The top three medical stories from China this week

Medical exam fraud: A medical examination cheating ring has been uncovered in Hebei after a 29 year old woman was found to be taking a postgraduate exam in place of someone else. The woman was arrested after it was found the ID card did not match the details of the doctor who was supposed to be taking the test, who was from Chengdu. The woman said she was paid 60,000 yuan (about US$9000) to take the test on behalf of another person. The woman, who was originally a doctor, said she had given up her job in 2013 after she discovered she could make more money through exam fraud.

Influenza deaths: There have been three severe cases including one death from severe H5N6 influenza in Guangdong and a further death of an overseas visitor from H1N1 influenza, according to media reports. Chinese media said that a a 25-year-old man from Shenzhen, was in a serious condition in hospital. A 26 year old woman died of the same infection in Shenzhen last week, while a third person in Zhaoqing, Guangdong was in a serious condition. Meanwhile a Guyanese man has died of H1N1 influenza in a Miami hospital after returning from China. The infections are presumed to have come from exposure to live poultry and it is not thought there is a high risk of human-to-human transmission.

Air pollution harms fetus: Pregnant women who are exposed to the high level of air pollution in China are likely to have low birth weight babies, a study shows. Exposure to high levels of PM2.5 particles, as found in China's smogs, was linked to a decrease in birth weight and an increased risk of low birth weight, according to a study by specialists at the Guangdong Women and Children Hospital, Guangzhou. The doctors said the effect of air pollution on fetal growth was similar to that seen with cigarette smoke, and was due to immature fetuses being more susceptible to air pollution because they are in critical periods of organogenesis.

Dodgy hospital uses call centres to lure bumpkin victims

by MICHAEL WOODHEAD
A backstreet private clinic in Beijing is using call centre staff posing as doctors to lure unsuspecting victims to have expensive and often unnecessary medical procedures. In an expose, a Beijing Times reporter spoke to call centre staff for the Beijing Sande Weiye (三德伟业) clinic, who described their high-pressure sales tactics to bring patients in for high tech and often unproven treatments such as 'stem cell' technology for arthritis.

The call centre staff said they were given a script and a template to respond to phone inquiries coming from people who had been deceived by fake websites and Baidu advertisements that claimed their 'hospital' was affiliated with prestigious major hospitals in the capital. When answering calls, the sales staff said they were doctors but in reality they were unqualified and just ran through a script whose aim was to convince callers that they could jump the queue and get access to top specialists at the city hospitals. Most of the callers tended to be gullible out-of-towners who were seeking treatment in the capital rather than rely on the more basic and underfunded rural hospitals.

Sales staff told the reporter that they were pressured to get the caller's mobile, after which they would make a series of promises and phone calls to establish a relationship with the prospective customer. They were paid on commission: 2 yuan for getting a call, 20 yuan for getting a registration (ie phone number and verbal contract) with the 'network' and 60 yuan for a hospital visit. The sales person also got a cut of the treatment fees and drug fees. A successful telesales operator could make 5000 yuan in this way. The treatments offered were often high technology - such as joint replacement - and were offered regardless of whether they were really appropriate for that patient.

When the reporter visited the 'hospital' he found it to be just a standard clinic with unscrupulous doctors offering treatments that were much higher in price than the same treatment in public hospitals. A knee replacement, for example was priced at 60,000 yuan.

When the reporter informed the top three hospitals that their name (and reputation) was being hijacked to promote a bogus clinic they said they did not have the staff or resources to chase up the many such cases they heard about from complaints. They suggested the fraud be reported to the Public Security Bureau, but the PSB said they would only follow up complaint from people who had been swindled and who had evidence to show criminal behaviour. They instead suggested that the reporter called the consumer affairs bureau.

The Beijing Industry and Commerce Bureau  told reporters that any company making false propaganda, should be reported to the bureau's hotline and would be investigated, with fines and business license suspensions for offenders..

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.

Academic fraud in China: 43 medical studies retracted

by Michael Woodhead
Medical research fraud in China - the latest development is the discovery of widespread fake peer review. The open access publisher BioMedCentral has this week announced the retraction of 43 medical journal publications by Chinese researchers after it discovered widespread peer review fraud. Most of the articles were submitted by medical researchers at universities in China, including China Medical University, Sichuan University, Shandong University and Jiaotong University Medical School. A full list is given here.
 
