China medical news roundup for Tuesday 12 November

Polio vaccine switch within two years

 China’s switch from live to inactivated polio vaccine will make the rare paralysis reaction a thing of the past.

Xia Maoqiu knows his son Yu Han is one in a million — he was diagnosed last year.

The 2-year-old is among the small number of children in China who have suffered a negative reaction to the oral polio vaccine, which has helped eradicate the disease.

Health specialists say only about a dozen cases of the condition — vaccine-associated paralytic polio — occur every year.

"According to the Health and Family Planning Commission, only one out of every 1 million children who take the vaccine has an abnormal response," Xia said.

His son, who is believed to be the first child in Sichuan province affected, received the oral vaccine at a clinic in Chongzhou in October 2011 but was back in hospital a month later with a fever.

"After he recovered and was back home, we noticed something strange during bath time," said Tu Tao, the boy's mother. "His left leg was turned inward and he was feeble. I asked him to walk a few steps, but he kept falling."

Unhappy with an initial diagnosis by local medics, Xia and Tu contacted the Chinese Medical Association in Chengdu, where experts confirmed the oral vaccine had caused the paralysis.

Since then, the toddler has undergone more than 1,000 acupuncture treatments, and the family has seen its savings of 200,000 yuan ($33,000) disappear, despite receiving 178,000 yuan in compensation from the Sichuan provincial government.

"Yet his leg is no better than when we discovered the problem," Xia said.

Although rare, China is working to make the condition a thing of the past.

The country has set a goal to introduce the inactivated polio vaccine, which does not pose a risk of paralysis, into its routine immunization program in two years, and officials say an application has already been filed with the State Food and Drug Administration for mass production and use of the first domestically made IPV.

"The oral vaccine has helped China eliminate polio, and now we're preparing to introduce IPV, which is in line with the international standard and can better protect against the polio infection," said Shen Qi, deputy director of the National Institutes for Food and Drug Control's Institute for Biological Product Control.

Worldwide, most polio vaccine in use is oral, yet more than 60 countries and regions have introduced IPV. Some only use IPV, while some use both.

"Eventually all use of OPV (the oral vaccine) will be ended in China and the world," Rodewald said. "However, there will be a few years in which both IPV and OPV are likely to be used together."

It is critical, he said, that polio vaccination coverage remains high in China, as it shares borders with Pakistan and Afghanistan, where polio remains endemic.

An outbreak of polio reportedly imported from abroad hit the Xinjiang Uygur autonomous region in 2011. Twenty-one cases were detected between August and October that year, killing one and leaving 17 people paralyzed, including eight children.

"That outbreak was the first to come from abroad since 2000, and the risk remains as viruses know no boundaries," warned Luo Huiming, deputy director of the Chinese Center for Disease Control and Prevention's National Immunization Program.

Che Yanchun, director of science and technology at the Chinese Academy of Medical Sciences' Institute of Medical Biology, said in February it applied for a license to produce and use IPV after clinical trials.

"To eliminate polio thoroughly, we can't depend solely on foreign products. We must have a homegrown IPV," she said.

However, Rodewald said China faces challenges in introducing an IPV.

The supply will need to be sufficient for all children to receive at least one dose, he said, while the increase in injections will put pressure on public health workers.

Shen at the Institute for Biological Product Control also said there is a cost implication. According to her, one dose of the oral vaccine costs less than 1 yuan, "but IPV is far more expensive."

Source: China Daily

China’s new health insurance scheme having positive impact – study

The Urban Resident Basic Medical Insurance (URBMI), launched in 2007 has had an appreciable positive effect on health service utilisation in China, a new study has found.

The scheme that aims to cover around 420 million urban residents in China significantly increased the likelihood of insured people receiving both inpatient and outpatient treatment, according to an evaluation by Dr Chen Gang of the Flinders Health Economics Group, Australia and colleagues at the National School of Development, Peking University.

The scheme increased the probability of using outpatient services in the past two weeks, although the insurance reimburses mainly against critical outpatient care.

However, based on data from the URBMI Survey from 2008–2011  the study also found that the insurance scheme did not reduce rates of people being refused hospitalisation based on financial difficulty.

