Chinese media cranks up "Heroic, Selfless Doctor" propaganda

by MICHAEL WOODHEAD
For the last year there has been a steady drip-drip of doctor-as-hero stories appearing in the Chinese media. A typical (and recurrent) one is the story of the sick doctor who keeps on working despite being ill enough to require an infusion line stuck in his or her arm. This is presumably intended show show how dedicated the doctor is in the spirit of that selfless icon Lei Feng.

In reality these stories make the doctor and the health service look foolish and backward. No professional doctor would turn up at the hospital if they have an infectious disease. And no self respecting doctor would believe that an infusion is the right treatment for an ambulant patient. If you're sick enough to require IV antibiotics then your place is in a hospital bed, not the doctor's seat.

The fact that these stories appear on a regular basis in the Chinese media suggests that there is some ongoing propaganda edict from on high to publicise selfless healthcare staff.

Until now, these doctor-as-Lei-Feng stories have just been an occasional eyebrow-raising oddity. However in the last month or so there have been more and more such stories appearing in the media. Last week there was a story of a doctor who was so busy that his son resorted to booking an appointment as a patient so that he could get to see his father. In a family-focused society such as China this 'heart-rending' story was no doubt intended to show how overworked and noble the Chinese doctor is.

This week the selfless medic story of the moment is one concerning Zhejiang doctors who have reportedly been lending money to poor patients so that they can pay for their medical treatment.

According to the local media, a female doctor Yang Yonghong, chief physician at Zhejiang Taizhou Municipal Hospital of Infectious Diseases lent 500 yuan to a patient who said he could not afford to pay for the antibiotics he had been prescribed. Dr Yang insisted that the man take the money to pay for an IV infusion for his sepsis. According to Dr Yang, the man had a life threatening infection that needed immediate treatment. When he wavered about paying, Dr Yang handed over the money and said he could repay her later.



The man reportedly left and did not return for his infusion. But Dr Yang said it was better to offer money and lose it than to risk a patient dying. Fortunately for this doctor the story had a happy ending when the patient returned two days later to repay her. He said he had sought treatment at a local clinic because it was too late to return to the hospital. The patient then allegedly made a full recovery.

Dr Yang has since become a local hero on social media for her generous and selfless action - especially as she was very self deprecating, saying it was nothing, and that many doctors performed similar acts of generosity every day.

"I often ask patients about their economic circumstances and if they are not rich I try to prescribe cheaper drugs and treatment. Last year I lent several hundred yuan to patients who could not afford treatment - I did not hear back and I hope they are well," she is quoted as saying.

The whole sounds very fishy and too good to be true. Is this Xi Jinping's way of sugar coating the medical reforms that will require patients to pay higher fees for medical care?

Self circumcision attempt goes horribly wrong for Zhejiang man

by MICHAEL WOODHEAD
After working as a urological surgeon for five years at Zhejiang's Yongkang No1 People's Hospital, Dr Hu Xiang thought he'd seen it all. But near midnight on the 11th of June, a delicate-looking young man waddled into the department clutching at his groin. When Dr Hu asked what was the matter, the man removed his hands to reveal his trousers were stained with blood. After getting him to lie down on the bed, the man revealed that he had circumcised himself at home, and his penis foreskin would not stop bleeding. 

"Have you had medical training?" asked Dr Hu. The young man shook his head and said he had heard that circumcision was a simple operation and thought he would do the it himself. He had looked up how to do it in books and on the internet and had made an attempt when the rest of his family were out of the house.

When Dr Hu inspected the man's penis, he observed that it had been unevenly cut and what remained of foreskin was 'mashed' and was bleeding from areas where small blood vessel had been severed. The man had also tried to stitch up the cut penis with eight stitches of white sewing cotton.

Dr Hu asked him what had happened. The man said he was 30 years old, married with a daughter, and did not like the appearance of his foreskin, and thought it 'too long'. He had therefore gathered some scissors and some sewing needles and cotton and attempted to circumcise himself. When the scissors proved too blunt, he had tried a razor blade instead and was able to cut the foreskin. The man then sewed eight or nine stitches in the wound. None of the cutting and sewing implements had been sterilised, he admitted. Dr Hu noted that the man had cut too much and had damaged some of the erectile tissue of the penis in his amateur attempts at self-surgery.

