Three vastly different articles on medical disputes - which one gets closest to the truth?

by MICHAEL WOODHEAD
Violent and disruptive medical disputes have become so common in China that they barely rate a mention in the media any more. There has to be something quite different about an attack on doctors for it to make the headlines these days. The recent incident in which a mob of disgruntled relatives of a former patient took over a Shenzhen hospital and forced doctors to kowtow to a 'shrine' was one such incident.

In response, the Chinese authorities have said they will now adopt a new zero-tolerance approach to such protests and attacks on healthcare staff.

"Vice Public Security Minister Huang Ming said police will crack down on hospital-related crimes and show zero tolerance to perpetrators who assault and injure medical personnel. He made the remarks at a meeting on safeguarding order at hospitals and promoting harmonious doctor-patient relations on Thursday."

Ho hum - we've heard it all before. Every time there is a violent attack on hospital staff there are pledges to crack down, strike hard etc etc. A few weeks later it is business as usual. As I've written on this blog before, nothing will change until the government addresses underlying reasons for these disputes: under-resourcing of hospitals leading to ridiculously high throughput of patients - 3 minute consultations in which patients are barely listened to and prescribed the most expensive treatments (so that the hospital can get a bigger profit).

According to the latest empty promise to 'take action' the minister Huang "ordered better settlement of medical disputes by taking precautions, conducting risk assessment and spotting and containing disputes at an early stage." Gee thanks.

The article also makes the implausible claim that the number of hospital-related cases of violence continued has fallen four years in a row, and is down 12.7 percent year on year. The reality is quite the opposite.

And while on the subject of propaganda, the Hong Kong based SCMP, always keen to peddle a  more palatable version of Beijing's policies to foreigners, this week has an interview with a doctor who believes the answer to medical disputes is in looking to China's history. In a Q&A article, journalist Zhuang Ping throws a few easy questions to Dr Yang Zhen, a surgeon and deputy chief of the hospital administration office in Shanghai’s Zhongshan Hospital.

Dr Yang says China should take a look at how doctors in China traditionally established good relations with patients. Other than a few glib statements about being nice to patients and showing a more human face, he doesn't explain how doctors will make this happen when they have to rush through 80-120 patients in one short shift ( and prescribe enough drugs to them to hit their salary bonus target). All pretty worthy sounding but meaningless, really.

The article with the greatest insight into China's medical disputes in published in an academic journal (Health Economics, Policy and Law) and is based on interviews with 12 doctors from a multitude of specialties working in Shenzhen.

Interestingly, the article starts off by directly contradicting the claims of the public security minister,  quoting figures from the China Hospital Association showing that the number of medical disputes has increased by about 20% a year.

"Once worshiped as ‘angels in white,’ members of the medical profession in China are facing unprecedented challenges. Due to the deteriorated public trust during the marketisation reforms of the last three decades, Chinese physicians are working in an antagonistic environment. Heavy workload, low remuneration, and tainted social prestige have left millions of physicians feeling undervalued and
made medicine a career to be avoided, a situation rarely seen in other Confucian societies," it notes.

The article makes several points about medical disputes that have been raised before - but also includes one new one that is unique and potentially game changing.

The authors say that whatever the causes, medical disputes are rarely settled through legal channels, despite there being an officially recommended dispute resolution pathway and laws that in theory should cover medicolegal areas of dispute. The reality is that patients and their families have found that they are much more likely to get results - and get them much faster - if they take matters into their own hands. In other words, mob rule. According to the article, aggrieved patients and relatives of those affected by medical misadventure have found that they can get financial compensation and see their grievances gain attention if they take violent and disruptive action against hospitals and their staff. In practice this means staging demonstrations, blockading departments - and even whole hospitals - and threatening staff. They do it because it works.

This is the testimony of one of the doctors interviewed:

"Because the macro political environment attaches paramount importance to the so-called
‘maintenance of social stability,’ hospital managers are very afraid of high-profile incidents because local government may blame them for failing to mitigate the tension. If payment can quench patients’ anger, hospital managers would certainly love to do that, even when the patients are obviously blackmailing them. Patients also know the hospitals’ mentality very well, and actually take advantage of it. Some have chosen to stage farcical protests because doing so best maximized their interests. In fact, they deliberately avoided legal resolution because they knew hospitals would satisfy their monetary demands anyway."

The article goes on to say that hospitals fear high-profile protests because of the detrimental impact on their reputation, (which would inevitably affect their income) and also the political mandate imposed by local government to avoid mass incidents.

"They are also generally reluctant to resort to legal channels as litigation will not only ruin their reputation, but also consume a great deal of energy and time. Many studies have identified private settlement as the most popular means of resolution, even when patients’ complaints are clearly
unreasonable," it says.

