Alibaba Health, iKang, Online consultations, Tobacco advertising ban, Antibiotics in food, HIV discrimination

by MICHAEL WOODHEAD

Hello and welcome to another week of China Healthcare. As China makes headlines around the world for its slowing economy, few have remarked that China's entrepreneurs are taking a different and more rosy view by re-focusing on healthcare. This week the Alibaba internet billionaire Jack Ma has issued a $2.5 billion vote of confidence in the prospect for online pharmacy in China by transferring his pharmacy e-commerce section to Alibaba Health ("Ali Jiankan" or alijk.com).  According to the WSJ, "Alibaba said the deal would position it to sell prescription pharmaceuticals should China’s reforms allow retailers to move in that direction".

At the same time, Forbes has profiled another internet millionaire who has made his fortune by turning to health. Zhang Ligang made his first fortune by founding the travel booking site e-Long, but he is more famous for building a chain of private clinics under the banner iKang. And if China really does shift to a more private healthcare system, companies like iKang should be at the forefront of the wave.

The NHFPC has banned online medical diagnosis. In a statement this week the health ministry said medical consultations cannot be conducted online as there have been too many cases of unqualified people offering medical advice, purporting to be experts. The ban does not seem to apply to accredited hospitals that have approved programs. What this means for online doctor apps such as Spring Rain (www.chunyuyisheng.com) remains to be seen.

Children in China are exposed to a wide variety of antibiotics in food, which may promote resistance. A study in Shanghai that tested the urine of more than a 1000 children aged between 8 and 11 years of age found that as most had traces of at least one antibiotic and many had several antibiotics in their system.  Altogether 18 different antibiotics were found in the urine of Shanghai children, reflecting the high levels of antibiotics used in food production in China. This was confirmed by another report out this week which noted that the Chinese food and livestock industries use 100,000 tons of antibiotics  a year to promote growth in animals reared for their meat.

A total ban on tobacco advertising n China has been urged by the WHO. The head of the China office of WHO said China had a treaty obligation to phase out tobacco advertising, and should start to do so at retail points of sale. However, the powerful state-owned tobacco industry might baulk at that. The relative power of the health and tobacco industry was shown this week when health minister Li Bin noted that new graduates could earn twice as much in the tobacco industry compared to medical graduates working in hospitals. She made the point that the basic salary for a university graduate working in the tobacco industry was 4571 yuan a month compared to only 2100 yuan a month for a junior doctor. Li Bin said there was a need to learn from Adam Smith and pay the market rate for medical graduates - and this would mean patients being prepared to pay higher medical fees.

And finally the question arises of whether anti-HIV discrimination still exists in the China's hospitals. A patient at the Sichuan University Huaxi Hospital says he was refused surgery when doctors discovered his HIV positive status. The man said he had been scheduled to have surgery for haemangioma but it was cancelled and he was told that he would instead be kept 'under observation' instead. The hospital rejected the discrimination claim, saying that it was standard practice to keep patients under observation before going ahead with surgery for this condition.

Cancer treatment unaffordable | Drug pricing corruption | Premier tackles HIV stigma | Rare diseases not reimbursed | US medical exams popular in China

Public punchbag to pay son's cancer fees
In Beijing a man who cannot afford the Y700,000 ($114,000) medical bills for his son with leukaemia has offered himself as a public punchbag to raise money. The man called Xia Jun stands outside Guomao station and asks for 10 Yuan to be thumped. He says he has collected 10,000 yuan in one day without anyone taking up the opportunity to hit him.

Corruption on drug price setting cited as reason for abolition
The recent move to abolish price caps for prescription medicines was triggered by corruption in the agency charged with setting drug prices. Critics said officials in the National Development and Reform Commission (NDRC) were under investigation by the anti-corruption and bribery bureau under the Supreme People's Procurate for taking bribes. Pharma company executives said the current pricing system forced them to pay bribes to regulators to set higher procurement prices.