The doctors in the urology department took the man in for surgery, to try curb the bleeding and prevent further complications. They did this under local anaesthetic, but were amazed to find the man kept sitting up and giving them advice on how they should do the operation. "Don't make any creases here .. make that bit look a bit more beautiful ..." he told them.

Dr Hu told local reporters that he was experienced in performing circumcisions, and these usually took no more than 20 minutes without complications. However, the self-circumciser had needed about an hour of surgery, including restorative plastic surgery to avoid disfigurement. The man had also warned them haughtily not to tell anyone about what had happened and not to talk to other members of staff at the hospital.

To add insult to injury, the patient then 'did a runner' after being left in the hospital ward to recover overnight. The next morning he had left without leaving any contact details. Dr Hu said the usual cost of circumcision was about 500 yuan, but this man had left an unpaid medical bill of 1000 yuan. He advised the man that he would have to return for follow up of his operation. If not, he could face serious complications such as infections and disfigurement.

Dr Hu's advice was that all circumcisions should be done in a proper hospital environment. he said he sometime had seen men who had circumcisions done in unofficial 'backstreet' clinics that did not have sterile equipment - and this could lead to excessive bleeding and skin  infections. However, he said this case was the first time he had seen someone try perform a circumcision on themself.

Good news on infant mortality rates in China - but have the numbers been exaggerated?

by Michael Woodhead

The Economist [aka 'the Monetarist'] is impressed with China's socialist achievement in reducing rates of maternal and infant mortality over the last decade. 

The magazine this week cites a WHO report that praises China for reducing rates of infant mortality from 61  to 12 deaths per 1,000 live births since 1991 - meaning they are now one fifth of what they were in the time of Deng Xiaoping. Maternal mortality rates have also dropped by about 70% over the same period. The improvements are attributed to the introduction of universal health insurance  schemes that subsidise hospital care for maternity care - and also implementation of infant vaccination programs.

The Economist then raises a lot of questions about whether China's vaccination program is as safe and appropriate as it could be - mentioning the recent scare about hepatitis vaccine quality and the ineffectiveness of measles vaccine programs. It even makes an absurd suggestion that China should step back from blanket immunisation and instead test mothers for immunity to various diseases before vaccinating them accordingly.  The overall message, however, is that China deserves credit for a major improvement in mother and baby health.

Coincidentally this week a letter is published in The Lancet Global Health from Chinese researchers questioning whether the gains are as extensive as they seem. Dr You Hua and colleagues at the School of Public Health, Zhejiang University School of Medicine, Hangzhou, write that recent improvements in infant mortality have been confined to rural areas - with little change in urban areas despite much greater rises in standards of living. 

Like WHO, they also attribute the improvements in rural areas to the introduction of the New Cooperative Medical Scheme in 2003. The coverage of this scheme reached 97% of village hospitals in 2011 and the subsidies allowed pregnant women to access antenatal and postnatal services. The Chinese researchers note that maternal mortality rates fell from 65 to 27 per 100 000 between 2003 and 2011 in rural areas, but remained virtually unchanged in urban areas. They speculate that the lack of change in cities may be due to the influx of uninsured women from rural migrant worker families.

Dr You also questions whether the impressive reductions in maternal mortality reported by the government are authentic. She remarks that health departments are financially rewarded for achieving targets such as maternal and infant mortality - and punished for not meeting them. The officially reported figures may therefore be subject to 'inflation', she suggests.

"These reservations notwithstanding, it is important to call attention to the dramatic reduction in rural maternal mortality in China and the lack of progress in the urban maternal mortality. The levelling out of urban maternal mortality in China in the past decade calls for increased attention," the researchers conclude.

Defiant words of a doctor killer: Lian Enqing has no regrets for murdering surgeon he blamed for botched rhinoplasty

by Michael Woodhead
The 33-year man Lian Enqing found guilty of killing a Zhejiang doctor over failed nasal surgery has had his appeal against a death sentence turned down, but seems to have no regrets about what he did.
A lengthy article in Guangming Daily portrays faults throughout the system, including sub-standard medical treatment, shoddy hospital record keeping, a flawed medical dispute resolution system and a harsh legal system that condemns a mentally ill man to death. The article includes a few words from a CCTV interview with the murderer, Lian Enqing, from which it is apparent he is delusional and convinced that his victim got what he deserved.