“Given that it is still early days for the URBMI scheme, the positive effect on health services utilisation is appreciable,” the study authors concluded.

Read the full study at Pharmacoeconomics

Unlicensed Korean cosmetic surgeons work in Beijing

Eight plastic surgery hospitals in Beijing have claimed to have famous surgeons from South Korea on their staff, but 13 out of the named 14 surgeons are unlicensed, the Beijing News reported.
According to Qi Shiming, an official at the Beijing Municipal Health Bureau, most of Beijing's more than 260 plastic surgery hospitals tout the services of renowned surgeons from South Korea. The bureau recently published a list of Beijing's licensed plastic surgeons. From October of 2012 to October of 2013, only eight foreign doctors were registered in Beijing, of whom six were from South Korea.

Source: Global Times

China medical reforms – what’s ahead?

At the 18th National Congress of the Communist Party of China (CPC) last November, China pledged to advance the nation’s medical insurance system to one that covers the entire population, as well as establish a mechanism to provide insurance and aid in treating critical illnesses. As the Third Plenary Session of the 18th CPC Central Committee opened this Saturday, people are expecting the meeting will charter the next stage for China’s healthcare reform.

Since 2009, China has accelerated its reforms to make health care more accessible and affordable. By 2013, medical insurance covered 95 percent of the population, with 265 million people enrolled in the Basic Medical Insurance for Urban Employees (BMIUE), 271 million covered by the Basic Medical Insurance for Urban Residents (BMIUR) and 805 million enrolled in the New Rural Cooperative Medical Insurance Scheme (NRCMS).

As the Report of the 18th National Congress of the CPC pointed out, everyone should have access to basic medical and public health services. By 2015, the percentage of people covered by medical insurance will have increased by 3 percent.

Despite the universal coverage, public dissatisfaction with the health service is growing. We have seen a rising number of attacks on medical staff across China. According to figures from the Chinese Hospital Association, from 2008 to 2012, the number of incidents aimed at doctors and nurses per year increased from 20.6 to 27.3 on average in every hospital across China. Doctors and nurses are experiencing a crisis, and so is patient-doctor trust.

Violence has become an expression of the patients’ resentment over the high costs of treatment and medicine, as well as over corruption. The semi-marketization reform has left China’s public hospitals struggling to make ends meet. To boost salaries, doctors are forced to over-prescribe medicines and tests, and even receive grey incomes -- kickbacks from medicine companies.

In July this year, GSK’s China business was probed for allegations of bribing doctors to boost sales. In an effort to end their financial dependence on medicine, authorities have since last June started reforms at county-level public hospitals to wean hospitals away from medicine. Reforms are expected to be extended to all public hospitals by 2015.

As healthcare coverage has broadened, the share of patient spending has also declined dramatically. The NRCMS pays for 75 percent of in-patients’ costs once they are admitted to hospital and the BMIUR covers 70 percent. Yet challenges remain daunting as the high proportion of reimbursement may not be of much help to those patients suffering critical illnesses.

When addressing the 16th National Congress of the All-China Federation of Trade Unions on Oct. 21, Premier Li Keqiang emphasized the importance of establishing a critical illness coverage system. “There are 3 million people every year who can’t afford to pay for the bills when diagnosed with critical conditions despite the reimbursement,” he pointed out.

Serious health expenses dragging a household into poverty is nothing unusual, especially not among low and middle income families who are particularly vulnerable to critical illnesses. The Guiding Opinions on Providing Critical Illness Insurance for Urban and Rural Residents co-drafted by six Ministries was released at the end of last August. According to the Opinions, those insured by BMIUE, BMIUR or NRCMS will get at least half of the self-paid treatment expenses reimbursed once diagnosed with severe illness.

By the end of August 2013, 94 regions across 23 provinces had piloted the critical illness cover system and seven provinces had fully implemented the system, benefiting 210 million people. Patients with grave illnesses including uremia and cervical cancer have been reimbursed for 90 percent of the total costs in some regions.

In October, Russia announced that all Russians will enjoy free healthcare. The announcement aroused a debate over whether China can follow in Russia’s footsteps. Professor Zhou Zijun of School of Public Health, Peking University, opposed this idea. “Free healthcare for low-income groups is feasible, but free healthcare for all is impossible in China. It will put unbearable economic burdens on younger generations.”