Premier lends support to ending HIV stigma
Premier Li Keqiang has shown public support for people with HIV and aimed to dispel prejudice and ignorance about the infection by visiting  a HIV clinic at the inspected Beijing You'an Hospital.
 For World AIDS Day, the Premier met HIV patients and healthcare workers and said the old attitudes of fear surrounding the topic of HIV must be abandoned and HIV patients need more care.

Rare diseases slip through the health insurance cracks
China's health system is not working for children with rare diseases, as their families face high treatment costs and no access to medical fee reimbursement, according to an article in the SCMP. One mother of a 3-year old boy with Langerhans cell histiocytosis (LCH) said his bills for diagnosis and treatment had reached nearly 200,000 yuan ($33,000), of which just 4,800 yuan ($780) had been reimbursed by the rural medical insurance scheme.

US medical exams popular in China
Thousands of China's medical students and young doctors are studying for the US Medical Licensing Examination (USMLE) that will allow them to practice medicine in the US. However, despite studying for up to 1500 hours for the exam, many of them say they are taking it to improve their medical skill rather than just to get a better paying job. Many Chinese students said the US medical exams taught them a more patient-centred approach and put more emphasis on communication and empathy rather than just rote-learning of medical facts. The test is also taken by many of the 60,000 foreign students studying medicine in China.

Sunday snippets: health reformer sidelined, Hong Kong-style hospital fails, HIV activist banned

Three stories stand out this week: firstly, the  'open' reporting of Caixin is a refreshing change from the routinely stultified, narcissistic column fodder of the official English language publications such as China Daily. This week they have an interesting profile of Guangdong doctor-turned-health bureaucrat Dr Liao Xinbo. He is portrayed in Caixin as an outspoken critic of the system, who has put a few noses out of joint. One incident in particular seems to have seen him sidelined for not toe-ing the Party line - when he made promises to some pregnant women who were protesting about the one child policy. However, on closer reading Dr Liao doesn't seem to be that much of  maverick. His outspoken-ness relates to his advocacy of two policies that are already at the forefront of NHFPC reforms, namely allowing doctors more flexibility to work in the private sector and promoting 'social capital' (ie private investment) in medical facilities. Perhaps Dr Liao's real crime is to have highlighted the fact that the NHFPC is a relatively weak government ministry, and the real decisions are being made by ministers for finance and social security and the he National Development and Reform Commission. To the embarrassment of the NHFPC he also points out that local governments are a major barrier to real reforms - because they have a huge financial vested interest in running local hospitals (and the profits from drug sales).
On a related note it is interesting to see a model health reform project faltering. Shenzhen has set up a joint venture hospital with Hong Kong, in an attempt to bring in Hong Kong-style health systems - most importantly a 'gatekeeper' system in which patients are triaged by a generalist practitioner before going to see a specialist. Unfortunately for the project, mainland Chinese residents do not seem to be taking to this new model of care. Despite huge overcrowding in Shenzhen hospitals, they are staying away in droves from the Hong Kong-China hospital. And it's not because of the cost - fees are subsidised by the Shenzhen government to an embarrassingly generous  extent. According to one report, the HK joint venture hospital is costing a billion yuan a year - almost all of the Shenzhen city budget for supporting city hospitals. And yet it is operating at only a quarter of its capacity. The hospital management are pinning their hopes on the opening of a VIP section of the hospital to bring in some much-needed revenue - and yet VIP medical wards are exactly the opposite of what China's health reforms are supposed to achieve, and other hospitals have been ordered to phase them out. It looks like China health reforms have a rocky road ahead of them.

And finally, just when you think China is opening up and showing a more enlightened approach to health, the government shows that its repressive, authoritarian ways extend to advocates for appropriate HIV treatment.  Ms Ye Haiyan, a Hubei-based advocate for sex worker health, was banned from attending the International AIDS Conference in Melbourne. Her crime, it seems, has been to criticise Xi Jinping's crackdown on the sex trade, pushing brothels and sex workers further underground.Ye says this will inevitably make it harder to detect and treat HIV. Another more high profile HIV activist, Hu Jia, was assaulted by plainclothes police in Beijing. We can only hope that these regressive actions by the Xi Jinping administration  are raised at the International AIDS Conference.

