has become so common it is 'normal' says Harbin emergency physician.

Will the expanded cover for major illness bankrupt the rural health insurance scheme?

Monday, 10 February 2014

China's media lauds the "4 cent prescription doctor"


The Chinese-language version of the China Daily is lauding a Henan doctor who prescribed a treatment for a child's rash (an antihistamine) that cost only 4 cents. The cheap cure is seen as big news at a time when many Chinese are complaining about the high costs of medical treatment. The story is based on the overwhelming web response to the Weibo posting of a mother of a two-year-old child, who posted that she couldn't believe how cheap it had been for her child's treatment.
The Weibo post described how she took her child to see a doctor at the Zhengzhou People's Hospital No 3 paediatrics department. The female doctor there told her the rash was due to an allergy and she would prescribe an antihistamine called chlorpheniramine. Based on her previous experience with hospitals, the mother expected to pay several hundred yuan for a long course of medicines - and so she was very surprised when she only had to pay 4 fen for 4 tablets of the antihistamine. She was so impressed that she took a photo of her hospital bill. She was also doubtful that such a cheap treatment could work, and so was again surprised when her child made a quick recovery from the rash.
When she posted this on Weibo, her story and photo was immediately re-posted thousands of times, with netizens starting an online discussion about the high cost of treatment and the difficulties of getting to see a doctor. Many praised the doctor at the children's hospital and said such doctors were hard to find these days.
When a China Daily reporter tracked down Dr Qin Ruijuan, she said her 4 cent prescription was nothing special and that she had only been doing her duty. "Any other doctor in my position would have done the same thing," she said. Dr Qin said the antihistamine was the most appropriate drug for the condition and only a short course was needed.
Dr Qin said some patients believed that doctors made a lot of money in commissions when prescribing drugs and treatments, but this was not the case. She said there was no link between doctors' incomes and treatments ate her hospital, nor were there any targets or quotas.
The China Daily reporter wrote that this was supposed to be the case at all hospitals and a new directive from the National Health and Family Planing Commission issued in December had re-iterated this rule. This included a new series of prohibited practices in healthcare, known as the 'Nine Forbiddens' included taking commissions or kickbacks from prescribing and having quotas  or targets for treatments and prescriptions.
However, the reporter noted that there was a trend for hospitals to stock newer and more expensive medications at the expense of cheaper medicines . This led to a situation where it was impossible for doctor to prescribe affordable medicines because they were not stocked by the pharmacy. And because the profits were so tiny with cheap drugs "manufacturers don't want to make them, pharmacies don't want to sell them and doctors don't want to use them".

Violence in healthcare take a strange turn: nurse beaten by intern for questioning his advice

Healthcare staff in China have become inured to the threat of violence from disgruntled patients and their relatives, but this week a nurse has been subject to a violent beating from an unexpected quarter - an intern in her own department.
The nurse called Li Mei (pseudonym) says she still can't make sense of what happened, but she believes it was because she expressed doubt about the medical advice provided by a new intern in her department called Dr Du Mou.
A Shaanxi newspaper reports that the nurse was working in the internal medicine department of the Railway Hospital at Lueyang, Shaanxi alongside a male intern.
The nurse gave an interview to a journalist while she was lying in bed with an obvious red welt across her swollen face. She said the young male doctor had punched her repeatedly in the face, chest and stomach and also kicked her. She said it was because she had reminded him that his medical advice for one seriously ill patient was incorrect.
"As soon as I finished speaking he hit and kicked me. I was just stunned and dizzy and left with ringing in my ears," she said.
The nurse said she was now so sick she was unable to breastfeed her one year old child.
The local police station said they had sent officers to attend the incident, but when they arrived and ascertained what had happened, they were told by hospital management that this was an internal hospital disciplinary matter and they need not get involved. The head of the department confirmed to the reporter that an incident did take place but he refused permission for media to speak to the intern involved, who was still on duty.
The hospital director said the hospital managers said they were taking the incident very seriously and treating the injured nurse as best they could. An investigation would look closely into the events and would handle the matter gravely. The intern who hit the nurse was a recent graduate from medical school who had not yet passed his one year probation period. The intern said the nurse had sworn at him and cursed his family and he had impulsively struck out and hit her just once. The manager said interns did not have prescribing rights or the authority to give medical advice without supervision form a qualified doctor. He understood the two parties gave very different versions of the incident and the hospital was now investigating.