The tragic case originated in March 2012 when the man sought medical help for a chronic sinusitis and nasal obstruction. He had ENT surgery for his problem at a Wenling hospital with surgeon Wang Yunjie, but after a few weeks it became obvious to the patient that the surgery had not relieved his problem - if anything, his symptoms became worse. He went back to the hospital and sought a review, but was not satisfied with the results of the tests. he went back many times to several different hospitals - including some in Shanghai - and underwent many investigations, including CT scans, all of which could find no explanation for his ongoing nasal symptoms and discomfort.

Lian Enqing refused to believe the results of the tests and became convinced that there was a conspiracy, and that doctors were covering up their mistakes. His belief was bolstered by shoddy record keeping at the hospitals, with some hospitals giving his the wrong results or imaging scans. Lian became more angry and assaulted members of his family. In July 2013 he scrawled a message about his surgeon on his wall saying "Wang Yunjie must die". He was taken by his family to a psychiatric hospital in Shanghai and diagnosed as having depression and delusional disorder and he spent some weeks in treatment.

However, his basic belief and resentment against the doctors did not change, and in October 25 2013 he went back to the hospital and attacked his surgeon Wang Yunjie with a knife, stabbing him to death and injuring other doctors. Eyewitnesses say this was no spur of the moment killing -Lian was determined, and even prevented other doctors from getting to the injured surgeon to try and save him.
 An interview aired on CCTV showed that Lian still believed there was a cover up of mistake,

Journalist: Most people would believe the results of multiple repeated tests - what was your reason for not believing them?

Lian: Because doctors feared being exposed. It would harm their image and their reputation to be shown to be wrong.

Journalist: Do you think doctors need to create such a big and complex set of lies over one pateint and one operation?

Lian: Yes

Q: But this would mean collusion on a grand scale, not just within the hospital but withing the region and even with doctors in the Fudan University Hospital in Shanghai Why would they all do that?

Journalist: Because it is a stain on the medical community, a dark stain.

The judge in the case said that he sympathised with Lian a little as his frustration and sense of injustice was justified because he had received sub-standard treatment and his complaint had not been handled properly. Nevertheless, nothing could excuse the extreme violent reaction to the unfortunate events that befell him, he added. Lian still did not acknowledge his crime or show any remorse.
In this situation, given what he did, the court had no alternative but to follow the law and conform the death sentence, he said.

The judge said that if doctors weren't so busy and if the hospital system wasn't under so much pressure, then such a tragic event may not have occurred. He urged doctors to improve the system
and be more understanding of the patients situation.

Eight medical stories from China you should read

by Michael Woodhead

1. Beijing will start to enforce new anti-smoking laws with 200 yuan on-the-spot fines (up from 10 yuan) for people who smoke in public indoor shared areas, and institutional fines of 30,000 yuan (up from 5000 yuan). Cameras will be used to compensate for the lack of enforcement officers, especially after hours, the city government says.

2. The Chinese government has been accused of withholding medical care from dissidents. An article by Sophie Richardson in the WSJ says civil rights campaigner Cao Shunli is now in intensive care because she was denied access to medical care while detained for her efforts to promote a civil society.

3. A link has been found between damp housing in Shanghai and rates of asthma in children. Researchers from the University of Shanghai for Science and Technology say asthma symptoms could be reduced by 25% by simply keeping a child's window open at night.

4. A vaccine against enterovirus 71 developed by Sinovac Biotech has proved effective against EV71-associated hand, foot, and mouth disease or herpangina in infants and young children, according to a study in 5000 children done by the Jiangsu Provincial Center for Disease Control and Prevention, published in the New England Journal of Medicine.

5. Eating shark fin is not only cruel and bad for the environment, it is also a health hazard because of high mercury levels in the product, researchers from Zhejiang have shown. After testing samples of shark fin they found that up to 33% contained toxic levels of mercury.

6. Antibiotics are widely overused by parents in rural China, with more than 60% dosing their children with antibiotics bought over the counter, Shanghai researchers have found. Most parents were ignorant about how antibiotics worked and had little idea hat they do not help viral infections.

7. Migrant workers have little access to healthcare and many of them put off seeing a doctor for illness, a survey in Shanghai has found. Two thirds of migrant workers said they had never had a medical check up and nearly 40% said they had ignored symptoms because they couldn't get to see a doctor.

8. Health workers in Guangdong have completed a successful pilot trial of a cervical cancer screening program using the ThinPrep cytological system. The program offered Pap test cancer screening to more than 40,000 women, and found that improvements are needed in basic education regarding cervical cancer screening for young and poorly educated women.