Here's how fake peer review works: When a scientific paper is submitted for publication to an academic journal, the journal invites authors to suggest potential reviewers for their papers. The authors or their agents can then provide bogus names with e-mail addresses that go directly to them. They fill in their own peer review form, and bingo - satisfy the publisher's requirements, without actually having the article checked by an independent reviewer.  There's a full article on the topic in Nature.

According to Ivan Oransky's Retraction Watch, the BioMedCentral senior editor of scientific integrity Elizabeth Moylan said some of the fake peer reviews "appear to have been conducted by third-party agencies offering language-editing and submission assistance to authors. It is unclear whether the authors of the manuscripts involved were aware that the agencies were proposing fabricated reviewers on their behalf or whether authors proposed fabricated names directly themselves."

On BioMedCentral's blog, she wrote that "During the course of our investigation, authors have shared with us the names of third-party agencies that offer support to authors but also guarantee favourable peer review outcomes in return for a fee. Other services sell authorship on entire papers written by others. Clearly, there is a need to distinguish the characteristics of reputable third-party agencies from those that are dishonest (in much the same way that bona fide open access publishers can be distinguished from those that are predatory)."

To try combat the fake peer review scams, the publishers have deactivated the automatic "suggest peer reviewer" box in the submission forms. Authors will now have to suggest peer reviewers in their covering letter, and provide verifiable email addresses for their institutions. Other journal editors say this is too lenient, and that authors should not be allowed to suggest peer reviewers at all.

The publishers are at pains to suggest this is not just a China problem. Other incidents of fake peer review have been reported recently from other countries, including South Korea and Taiwan (the latter even resulted in the resignation of a government minister whose name had been cited as a co-author on several of the fraudulent publications).

As the BMC publishers point out, peer review is based on trust, and there is only so much that can be done to prevent deliberate fraud. One of the key factors driving the fake peer review in China is the need for Chinese doctors to publish a quota of papers each year in order to retain their posts and qualify for promotion. It is literally publish or perish, career-wise. I've previously blogged about China's  publish-for-promotion system for doctors and the scams it encourages, including the use of agencies and ghostwriters to generate scientific papers. This latest development seems to suggest that there are now ghost reviewers too.

Research fraud and inappropriate treatment: my blog about medical news from China for Sunday 15 February.

Last week I blogged about how so many medical journal articles in China are simply "vanity publications", written by ghostwriters to satisfy the doctor's need to achieve a quota of published articles. However, this week we see that there are also major problems with 'serious' research clinical trials carried out in China. An article in JAMA this week by Charles Seife reveals that the FDA found serious problems with the Chinese clinical trials of apixaban, a novel anticoagulant.
 At one site the FDA concluded that patient records had been altered. When they investigated further the FDA inspectors declared that data from 23 other Chinese clinical trial sites was suspect and should be excluded from their evaluation of apixaban (Eliquis). We often hear that western pharma companies are shifting their R&D from the US and Europe to China. It may be cheaper but with reports like this you have to wonder if it is worth it in the long run.

China is also trying to make a name for itself in high tech areas such as stem cell transplantation. An announcement in the Shanghai media said the city was to build the world's largest hospital for 'blood diseases'. This seems to be a reference to  hematopoietic stem cell transplant procedures for patients with blood diseases such as leukaemia. This is a highly specialised and expensive form of treatment for a small niche of patients (and often of limited benefit), so it is odd that a city that can't even meet demand in its emergency departments  is pushing ahead with a hospital for rare diseases. perhaps the explanation is that the project is being run by the China Stem Cell Group Co Ltd. This may be more about making profits than providing needed health facilities.

China's love of high tech for its own sake is  also manifest in the move by a Guangdong hospital to set up 1000 telehealth stations in pharmacies to provide online consults. The move by the Second People's Hospital of Guangdong to set up the Guangdong Online Hospital will reportedly include 200 doctors providing services via videolink. All sounds very modern, but how exactly does a doctor do a physical exam, order tests and imaging and provide 'hands on' care over a video link? It might be of limited value in follow up counselling consultations and for repeat prescriptions, but it sounds like a gimmick to me.