Sunday, 9 February 2014

A note on China's 'guided news' in healthcare

Editor's note: In the three months that I have been translating Chinese-language medical and healthcare stories into English I've noticed that a clear pattern emerging. Every week or so a story theme emerges for stories across China, in which a certain issue is covered in slightly different ways by local media outlets. One clear example of this has been the  shortage of doctors in certain specialities such as emergency medicine and paediatrics. Over a period of 10-20 days I would notice a crop of stories about paediatrician shortages emerging from right across the nation.  Interestingly, each region would have its own angle on the issue: in Heilongjiang the local media might interview a hospital manager and get feedback about difficulties in recruiting new doctors. In Nanning, however, the local media might do a 'day in the life' type feature on the problems of being a paediatrician in a busy and understaffed children's ward. The overall message would be the same. I don't think I'm being too paranoid in thinking that this suggests a certain degree of 'guided news coverage' is being co-ordinated at a national level. In other words, a central media department is instructing regional media outlets that a certain issue must be highlighted in local news coverage. In the last few weeks I've noticed that there have been more stories about the costs of drugs and how hospitals and doctors are tackling the problems of overservicing and high drug prices (eg with the' corridor doctor' story). All these stories seem to be aimed at supporting the Chinese government's latest policy of curbing high drug prices and reining in hospital costs.
Here are a few examples of  'news themes' from the last few weeks:

  • Doctor shortages in emergency medicine and paediatrics.
  • Overservicing by hospitals
  • Drug prices too high - and corruption/kickbacks
  • Violence against doctors - and the contributory factors of workforce supply and demand
  • Medical insurance coverage to be extended
  • Primary care clinic expansion
  • Medical education reforms - internships
  • Private investment in healthcare

Antibody vaccine for H7N9 is more effective than Tamiflu, say Shanghai researchers

translated by Michael Woodhead
Shanghai researchers say traditional inactivated vaccines cannot be developed against H7N9 but they have developed a gene vaccine which is more efficacious than Tamiflu against the virus.
According to an article in the Workers Daily, an antibody therapeutic vaccine that is effective against the current strain of H7N9 has been developed by Shanghai researchers and is now about to start  clinical trials. Researchers at the Shanghai Public Health Clinical Centre Infectious Disease Research Institute said they had developed antibodies that were effective against H7N9 in vitro and they are now starting tests in humans.
Professor Xu Jianqing of the Infectious Disease Research Institute said that work on the vaccine began in April last year after the first major H7N9 influenza virus outbreaks.  He said the team had made a breakthrough with a gene vaccine in December when they injected the vaccine into 30 mice infected with H7N9. After 30 days none of the mice had died and none had signs of H7N9 infection, which represented the first real proof of efficacy.
Professor Xu said many other research groups in China were doing H7N9 vaccine research but using  traditional inactivated vaccines. However, he said experiments had shown time and again that compared to other influenza viruses, the H7 influenza virus was not amenable to being incorporated into an inactivated vaccine, as it was deformed by the chemicals used, rendering the immune response inadequate. Similar efforts by Dutch researchers to develop a vaccine against the H7N3 virus strain in 2003 were also a failure for a the same reason. This showed that inactivated vaccine technology was not going to catch on for the H7 virus, he said.
The Shanghai researchers had therefore taken the bold step of taking the most important genetic material from the H7N9 virus and implanting it into a mature vaccine carrier. This was the equivalent of putting it into a safe and inserting this into a cell, said Professor Xu. And because the virus structure was not destroyed by putting it into an egg albumen, it elicited a good immune response, he added.
Professor Xu said the new vaccine would be suitable for people at high risk of H7N9 such as those working in live poultry markets and household members.
Within Shanghai's R&D community the new H7N9 vaccine was seen as a breakthrough after an audacious attack. Xu Jianqing said the immune system of H7N9-infected people produced antibodies, and the sooner the body produced antibodies the better the prognosis. He added that Tamiflu was effective if given within the first few days of viral infection, as this was the 'empty' window before the body had started producing its own antibody.  But after more prolonged infection Tamiflu quickly became ineffective,  and drug resistance appeared quickly. Researchers were inspired to try using exogenous antibodies during this initial 'empty window' period when there was no natural H7N9 antibody being produced. The observed effects of the gene vaccine were clearly better than Tamiflu during this period, said Xu Jianqing. In fact, in 2003 during the SARS outbreak, there had also been small scale treatment models of experimental antibody treatment that were successful in curing a patient.
It is reported that at present the H7N9 antibody treatment has already successfully completed two phases of in-vitro testing and it is estimated that Phase 3 testing will be complete within one month. From among the 100+ types of antibody currently in testing the best will be selected for clinical use.