In a second part of the study, two thirds of 300 doctors surveyed described relations with patients as 'very tense' and a similar proportion (65%) had been physically assaulted at least in the previous year.

The authors of the study say there are several key lessons for preventing and managing medical disputes in China. First and foremost is the need to reduced doctors' workload to a level where they have time to interact with patients and spend a meaningful amount of time with patients to allow good communication, adequate assessment and diagnosis and explanation of medical matters so that patients can make 'informed choices'.

Secondly, there is an urgent need to remove the profit/bonus incentives for doctors so that they paid according to their performance on good clinical practice rather than on how many drugs they have prescribed.

The study authors have a rather bleak outlook about the possibility of curbing attacks on healthcare staff - at least in the short-to-medium turn:

"For decades, health policy reform proposals have always put financing reforms, realignment of provider incentives, or organizational restructuring first. However, the [medical dispute] crisis in China shows policymakers and advisors the detrimental consequences of hostile interactions between doctors and patients. While it is not unreasonable to expect systemic reforms to restore trust between the two parties, one must bear in mind that it may take much longer than anticipated to see the effects; in the meantime, the dysfunctional doctor–patient relationship continues to deteriorate," they conclude.

The right and wrong way to do primary care: Shanghai vs Shenzhen

by MICHAEL WOODHEAD
Pilot programs in primary care have been carried out in two of China's largest and wealthiest cities since 2009: they used different models and it looks like Shanghai got it right and Shenzhen got it wrong. 

The basic difference between the two models of care was that Shanghai went with a more UK/European model of having independent general practitioner-owned centres that were publicly funded via a capitation model and which were based around multidisciplinary teams. Shenzhen, by contrast, used a more conservative approach based on clinics run by existing hospitals that installed GPs in rented premises and who were given only minimal funding, and thus they had to charge patients or make revenue from commission on drug sales.

In other words, the Shenzhen system was really just using primary care practitioners in the same failed model that currently operates in China's hospitals. GPs in Shenzhen felt underfunded and they had no support staff - and this inferior quality was noticed by patients. In an evaluation of 3421 citizens carried out by health researchers from Hong Kong, it was found that the perception of primary care quality among local residents improved in Shanghai since 2009, whereas it deteriorated in Shenzhen.

What were the factors that worked for Shanghai? According to the researchers, the Shanghai model was based on public-funded primary healthcare teams that included doctors, nurses and public health specialists. They tailored their care to local needs - offering programs for chronic diseases of the elderly such as diabetes and hypertension, and also for maternal and child health.

The Shanghai funding model was partially based on capitation - in other words, the clinics received about $20 a year per patient they enrolled. Enrolment with a community health centre was a key feature of the Shanghai model, with residents offered free care if they stuck with the same clinic rather than attend tertiary hospitals for care. The Shanghai GP centres were funded by local government and could provide services and prescriptions at no cost to local people.

In contrast, the Shenzhen clinics were set up and operated by hospitals, which ran them along the same lines as other hospital departments - namely with GPs having to derive their income from fees and drug sales. This meant that many patients had to pay upfront fees - especially as about 70% of the local populace are internal migrants and their fees are not reimbursable by their hometown-based health insurance policies.

It seems that Shenzhen's primary care clinics were Cinderella services - playing second fiddle to well-funded and high prestige hospital clinics. GPs were underpaid and poorly resourced compared to their hospital counterparts. No wonder patients perceived a lack of quality in their services.

The study authors make the obvious conclusion that the Shanghai model if the better one: "The quality of primary care improved in Shanghai but not in Shenzhen. This may be because, in Shanghai, beneficial long-term relationships between patients and general practitioners were supported by capitation payments and the provision of services tailored to local health priorities."

Source: WHO Bulletin

Why don't Chinese bystanders assist in medical emergencies?

by Michael Woodhead

A frail women collapses at a train station but passers by do nothing. She lies there for almost an hour before emergency services arrive, by which time the woman has died. This was a real incident at Shenzhen railway station in February this year. 

Why do mainland Chinese people not act as Good Samaritans? asks Dr Dan Xiuli of the nearby Faculty of Medicine at the Chinese University Hong Kong, Shatin. Writing in the Emergency Medical Journal this week, he asks, is it because would-be helpers in China have a fear of being wrongly blamed by victims as perpetrators and subject to demands for compensation?

A recent survey found that only 14% of mainland Chinese would be willing to provide assistance to a stranger who needed medical assistance. And that reflects what happens in real life: most bystanders don't get involved, they hover and watch or they scuttle past without offering help. This reluctance to help has major implications for the 1.2 million Chinese who have accidents in public and require assistance each year, he says. Heart attacks, sudden illness in public, traffic accidents, natural disasters etc all require people who are willing to step forward and provide first aid skills. Is there any possibility of this happening in the People's Republic?