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

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

Today's China medical links

An inside look at a Guizhou hospital 
What's it really like getting treatment at a Chinese hospital? How much does it cost, how do patients pay and what happens when you run out of money? Ashish Jha, an associate professor of health policy and management, Harvard School of Public Health, has a great blog post at KevinMD on the nitty gritty of patient care. How do pateints get seen? How doctors manage patients (much more conservatively and slowly) - all based on a visit to the Huaxi District People’s Hospital in Guiyang.

Blood supplies drying up
In the China Daily, blood donations in Beijing have been falling slightly for three consecutive years, and legislation is needed to ensure supplies, according to Ge Hongwei, director of the testing department of the Beijing Red Cross Blood Center. She says the amount of blood used has been increasing by about 15 percent annually in China, widening the gap between supply and demand.

Get me out of here!
A British traveller, Sammy Corfield, blogs about his nightmare experience with various hospitals and doctors  in Zhejiang, when he went seeking treatment for chronic diarrhoea.

Zhejiang researchers identify the two greatest risk factors for H5N1 avian flu infection

After analysing an outbreak of H5N1 avian influenza in Zhejiang in 2011-12, researchers have the two main risk factors for infection as being in close proxiity to poultry and being somewhere wehere large numbers of birds are bred.
In a study of 3,453 environmental samples, 3% tested positive for H5 avian influenza virus and 4.7% of 1,169 people tested seropositive for anti-H5N1 antibodies. The H5N1 virus detection rate was highest in poultry slaughtering and processing plants (14.6%). and the most common sources of infection were sewage (4.5%), drinking water (3.1%), faeces (2.3%), cage surface (2.0%), and slaughtering chopping boards (7.0%). The two main risk factors for infection were direct or close contact with poultry (five fold higher risk) and breeding numerous poultry (four-fold higher risk). Source:  Journal of Thoracic Diseases

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.

Doctors prepare for surge in demand for maternity care

The government's relaxation of its birth rule to allow more couples to have a second baby provided an instant stimulus to maternity-care and fertility centers on the Chinese mainland.
Preparations for changes that will come with the new policy — which authorities expect to be implemented early next year — are now under way.
Late last month, the Obstetrics & Gynecology Hospital affiliated with the Zhejiang University took the national lead by opening a special consultation unit designed to help newly eligible couples have a healthy second child.

Hospitals launch second child clinics to deal with new family planning policy

by Hu Qingyun
After striving to get up at 4 am, and starting to queue at 6:30 am in the hospital hall, Wang Juan and her husband finally secured an appointment at 10 am with a famous obstetrician at a clinic specializing in second children in Hangzhou, Zhejiang Province.
The obstetrician asked thoroughly about Wang's health, including whether, like the majority of Chinese mothers, she gave birth to her first child through a Caesarean.
In a latest decision, the Communist Party of China (CPC) Central Committee allowed couples to have a second child as long as either the husband or the wife is from a one-child family. Previously, the policy required both to be single children.
The easing of the family planning policy delights but also worries Wang, who unlike her husband is an only child. She is the mother of a 3-year-old girl but now yearns for a second child.
"I'm 38 now. I have to consult obstetricians on whether it's OK to do so," said Wang, a white-collar employee in Hangzhou.

Police station set up in Zhejiang hospital to deter attacks on doctors

by Yan Yiqi
Police in Taizhou, Zhejiang province, have started patrols at hospitals in the city to ensure the safety of medical staff and to maintain order.
The patrols follow increased doctor-patient disputes that include a doctor in the city being fatally stabbed by a disgruntled patient in October.
Taizhou Municipal Hospital is the first one where police officers and security equipment have been stationed.
Three police officers are assigned per 100 medical staff and security guards at the hospital are equipped with stab-proof vests and gloves and tear gas in case of emergencies, said Xu Guocai, deputy director of the Jiaojiang district police department in Taizhou.

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.

Was "Empty Nose Syndrome" the cause of the doctor-stabbing case?

The Internet has lit up with conversations about an obscure complication from nose surgery this month, after an article titled "Empty Nose Syndrome - the real murderer of the doctor-stabbing case?" started circulating.
The tragic case happened last month in the No.1 People's Hospital of Wenling, Zhejiang Province, where Wang Yunjie, the chief physician of the ear-nose-throat department, was stabbed to death by Lian Enqing, a patient who had been dissatisfied by surgery performed at the hospital, the Global Times reported on November 1.
Lian was reportedly suffering from nasal obstruction, headaches and insomnia after nose surgery, but several examinations showed nothing wrong. Lian's family suspected him of having psychological problems and forced him to accept mental treatment.
The article said Lian killed the doctor because Lian suffered from Empty Nose Syndrome (ENS), a side effect of nasal surgery.

