Universal health insurance comes one step closer - but who's paying?

by MICHAEL WOODHEAD
The big healthcare news from China this week is that a health insurance safety net for serious illness is being extended nationally. This means that if all goes to plan, poor people who develop catastrophic diseases such as cancer should not be left destitute by medical bills for care. Pilot programs that have been running at provincial level will now be extended to all provinces, according to an announcement by the State Council on July 22.
This will be good news for the many sad and desperate Chinese families who face financial ruin because of medical bills - or who are simply unable to pay and have to watch their loved ones die of treatable diseases. Some of them resort to all kinds of bizarre publicity stunts and begging methods to try raise the money to pay the medical bills. I have recently before about a girl who offered herself as a bride to any man who would pay her brother's medical bills.

According to the China Daily (hardly the most reliable of outlets), the meeting chaired by Premier Li Keqiang, cover for major illnesses will "cover all the subscribers to the urban and rural resident basic medical insurance as of the end of 2015", with full implementation in all 6800 public hospital in China by 2017.

A spokesman for the council said that there were 700 million impoverished people in China, of whom about 10 million are suffering from a chronic disease or major illness.The scheme will cover 50% of expenses initially, but this will be increased over time.

According to state media, the funding for the scheme will come from existing insurance accounts and therefore "will not be a financial burden to the beneficiaries". However, it also slipped in the detail that the safety net scheme will be run by commercial insurance agencies chosen by the government through bidding, with limits of 2-5% on profit margins.

"Introducing the third-party commercial insurance as operators will bring a better inspection performance to control medical fees and prevent waste or ill-designed fees" a government spokesman said.

China's commercial insurance companies are keen to get into the lucrative business of providing private health insurance. However, reading between the lines, it looks like the government has told them that covering the safety net for the impoverished will be a condition of their getting access to this market.

As China Daily, puts it:

Wu Ming, a professor of public health at Peking University, said many insurance companies may compete for the business despite lower profit margins, since it can bring many potential benefits.
"Participation in the program can pave the way for the insurers to enter further into the medical care sector in the future," she said.

However, as the more reliable Caixin magazine reports, commercial insurance companies are worried about the financial implications of taking on serious health insurance policies. The various pilot projects run in places such as Jiangsu and Zhejiang have shown the potential for major cost blowouts for uncapped schemes, and also problems with defining which illnesses are covered and who should pay for what. In some cases local governments, which administer (and fund) health insurance schemes tried to unload all their difficult patients onto the safety net. Or as they told Caixin magazine: "all the risk, none of the power, no voice".

The commercial companies also fear that they will be required to take on patients only after they have gone through the regular health insurance system over which they have not control. They believe that if they have a full package of insurance they would be able to control costs (and potentially prevent patients from developing serious illness) rather than just picking up the pieces.

At the State Council meeting chaired by Premier Li Keqiang, the government said it would be keeping a close watch on the safety net scheme and conducting many checks and inspections to ensure there was no abuse of the scheme.

Insurance fraud: how three doctors placed the bodies of dead cancer patients in staged traffic accidents to swindle $225,000

by Michael Woodhead
In a sophisticated and ghoulish scam, three doctors at an Anhui hospital used the bodies of recently deceased cancer patients in staged traffic accident in order to claim thousands of dollars in insurance payouts.
The doctors who worked in the intensive care unit of Lingbi Hospital were part of a gang of seven, including former insurance company employees, who used the bodies of cancer patients to swindle insurance companies out of 1.4 million yuan ($225,000) in payments for 42 fraudulent claims.
The doctors used their contacts to identify terminally ill cancer patients, who they would then arrange to have insurance policies for accidental death taken out. After they died, the doctors did not carry out the usual death certificates, but instead shipped the bodies to locations where they set up traffic accidents, often involving motorbikes or scooters. When police and emergency services arrived on the scene they would declare the victim dead due to a traffic accident, and the insurance companies would pay out on their policies.
However, authorities became suspicious when a large number of traffic accident claims were made in a short period. When they set up an investigation, they found the same three doctors - and their relatives - were involved in all the claims.
The doctors have now been arrested for insurance fraud and suspended from their positions at the Anhui Lingbi hospital.