Why do some Chinese patients with HIV refuse lifesaving antiviral treatment?

by Michael Woodhead
[UPDATED] China has a huge number of people with HIV, though fortunately there are now effective antiretroviral drugs that can prevent progression of the infection and allow people to live with HIV rather than die from it. However, for some reason some Chinese people refuse antiretroviral treatment and become victims of AIDS.
According to Dr Lu Hongzhou an infectious diseases specialist at Fudan University, this is because some Chinese still have 'traditional thinking' and believe they can overcome the disease through traditional methods such as Chinese medicine rather than with 'superficial'  western medicine. Writing in Bioscience Trends this week, Dr Lu describes a typical such case involving a man called Zhang Shan who was diagnosed with HIV in 2010. At that time he was already quite unwell with a CD4 cell count of 49/μL and he also had tuberculosis.  His prognosis was poor and he was advised to immediately start antiretroviral therapy. However, Zhang refused, citing his belief that he did not believe in  western medicine and that he could conquer the infection by finding out more about the virus and seeking Chinese remedies. For the next year he did a lot of reading and travelled to visit several famous "monks and Taoist priests" who claimed that they could cure him of his disease. Zhang's HIV infection deteriorated and he eventually decided to seek medical help again when he was extremely sick with a CD4 cell count of just only 8/μL. He was persuaded to start on anti-retroviral medications and made some recovery, but by that time he had left treatment very late and had already experienced some disability. After several months of antiviral treatment Zhang was still alive, but his doctors told him that he had missed his best opportunity because the earlier treatment begins, the better.
Dr Lu said the case highlighted the barriers that Chinese beliefs represented to delivering effective treatment for HIV. He characterised these barriers as including "society, history, morality and ideology, family, education" (- and most of all,the patient’s mindset).
"The daunting task is to transform or change traditional or inculcated beliefs of potential AIDS patients so that they are open to antiretroviral therapy, which is a product of modern science, to help their plight," he concludes.
Update: A newly published study shows that only about half of patients with HIV were still taking their antiviral medication after six months. One significant finding in this study was that many patients had depressison, which may have affected their motivation to continue with treatment.

Urgent action needed on alarming rise in HIV rates in gay men in China

by Michael Woodhead
Rates of HIV in gay men in China are increasing dramatically, and many of them are passing on the infection to wives in sham marriages, a study from Beijing has shown.
The prevalence of HIV in the gay community is now as high as 10%, up from only around 6% in 2006, showing that urgent action is needed to contain the infection, according to researchers from the National Center for AIDS/STD Control and Prevention at the Chinese Center for Disease Control.
In a study of HIV rates in samples of 500 gay men from 2009 to 2011 they found that the overall prevalence rate was 8%. The incidence increased from 2009-2010 from 6.8 to 11.2/100 person years and then declined to 5.8/100 person years.
The main risk factors for HIV infection were being bisexual (ie living with a woman in a  marriage of convenience to avoid the family stigma of homosexuality), recently arrived in Beijing, and a negative attitude to safe sex. Between 40-50% of gay men reported having recent unprotected sex but only about a third said they knew the HIV status of their male partners. Up to 20% of gay men had female partners and about 75% of sex with women was unprotected sex
The researchers said the "alarmingly high HIV prevalence" showed that urgent action was needed to stop HIV spreading beyond the gay community.
"The findings from these three consecutive surveys signal the beginning in changing the landscape of the HIV epidemic in China," the researchers said. "HIV transmission has begun to shift from the historically main transmission route, intravenous drug users, to populations at risk through unprotected heterosexual contacts or male homosexual sex."
They added that their findings "underscored the urgency of increasing effective and better-targeted intervention services to stop the rapid spread of the virus, which includes risk reduction education, condom promotion and distribution, encouraging early and frequent HIV testing, and expanding the coverage of HIV prevention measures. These interventions will help curb the spread of HIV infection inside and outside the [gay] population."
The study is published in Biomed Research International.