China medical research in the journals

No increase in obesity among rural children

There are no signs of an obesity epidemic among rural Chinese children, a study from has shown

Researchers from the Capital Institute of Paediatrics, Beijing, monitored overweight and obesity rates in more than 280,000 children from eight counties in Jiangsu and Zhejiang between 1998 and 2005. They found that the prevalence of overweight was barely changed from 3.7% in 1998 to 3.9% in 2005 and there was no increase in the 0.5% prevalence of obesity.  An increase in overweight/obesity was more likely in boys than girls, especially among those aged over three years. The study also found that the prevalence of stunting decreased dramatically.

Full study: Public Health

IVF conception for 1% of Chinese babies

About one in a hundred Chinese babies is born to women undergoing IVF or other assisted reproductive technology, Beijing researchers have shown. Dr Yang Xiaokui and co-researchers from the Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital analysed rates of ART among 112,403 deliveries from 14 provinces and 39 hospitals. They found the proportion of infants born as a result of ART in China was about 1.013% in 2011, compared to 4% in developed countries. Their study also found an increased maternal complications such as multiple gestation, higher cesarean section rate, low birth weight infants, higher infant mortality in women who conceived with the help of ART, compared with spontaneously pregnant women.
Full study: Fertility and Sterility

Urgent action needed on liver fluke infections in Heilongjiang

Liver fluke infestations are a common and increasing problem in China’s north east province of Heilonjiang, a study from Harbin Medical University has shown.

The infections, which are caused by eating undercooked fish,  were  seen commonly throughout Heilongjiang Province and mainly along the Songhua River, according to Dr Han Su and colleagues from the university. In a review of 4951 outpatients with suspected liver fluke infections the overall prevalence of clonorchiasis was 26%.  Rates of infection increased from 22.5% in 2009 to 34% in 2012. Farm labourers accounted for two thirds of cases and consumption of freshwater fish was the strongest risk factor. Cases of re-infection were common.

“The present study revealed that clonorchiasis remains widespread and prevalent in Heilongjiang Province. An integrated control programme is urgently needed to reduce the public health impact of clonorchiasis in this endemic area.”

Full study: PLOS One

Benzodiazepine use linked to benign brain tumours

Benzodiazepines may increase the risk of benign brain tumours, according to Taiwanese researchers. In a review of  62,186 patients who had been prescribed benzodiazepines, they found that rates of benign brain tumours were more than three times higher in patients using benzodiazepines. The risk of benign brain tumours was dose dependent and increased over time with increasing exposure to benzodiazepines. There was no increase seen in risk of malignant brain tumours, but this may have been due to the low number of such tumours in the study group.

Full study: Journal ofthe Neurological Sciences

SMS reminders improve allergy medication compliance

For patients with allergic rhinitis, a daily SMS reminder is an effective way to improve adherence with intranasal corticosteroid treatment medication and treatment outcomes, according to researchers from the Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital.

In a study of 50 patients with allergic rhinitis they showed that adherence to medication was 60% in the SMS group and 28% in the control group. Clinic attendance and allergy symptoms scores were also better for patients who received SMS reminders.

