Multidrug resistant leprosy, Tuberculosis costs; Clinical trial problems; Milk formula mispercetions, Rheumatoid arthritis drug unavailable

Doctors in Shandong have reported China's first cases of multidrug resistant leprosy. Testing 85 samples of the causative bacteria Mycobacterium leprae, doctors found that some were resistant to  standard antibiotic treatments including dapsone, rifampin and ofloxacin.

In theory, tuberculosis treatment is free in China, but in reality patients  still face enormous out-of-pocket costs for treatment, a study from Jiangsu show. In a survey of treatment costs for people in the province, researchers from Nanjing Medical University found that the average cost per patient was as high as 19,000 yuan (US$3000). Even for patients who could claim back medical costs on their health insurance, out of pocket costs were still around 14,000 yuan ($2260) a year for clinic visits, hospital stays, tests and drug therapy.

Clinical trials are difficult to set up and run in China due to a lack of qualified and experienced clinical research staff and poor research infrastructure, an experts says. Dr Wu Yangfeng Wu of the Peking University Clinical Research Institute (PUCRI) said clinical trials required a pool of many hundreds of clinicians who were educated and well versed in basic research techniques - something which China lacked. He told Forbes that China's medical institutions also lacked  basic infrastructure and research management systems to conduct trials. There were also few allowances or rewards for doctors who took part in research, he added.

As many as one in five village doctors have latent tuberculosis, according to a study carried out in the Chinese province of Inner Mongolia. Dr He Guangxue and colleagues at the Chinese Center for Disease Control and Prevention, Beijing, surveyed 880 village doctors and found that 19.5% had positive tuberculin skin reactions. Latent tuberculosis risk was highest in doctors who had been in practice for a long time and for doctors who had more exposure to patients, they showed in PLOS One.

About 90% of Chinese mothers opt for milk formula within a month of giving birth, often driven by misguided beliefs and fears, a study from Sichuan has found. In a survey of 695 new mothers, 88% had initiated formula within 4 weeks of giving birth, often believing that babies slept better after fed with formula, and many believing they had insufficient breastmilk.

One of the best drug treatments for rheumatoid arthritis is out of reach for many Chinese patients because of cost, rheumatologists say. Chinese clinical experience with tocilizumab (Actemra) showed that it was highly effective and safe.  However, the high cost of the drug limits its prescribing in China, according to Dr Wang Geng of the Department of Rheumatology and Immunology, Changzheng Hospital, The Second Military Medical University, Shanghai.

Seven China medical news snippets for Thursday 13 March

1. Antivirals at kindergarten
Children at a kindergarten in Xian have been treated with an antiviral without the knowledge of their parents. Parents were furious to discover their children were dosed with moroxydine thee days a week supposedly as prophylaxis to prevent viral infections, at the direction of a doctor who was only licensed to practice in Guangdong.

2. Private health eyes China profits
Private healthcare operator Concord Medical says it sees huge potential in the Chinese health system reforms. The group already owns 144 medical centres and the Chang'an Hospital in Xi'an, and is now building three high-end specialty cancer hospitals in Guangzhou, Beijing and Shanghai.

3. Stroke risk with high normal BP
Cardiologists in Guangzhou have shown that pre-hypertension (systolic BP of 120-140mmHg) is a risk factor for stroke. Their research showed that low range hypertension increased stroke risk by 44%, according to the meta-analysis published in the journal Neurology this week.

4. Needlestick risks in Chinese hospitals
Doctors and nurses in Chinese hospitals face high risks of blood-borne infections because of poor needlestick injury prevention practices, a study has found. Doctors faced a high risk of infections from suturing needle accidents while nurses often had needlestick injuries with syringes and IV infusion sets,w ith an average of two injuries per year, a study in the American Journal of Infection Control showed.

5. Medical article fraud
A doctor in Hainan has been jailed for eight years for fraud after it was discovered he wrote 11 medical articles and dissertations for others. The doctor charged about 12,000 yuan for each article.

6. Knee OA undiagnosed
Knee osteoarthritis is common among elderly people in Guangzhou but often goes undiagnosed and untreated. A study of elderly inpatients at a city hospital found the prevalence rate of knee arthritis was 10% in males and 38% in females. Only about half of patients were aware they had arthritis, and among these only 77% had adequate treatment.

7. Dust full of carcinogens
Inhabitants of Guangzhou are exposed to toxic levels of arsenic and chromium in PM2.5 particle in dust, a study has found. Using hair analysis, researchers from Sun Yat-sen University, Guangzhou found that Guangzhou residents had high and carcinogenic levels of accumulated metals and other toxic elements.

Shanghai researchers identify genetic markers for rheumatoid arthritis

Shanghai researchers have helped identify new genetic regions involved in rheumatoid arthritis that will shed light on medicines that could be effective in treating the disease.

Professor Xu Huji and colleagues from the Second Military Medical University, Shanghai, worked with other groups from around the world to identify 42 new genetic regions involved in the disease, bringing the total known to be involved to 101.

It is believed that 65 per cent of the risk of rheumatoid arthritis is genetic.

The research involved several thousand Chinese rheumatoid arthritis patients and is the largest such genetic study in the world and the first in Han Chinese.

The study, to be published in Nature and in Arthritis and Rheumatism, has nearly doubled the number of regions of the genome associated with the disease.

The researchers identified several genes that are already targets of approved treatments for other diseases, including cancer treatments. These drugs could now potentially be repurposed for rheumatoid arthritis treatment.

They showed that existing rheumatoid arthritis drugs only target 30 of those genes, meaning a large number of potential new drug targets can now be investigated. 

Source: University of Queensland News

Diclofenac causes 14,000 deaths a year in China and should be banned: researchers

The anti-inflammatory drug diclofenac should be withdrawn from sale in China because of its high risk of cardiovascular adverse effects that may be responsible for 14,000 deaths a year, researchers say.
The call to withdraw the drug comes from UK and Indian researchers who found that diclofenac was still the most popular NSAID drug for pain and arthritis in countries such as China despite having a higher risk of cardiovascular disease.
They called for the drug to be removed the the list of essential medicines because safer alternatives such as ibuprofen and naproxen are available. For China, they estimate that
"The findings  ... have significant implications for public health. In China the age- and sex-standardised death rate from cardiovascular disease is estimated to be 312/100,000 for males and 260/100,000 for females. Diclofenac is the most commonly used NSAID in hospitals in China.  If it were taken by only 1% of China's population of approximately 1.3 billion annually, based on the relative risk calculations from meta-analyses it could cause 14,000 additional unintended deaths. These deaths are preventable - lower risk NSAIDs, including naproxen and low-dose ibuprofen, are widely available and are equally efficacious," they write.
According to the researchers, NSAID recommendations on national essential medicines lists should be based on the optimum balance of benefit and harm and give preference to low risk drugs, in particular to ibuprofen and naproxen.
"Diclofenac has no advantage in terms of gastrointestinal safety and it has a clear cardiovascular disadvantage. Given the availability of safer alternatives, diclofenac should be de-listed from national EMLs. There are strong arguments to revoke its marketing authorisations globally."
Source: PLOS Medicine