Monday, 30 November 2015

China is crazy for medical apps

The latest medical app craze in China is iBaby, developed by an entrepreneur from Harbin to provide antenatal, childbirth and childcare advice to Chinese women. The creator Lu Guotao featured on a recent Apprentice-style TV show on which he demonstrated how his app can link women up to advice via video and online help from obstetricians. Lu turned down offers from investors and went it alone to market the app, which he says now has tens of thousands of users in 31 provinces. Lu says he has had 10,000 obstetricians sign up to provide medical advice online via the app. The one stop platform for pregnancy advice also links women up with local clinics and offers links with merchandisers for pregnancy wares.

Lu says he was already a successful businessman when his wife became pregnant, but they were so busy attending to their work that she lost the baby through a miscarriage. Lu turned his grief into an energetic mission to help avoid such incidents again, by providing accessible information, advice and contacts for prospective parents.

He says the huge success of the app is not surprising given China's move towards relaxing the one child policy and also the opening up of the healthcare system to private investment and more flexibility in doctor roles.

The app has received backing from national obstetric experts including Professor Liu Xinghui, director of the West China Second Hospital, Sichuan University, Chengdu. Professor Liu offers weekly online lectures via the app. She says women can access a wide range of obstetric experience via the app.

Sunday, 22 November 2015

Medical news from China: 7 stories that made the headlines this week

1. Nurses in Wuxi are being taught lessons in etiquette by air hostesses. The aim of the program is to make the nurses more customer focused and dispel their image as unfriendly.

2. Acute kidney injury is common in China with 700,000 deaths a year. Researchers from the Medical College of Nantong University found that acute renal impairment went undiagnosed in more than 70% of cases, and was often caused by patients taking nephrotoxic drugs or TCM.

3. A female neurologist in Wuhan is suing a woman for slander and damage to her reputation after the women mounted a four year campaign to blame her for her mother's death. Dr Mei Bin is suing the woman for 5000 yuan in compensation and apology after the woman spread false stories about her and claimed she was unqualified for her post. Dr Mei Bin said she had nothing to do with the care of the women's mother and the allegations against her were false, probably related to a doctor with a similar name in another province.

4. Researchers from Zhejiiang report a case of human to human transmission of H7N9 influenza in hospital from Feb 2015. Both men died, according to a report in the BMJ.

5. Health inequalities: hospital mortality rates are 40% higher in rural areas compared to the cities, a new study shows.

6. About 44% of Chinese women take Traditional Chinese Medicines during pregnancy, the most common being Angelica sinsensis (29%), Ziziphus jujuba (21%) and Dioscorea opposita (13%). Most women used TCM on the advice of their mother or mother-in-la, according to the survey of 700 women in Sichuan. The researchers warned that TCM may cause fatal hepatic and renal effects and some are adulterated with lead or pesticides.

7. A Beijing medical school has started a program to train more psychiatrists to help overcome China's widespread lack of mental health clinicians. The Beijing Huilongguan Hospital Clinical School of Peking University aims to help train several hundred psychiatrists over the next decade. China currently only has 20,000 psychiatrists and needs at least three times that number to match other countries.

Wednesday, 18 November 2015

Antibiotics in China: not quite there yet

Regular readers of this blog will know that antibiotic misuse is one of my real bugbears about medicine in China. Seeing rows of patients in emergency departments routinely hooked up to infusions of broad spectrum antibiotics for fevers is a symbol of everything that is wrong with healthcare in the PRC.

Well it seems that I'm in good company in deploring this unwelcome practice. As part of Antibiotic Resistance Awareness Week, the World Health Organisation has taken China to task for its misuse of antibiotics. In a new global report it singles out China for having particularly poor usage and knowledge of antibacterials. A survey reveals that more than 60% of Chinese think, incorrectly, that colds and flu can be treated by antibiotics. A similar proportion have used antibiotics in the past few months and one in four bought them over the counter rather than obtain them on prescription. And while 67% were aware of the term ‘antibiotic resistance, few realised that cutting down on antibiotic use was the way to tackle it.

The WHO states that China is one of the worst offenders for antibiotic misuse and blames the lack of awareness among the citizenry for this problem. For a country that prides itself on such a good education system, how can Chinese be so badly informed about such an important matter?

The head of the pharmacy department at the Beijing Union Medical College Hospital, Zhang Jichun, says many Chinese demand antibiotics as a "quick fix". At the hospital if doctors say that antibiotics are inappropriate for patients with a fever or a cough they are rebuked with: "my illness so bad, why don't you give me an infusion for it?" Doctors say patients accuse them of not taking their illness seriously and demand "give me an infusion quickly so I will recover quickly and can get back to work!"