Full study: International Archives of Allergy and Immunology

Viewpoint: Financial compensation for deceased organ donation in China

by Dr Qiang Fang, Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou.
In China, about 1.5 million Chinese patients are placed on organ transplant waiting lists each year, yet less than 1% of them have managed to receive an organ.
The gap between the need for and the supply of organs is large—and growing. The Regulation on Human Organ Transplantation strictly stipulates that living organ donation is limited to relatives. The number of organs from executed prisoners is decreasing. In March 2010, the Red Cross Society of China (RCSC) and the Ministry of Health of China jointly launched a pilot programme of deceased organ donation in 10 provinces and cities.  This programme marks a turning point in the transplant history of China. By March 2012, there were 207 deceased donors in total. However, with the country's population of 1.3 billion, the deceased donor rate remains significantly lower than in Spain and other Western countries.
In China, the shortage of deceased organ donors is due to a belief that the body should be left intact, a lack of incentive policy to increase the donation rate, and the weakness of programmes promoting voluntary organ donation. Traditional cultural beliefs about the proper disposition of a corpse constitute the major obstacle to deceased organ donation in China. The Confucian tenet of filial piety requires that a body be returned to the ancestors in an intact state and declares that every part of the body that is given by the parents deserves respect. People have also believed for thousands of years that keeping the dead body intact is a way of respecting the dead. These beliefs produce resistance to organ donation. Although nowadays cremation is carried out in many parts of China, most people still insist that the dead body be kept intact before being taken to cremation.
In order to provide incentive for deceased organ donation, five pilot provinces and cities (Zhejiang, Tianjin, Jiangxi, Jinan and Liaoning) have launched a financial compensation policy. We will take Zhejiang Province as an example. Zhejiang Red Cross established the Human Organ Donation Compensation Foundation in March 2012. From March 2010 to March 2012, there were 20 donors.  From April 2012 to the end of July, there were 23 donors. During these 4 months, Zhejiang organ donation witnessed rapid growth. Zhejiang Province, with 43 donors, is now rated number 2 of the pilot provinces and cities.
Organ donation can proceed only if one of the following conditions is met: the deceased has expressed a willingness to be an organ donor in either a living will or another written form, and his or her closest relative provides written consent for organ donation, or the potential donor has not expressed opposition to donation before his or her death, and his or her closest relative provides written consent for organ donation.
A characteristic of organ donation in China is that the Red Cross acts as the third party non-profit organisation in implementing the donation policy with the authority of law. In Zhejiang, the Red Cross is responsible for raising and managing funds for financial compensation, thus ensuring that money is used in a fair and legal way. Transplant hospitals are not allowed to be involved in management of the funds. Government appropriation, transplant hospital contributions and charitable donation are the usual sources of funds.
Financial compensation can be considered to include two main forms, the ‘thank you’ form and the ‘help’ form. ‘Thank you’ compensation includes three aspects. First, Zhejiang Red Cross Society will pay for basic funeral expenses, which cover body transportation, cremation and ash urn storage. Then the Society will offer the donors’ families USD 1600 for the cost of purchasing a grave plot. In addition, the donors’ families will be provided with USD 3200 allowance. This kind of compensation is gratitude on behalf of the Society for consenting to donation. If the families of deceased donors face hardship, Zhejiang Red Cross will offer them extra compensation, which can be no more than USD 4800. The family is eligible to apply for extra compensation only if one of the following conditions is met: the family has been designated a low-income family by the local Bureau of Civil Affairs and receives dole from the government every month, or the income of the family is at the level of local per capita income before the donor's death and the deceased donor was the family's main earner. The committee of Human Organ Donation of Zhejiang Red Cross will assess applicants’ eligibility. Then the committee will discuss how much money should be offered to a donor's family. The amount of compensation offered to a family is not according to the number of procured organs, but according to the degree of the family's suffering. However, there is no formal criterion to estimate the degree of suffering. Generally, the committee will make enquiries into the family's financial situation, assessing such factors as how many dependants the family supports, and whether the donor's spouse has the ability to support the family. Then the final decision will be made by the committee. This kind of compensation is social welfare support for needy families.
Those who consent to donation out of altruism deserve social appreciation and respect. Chinese social ethics not only upholds the moral value of benevolence, humaneness and mutual aid, but also advocates rewarding a good deed. In 1993, China established the China Foundation for Justice and Courage aiming to carry forward traditional Chinese virtues, foster healthy social trends, commend justice-upholding volunteers, and provide legal protection and financial assistance for those who take up the cudgels for a just cause. In July 2012, a Good Samaritan regulation was placed on the legislative agenda to protect those who lend a hand. A good deed itself might not have any economic value. However, the reward could be offered in spiritual and material form. A survey of 463 people of different educational level showed that 87.96% supported financial compensation.  Financial compensation could express society's gratitude for altruistic spirit and ease the financial pressure of voluntary donors’ families in needy circumstances.
In January 2012, a student from Hubei Province died from carbon monoxide poisoning in Shenzhen city. The grieving parents donated their daughter's organs and body. Meanwhile, they were unable to pay USD 11 200 for medical expenses, which is a heavy burden for a blue-collar family. As Shenzhen has not yet implemented the financial compensation policy, the organisation's charitable donation provided the family with the means to meet these expenses. China is a developing country with a gross national product of USD 5432 per capita in 2011. There are 128 million citizens, accounting for 10% of the country's total population, living below the poverty line (per capita income for living expenses of urban households less than USD 368 a year). The majority of them live in the country. In addition, medical expenses are a heavy burden for rural residents because of the lack of a good medical insurance system. If a donor's family is faced with financial problems, financial compensation will give timely assistance to that family.
Although China needs a financial compensation programme for deceased organ donation, undesirable consequences have emerged. Of the 207 deceased donors, the proportion of poor donors is much higher than that of other donors. The vice minister of the Red Cross, Zhao Baige, said in an interview that 90% of 207 deceased donors’ families faced financial difficulties. This indicates that some of these families consented to donation because they were in need of financial assistance. With the developing economy, the continued increase in deceased organ donation rate dependent on this policy is doubtful in the long run. In addition, some donors’ families in needy circumstances have suffered great stress, as they were thought to have sold organs of their deceased loved ones.
Financial compensation for deceased organ donation is not unique to China. In 2000, the US state of Pennsylvania implemented a programme of offering USD 300 to the families of organ donors to defray funeral expenses. In 2010, Israel launched a new policy to offer compensation to the families of deceased organ donors. The Israeli Ministry of Health stipulates that families who agree to donate the organs of deceased loved ones will receive USD 13 400. However, China differs from other countries with similar programmes by offering extra compensation for needy families of deceased donors.
In July 2012, the State Council of China issued a guideline for promoting the development of the RCSC. According to the guideline, the government will help the RCSC found provincial organ donation foundations that can sponsor donations and transplants. Financial compensation programmes will be implemented in other pilot provinces and cities. To promote the healthy development of deceased organ donation, programmes promoting voluntary organ donation should be operated extensively to encourage altruism and raise the proportion of donors other than poor ones.
Source: Journal of Medical Ethics