Groups such as the Red Cross have suggested that a minimum of 30% of the population should have first aid skills training in order to be able to provide assistance in public emergencies. In developed countries such as Norway, more than 85% have skills in First Aid, whereas in the UK only 14% of people profess to have such skills. At the time of the Beijing Olympics in 2008 the Chinese government aimed to have more than 1% of people trained in first aid, but failed to reach this target. For most Chinese the only aid they are able to provide is notifying the 'relevant authorities' such as by dialling 120.

Not surprising then, that studies have estimated that 87% of deaths from accidents in China are due to the lack of first aid. And shockingly, even staff entrusted with the care of the vulnerable, such as infants have no training or skills in first aid - fewer than 4% of kindergarten teachers could achieve even basic knowledge in first aid.

Dr Dan concludes by saying that "First aid is not merely a skill but an act of humanity." He notes that China has a culture of many thousands of years, but most Chinese seem to have forgotten the traditional call to virtue of: ‘To rescue one person from death is better than to build a seven storeyed Buddha pagoda’ .

Update: Some interesting research on Australian bystander reactions to medical emergencies from Flinders University.

One Country, Two Health Systems: or how Hong Kong has a socialist health system while China has a capitalist one

by Michael Woodhead
It is seldom remarked, but capitalist Hong Kong has a socialist health system while 'communist' China has a capitalist one. 
Hong Kong has a British NHS-inspired publicly-funded health service that remains efficient, good value for money and corruption free. China, on the other hand, has ditched its Soviet-era state-run 'health for the masses' system and replaced it with a state-owned user-pays system that is run on private lines. Don't take my word for it - there is an excellent article illustrating this in the obscure medical journal the International Journal of Radiation Oncology. It makes an interesting comparison of the Hong Kong and Chinese health systems through the eyes of oncologists who work in a cross-border co-operation clinic in Shenzhen.

Health systems
The oncologists note that Hong Kong's health system is based on heavily-subsidised public hospitals that provide treatment at no cost or only minor cost to all Hong Kong residents. It is an efficient system that accounts for only a modest 5.2% of GDP (compared to around 9% for many western  countries and 17% for the US). The Hong Kong public health system is perhaps a little too successful for some interest groups, as it means there is a very low uptake (27%) of private health insurance.
In contrast, China has a capitalist health system (where “money follows the patient') that is struggling to meet the needs of many citizens. Although China has a high rate of health insurance (often funded by employers), this does not cover expensive drugs or medical treatments. There is no safety net system provided by the state, and medical bills are a major burden, especially for low-income families. Initial consultation charges are a modest $2-3, but all Chinese hospitals have to be financial sustainable and thus doctors are encouraged to prescribe expensive drugs, order tests and even promote nutritional products, none of which may be justified by the patient's condition. As the oncologists say with some understatement: "there are serious concerns about the cost effectiveness and quality of services." 

Disease trends
In terms of cancer, Hong Kong and China are also poles apart. Due to preventive health and better treatment programs, cancer rates have decreased by 22% in Hong Kong in the last 25 years and cancer death rates have decreased by 29%. In China, however, rates of cancer have increased dramatically in the last decade as Chinese people have become wealthier and adopted unhealthy lifestyles and persist in smoking. In Shenzhen, cancer rates increased  from 37 per 100,000 people to 100 per 100,000 in the last 10 years. Many of the common cancers could have been prevented through screening and early detection- such as cervical cancer in women, rates of which have been decreasing in Hong Kong. Hepatitis B vaccination is another intervention that should reduce liver cancer rates. 

Doctor training
For oncologist training, Hong Kong follows the UK system of requiring several years postgraduate training regulated by peer group 'colleges' during which clinicians must demonstrate practical expertise in medical oncology, radiation oncology and palliative care, rather than being single branch specialists. Thus patients are treated by a team of oncologists in a 'one stop shop' model. In China there is no formal training program for oncologists, most specialise in one branch of oncology by doing written exams and there is no palliative care training. In China the work of oncologists is governed by 'standard operating procedures' in which the emphasis is on compliance rather than quality or outcomes. 

Access to treatment
When it comes to treatment, cancer patients in Hong Kong have access via public hospitals to the latest technology such as linear accelerators, at modest cost (US10 per attendance). Access is based on clinical need, not financial status or connections. Thus a full course of radiotherapy would be about $400 for a public patient, whereas it would cost $36,000 for a private patient. Across the border in Shenzhen, access to the latest radiotherapy equipment is - in the words of the authors - "appalling". There are only a handful of poor-quality liner accelerators and they are scattered across various hospitals - most patients and doctors do not know how to access them, and even those who do are often reluctant to use them because of fears about toxicity, not to mention the high cost. Shenzhen needs at least 16 such machines (Hong Kong has 37) but hospitals find it extremely difficult to buy such major items because of red tape from the Ministry of Health and the inflated costs of middlemen and the 'commissions' needed to import high-tech equipment into China. 