Personal experience of the Chinese health system

An overseas Chinese friend of mine has just come back from China, where she returned to care for her dying father. Her experience of the Chinese health system was mostly positive, but her story reveals some of the reality behind the rhetoric of recent government pronouncements on reforms.
Her father was seriously ill with lung cancer and had only a few weeks to live. After the diagnosis, at an army-affiliated hospital, the doctors did not try to offer futile chemotherapy with expensive drugs, but just offered a poor but honest prognosis. There was no access to what we in the west would call palliative care. Instead, doctors recommended that he return home, to be cared for by family members. In some pain and discomfort, the father was provided with some analgesics, but no opioids.

After about a week, the father was in considerable pain and returned to the hospital for treatment. He lived for another 18 days, being given a mixture of analgesics and other drugs to ease his bowel problems. The cost of treatment was 18,000 yuan. As he had been a member of his employer's urban health insurance plan, the father (or rather his family) was able to claim back about 70% of the medical expenses. However, the hospital treatment did not include 'extras' such as meals, dressings and bed linen! The nurses provided most of the basic medical care but none of the ancillary care such as washing, feeding and chaging bed linen that nurses in western hospitals would do. Instead this was left to the family. As the family were not able to be on 24/7 carer duty they hired a 'kanghu' carer at a cost of 800 yuan per day, to do basic chores such as feeding and cleaning the patient.

The family were satisfied with the overall level of medical care provided by the hospital, though they found it somewhat basic until they used their guanxi to find a better team of doctors and nurses. This was done because they knew someone who knew one of the senior doctors at the hospital.No money changed hands, but the father benefited form having more attention paid to his care by the more senior medical practitioner in the hospitals. After the father passed away, the family presented hongbao containing about 200 yuan to each of the 20 medical team who cared for him. This was done to maintain face and  confirm the good guangxi that was used to obtain better care for the father.
Funeral arrangements were made for the father via the hospital contacts, who no doubt gained some financial advantage from their referral.

The family believed their father received good care that was personal and respectful - but no doubt because they were able to use their connections in what was essentially a small city where everybody knew everybody.

Rural doctors in China; Free cancer screening; New TB vaccine; Do doctors have good cardiac skills?

by MICHAEL WOODHEAD

In a sign of the increasing concern about the demise of rural healthcare, China's 1.4 million rural doctors have now been given their own professional organisation.
Although it's not quite a trade union, the Chinese Medical Association has established a rural doctors section that will represent the interests of the many village doctors. The move is in response to the ageing of the semi-skilled workforce, most of whom lack medical degrees and have only high school education and a short training course on healthcare provision. According to the CMA, the new Rural Doctors Association "will assist the government to strengthen and promote rural doctor team building for the survival and development of rural medicine and safeguard the legitimate rights and interests of rural doctors."
Earlier this year Premier Li Keqiang acknowledged that it was important to retain doctors in rural areas, because their primary care role was "more effective than building a large hospital." The State Council acknowledged that rural doctors were the cornerstone of primary healthcare for hundreds of millions of rural residents.
However, most rural doctors are approaching retirement and younger people do not want to work in remote 'backward' areas in a role that is poorly paid and has few career prospects. Rural doctors by decree are paid the same salary as rural teachers - which is a pittance.Their miniscule pensions are an even greater cause for complaint.

Free screening programs for breast cancer and cervical cancer are to be developed nationally in China, according to the National Health and Family Planning Commission. The ministry said 48 million women in rural China had already received cancer screening interventions since 2009,  and there were now plans to increase promotion of screening services, co-ordinated by the All-China Women's Federation.

Despite studying medicine for seven years, China's junior doctors are unable to manage the basics of dealing with a heart attack, a study shows. A survey of 362 new medical graduates found they had little knowledge about basic cardiac diagnosis and resuscitation. Only about 50% of the doctors were able to identify common normal and abnormal ECG changes such as ventricular fibrillation. Likewise only half knew the basics of which drugs should be given for such conditions. The findings showed that many medical graduates were unprepared to manage the most common cardiac emergencies said researcher Dr Xi Huijun and colleagues from the Changhai Hospital, Shanghai.