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.

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.

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.

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.

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.

Doctor attacked for refusing drip | National roaming needed for medical insurance | Community HIV testing | Hand, foot and mouth disease surveyed

Doctor assaulted for refusing to put feverish child on IV drip
China's unscientific obsession with IV infusions for every malady has been brought into focus by an assault on a doctor at a Shenzhen hospital. In a widely reported story, it was said that a family attacked a doctor at a Shenzhen children's hospital when the doctor refused to arrange an IV infusion for a one year old child with a cold. The child had been brought into the hospital by his parents and was given oral medication after it was found to be feverish and diagnosed with a viral respiratory tract infection. However, the family were not satisfied with the oral medication and went back to see the doctor to demand their child be given an 'infusion'. When the doctor refused, the child's father smacked him in the face several times until the doctor was bleeding from the mouth. The attack was only stopped after the intervention of security guards and nurses. The attacker was taken into police custody where he will remain for at least three days while his case is investigated.

Health insurance won't work for floating population
China's goal of providing universal national health insurance is being hampered by the huge 'floating population' of migrant workers, a report has found. While more than 90% of the population are now covered by some kind of medical insurance scheme, the reality is that China's 240 million  'floating population' cannot take advantage of their insurance because it is only valid in their home town or province. This means that many migrant workers and their families from rural and regional areas face large medical bills that they cannot get any compensation for. IN some cases, floating workers will return home to take advantage of medical facilities where they can get some reimbursement, the report said. Integration of China medical insurance schemes is fraught with difficulty because different provinces and cities have different insurance schemes with different premiums and entitlements, the report notes. This means that local hospitals and health insurance schemes are unwilling to deal with 'outside people'. The solution may be some kind of 'national roaming' scheme for health insurance, the report concludes

Community HIV testing a hit
Rapid HIV testing is well accepted and detects many HIV positive people when offered by community clinics in China to high risk patient , a study has shown. In a trial of rapid HIV testing involving 42 sites community health centres in China, 23,609 patients underwent HIV testing. The positive screening prevalence was 0.41%, which is higher than in general hospitals (0.17%). Published in PLOS One, the study findings provide concrete evidence to support the involvement of community health clinics in the expansion of HIV/AIDS testing and case finding, said the researchers from the National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing.

Hand foot and mouth disease surveyed
China's largest ever study of hand, foot, and mouth disease has shown that it is most common in June in north China, whereas southern China has semiannual outbreaks in May and September. The review of seven million cases cases of hand, foot, and mouth disease showed the annual incidence was 1·2 per 1000 person-years, of which 2457 (0·03%) were fatal. The incidence and mortality were highest in children aged 12-23 months, according to the study published in the Lancet Infectious Diseases.

Hypertension more common among Mongolians
A study carried out in northern China has found that hypertension is more common among ethnic Mongolians. Mongolian and Han populations in northeast China. In a study of 4753 Mongolian people and 20,247 Han people, rates of newly diagnosed hypertension over a four year period
were 12.64 per 100 person-years for Mongolians and 9.77 for Han. The rates of awareness of hypertension were low for both Mongolians (36.5%) and Han (42.3%) Likewise, rates of treatment (13.1% vs. 18.2%) and control of hypertension (0.7% vs. 1.3%),were low among both Mongolian and Han population, the study in PLOS One found.

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

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

Five Chinese medical studies you should know about in January 2014

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

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

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

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

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

Medical news in China's media

HIV is one of several conditions newly listed as occupational diseases for police and  medical workers, meaning that those who develop the illness will be eligible for work-related injury insurance reimbursement. Other new conditions covered are leukasmus, blast exposure hearing damage, and ocular burns (such as to the cornea, lens of the eye or retina) caused by laser light and frostbite, according to Women of China.