Drugs - if you can afford them
Access to chemotherapy drugs also differs markedly between Hong Kong and China. In Hong Kong, drugs are approved for use if they can be shown to be cost effective. Regulators model their the drug approval processes on those of western countries.
Patients pay US $13 per oncologist consultation and US $1.30 per drug prescribed. Some high cost drugs are not publicly funded but some costs may be covered by the public safety net or by charities.
In China, many chemotherapy drugs are not available or are long delayed in gaining approval from the China FDA. Drugs that are approved are available on a user-pays basis and can be very expensive. Pemetrexed, for example, costs US $1155 for the genuine drug in Shenzhen although a Chinese generic version is available for US $353. However, the quality of generic drugs is often poor. There are no programs for low income patients. 

Opium wars left their mark?
For palliative care, Hong Kong has developed an integrated  multidisciplinary system based in public hospitals and with hospices. In China, palliative care services are limited or non-existent. There are no palliative care specialists, and so treatment is provided - if at all - by anaesthetists. Pain relief is hampered by draconian regulations over the use of opioids. Most doctors are not allowed to prescribe them, and those who are authorised can only provide a week's supply. Many terminally-ill cancer patients are too weak to return to the hospital every week. This means that cancer pain is under-treated in China.

Looking to the future, on the positive side, health services in China are now evolving rapidly and there is a huge demand for good-quality clinical services. The authors say their Hong Kong-Shenzhen hospital has been operating for only a year but is already providing valuable lessons and experience. It has established a strict 'no-bribery' rule and has also become the first hospital in China to gain international certification for quality of management.

[Editor's note: This story is based on an article by Drs Anne Lee, Henry Sze, Lam Ka-On and Chen Xian of the Clinical Oncology Center, University of Hong Kong – Shenzhen Hospital.]

Shenzhen takes to family doctors

by Michael Woodhead
On International Family Doctor Day a Shenzhen joint venture clinic with Hong Kong University is claiming that general practitioners are proving popular with patients. 
The HK University Shenzhen Hospital clinic offers a GP service in which patients with chronic diseases can book face to face appointment with their family doctor. The clinic has an 80% return rate and the main diseases treated are cardiovascular disease, diabetes, arthritis and mental health problems, according to GP Dr Liu Ruihong. He said other hospital clinics are not open to external referrals, and only accept internal referrals. However, the GP clinic works on international model in that a GP can refer to the hospital clinic and vice versa. He says that according to WHO criteria, patients with chronic diseases are best treated by a generalist doctor with continuity of care and an emphasis on preventive care. With good GP care, patients with chronic diseases can stay healthy and avoid the need for hospital treatment for decades, he says.
After six months of a pilot program, the clinic is proving popular with patients and an increasing numbering are registering with the clinic and returning to see their personal doctor, he added.

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."

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.

Shenzhen 'fake doctor' jailed for two years for running sex-selective abortion clinic

A woman with no medical qualifications who ran a sex-selection abortion clinic from her own Shenzhen apartment has been jailed for two years.
The woman was prosecuted after one of her clients had a botched abortion that left her infertile. A Shenzhen court was told that the woman called Liu Mo had offered a 'quick and painless' abortion for 800 RMB to a woman who came to her clinic after having a scan showing she was pregnant with a female foetus. Her family had pressed her against having a girl and Liu Mo performed an abortion. However the procedure was done badly and the woman had severe haemorrhage and was taken to the public Renmin hospital in Shenzhen. Doctors there were able to stop the bleeding but told the woman she would most likely be unable to have children.  According to Sohu, the fake doctor was sentenced to two years in prison and fined 5000 RMB.

Seven important items of medical research from China

N95 masks don't work for Chinese faces
The specialised N95 face masks used to protect against infections such as influenza are not shaped to fit Chinese faces and most would fail to prevent transmission because of poor fit and leakage, tests by Wuhan researchers have shown. Evaluation tests on ten different types of N95 mask found that only two performed within acceptable limits to prevent transmission of infections. Performance of some masks was better when users were trained and they were specially fitted, the study in PLOS One showed.
"This study indicated that widely used N95 filtering facepiece respirators in China didn't fit well and can't provide desired protection for respirator users," the researchers concluded.

Malaria from Africa now a problem in China
Malaria has been virtually eliminated in China but doctors now face the problem of treating malaria in Chinese workers who have returned from Africa. In Jiangsu there have been 918 malaria cases and six deaths in the last decade due to malaria imported from other countries. The imported cases make up 12% of all malaria cases and account for all malaria deaths, according to researchers from the Jiangsu Institute of Parasitic Diseases, Wuxi, writing in the Malaria Journal.