The WHO says it hopes the new report will raise awareness about antibiotic overuse and the risk of resistance in China. I'm not holding my breath.

Sunday, 15 November 2015

Top 10 hospitals in China


I'm not a big fan of top 10 lists, and I would approach this one for hospitals in China with caution. The China 2014 Good Hospital Ranking is produced by the Fudan University Institute of Hospital Management.

I'm not quite sure what criteria they use to decide what makes a good hospital but they claim it is based on factors such as clinical competence, scientific research and academic rigour. How they measure that objectively is anyone's guess. The Fudan team also say they consulted many 'national experts' to rank the country's top hospitals. They say the rankings are a good guide to clinical excellence and should be a benchmark that other hospitals strive for.

I don't think anyone is going to see any surprises in the list - all the top hospitals are the 'usual suspects' in the major cities such as Shanghai and Beijing and Guangzhou. I'm also not sure what the point of league tables for hospitals is - if you asked me to name the top 10 hospitals in Australia I could tell you quite easily without having to do a ton of homework - just based on location and whether they are teaching hospitals with a good research culture.

The rankings actually extend to 100 top hospitals, but I've only listed the top 10 here for brevity. I'm also not sure what the point of doing these survey on an annual basis is - it's not as if hospitals will move up and down the list very much and whether that is significant anyway. Any doctor will tell you that some good hospitals can have very bad departments and vice versa - some hospitals have a good reputation in certain specialities and can be terrible for others. Much of it is down to personalities and medical politics. I can also think of some 'good' hospitals that are over-rated and charge exhorbitant fees based on their reputation and "closed shop" monopoly status.

But what do I know. Here's the list:

  1. Beijing Union Medical College Hospital
  2. Sichuan University, West China Hospital
  3. People's Liberation Army General Hospital (aka 301 Hospital, Beijing)
  4. Shanghai Jiaotong University Affiliated Ruijin Hospital
  5. Xijing Hospital (No 4 Military Hospital) Xian
  6. Zhongshan Hospital, Fudan University, Shanghai
  7. Huashan Hospital, Fudan University, Shanghai
  8. Zhongshan Hospital, Guangzhou (First Affiliated Hospital of Sun Yat-sen Univeristy)
  9. Tongji Medical College Hospital, Shanghai (Huazhong University of Science and Technology)
  10. Peking University First Hospital

Wednesday, 11 November 2015

Dodgy hospital uses call centres to lure bumpkin victims

A backstreet private clinic in Beijing is using call centre staff posing as doctors to lure unsuspecting victims to have expensive and often unnecessary medical procedures. In an expose, a Beijing Times reporter spoke to call centre staff for the Beijing Sande Weiye (三德伟业) clinic, who described their high-pressure sales tactics to bring patients in for high tech and often unproven treatments such as 'stem cell' technology for arthritis.

The call centre staff said they were given a script and a template to respond to phone inquiries coming from people who had been deceived by fake websites and Baidu advertisements that claimed their 'hospital' was affiliated with prestigious major hospitals in the capital. When answering calls, the sales staff said they were doctors but in reality they were unqualified and just ran through a script whose aim was to convince callers that they could jump the queue and get access to top specialists at the city hospitals. Most of the callers tended to be gullible out-of-towners who were seeking treatment in the capital rather than rely on the more basic and underfunded rural hospitals.

Sales staff told the reporter that they were pressured to get the caller's mobile, after which they would make a series of promises and phone calls to establish a relationship with the prospective customer. They were paid on commission: 2 yuan for getting a call, 20 yuan for getting a registration (ie phone number and verbal contract) with the 'network' and 60 yuan for a hospital visit. The sales person also got a cut of the treatment fees and drug fees. A successful telesales operator could make 5000 yuan in this way. The treatments offered were often high technology - such as joint replacement - and were offered regardless of whether they were really appropriate for that patient.

When the reporter visited the 'hospital' he found it to be just a standard clinic with unscrupulous doctors offering treatments that were much higher in price than the same treatment in public hospitals. A knee replacement, for example was priced at 60,000 yuan.

When the reporter informed the top three hospitals that their name (and reputation) was being hijacked to promote a bogus clinic they said they did not have the staff or resources to chase up the many such cases they heard about from complaints. They suggested the fraud be reported to the Public Security Bureau, but the PSB said they would only follow up complaint from people who had been swindled and who had evidence to show criminal behaviour. They instead suggested that the reporter called the consumer affairs bureau.

The Beijing Industry and Commerce Bureau  told reporters that any company making false propaganda, should be reported to the bureau's hotline and would be investigated, with fines and business license suspensions for offenders..