China medical news in brief

Headache and migraine a problem for one in ten Chinese children

A study of 4812 children and adolescents in Shanghai, China has found that 10% experienced a headache in the past three months. Of those who had headache, 45% were classified as having migraine. with the highest rates of migraine found at ages 14 years and 15 years. Tension-type headache accounted for 29% of headaches, while  cluster and other headache were responsible for 6.2% and 20%, respectively.
Source: Clinical Journal of Neuroscience 

Zhejiang prostitutes have high HPV rates and cervical cancer risk

Two out of three sex workers are infected with high risk subtypes of HPV putting them at increased risk of cervical cancer, a Zhejiang study has found.
Cervical samples from almost 300 female sex workers  in Huzhou, Zhejiang, showed that the prevalence of HPV was 67%, compared to 19% in the general population. Among the different types of HPV found,  HPV-16 (29%) was the most prevalent, followed by HPV-58 (24%) and HPV-52 (21%), and these were significantly associated with abnormal cervical cytology. The rate of cervical abnormalities was also higher among female sex workers (21%) than among the general population (5%). Researchers from the Huzhou Central Hospital conclude that female sex workers in the city have a greater probability of being infected with high-risk HPV, and novel vaccines against HPV-58 and HPV-52 should be developed. Using condoms could reduce the risk of infection.
Source: International Journal of Gynecology & Obstetrics 

Jiangsu simplifies medical insurance claims

Medical insurance claims can now be settled on the spot for outpatients in  Jiangsu. Outpatients from 13 cities including Changzhou, Nantong, and Wuxi can immediately settle their medical insurance if they go to see a doctor with their medical insurance cards, according to Jiangsu provincial Human Resources and Social Security Bureau.
Source: Jiangsu China.


Gay men in Yunnan have high HIV risk

More intensive HIV and STD screening and prevention campaigns are needed for gay men in Yunnan, say researchers who found a high incidence of new infections. In an 18 month study of 378 seronegative gay men in Yunnan they found that 11 became infected with HIV and 15 were infected with syphilis. Subgroups at high risk included students, retirees and minority ethnic groups, say the researchers from the No.1 Hospital of China Medical University, Nanjing.
Source: BMC Infectious Diseases.

China has low rates of adverse reactions to immunisation.