No cardiovascular treatment for many Chinese patients
Two out of three Chinese people with cardiovascular disease are still going untreated, a major study has found. Data from of 512,891 Chinese adults showed that 5% had a history of cardiovascular disease. However, of these only 35% had been treated with any cardiovascular medicine for secondary prevention such as statins, antiplatelet drugs or antihypertensives. The findings from a team from Oxford and Beijing universities, are published in the International Journal of Cardiology.

Shenzhen women have high rates of HPV
More than one in ten women in Shenzhen are have HPV serotypes that put them at risk of cervical cancer, researchers say. A study of 4, 413 women measured HPV infection rates and the prevalance was 14%. The high risk HPV types 16 and 18 that are likely to cause cervical cancer were found in 3.5% of women and 1.27% of women, according to the study published in the Asia Pacific Journal of Cancer Prevention.

Avian H7N9 flu virus on way to mutation
The H7N9 influenza virus is genetically much more diverse than previously thought, suggesting that it is reassorting and closer to mutating into a pandemic virus, researchers from the Jiangsu Provincial Center for Disease Control and Prevention, have shown. They report their findings in Nature.

Medical teacher burnout
Staff at medical colleges in China have high rates of burnout, a study from Shanxi shows. Staff who had a love of teaching and those who received praise and recognition were less likey to suffere burnout, according to the study in Archives of Environmental & Occupational Health.

Pancreatic cancer in Shanghai
The diagnosis and treatment of pancreatic cancer in Shanghai has room for improvement, according to researchers from Fudan University. In a review of management of pancreatic cancer published in Cancer Letters, they report that most patients miss out on the recommended histologically verified diagnosis and the 1-year and 2-year survival rates were 35% and 14.4%, respectively.

Family facing 180,000 RMB medical bill refuse to move out of Shenzhen hospital

A teenager has been staying in a hospital in Shenzhen, Guangdong Province for about 500 days after she received medical treatment there, though the hospital suggested she leave 14 times considering her healthy condition.
Xiaomin, 16 years old, came to the Shenzhen Children's Hospital for dilated cardiomyopathy with fatal arrhythmia on July 2010, when the hospital gave medical treatment for three days and saved her life.
From August 2012, the hospital began to suggest Xiaomin leave the hospital considering her healthy situation.  The hospital also invited experts to carry out consultation meetings on the teenager's health several times.
The hospital said the family used the patient room with three beds as their home, living there, cooking meals, bathing and resting. However, the family refused to move out.
In the past 500 days, the medical fees reached another 180,000 yuan ($29,646), and the family had only paid 8,000 yuan.  Xiaomin's father surnamed Ge said he could only earn about 1,000 yuan a month, and his factory was about to go bankrupt.
Source: Global Times

Shenzhen Kangtai Hepatitis B vaccine withdrawn after four infant deaths

by Michael Woodhead
The China Food and Drug Administration (SFDA) has suspended the use of recombinant hepatitis B vaccine for children manufactured by Shenzhen Kangtai Biological Products (Shenzen Kangtai Shengwu Zhipin, 深圳康泰生物制品股份有限公司) after the four deaths were reported among children who received the vaccine. According to an announcement by the SFDA on 20 Dec, the four deaths were reported following vacination with batches of the company's vaccine in Hunan, Guangdong and Sichuan. The SFDA says an investigation into the cause of death is still underway and until the results of this investigation are available, the use of all batches of the vaccine is being suspended immediately, in the interests of child safety and safety of the infant vaccination program.

Shenzhen the source of Hong Kong's H7N9 infections

by Lisa Schnirring
Health officials in Hong Kong today said they detected a second imported H7N9 flu case, in an 80-year-old man from the mainland, while mainland China reported another new infection, which sickened a 30-year-old man from Zhejiang province.
Both of the H7N9 cases reported this week have travel ties to Shenzhen, a major city just north of Hong Kong in China's Guangdong province. The new case in Zhejiang, about 800 miles northeast of Guangdong province, further boosts the province's status as China's hardest hit by the H7N9 virus.
Meanwhile, new scientific findings released today suggest that the virus doesn't latch on to human cells strongly enough to pose a pandemic threat, though the virus bears close monitoring for further changes.