Online hospitals are supposed to help address the problem of overcrowded hospitals. I'm not sure how they will help the cancer patients who need a bed but can't get one. In places such as Changsha in Hunan the hospital bed shortages are so acute that patients have to make do with 'cancer hotels' instead. Patients with cancer who require treatment but who are on the waiting list pay 1100 yuan a month to stay in hotels adjacent to the cancer hospitals so they can go into outpatients for treatment. Locals say that about half the hotels near the hospital are occupied by patients, who face 1-2 month waits for a bed.

Breast cancer is an increasing concern in China, but rates are still not as high as in the west, perhaps due to dietary and lifestyle factors. Screening for breast cancer is also not part of the Chinese health system, although there has been some use of mammography. However ultrasound has been favoured by some Chinese clinicians, reportedly because it is more suitable to the smaller and more dense breast tissue of Chinese women. Now a study has confirmed that ultrasound is a more effective screening method for breast cancer in Chinese women. A study of more than 12,500 women who underwent either or both found that of the 30 cancers detected, five were in the mammography group and 11 in the ultrasound group, and 14  in the combined group. Ultrasound was more sensitive had the same specificity and positive predictive value as mammography. It was also considerably cheaper, costing $7876 to detect one cancer compared to $45 253 for mammography.

In other clinical news, metabolic syndrome (a highly dangerous combination of abnormal cholesterol, high blood pressure and pre-diabetes) was found to occur in 27% of Chinese people. A study of 15,477people in NE China found that 28% of men and 26% of women had metabolic syndrome. The condition was more common in Chinese on high incomes, those who ate more rice and those who did less physical activity - in other words, 'to get rich is glorious' but it also comes at a price of this disease of affluence. 

However, Chinese people might be forgiven for thinking twice about going for a jog, given the terrible air pollution in many cities. This has now been confirmed by Dr Liu Yu of the Key Laboratory of Exercise and Health Sciences at Shanghai University of Sport. This week he published an article in the BMJ which warned that the harms of ambient air pollution on the cardiovascular and respiratory systems might outweigh the benefits of exercise. He estimated that air pollution probably caused more than a thousand deaths a year in the city.

It's not all bad news from China, though. A paper published by the WHO this week shows that Chinese healthcare workers have had great success in reducing deaths from HIV using a simple 50c antibiotic, co-trimoxazole. Their study showed that giving the antibiotic at the same time as antiretroviral reduced HIV deaths by 37% - a staggering achievement. If routinely use in China for HIV patients  this could save thousands of lives among HIV positive people, the researchers sai.d Unfortunately, however, antibiotic use if often missed in this patient group.

My weekly medical news blog for 7th February

There have been few takers for GP training places in Nanjing. The city's community health centres need to recruit 110 family doctors to fill their positions but have only had 49 applicants. Under new health ministry regulations, all doctors including GPs must have the 5+3 education and training (5 years undergraduate and 3 years postgraduate.) However, despite offering a masters degree and a one month placement with GPs in Taiwan, most medical graduates have given the GP training scheme the cold shoulder. The reason is the low status and poor pay of 'community doctors'. After eight years training, GPs can expect to earn only about 80,000 yuan (US$13,000) a year, which is much lower than hospital-based specialists earn. Also there is no chance of promotion or career progression and GPs are expected to move around many clinics in suburbs and villages. Health educators say the Chinese government needs to put more emphasis and resources into primary care if it is to develop a healthcare gatekeeper system similar to those used successfully in developed countries.

Most of the 'research' published by China's doctors is rubbish and there's a simple reason for this - the publish-for-promotion system. To gain promotion (and often just to stay in the job) all China's doctors have to meet a certain quota of  papers published in medical journals. The problem is that most of China's doctors are way too busy treating patients to be doing research and writing up papers. Many are simply not interested. The result is a thriving industry in academic fakery and plagiarism. It is common knowledge that doctors hire 'publishing agents' and ghostwriters to source the articles that will be published under their name. Ironically, many of the articles are written by medical students, and so there is an inverted system whereby the most knowledgeable and experienced clinicians are publishing articles written by the least knowledgeable. The going rate is about 3000-4000 yuan for a good paper - payment on publication, of course. Experts say the system has become a wasteful farce, and they are calling for reform of the one-size-fits-all quote system, to divide doctors into three categories: 'craftsmen' (no research, just treating patients), physicians (some research) and medical scientists (more  research, fewer patients).