Adverse reactions to immunisations are uncommon and generally non-serious, new figures from Zhejiang show.
Passive surveillance data for adverse events following immunisation (AEFI) reported to the National AEFI Surveillance System in Zhejiang province show that the overall rate was 9.2 per 100,000 doses for 2008-2011. There were two spikes in adverse reactions, one associated with the introduction of pandemic H1N1 influenza vaccine (pH1N1) in 2009 and the other for a Measles-Mumps vaccine (MM) campaign in 2010. The majority of adverse reactions reported were non-serious events. There were15 deaths were recorded but only one was possibly related to immunisation. The most frequently reported reactions were fever and injection site reaction.
Source: Clinical Vaccine Immunology

Depression a "time bomb" for China's wife-less young men

China's increasing numbers of unmarried men are prone to depression, suicidal feelings and aggression

by Michael Woodhead
China's sex ratio imbalance is producing an increasing number of unmarried men who have a high risk of depression, suicidal ideation, lower self-esteem and greater propensity to aggression, a Hangzhou study has shown.
Dr Zhou Xudong and researchers at the Institute of Social and Family Medicine of  Zhejiang University,  Hangzhou, studied psychiatric characteristics of 1,059 never-married men and 1,066 married men aged 30–40. They found that never-married men were poorer, less well educated and had lower self-esteem than married men. Never-married men were also much more likely to have depression symptoms, higher levels of aggression and were more likely to have suicidal thoughts or wishes  than married men.
The researchers say China has the highest excess of male births in the world at 118 to every 100 female, with a current excess of 20 million men of reproductive age. They say their study is one of the first to show that this sex imbalance is having an impact on the psychological well-being of the large numbers of men who will never marry.
"The high prevalence of severe depression and suicide ideation in these men is of particular concern. In rural China mental health services are currently very sparse, but rural doctors could be trained to use a check score to identify severe depression, and refer as appropriate to specialist services," they say.
"Our results present evidence for a potential mental health timebomb in rural large areas of rural China," they add.
They say the immediate question is what can be done to support the millions of men who, through no fault of their own, will be unable to marry and have children, and who, as a consequence have high rates of depression and suicidal tendencies.
"The challenge here is the virtual non-existence of mental health services in most of rural China. There are 1.3 psychiatrists and two psychiatric nurses per 100,000 people in China, but the overwhelming majority are in urban areas."
According to the researchers few men with depression are diagnosed or treated because of the lack of trained mental health professional in rural China.
"It would be straightforward and feasible to train rural doctors to identify key symptoms and signs of mental illness, or simply to administer a mental well-being check list as a screening tool for referral. The problem of depression is not of course confined to older unmarried men and such screening would identify vulnerable married men and women as well. This would of course require a major strengthening of mental health services at county level and above. But with mental health now rising on the health agenda and more resources available for health services as a result of the health reforms in China, there is a real opportunity now to address this," they conclude.
Source: Social Psychiatry

Medical officials sacked for unethical GM rice clinical trial

Clinical trial was run without informed consent by officials from the Zhejiang Academy of Medical Sciences

Three officials who had approved and conducted a controversial test of genetically modified (GM) rice on school children in central China's Hunan Province had been sacked, authorities said on Thursday.
The officials were punished for "violating relevant regulations, scientific ethics and academic integrity," according to a statement jointly released by Chinese Center for Disease Control and Prevention (China CDC), Zhejiang Academy of Medical Sciences, and Hunan provincial CDC.
The officials include Yin Shi'an from China CDC, Wang Yin from Zhejiang Academy of Medical Sciences and Hu Yuming from Hunan provincial CDC.
Earlier, the Ministry of Health ordered China CDC to investigate whether dozens of children in Hunan were used in 2008 as test subjects in a U.S.-China joint research project that included GM food Golden Rice.
Greenpeace broke the news on the controversial test in late August this year, saying that the joint research involved feeding Golden Rice, which is genetically modified to be rich in beta carotene, to 25 children aged between six and eight in Hunan.
It cited a paper published in the August edition of The American Journal of Clinical Nutrition.
The paper claimed that Golden Rice is effective in providing vitamin A to children.
The research, approved by the National Institutes of Health of the United States in December 2002, was led by Tang Guangwen, director of the Carotenoid and Health Laboratory of Tufts University in the United States. It was intended to explore ways in preventing deficiency of Vitamin A in children.
Tang conducted the research in cooperation with Yin Shi'an from China CDC and Wang Yin from Zhejiang Academy of Medical Sciences.
In 2008, the test was conducted on 80 pupils in Hengnan County of Hunan Province, with 25 of them being fed 60 grams of Golden Rice on June 2.
The research team had informed parents of the tested children about the experiment but withheld the truth that GM rice would be used.
Source: China Daily