China is leading the world in developing a new TB vaccine to replace the largely ineffective BCG vaccine against tuberculosis. At a TB vaccine conference held in Shanghai, researchers heard that a vaccine called Vaccae developed by an Anhui pharmaceutical company is in Phase 3 trials, whereas other candidate vaccines from other countries are only in the preliminary stages. Researchers said the vaccine would probably of most use in the elderly, who are expected to account for more than half of tuberculosis cases in the future.

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

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

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

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

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

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

The two H's that cause the most common cancers in China

Pre-cancerous cirrhotic liver

by Michael Woodhead
In western countries we are quite rightly focused on the high profile cancers and how to prevent them. Lung cancer is now in decline due to the very successful campaigns to stop smoking. Likewise in sunny Australia we are starting to see declines in skin cancer thanks to the campaigns that encourage people to cover-up and avoid carcinogenic UV rays. Other common cancers that are the focus of public attention are of course breast cancer, prostate cancer and to a lesser extent cervical and bowel cancer. All of these are the focus of major screening activities - some with official blessing, others (hello prostate cancer) despite a lack of evidence that they reduce cancer deaths.
In China it's a very different story. As you'd expect given the high rates of smoking, lung cancer is the most common malignancy seen in the country, but the other common cancers are those of the liver and digestive tract - hepatic cancer, gastric cancer and oesophageal cancer, in that order. A new review finds that the incidence of these cancers has increased dramatically since the 1980s. Perhaps because Chinese people now live longer or have better access to diagnostic services, but the gastric and liver cancers are now more common than ever. And the causes? It's the "H''s  - hepatitis and H. pylori. The high rates of hepatitis B in China are the reason for the country's huge rates of liver cancer. China has some of the highest rates of hepatitis B in the world (almost one in ten people have been infected) and new infections are still a major problem. The good news is that most children are now being immunised against hepatitis B, and the government believes that there will be far fewer hepatitis cases by 2050, when the current generation of immunised kids are adults.
Gastric cancer is the third most common cancer in China, and much of this may attributable to diet and chronic infection with the carcinogenic H. pylori pathogen. It has been estimated that the number of people in China infected with H. pylori infection rate is still above 50%, and as high as 80% in rural areas. Some hospitals are now implementing a 'test and treat' H. pylori screening approach and providing antibiotic-based eradication therapy to those found to be positive. There have also been some attempts to screen patients with endcoscopy - but is going to be a resource-intensive and logistically impossible approach to adopt nationally. Oesophageal cancer is another common cancer in China. To try prevent more cases, the government is focusing on diet in rural areas, and urging pubic health services to improve nutritional campaigns and avoid agents such as nitrosamines and harmful water contamination.
For the time being, however, China will continue to have high rates of liver and gastric cancers. Eradicating hepatitis and H. pylori will help in the long run, but Chinese people should be aware of the cancers that currently pose the greatest risk to themselves and their families.
[Based on an article by Dr Wang Rui and colleagaes at the Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, published in Clinics and Research in Hepatology and Gastroenterology)

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.]

Doctor taken hostage after patient dies of lung cancer

by Michael Woodhead
An oncologist was taken hostage by a knife-wielding man at a Dongguan hospital after the man's father died from lung cancer, Guangdong media have reported.
The doctor, surnamed Chang, was able to escape from his captor during negotiations with police, but two police were injured while trying to apprehend the hijacker. Doctors say the man was the son of a patient who died after an operation for lung cancer on 9th May. Doctors said the patient had been unco-operative throughout his treatment and had refused to follow doctor's advice, even refusing to stay in bed when he was sick. When the man got out of bed and started moving round, he had breathing difficulties and his condition deteriorated and he collapsed. After the man died, his son left and returned with a knife, which he used to threaten staff, and he took Dr Chang hostage and locked the door. He called for Dr Wen to come over, believing him to be the one responsible for his father's death and said he would kill him and then himself. Dr Chang told the man that he was the one who operated on his father and only he was responsible. When he tried calling for Dr Wen three times without success, the man got more agitated.
A police hostage squad with shields came to the hospital and started negotiations with the attacker, who had Dr Chen held with a knife at his neck. When the hostage negotiator asked the man to approach to talk, Dr Chen was able to suddenly break away and escape from the room. The attacker chased after the doctor but was stopped by police who used their shields to press him to the wall. When the attacker was trapped he lashed out at police with the knife, stabbing two of them around the ear and the hand, injuring them.
The 28-year old man was then arrested by police. Dr Chang said it was the first time in his career that he had ever come across such an extreme situation.