The government says it expects to see a dramatic increase in uptake of private medical insurance before 2020, with new policies encouraging Chinese citizens to take out private cover. Ma Xiaowei, deputy head of the health ministry, the National Health and Family Planning Committee, told a news conference this week that the central and provincial government would "encourage the development of various types of commercial insurance to increase people's ability to deal with risks posed by major diseases." He said private cover was needed to help fund demand for health services, with the number of people over 60 already exceeding 200 million. However Mr Ma didn't explain how people will be enticed to take out private health insurance given that there are currently virtually no private doctors or hospitals and very few services or benefits from having insurance.

Underpaid, overworked and under fire: that's the life of an emergency medicine specialist in Guizhou province, according to a Sina article this week. In China, emergency doctors accompany ambulances and are often first on the scene of trouble, even before police. One doctor said he often had to jump in and stop bleeding in stabbing victims while people were still fighting around him. Another said emergcny doctors were often faced with physical challenges such as getting critically ill patients down stairs of apartment blocks with no lifts. Emergency doctors said they worked 24 hour shifts then had a day off during which they mostly slept, and there was no time for leisure, holidays or study. The stress of daily life as an emergency doctor meant there were high rates of burnout - and doctors were considered grizzled veterans if they lasted three years, they said.

In clinical news, new research shows that older Chinese are consuming more calories - and eating more unhealthy food - than their counterparts of the previous generation. A study from nine provinces found that the average daily energy intake had increased among older Chinese adults from 1379 total kilocalories in 1991 to 1463 kilocalories in 2009. The increases had come from greater consumption of high fat and high carbohydrate foods such as plant oil, wheat buns, and wheat noodles.

Chinese are also consuming more polluted air and it is killing them as much as smoking. A study carried out by the School of Public Health in Peking University found that there were
257,000 premature deaths related to PM2.5 pollution in 31 major Chinese cities. This made air pollution a major killer equivalent to smoking. Conditions such as lung cancer and stroke triggered by air pollution killed about 18,000 people in Beijing alone in 2013, the researchers said.

And finally, a study from Shanghai as shown that the number of cervical cancer diagnoses in the city has increased six fold in the last decade. Data from 13,518 women with gynaecological cancers  from 2003 to 2013 showed that the number of women with diagnosed gynaecological cancers increased by almost sixfold with the increase largely due to the increase of women with newly diagnosed cervical cancer. The study also showed that the age of diagnosis of cervical cancer had increased.

How an uneducated migrant worker became a successful medical journal editor: the publish-for-promotion swindle

 by Michael Woodhead
An amazing and hilarious story in the Chinese Legal Daily this week about how a rural migrant came to Beijing and set up a fake medical journal to publish scholarly articles for senior doctors wanting to boost their promotion prospects.

The young man ran a highly successful publishing operation and made almost two million yuan ($325,000) between 2009 and 2013 when his operation was busted by police. The man called Liu Yang was only 23 years old when he came to Beijing and started working on the reception desk of a hotel in 2009. It was while he was talking to a doctor at the hotel that he hit on his money-spinning idea. The doctor was complaining about how difficult it was to get promotion because of the requirement to have a quota of articles published in medical journals. The problem, he said, was simply that there were too many doctors trying to get published and not enough journals.

Liu Yang had the obvious idea of inventing a medical journal to meet that demand. Despite having only a middle school education and knowing nothing about medicine, he quit his job at the hotel and borrowed  money to buy some basic publishing equipment such as a scanner and large printer. He installed this at his apartment, which would become his editorial office. However, his most important investment was 200 yuan for copies of the leading medical journals, whose style he copied. He also bought a list of top doctors and top hospitals around China.

Awarding himself a doctorate and appointing himself editor and publisher, Liu Yang then wrote to the hospitals on his list and offered the services of his medical journal for publishing. He was immediately inundated with manuscripts from mid-career doctors. As a police investigator later explained to the reporter, the medical career pathway in China is based on publication of scholarly articles for advancement. Promotion from hospital resident onwards is dependent on having a list of articles that have been published in journals. No publication, no promotion.