When talking about the critical illness cover system, Li said, “To explore solutions for this problem, the government along with society and its individuals should work together.” As China’s healthcare reform rolls forward, the country’s total health expenditure has ballooned. Complete reliance on the government and public hospitals may not be an ideal option in China.

At the 18th National Congress of the CPC, China renewed its health policies and for the first time the Report explicitly stated, “We should encourage the development of private hospitals.” Fortunately, we don’t have to wait much longer to welcome a major breakthrough in this area.

On September 29, 2013, the China (Shanghai) Pilot Free Trade Zone was launched and the establishment of wholly foreign-owned medical institutions will be allowed within the Zone. Although the government is not making much bolder moves, it is still good news for China’s patients. It may still be too early to say that China’s public hospitals will be challenged, but at least we can expect more foreign funding will be poured into China’s medical sector. Now that the door has been opened, who knows what will come next?

Source: china.org.cn 

Hangzhou scientists make body parts with 3D bioprinter

Body parts in a Petri dish: scientists in Hangzhou say these could one day be the solution to the dire shortage of human organs available for transplant in China. Except for spouses and relatives, living donor organ transplants are banned in the country. But Professor Xu Ming'en and his team believe this 3D bioprinter might hold the key to a future of regenerative medicine, where new body parts can simply be printed to order. Dubbed Regenovo, it builds organs with cells made of a biological gel and layers them in much the same way as bricks and mortar in a wall. Eventually, says Xu, an organ prototype like this kidney emerges, a version that at this stage lacks blood vessels or nerves.

Says Professor Xu: "The materials we use all belong to a type of hyrdogel. That hydrogel is like gelatin or collagen which have the same physical property in our bodies. This stuff usually exists outside of our cell matrixes. So we extracted this material and we're using it in the printer. It's just like mud for some cells - it builds cells in the appropriate places, just like bricks. It's a meticulous process." The science is not new - teams in the United States have pioneered biomedical research, printing tissue for a variety of organs, from kidneys to livers. But a thriving organ production market is still a long way off. Xu says one of the main challenges is finding a way to engineer the artificial organs to interact properly with the rest of the body.

"It could take fifteen to twenty years before the 3D printer can print more complex organs, and that's because some important problems need to be solved. First, the materials that the 3D printer uses need to have a higher level of precision, and need to be able to print a larger variety of cells and create a more complex cell structure. We also need a considerable number of cells for the printing process. So, stem cell research can advance the 3D printer's development." And if they succeed, Xu and his colleague say millions will benefit, not just in China, but around the world.

Source: Reuters

Shanghai girl with rare tumour seeks foreign help

The parents of an 11-month girl, who was diagnosed with a rare brain tumor, are looking for help from abroad in an effort to save their child.

The girl, Yang Yang, suffers from atypical teratoid/rhabdoid tumor (AT/RT), a rare and aggressive form of cancer that occurs among children.

"Doctors at the Shanghai Children's Medical Center have told us that my daughter has only some months to live," said Yang Jing, the girl's mother. But she and her family are not about to give up.

The baby was first diagnosed with pneumonia at Renji Hospital in September and was transferred to Shanghai Children's Medical Center after her situation worsened with a facial paralysis.

On October 25, a Beijing doctor was invited to operate on Yang Yang and remove the tumor in her brain. The tumor's size was bigger than an egg and was bonded to the brain stem. Yang said her daughter needs urgent after-treatment but Chinese hospitals do not have the experience of treating the disease.

Doctors at Shanghai Children's Medical Center said they come across cases like this just once or twice a year.

Yang even went to Beijing where she visited five hospitals but it was all in vain.

"The hospitals either did not have any cases that were successful or simply did not haven't come across an AT/RT case," she said.

She corresponded with hospitals abroad and got feedbacks from University of Texas MD Anderson Cancer Center, St Jude Children's Research Hospital and Dana Frber Cancer Institute. But most of them wanted her to bring the baby to the US, which is expensive. The family has already spent 120,000 yuan (US$19,704) in the past two months.

"The ideal situation would be that my daughter receives the treatment in China with help from abroad," Yang said.

Source: Shanghai Daily