The top 8 medical news stories from China for Thursday 1 May

1. A person's blood group may influence their survival from cancer according to oncologists in Guangzhou. In a study of patients with oesophageal cancer they found five year survival rates were 50 % for patients with blood type A, 45% for type B, 51% for type O, and 61% for type AB.

2. The incidence rate of type 1 diabetes is increasing at a rate of 14.2 % per year in Shanghai and if present trends continue, the number of new type 1 diabetes cases will double from 2016 to 2020, researchers say.

3. Chinese neurologists say people with atrial fibrillation may be able to avoid the need to take lifelong anticoagulant drugs to prevent stroke by using a minimally invasive surgery procedure called left atrial appendage closure (using a system created by Boston Scientific Corp - could be an advertorial).

4. The introduction of the New Cooperative Medical Scheme (NCMS) has increased access to healthcare for elderly people, but not had any effect on their overall health, a study from Nanjing University shows. The study found that the health cover did not affect overall health status and did not reduce the out-of-pocket spending of elderly people.

5. An outbreak of hand, foot, and mouth disease that hospitalised 1844 children in Central China from 2011 to 2012 was caused by a mixture of co-circulating coxsackievirus A16 (CVA16). and enterovirus I71 (EV71). This may have contributed to the genomic recombination between the pathogens say researchers from Wuhan University.

6. The whistleblower 'Corridor Doctor' doctor of Mianyang who worked in a corridor after being suspended from her job for two years, has now been sacked. Authorities said Dr Lan Yuefeng had been absent for almost two years and had been disruptive and uncooperative. Her colleagues rejected charges of overservicing at the hospital and went on strike claiming she had made false allegations and damaged their reputation.

7. Health authorities in Beijing are urging adults to have measles vaccination after a surge in cases in thecity. They say there has been a spike in cases in the past two months, and more than half of the infected are in adults, probably because protection from childhood vaccination has waned.

8. Radiologists in Sichuan claim that resting-state functional MRI could be useful in providing early and accurate diagnosis of ADHD. In a study published in Radiology, Dr Qiyong Gong of the West China Hospital of Sichuan University, showed that the boys with ADHD had altered structure and function in certain areas of the brain, such as the orbitofrontal cortex and the globus pallidus. that play in executive inhibitory control - the ability to control inappropriate behaviors or responses.

Cancer in China: don't be distracted by the smog

by Michael Woodhead
Forget about the smog scare - if you want to tackle cancer in China, you need to focus on smoking, diet and physical activity. That's the message from the Asian regional representatives for the World Health Organisation in the Lancet this week. Cherian Varghese and Shin Hai-Rim urge China to act on the obvious causes of cancer and implement practical programs that will achieve the greatest change with the least resources.
In their commentary they note that China has a huge burden of cancer, but there is still a lot that is not known about the causes of cancer and the types of cancer in China.  They note  there is a lot of concern about very evident environmental factors such as air pollution, but they say this is a minor contributory factor compared to factors such as infectious diseases, smoking, poor diet, alcohol consumption and lack of physical activity. Therefore they say much could immediately be done to prevent and reduce cancers by implementing policies such as smoking cessation and vaccinating against hepatitis B and HPV. They also stress the need for a more skilled health workforce and system to deal with cancer, such as by identification of early-stage disease, referral, and palliative care. They warn against the temptation to put resources into expensive new cancer drugs, which would probably have only minimal effect on cancer survival rates.
"A set of very cost-effective interventions are provided in the [WHO] Global Action Plan to reduce tobacco and harmful alcohol use, improve unhealthy diets, and increase physical activity. These measures are mostly regulatory, legal, and fiscal interventions, and will affect rates of non-communicable diseases (including cancer) in large populations," they say.