"Dr" Liu Yang received so many submissions he was rushed off his feet publishing his journals every month, and soon had to call in his wife and other family members to help out. The journals were only circulated to the doctors who had articles published in them. It was essentially vanity publishing. And yet, to maintain some credibility, Liu Yang even started to reject some manuscripts. The fake journal published articles from doctors all over China: the most frequent users were doctors seeking elevation to 'deputy director of department' level, a career step which required many published articles.

At first, the fake journal was a print operation, but doctors then started asking 'Editor' Liu Yang why their articles were not being published online. The fake editor then expanded his shanzai operation online and hired a web designer to copy the website  of a leading medical journal and set up a website for his own fake journal. Now Liu Yang offered digital journal publishing to his hundreds of clients.
In total he published articles by more than 800 doctors, and most were senior doctors at major hospitals, including military hospitals. Most did not realise the journal was a fake operation. A few suspected things were not quite above board, but still paid Liu Yang to publish their efforts because they believed others would not notice.

And for four years they didn't. As a police investigator remarked, there are hundreds of such medical articles and theses published every year and nobody is much interested in what they say - they are simply published to impress hospital administrators. And so until recently nobody was auditing these medical articles or the journals that published them.

However, somebody must have eventually twigged to Liu Yang's ruse. In September 2013 police came calling at the new expanded Chaoyang offices that Liu Yang had expanded into. As cops banged on the door, his wife tried to throw plastic bags of money out of the window, whereas Liu was more interested in trying to save the raw materials for his publishing operation. The police gained entry to the premises and shut down the publishing business, confiscating equipment and 600,000 yuan. Liu Yang and his wife were arrested by police and charged with fraud.

Commenting on the case, a senior doctor at a Beijing Hospital said the fake journal saga highlighted a major fault of the medical career system in China, namely the reliance on having papers published. The doctor said there was enormous pressure on doctors to publish, because promotion offered higher income through access to prescribing a wider variety of drugs. Doctors who were good clinicians but did not publish remained stuck on the lower rung of the hospital ranking and only treated large numbers of patients. Some hospitals even fined their doctors if they did not achieve a quota of published article, he said. And the doctor said the busted operation was not the only fake journal -  he still regularly received emails from dubious sources offering journal publishing services and also ghostwriting services.

Liu Yang's fake publishing operation is now smashed, but the publish-for-promotion system is still intact in China. And while doctors are under enormous pressure to publish, other loopholes will be exploited, corners cut and more scams like those of Liu Yang can be expected to occur.

Public warned of fake doctors soliciting bribes

by Michael Woodhead

The families of patients discharged from hospital are being phoned by scammers pretending to be doctors and soliciting 'red envelope' bribes, Guangzhou media report.

The Guangzhou Daily reports the case of a women referred to as "Auntie Chen" whose elderly mother had just come out of hospital for treatment of stomach cancer. Ms Chen received a phone call from a "Dr Wang" at the hospital who seemed to be familiar with Ms Chen's mother's case and said she needed to have her treatment adjusted after her last visit.

The 'doctor' said he could arrange this the next day, but the medical team would require red envelopes containing 2-3000 yuan to speed things up. He put pressure on Ms Chen, asking if she wanted to take up the offer, but time was limited and other might take the free appointment time. Ms Chen  panicked and agreed to come to the hospital the next day to arrange matters.

The next morning when she arrived at the hospital she called the number supplied by Doctor Wang and he told her he would meet her in the foyer, there was no need to go back to the clinic reception. Ms Chen became suspicious and phoned the clinic where her mother had been treated. They said they knew nothing of any changes to the old lady's treatment plan and Dr Wang had not made any calls to patients. When Ms Chen reported what had happened to the hospital security department, she was told that several families had been called by scammers, trying to dupe families to hand over money as bribes for 'special treatment'.

The head of hospital security said families should be aware that doctors and staff at the hospital would never ring patients asking for money. If there were bills to be paid this would be requested in writing and the bills paid at the hospital cashier.

 When asked how the fraudsters knew the details of the doctor and her mother's condition, the security chief said it was possible that criminal gangs had spied on people when they were registering at the hospital reception. He warned patients and families to be careful when filling in details on forms and not to discard any incomplete forms in rubbish bins. He also warned the public not to discuss the details of cases with strangers or in public where others may overhear.