The city of Lanzhou in Gansu has adopted tough new anti-smoking measures in public places. New legislation specifies "non-smoking" indoor areas, including medical institutions, schools, government office buildings, public dining places, and public transport carriers. Smokers, face fines from 50 to 200 yuan, according to the Peoples Daily.

Police in Henan broke up a fake medicine production ring that placed fake-drug ads on the radio and the internet and used bogus medical experts to talk with patients.According to CRI the fake drug operation had earned the fraudsters 300 million yuan

And in the China Daily, psychiatrists are reported to be looking at links between China's terrible smog problems and mental health. Clinicians say studies are needed on the negative impact of smoggy days on anxiety and depression due to lack of sunlight and production of the hormone melatonin.

Medical news from China's media

In the China Daily, womens' hospitals says they are being inundated with inquiries from women about having a second child following the amendment to the family planning policy in early November. One hospital, the Women's Hospital of Zhejiang University's School of Medicine has opened a consultation clinic for women considering a second child.

Xinhua reports that two more babies have died after receiving hepatitis B vaccinations, this time in Shandong province. However, the report does not say which brand of vaccine the cases are related to, even though the Shenzhen Bio Kangtai vaccine has been withdrawn.
According to the provincial Centre for Disease Control and Prevention they have also received a report of a baby that died in October after a hepatitis B vaccination.
At least twelve infants are reported to have died in China after receiving vaccines against Hepatitis B.

The People's Daily has a report on gay college students being targeted for HIV prevention measures, as the number of cases in young gay men in China is increasing dramatically. The article says that in
Guangzhou there have been 117 cases of HIV in 48 colleges or universities, according to  the Guangzhou Disease Prevention and Control Center. Ninety percent were infected via homosexual behavior, with high risk sexual activities being common. Students are being targeted for safe sex behaviour campaigns and also for HIV testing.

CRI reports that a tourist from mainland China has brought H7N9 influenza into Taiwan.
Disease control authorities said an 86-year old  tourist from Jiangsu was confirmed with H7N9 avian influenza. The man showed first symptoms on December 19 and has been hospitalized since Dec 24.
This is Taiwan's second case of H7N9, the first imported case  occurred in April this year.

China halts imports of Pfizer's Diflucan for HIV due to paperwork problems

China suspended imports of U.S. drugmaker Pfizer Inc's AIDS-related drug fluconazole (Diflucan) on Tuesday, citing a problem with late paperwork, the country's food and drug watchdog said in a statement on its website.
Pfizer, the largest drugmaker in the United States, contravened Chinese law when one of its France-based factories failed to submit a supplementary application on time, the China Food and Drug Administration (FDA) said in the statement.
With the country's healthcare spending forecast to nearly triple to $1 trillion by 2020 from $357 billion in 2011, according to consulting firm McKinsey, China is a magnet for makers of medicines and medical equipment.
Pfizer has taken steps to resolve the issue and is working with China's FDA to ensure its products comply with Chinese law, it said in a statement on its Chinese-language website. The issue is not linked to quality or safety, it added.
Some analysts said the incident looked like a paperwork "glitch" and should be short-lived.
"It should not impact too much Pfizer's business in China and I am sure the imports will be resumed once the procedure is complete," said Simon Li, Shanghai-based general manager at Kantar Health China.
China has been cracking down this year on the healthcare sector, with investigations ranging from allegations of corporate bribery to how drugs are priced, as well as drives to increase quality and safety levels across the sector.
Diflucan, which treats fungal infections linked to AIDS, had worldwide sales of $259 million in 2012, according to Pfizer's latest annual financial statement, a small fraction of the firm's $59 billion revenue that year. Pfizer has more than 9,000 employees in China and operates in more than 250 Chinese cities.