HK doctors face official obstacles to running clinics in Shenzhen

by Ernest Kao
Hong Kong general practitioners operating clinics across the border have been facing many difficult challenges despite a huge market for quality medical services in China.
Complex bureaucracy, arcane regulations and operating costs even higher than Hong Kong's have been weighing heavily on private medical practices in Shenzhen - like the one belonging to Wu Wei. The Hong Kong doctor set up his clinic there three years ago.
But Shenzhen’s Health, Population and Family Planning Commission has suspended Wu’s practice for “poor business management” and ordered the clinic to "rectify its problems by March 31", the Southern Metropolis Daily reported on Tuesday.
Wu’s practice provided a range of services including traditional Chinese medicine, gynaecology, dentistry - even cosmetic surgery. Wu was contacted by reporters at the Daily, but staff at his clinic said the doctor had been away since the beginning of the Spring Festival. They did not know where he was.
Wu opened his Luohu clinic in 2010 and was one of the first Hong Kong GPs to capitalise on new Closer Economic Partnership Arrangement (Cepa) rules. These allow medical service providers from Hong Kong to tap the mainland market and enjoy "national treatment” in setting up wholly-owned or joint medical institutions.
The aim was to develop a market in Guangdong for quality Hong Kong-based medical services for China's rich.
Hong Kong-based Dr Wong Chi-ho told the South China Morning Post that although there was still a large market for Western and Chinese medical services on the mainland, operating and start-up costs were still too high.
“Moving up to the mainland will still be the trend, but doctors must be prepared to spend a lot of money for new equipment and meeting the regulations of local authorities,” he said.
Wong says he is one of the few Hong Kong GPs left in Shenzhen and alternates from his Shenzhen and Tuen Mun clinic throughout the week. He was the first Hong Kong doctor to obtain a licence to practice western medicine in China and opened up his clinic last May.
“Some of the current medical practice regulations for hospitals may not be suitable for private clinics,” he added.
Private clinics charge about 500 yuan (HK$620) for a single consultation in Shenzhen, about three to five times more than hospital outpatient departments.
Source: SCMP

Aged care home shortage shows need for insurance plan: adviser

Shenzhen has only 4894 aged care places its 862,000 elderly population

A political advisor in Shenzhen in Guangdong province, has suggested the government establish an insurance plan to pay for aged care.
Xu Long , a member of the Chinese People's Political Consultative Conference (CPPCC) Shenzhen committee, said in a proposal that there are 862,000 people over 60 living in Shenzhen, but the 30 aged care homes in the city can only accommodate 4,894 people.
Despite the lack of beds for the elderly, many old people opt to spend long periods in hospital, receiving care at the cost of medical insurance, because the current medical insurance does not cover daily care for the aged.
This has led to immense growth in the city’s medical insurance expenditure, he said at the fourth conference of the fifth session of CPPCC Shenzhen Committee, which is being held from Sunday to Wednesday.
Xu, who is also deputy director of a hospital in Shenzhen, Guangdong Province, proposed that Shenzhen should establish a long-term elderly care insurance system.
Individuals, the government and the enterprises should pay for the insurance premium together, he said.
Eventually, the insurance will help lift some of the financial burden from both the government and families, he said.
Source: China Daily

Ketogenic diet helps reduce seizures in Chinese children with epilepsy

by Michael Woodhead
One in three Chinese children with epilepsy reduced their rate of seizures when they tried the ketogenic diet, a study conducted in Shenzhen has shown.
Dr Suo Chenqu and co-researchers at the Shenzhen Children's Hospital conducted a trial of the high-fat, low-carbohydrate dietdiet which has been used to treat refractory epilepsy in childhood internationally.
Between 2004 and 2011, the researchers assessed the diet in 317 children with refractory epilepsy and followed them up for at least a year. After 3, 6 and 12 months, 63%, 42% and 24% of children remained on the diet, and at these times 35%, 26% and 19% of children respectively showed at least a 50% seizure reduction.
These improvements included 21%, 14% and 11% of children who remained seizure free while on the diet. The researchers found that the starting age for the diet influenced efficacy. Children aged over ten when they started the ketogenic diet showed a worse response than the under 10 age group. Other variables such as duration of epilepsy at the start of the diet, seizure types and aetiologies showed no significant influence on efficacy. Outcome was measured by seizure frequencies before and after the diet, change in anticonvulsant use and adverse effects. Common complications of the diet included GI disturbance, food refusal and hypoproteinaemia.
"The ketogenic diet is a safe and efficacious therapy for intractable childhood epilepsy in Chinese children," the researchers conclude.
Source: Seizure Journal.