New non-interferon antivirals will not eliminate hepatitis C overnight, say Chinese experts

by Michael Woodhead
New antiviral drugs offer the chance to eliminate hepatitis C from China, but over-optimistic predictions need a reality check, says a leading Chinese virologist.
In an article in Gastroenterology, Dr Lai Wei of the Peking University People’s Hospital and the Beijing Key Laboratory for Hepatitis C and Liver Disease Immunotherapy says there has been a lot of hype about new pipeline drugs bringing about a "hepatitis C revolution". It is claimed that a whole new range of drugs soon to be released will be able to treat the intractable blood-borne viral disease much more effectively and quickly than current treatments - and most importantly without the debilitating side effects of current drug regimens based on interferon. It is said that drugs such as simeprevir and sofosbuvir will be able to cure hepatitis C infection in 95% of people after a single 12-week course of treatment. If this is true then these drugs could potentially have a major impact in China, which has one of the highest rates of hepatitis C in the world.
It is estimated at least 2% of the Chinese population - about 30 million people - have chronic hepatitis C infection. The disease burden for China in terms of hepatitis C-related cirrhosis, liver failure and liver cancer is huge.
Hepatitis C is a chronic disease, and many of those with the infection remain undiagnosed and untreated until it progresses and the severe consequences such as cirrhosis and liver cancer become apparent. In China fewer than 3% of people with the infection are diagnosed, and only half of those diagnosed get any treatment. And the treatment itself is not very effective or tolerable. The best available agents are peg-interferon and ribavarin, which can produce a 'sustained viral response' in about 70% of patients with a 24-week course - but only in people with certain types of HCV (genotypes 2 or 3). Treatment success rates are much lower for people who have HCY type 1, even with much longer treatment courses. The side effects of treatment resemble a very bad case of flu, and many patients simply cannot or will not tolerate these effects and stop treatment.
The appeal of the new anti-hepatitis C drugs is therefore obvious. They are more effective and bettwr tolerated. Within five years it is theoretically possible for all types of hepatitis C to be cured with a single course of treatment lasting as little as eight weeks.
The reality for China, however, is not so simple. There are three major barriers to eliminating hepatitis C from China.

1. First and foremost is the problem of identifying the 97% of people in China who have hepatitis C infection but are not diagnosed. This will require some kind of screening program - and this may be very expensive unless there is an accurate and affordable test available. Identification of hepatitis C also requires the public to be aware of the disease and that it can be treated.

2.If patients with hepatitis C are identified they then need to be able and willing to access treatment. Many people with hepatitis C live in rural areas. Even in cities, China does not have a sufficiently large medical workforce with the skills to accurately diagnose hepatitis C and provide appropriate tailored treatment and follow up. A major medical workforce expansion and education program would be needed.

3. The new hepatitis C treatments are not affordable for a developing country like China . The costs of the new anti-hepatitis treatments are enormous. In the US a single course of sofosbuvir costs $84,000. Some countries such as India and Egypt have planned low cost programs for antiviral drugs for hepatitis C. But even if low cost versions of these new drugs are produced generically, the costs of treating 30 million people will still be huge. There is also a question of whether the new drug treatments can be used in sub-groups of patients with hepatitis C such as those with co-morbidities, cirrhosis the elderly and most importantly, in children

In summary, China has potentially much to gain from the new era of hepatitis C treatment - but huge practical problems lay ahead in identifying people with the infection and getting them into treatment.

Schistosomiasis test | Cancer snapshot | Stroke survival: six medical news stories from China

A simple and accurate test for schistosomiasis developed by Shanghai researchers could help in the eradication of the disease in China. The rSP13-ELISA method is an affordable serology test for markers proteins of Schistosoma japonicum. The test is highly specific, sensitive and affordable, according to researchers from Tongji University, Shanghai, in an article in Lancet Infectious Diseases this week.

 One in five Chinese people will develop cancer and 13% will die of cancer before the age of 74, data from the nation's cancer registries show.  The most common cancers in China are lung cancer, gastric cancer, liver cancer, oesophageal cancer, colorectal cancer, pancreatic cancer, breast cancer, leukemia and lymphoma, which account for 80% of all cancer deaths.

Chinese people with stroke are more likely to survive now than they would have five years ago, say researchers from the Second Military Medical University, Shanghai. A decrease in mortality from stroke probably reflects advancements in stroke care and prevention. With better survival rates, we should pay more attention to rehabilitation and quality of life for stroke patients. 

Two children in Shanghai have died from hand foot and mouth disease, the infection caused by EV71 enterovirus. The children were from migrant worker families and attended a Jinshan District care center blacklisted over hygiene issues.