Clinical news round-up from China

From the medical journals .... by Michael Woodhead

Trends in HIV treatment in Shanghai: antiretroviral treatment has been increasingly used in patients with higher CD4 counts since 2006 and stavudine regimens are prescribed less frequently.
“Strategies to facilitate early access to antiretroviral treatment and further reduction in stavudine use are needed,” says Dr Lu Hongzhou and co-researchers from the Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China .
Source: International Journal of STD and AIDS

Why do Chinese consumers opt for more expensive branded drugs over cheaper generics? Because they don’t trust cheaper drugs and the stores that provide them, according to a survey of 250 consumers by Dr Zhou Zhiliang of the China Pharmaceutical University, Nanjing.
Source: Health Marketing Quarterly

Pertussis is still circulating in China, and the reported incidence might be underestimated, according to a study of children in a regional town in Hebei by Dr Zhao Shuzhun of the Department of Respiratory Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Beijing.
Source: Epidemiology and Infection

How does the composition of surgical teams in the operating room affect surgical team performance and procedure times? Interesting results from Dr He Wenjing and co-researchers at the Department of Minimally Invasive Surgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong.
Source: Surgical Endoscopy

Nontyphoidal Salmonella pathogens are a common cause of serious gastrointestinal infections in children, and there is a worrying level of antibiotic resistance, according to a study by Dr Wang Xiaohong and co-researchers at the Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai. “Ongoing surveillance for Nontyphoidal Salmonella infection and antibiotic resistance is needed to control this pathogen in Shanghai,” they conclude.
Source: Foodborne Pathogens and Diseases

Human enterovirus 71 (EV71) was the major pathogen of Hand, Foot and Mouth Disease in Guangdong during the 2010 epidemic, a study from the Guangdong Provincial Centrr for Disease Control and Prevention, Guangzhou has found. The infection occurs mostly in children less than 3 years of age, who should have first priority to receive an EV71 vaccine, the researchers say.
Source: PLOS One

Syphilis is still an important cause of pregnancy loss and infant disability in China, particularly among women who do not receive prenatal care or have late or inadequate treatment, a study from Shenzhen has shown. Researchers from the School of Public Health, Central South University, Hunan, screened 279,334 pregnant women and identified 838 (0.3%) women infected with syphilis. About 8% of infants born to syphilitic mothers were diagnosed as having congenital syphilis and 25% of women had adverse pregnancy outcomes.
“These study results can inform antenatal programs on the importance of early syphilis testing and prompt and appropriate treatment,” the study authors said.
Source: Sexually Transmitted Diseases

Hospitals ordered not to refuse HIV patients

Medical institutions are not allowed to refuse HIV/AIDS patients for any reason, central government authorities said on Friday.
Local health authorities will strengthen supervision of practices and deal with violations, said a National Health and Family Planning Commission statement.
A recent circular jointly issued by the commission and five other central government departments demanded more efforts to protect the rights of those with HIV so they receive proper treatment, according to the statement.
Hospitals should provide treatment and if a patient is diagnosed with the HIV/AIDS infection, the institution that first received them should be responsible for treating them, the statement quoted the circular as saying.

Liangshan region of Sichuan ravaged by HIV

by Andrew Lee
The Liangshan region has been ravaged by an AIDS epidemic for the past 25 years. Official numbers show Sichuan as having 50,000 cases of AIDS, but the actual numbers are sure to be much higher. Half of the cases are from Liangshan, home of the Yi people, and our destination.
Zi'er, 74, has had to bury two of her sons, who died of AIDS. Her other two sons are currently infected with HIV. (Andrew Lee/CBC)
In the small isolated villages lives the Yi minority. They lead a rural life, a world removed from China's big, booming cities. Chickens run across roads while cattle amble and heavy blue capes are worn almost like an unofficial uniform. Faces are darkened by sunshine and the elderly are stooped from carrying a lifetime of burden.
A local NGO worker took me to visit a family crushed by the disease, in a village where 10 per cent of the population has AIDS.
A wrinkled 74-year-old matriarch wanted to speak, and clutching a family photo collage, she started to tell me about how all four of her sons had AIDS; two had already died.
They had gone to the big city looking for work and a better life; instead they found hard drugs and an injection habit.