Shenzhen gene sequencers find clues to autism

Shenzhen's BGI genome centre has found mutation hotspots in people with autism

An international team, including a Shenzhen-based gene sequencing company, has discovered that "random" mutations in the genome are not quite so random after all. 
Their study, to be published in the journal Cell on December 21, shows that the DNA sequence in some regions of the human genome is quite volatile and can mutate ten times more frequently than the rest of the genome. Genes that are linked to autism and a variety of other disorders have a particularly strong tendency to mutate.
Clusters of mutations or "hotspots" are not unique to the autism genome but instead are an intrinsic characteristic of the human genome, according to principal investigator Jonathan Sebat, PhD, professor of psychiatry and cellular and molecule medicine, and chief of the Beyster Center for Molecular Genomics of Neuropsychiatric Diseases at UC San Diego.
"Our findings provide some insights into the underlying basis of autism—that, surprisingly, the genome is not shy about tinkering with its important genes" said Sebat. "To the contrary, disease-causing genes tend to be hypermutable."
Sebat and collaborators from Rady Children's Hospital-San Diego and BGI genome center in China sequenced the complete genomes of identical twins with autism spectrum disorder and their parents. When they compared the genomes of the twins to the genomes of their parents, the scientists identified many "germline" mutations (genetic variants that were present in both twins but not present in their mother or father).
Nearly 600 germline mutations – out of a total of 6 billion base pairs – were detected in the 10 pairs of identical twins sequenced in the study. An average of 60 mutations was detected in each child.
"The total number of mutations that we found was not surprising," said Sebat, "it's exactly what we would expect based on the normal human mutation rate." What the authors did find surprising was that mutations tended to cluster in certain regions of the genome. When the scientists looked carefully at the sites of mutation, they were able to determine the reasons why some genomic regions are "hot" while other regions are cold.
"Mutability could be explained by intrinsic properties of the genome," said UC San Diego postdoctoral researcher Jacob Michaelson, lead author of the study. "We could accurately predict the mutation rate of a gene based on the local DNA sequence and its chromatin structure, meaning the way that the DNA is packaged."
The researchers also observed some remarkable examples of mutation clustering in an individual child, where a shower of mutations occurred all at once. "When multiple mutations occur in the same place, such an event has a greater chance of disrupting a gene," said Michaelson.
The researchers surmised that hypermutable genes could be relevant to disease. When they predicted the mutation rates for genes, the authors found that genes that have been linked to autism were more mutable than the average gene, suggesting that some of the genetic culprits that contribute to autism are mutation hotspots.
The authors observed a similar trend for other disease genes. Genes associated with dominant disorders tended to be highly mutable, while mutation rates were lower for genes associated with complex traits.
Read more: Eurekalert

Carcinogens in Shenzhen food supply pose cancer risk

High levels of carcinogenic aromatic hydrocarbons have been found in vegetable, pork and rice samples collected from Shenzhen. The cancer risk from exposure to polycyclic and halogenated aromatic hydrocarbons was estimated to be between "serious" and "acceptable", with children facing the highest cancer risk, followed by adolescents, seniors and adults.
Read more: Science of the Total Environment

Envy and discomfort over China's industrial scale push into genomics

Companies like BGI in Shenzhen are sequencing the human genome on a a massive scale

In Shenzhen, the genetic secrets of life roll off machines by the minute. Here at the global headquarters of BGI-Shenzhen, housed in a former shoe factory, the genomic revolution runs on an industrial scale. Powered by an army of young lab technicians and banks of high-end, U.S.-made sequencers that hum 24/7, the DNA of human kind is decoded with conveyor-belt speed and brute force.
But not just human DNA. Once known as the Beijing Genomics Institute, BGI is on a mission to sequence the genomes of a vast array of living things. It has already done rice, the cucumber, the Giant Panda, the Arabian camel, the chicken, the coronavirus behind severe acute respiratory syndrome (SARS), 40 strains of silkworm and the Tibetan antelope, to name just a few.
Its services are in high demand. It has unravelled the DNA of a 4,000-year-old Greenlander dubbed Inuk, teamed with Saudi Biosciences to sequence Arab genomes and with the University of Edinburgh to decode plants, animals and people in Scotland. Canadian and U.S. research groups are repeat customers.
As with many things made in China, the price is hard to beat. Drug companies, doctors and researchers around the world are in awe, and more than a bit envious of BGI’s resources.
As a Canadian government scientist tweeted: “China’s big push in genomics. 128 Illumina sequencers in an old shoe factory and I can’t get a single one for my lab.”
But along with the envy, there is discomfort and, in the United States, outright fear that an enterprise backed in part with bank loans supported by the Chinese government has unfettered access to the genetic building blocks of humanity. DNA, after all, contains the chemical hallmarks of what makes each of us unique – the raw material that may hold the keys to the next breakthroughs in science and medicine.
What might China – with its poor record of enforcing intellectual property laws and history of human-rights abuses – do with this information?
U.S. officials first raised eyebrows after BGI snapped up a record-breaking order for 128 cutting-edge sequencers made by San Diego-based Illumina. but the concerns are more urgent now that the authorities are deliberating whether to allow the Chinese company to buy Complete Genomics of California, a major U.S. sequencing company.
The acquisition would help to cement China’s supremacy as the world’s top genome sequencer, boost its technical prowess and give it a strong U.S. base, but the deal has officials there fretting over both the security of genetic data and national security.
Because the technologies involved “have national security implications related to bioweapons, this bears strict scrutiny,” says Michael Wessel, who sits on the U.S.-China Economic and Security Review Commission. “Are there capabilities here that can be adverse to American interests?” he told the Washington paper Politico last week.
But some feel that such fears have more to do with trade than security. Last week, The Associated Press reported that China has overtaken the United States as the world’s largest trading partner. This week, the United Nations found it also has surpassed the U.S. in patent applications, although the quality of its patents is often disputed.
Harvard University geneticist and entrepreneur George Church, an adviser to many biotech companies, dismisses concerns over China’s dominance in genomics as “misplaced nationalism.” Mark Poznansky, head of the Ontario Genomics Institute, agrees: “There’s recognition that we just can’t compete. I think that’s part of the paranoia.”
BGI argues that there’s “absolutely no basis for such a wild and speculative claim” of national-security threats and bioweapons risks. It says those fears are sour grapes seeded by Illumina, which also bid for Complete Genomics but lost to out to BGI.
Writing to Complete Genomics directors last month, Illumina said BGI is a “foreign state-owned entity,” and the deal raises “national security, industrial policy, personal identifier information protection and other concerns.”
BGI denies that it is state-owned, but, ironically, even as it makes a big play for the world’s DNA, China is cracking down to ensure that the genomes of its own citizens stay home. Its state council is now drafting regulations to protect the country’s “human genetic resources,” fearing that it will lose intellectual-property rights over its citizens’ genetic information.
Source: Globe and Mail