Hospital are making large profits from mortuary services, the Global Times reports. Morgues are changing huge markups for services such as preparing corpses for burial and families typically pay 10,000 yuan for cremation and burying services. 

Cardiologists have dismissed internet claims that rubbing inside the elbow is  an effective way to treat people who have had a heart attack. The advice being circulated on social media sites claims that thromboses can be dislodge by  massaging blood vessel near the elbow.

Breast cancer is different in China:  women get it  at a younger age, are  less likely to have breast- conserving surgery and less likely to have positive oestrogen receptor cancers.

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.

HPV a risk factor for oesophageal cancer as well as cervical cancer: Chinese study

Human papillomavirus (HPV) infection is known to be associated with cervical cancer and now Chinese researchers have shown that HPV plays a similar role in the etiology of oesophageal cancer. According to a study in the Archives of Virology,  researchers in Linzhou, Henan, found that infection with high risk HPV types was the risk for both cervical dysplasia and oesophageal cancer by four fold.

Wuhan pollution causing cancer in children, says oncologist

by Michael Woodhead
The increasingly severe pollution and smog in Wuhan is having "terrible consequences" for  the health of local people, a cancer specialist has to the Wuhan political consultative conference.
Dr Liu Li of the Xiehe Hospital Cancer Centre told the Wuhan conference that cancer rates in the city had increased in the last 10 years and tumours were now being seen at a much younger age.
Dr Liu said the number of beds at the hospitals cancer centre has doubled to more than 1000 in the last decade, but they were still at 100% occupancy. He said the incidence and mortality of cancer in Wuhan were without precedent, and it was shocking to see infants presenting with tumours.
To see an infant needing chemotherapy can only make you cry" he told the conference.
Lung cancer is the most common type of cancer we see and the contributory factors are complex, but air pollutio is no doubt theimportant  'assasin'," he said.
According to the Hubei Daily, Dr Liu called on environmental protection department to take urgent action to address the smog problem. One example is the common practice of burning rubbish, he said, which causes large amounts of ash and hazardous particles to be released into the air.
"Air pollution is now a critical threat to population health in Wuhan, he said.

HPV linked to oesophageal squamous cell carcinoma in China

Medical researchers have uncovered an alarming link between HPV virus and the quadrupling of a string of deadly cancers in China.
The deadly Human Papilloma Virus increases the risk of oesophageal squamous cell carcinoma (OSCC) in China by almost four- fold, according to research led by University of New South Wales (UNSW) academics.
In addition to causing cervical, anal and genital cancers, HPV has more recently been found to cause head and neck cancers. OSCC is a cancer where a possible link with HPV has been postulated in the past, but not resolved.
"The problem with OSCC is that there is no way to screen for it, so it is usually diagnosed quite late and has a very high mortality," said the first author of the paper, Surabhi Liyanage, a PhD candidate with UNSW Medicine.

'Cancer street' set up by Hunan outpatients having treatment

Half a kilometer in length, the narrow Jiatong Street that cuts through the Hunan Provincial Tumor Hospital and Hunan Normal University Medical College has been dubbed "Cancer Street," as it is populated by hundreds of cancer patients seeking treatment at the hospital. 
It began with some patients who rented apartments in the street for long-term medical treatment, and after some time it naturally developed into a neighborhood accommodating hundreds of patients, most of whom live here for a couple of months at a time.
The street has fully adapted to its population. Small hotels full of tenants occupy this area, with groceries, eateries and pharmacies serving their needs. It looks like a common, rundown yet lively backstreet seen in most cities, but look closer and the vegetable shops here also sell stoves and woks to tenants, clothing shops offer wigs to those losing hair from radioactive treatment, and pharmacies and clinics are also a source of psychological support for patients fighting the fear of cancer.
On a fine day, tenants spread white bedding under the sun, like those in the hospital. Coming from all over the province, the tenants usually share their experiences in combating the diseases and try to encourage each other.
Some patients who have recovered and left Jiatong Street call it the "old place" that they will visit again, but not everyone will be fortunate enough to reminisce about this place.
Source: Global Times