Saturday, 8 February 2014

Vaccine for H7N9 | No smoking in medical centres | Cosmetic surgery boom among young Chinese

Vaccine developed for H7N9
Shanghai researchers say they have developed a "gene vaccine" for the H7N9 avian flu virus for humans that has succeeded in primary animal tests, according to Shanghai Daily. The claim was made by officials at an infection disease research body under the Shanghai Public Health Clinical Center

Now influenza H6 is a threat to humans
Yet another kind of avian influenza virus has been found to pose a threat to human health in China - this time it is H6. Researchers from Lanzhou tested samples from live poultry markets in southern China from 2008–2011 and found that among the 257 H6 strains tested, 87 viruses couldbind to human receptors. They found that there were 30 different H6 genotypes, showing that these viruses are actively circulating and reassorting in nature. "Our study demonstrates that the H6 avian influenza viruses pose a clear threat to human health and emphasizes the need for the continued surveillance and evaluation of the H6 influenza viruses circulating in nature," they concluded in the Journal of Virology.

Subway station radiation not a health threat
Operators of subway stations in cities such as Beijing and Chengdu say the radiation from security scanners poses no threat to human health. The doses from a typical security scan are equal to around 0.007 mSv per year if a person is scanned daily. This is lower than the safety standard of 1 mSv per person a year. Most X-rays are contained within the machines by protective curtains that block X-rays from escaping," and environmental expert told the Beijing Daily.

No smoking rule for medical centres
Doctors have been advised to deliver stronger anti-smoking messages to their patients ,according to ECNS. According to the report, doctors have been told by the National Health and Family Planning Commission to inquire and record the smoking history of patients during their initial diagnosis to help smokers quit. The NHFPC also says that there should be no smoking in medical establishment and medical workers are also asked not to put ashtrays in their offices. The NHFPC also recommends that smoking clinics be set up.


Cosmetic surgery rates highest in young people
Cosmetic surgery and other cosmetic procedures such as ear piercing have become very popular with young people during the holiday period, according to Xinhua. Many stalls in a Shenyang market offered ear, lip, tongue, nose and belly button piercing over the New Year holiday. The operators claimed to be trained nurses but failed to produce any medical license.  A cosmetic surgeon said that there had been a rise in young people undergoing minor surgeries too, with children as young as eight or nine getting double-eyelid surgery to give them the appearance of larger or "Western" eyes.

Friday, 7 February 2014

Xian doctor uses WeChat to connect with patients

The Economic Reference (Jingji Cankao) magazine has a story about a Xian female doctor who has started using WeChat to keep in touch with her regular patients. 'Dr Hao' is described as a well known and respected family doctor from a medical family. She is a third generation doctor and has followed in the footsteps of her grandfather and both her parents in running a private clinic in the suburbs of Xian. Dr Hao specialised in child health but also 'inherited' a lot of older patients with chronic diseases from her parents. She was very popular patients because of her kind and patient manner and because she had a high standard of medical ethics.
However, to years ago the much loved Dr Hao Clinic had to close down when the block in which it was located was earmarked for demolition. Not only did Dr Hao lose her clinic, many of her local patients were also re-housed and dispersed to other areas. These patinets were especially upset at losing their 'personal doctor', and Dr Hao also felt worried about losing touch with them. Shen then hit on the idea of using WeChat (Weixin) to keep in touch. When she opened a new clinic she also opened an online channel to her patients via WeChat, the social networking site that she had until then used frequently to keep up with friends and family. Dr Hao spread the word that she could be contacted by WeChat - and she also started getting details from the patients who tracked her down to the new clinic. At each consultation Dr Hao would finish up by explaining WeChat to her older patients and if necessary even helping them register for it on their mobiles.
Now Dr Hao is back in touch with many of her patinets, especially those who live futher aay and find it hard to come and see her regularly. Dr Hao uses WeChat to find out about their medical condition and ho they are managing. She uses it to give advice to pateints and also to help them with their medication. She has now even registered a unique "Dr Hao Clinic" name on WeChat.