Public hospitals in Beijing, Shenzhen raise doctor fees

Public hospitals are to raise doctor frees to compensate for lower medication fees

by Zan Xin
Public hospitals in two major cities have announced increases to doctors' fees and steps to lower medicine costs. However, one expert says the central government should let the market set fees for physicians.
Two years ago the State Council took steps to lowers costs in the public health care system, largely funded by sales of prescription drugs. Now, two governments are announcing major reforms on their own.
In May, Shenzhen and Beijing raised doctor fees while announcing new guidelines to cut prescription drug costs. Hubei, Shaanxi and Jiangsu provinces are also mulling plans to raise physician fees.
Across-the-board increases for physician services were first implemented in Zhejiang Province last year.
Beijing raised doctor fees from a standard 14 yuan per session to up to 100 yuan for specialists. A session with an associate chief doctor now costs 60 yuan while a chief doctor visit is now 80 yuan.
In Shenzhen, the fee to visit a doctor rose 12 yuan on average.
Song Ruilin, executive director-general at the Research Center for Medicinal Policy at the Chinese Pharmaceutical Association, said the central government should let the market set the prices for doctors' fees.
The two governments also announced they would not allow hospitals to mark up prescription medicines anymore. The central government allows hospitals to mark up drugs 15 percent. 
 
Capital University of Medical Sciences Professor Cui Xiaobo said eliminating the mark-up will not stop hospitals and doctors from receiving commissions from pharmaceutical companies.
Source: Caixin

In Shenzhen, rent boys have safer sex and lower HIV rates

Among gay men, those who sold sex had higher rates of condom use and lower rates of HIV

 by Michael Woodhead
Gay men who sell sex to to other men have higher rates of consistent condom use and lower rates of HIV,  researchers in Shenzhenhave found.
They say HIV transmission among men who have sex with men  has become an increasing concern in China. Money boys are a subgroup of gay men who sell sex to men. Direct comparison of HIV prevalence and related risk factors between "money boys" and non-commercial men who have sex with men has rarely been done.
Therefore, researchers studied HIV rates in 850 "money boys"  and 801 "non-commercial" gay men  in Shenzhen They found that the prevalence of HIV was 4.5% in "money boys" and 7% in  other gay men. Although "money boys" tended to have more male partners than  gay men, they were more likely to report a consistent condom use in male anal intercourse, especially in commercial sex. Noncommercial  gay men were more likely to visit parks and saunas instead of bars, massage centres, recreational centres, and home-based venues.
Syphilis infection and type of 'pick up' venue were associated with HIV infection in both "money boys" and  gay men. Being from a hometown with a high HIV prevalence was a risk factor for HIV infection in "Money boys", and early sexual debut was a risk factor in non-commercial gay men.
The researchers conclude that "money boys" differ from  gay men in the rate of HIV infection and some sexual characteristics and behaviours. Different safe sex and HIV-prevention promotion interventions specifically targeting the two subgroups may be necessary, they say.
Source: Sexually Transmitted Diseases