Guangzhou oncologists develop better staging method for colon cancer

Guangzhou oncologists have developed an improved staging method for colon cancer that accurately predicts the risk of disease recurrence and benefit of adjuvant chemotherapy for patients who have had surgery for stage II colon cancer.
Researchers from the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, used expression patterns of multiple microRNAs (miRNAs) combined into a single model to improve postoperative risk stratification and prediction of chemotherapy benefit for these patients.
Using this tool, they were able to classify patients as at high risk or low risk of disease progression. Five year disease-free survival was was 85% for the low-risk group, and 57% for the high-risk group. The six-miRNA-based classifier was an independent prognostic factor for, and had better prognostic value than, clinicopathological risk factors and mismatch repair status.
Patients in the high-risk group were found to have a favourable response to adjuvant chemotherapy The clinicians developed two nomograms which combined the smiRNA-based classifiers and clinicopathological risk factors to predict which patients might benefit from adjuvant chemotherapy after surgery for stage II colon cancer.
“Our six-miRNA-based classifier is a reliable prognostic and predictive tool for disease recurrence in patients with stage II colon cancer, and might be able to predict which patients benefit from adjuvant chemotherapy. It might facilitate patient counselling and individualise management of patients with this disease,” they concluded.
Full study: Lancet Oncology

Xinjiang study links oesophageal cancer to fibre intake

People in China's north-west have been the focus of research which investigated risk factors for oesophageal cancer. 
The research  found high dietary fibre intake can help reduce the incidence of oesophageal cancer, which has a low survival rate.

Shihezi University conducted the hospital based case-control study in remote north-west China (Xinjiang region), where the rates of oesophageal cancer are far greater than anywhere else in the world.

Oesophageal cancer is the sixth leading cause of cancer-related deaths worldwide.

The Chinese participants included 359 oesophageal cancer sufferers and 380 healthy controls. Participants were both male and female; and they came from the same area and were of similar age (average age 61 years).

With the information discovered the researchers advise that new dietary guidelines for China include a recommendation to increase fibre intake to prevent oesophageal  cancer.

Source: Medical Xpress

Tsinghua develops cancer biomarker

Tsinghua University researchers announced on Sunday they had developed a method to measure the concentration of a cell protein that enables the detection of cancer with only a drop of blood.
The amount of the cell protein in a cancer patient exceeds that in a healthy body, they said.
Luo Yongzhang and his team at Tsinghua University identified heat shock protein 90 alpha (Hsp90 alpha for short) - an essential and ubiquitous protein in various cell types - as a "novel tumor biomarker." The team has also developed a quantitative detection kit for clinical use.
"Levels of tumor biomarkers increase in accordance with cancer progression. It has become a useful approach for disease monitoring and efficient evaluation," Luo said.
Clinical trials showed the protein to be a useful tumor biomarker for lung cancer. More clinical trials for six different cancers, including liver cancer, breast cancer and colorectal cancer, have already started, Fu said.
"Very few of the known tumor biomarkers are specific for only one type of cancer, and there may not be any. As for Hsp90 alpha, it is sensitive to many cancers in theory, but we need to carry out more studies to find out."

In 2011, the US National Cancer Institute listed 31 tumor biomarkers for tumor diagnosis worldwide. All were defined by scientists outside China. The protein is the first to be discovered by Chinese.
The validation of Hsp90 alpha was based on a series of scientific studies conducted by Luo's team since 2009.
In 2009, Luo and his colleagues reported the regulatory mechanism of the secretion of the protein by tumor cells, and revealed for the first time the molecular difference between its intracellular and extracellular versions of the protein.
They also found that the plasma level of the secreted protein in cancer patients is significantly higher than it is in healthy people, which showed the great potential that the protein has as a tumor biomarker.
Later, Luo and his team collaborated with biotech company Protgen Ltd to develop the Quantitative Detection Kit for Hsp90 alpha.
With the kit, only 10 microliters of plasma is needed to detect the level of Hsp90 alpha for disease monitoring and therapeutic evaluation.
"This is a much more convenient and cheaper method compared with other traditional means of tumor detection; for example, computed tomography," Luo said.
The kit was used in clinical trials in 2,347 cases in eight hospitals in China.
In April, this kit was approved by the China Food and Drug Administration.

"Usually, doctors use multiple biomarkers to decide a patient's condition, because individual differences may impair their judgment. So the discovery of this new biomarker, Hsp90 alpha, offers a new option for doctors and patients," said Fu Yan, a research staff member of Luo's team.

Source: Peoples Daily