HPV vaccine delay | Baidu medical fraud | Malaria system success | Gassers in short supply | GSK case won't stop bribery

1. China may be delaying approval of HPV vaccines made by foreign companies until the country has a homegrown competitor, according to Global Times. The HPV vaccines Gardasil and Cervarix are still not available in China despite 30,000 women dying in China every year of HPV-related cervical cancer. Some Chinese doctors and officials claim there are ethnic differences in vaccine responses between Chinese and Europeans, and clinical trials that in Chinese people are needed to ensure of the vaccines' safety and efficiency on Chinese.

2.  Baidu earns its fortune by promoting fraudulent medical information at the cost of health and even lives, critics say. The search engine site is the main avenue used by illegal drug manufacturers and illegal hospitals to advertise in China, they claim. Many drugs that are explicitly banned by the China Food and Drug Administration (CFDA) are still on promotion on Baidu, an article in Daily Kos says.

3. A '1-3-7' system of dealing with malaria cases that is very successful and could be a model for other countries, researchers from the Jiangsu Institute of Parasitic Diseases claim. The system is based on case reporting within one day, case investigation within three days. and focus investigation and action within seven days.Since the system was implemented in 2012 the proportion of cases investigated in 3 days has reached 100%, and seven-day action rates are 50% and rising.

4. China has a shortage of 200,000 anesthesiologists as doctors avoid the speciality due to low salaries, heavy workloads and lack of a strong training system, experts say. A conference was told that China has only 100,000 anesthesiologists but needs 300,000. Eight anesthesiologists died of overwork last year, according to Yu Weifeng, head of the anaesthesiologist branch of the Chinese Medical Doctors Association.

5. A cure for the endemic corruption in China's healthcare system is still far away despite the scare campaign against executives of British pharma company GSK, the online magazine Caixin says. While the crackdown makes the authorities look like they are being tough on bribery for prescribing, the reality is that doctors still accept commissions and there is no fix for the 'demand side' of the bribery equation, the magazine says. The health ministry cannot afford to alienate doctors, who are central to the problem, it concludes.

In China, the identities of top medical specialists are being ‘pirated’ by imitators

(Pic: genuine doctors from Wuhan)

by Michael Woodhead
In many hospitals in China the “visiting specialist” all too often is a sham. The names and reputations of top specialists in areas such as dermatology and andrology are being hijacked by imitators – including many smaller regional public hospitals.
Leading specialists are complaining that their identities are being ‘borrowed’ by a wide variety of imitators and institutions, ranging from the blatantly fraudulent imposters to the deceptive and misleading government hospitals that wish to enhance their reputation and drawing power.
According to Xinhua, one Beijing dermatologist says he receives many letters of complaint every year from angry patients from all over China who he has never seen. They claim to have been treated by the dermatologist at one of his “visiting clinics” and say his treatments were worthless and demand their money back. Of course, the dermatologist has never conducted any such clinics outside of Beijing, and the patient has been duped by imitators who have stolen his identity. The dermatologist says that some imitators are quite blatant and his students have even seen the fake ‘him’ wearing a white coat and consulting patients at small clinics with his photograph displayed outside.

"China flooded with medical imposters"
The problem of medical identity theft is acknowledged by the Chinese Medical Association and also by skeptics such as Zhong Nanshan, who says the problem is widespread and that China is flooded with false doctors and false clinics. They have called for a crackdown medical fraudsters, but until now this has not had any effect on the problem.
The CMA says medical specialties such as andrology, infertility, obstetrics, gyanaecology and dermatology are the most popular targets for imitators.  Andrologist Professor Lu Guo said his colleagues recently asked him why he was advertising clinics in the newspaper of a nearby city. He told them he had not placed any such adverts. He followed up and actually went to the clinic that was advertised and found a large queue of patients waiting to see the imposter, whom he challenged – but found he was powerless to do anything, as the man was an itinerant who quickly disappeared.
Another well-known medical specialist, Professor Li Furen, found that an imitator had taken out large newspaper advertisements for pills that included his photo and biography. When he complained to the newspaper and the company involved he found he was powerless because the company had trademarked his own name!

Three kinds of medical identity theft
Experts say there are three basic kinds of medical identity theft. The first is the straightforward imposter, who uses the photo and biography of a well known medical specialist to advertise ‘visiting clinics’, typically in a regional area where people are less well informed and likely to be impressed by a top specialist visiting from a major hospital. These imposters may or may not be genuine doctors, they put adverts in local papers and posters up at the local hospital or clinic. This kind of imposter is very common and difficult to stamp out. They often prescribe inappropriate or fake medicines and charge patients for unnecessary tests.
The second kind of medical identity theft is done by smaller public hospitals wanting to enhance their reputation. These hospitals search the internet for leading specialists and download their photos and details, which they post on their own website, claiming that the specialist is a “visiting professor” (although the doctor never visits). This attracts more patients to the hospital and also makes the hospital appear more authoritative to other doctors.
The third kind of reputation theft is when hospital managers and lesser-known doctors attend conferences and have their photo taken with a top specialist. They then display the photo prominently in their department, saying that this eminent doctor is a ‘consultant’ at the hospital.

Punishment is too light, no deterrent
The top specialists who are affected by this kind of identity theft say it causes harm to patients and themselves. Patients receive poor and inappropriate treatment and are often ripped off and overcharged for fake or substandard treatments. “It is like rubbing salt in the wound” says one doctor. Another uses the Chinese saying “Hanging up a sheep’s head and selling dogmeat”.
The other harm is to the reputation of the genuine doctor. Specialists whose identity is stolen say they are accused of fraud, malpractice and receive legal letters demanding compensation. However, there seem to be no effective action being taken against fraudsters, they say. Offenders found guilty of medical fraud can incur a fine of up to 10,000 yuan, they note – but for many of those involved these fines are rarely imposed and the actual fines are lower and prove little deterrent to this lucrative business.
The other problem is that offenders are often local government departments that control local hospitals, and there is reluctance among their local government colleagues in inspection departments to take action against them, in order to preserve harmonious relations.
Another reason for medical identity fraud to go unpunished is that most patients do not complain – they only do so if they suffer a major adverse event or become very sick. And with ‘visiting specialists’, many patients who are swindled do not know which relevant department to complain to.

Reforms will worsen the problem
One specialist, Lin Xiaobo is urging the public to be wary of medical swindlers and encouraging them to post details of ‘visiting medical experts’ on social media sites such as Weibo and WeChat to expose them. He also wants government departments and legal authorities to take stronger action and impose heavier fines on the fraudsters. However, he worries that the problem will become worse as the government health reforms encourage public hospital doctors to branch out into private clinics.
“As these private clinics proliferate, how will the public know whether the information about their doctors is genuine or not?” he asks.

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.

The "Corridor Doctor" - whistleblower or crank?

translated by Michael Woodhead
An interesting follow up to last week's story about the female doctor from Mianyang, Sichuan, who ended up working in a corridor of her hospital for two years after being removed from office for raising concerns about overtreatment and profiteering at the hospital.
In a new article, reporter Chen Xi for the Sichuan office of the Peoples Daily describes how he went to the hospital to follow up her claims and find out the background to her sacking and allegations of 'overservicing'. What he heard was a mixture of  good and bad about the would-be whistleblower.
First he spoke to Dr Lan, who said that she had always aimed to be a 'pure' doctor and wanted to be seen as one of  the 'angels in white' (ie female doctors in white coats).
However, when she started working at the Mianyang hospital she found that every activity involved putting generation of income for the hospital first. She said that practicing good medicine was constrained by the pressure to meet income targets. Patients were often admitted for treatment they did not need, and Dr Lan felt this was a breach of medical ethics. When she took her concerns to the director of the hospital, his reply was: "What are you on?"
As we reported last week, Dr Lan was stood down and barred from using her office in the ultrasound department in 2009 after she questioned the use of a cardiac pacemaker in a 53-year-old patient who had varicose veins. She said there was no need for a pacemaker in a patient who had a stable heart rate and who had already been cleared for vascular surgery.
Dr Lan also had another complaint - she said that the hospital had misappropriated thousands of yuan in earthquake relief funds donated in 2008 by Macau to aid survivors from the Wenchuan earthquake. As head of the ultrasound department, Dr Lan learned there was 235,000 Yuan in donations provided to buy a state-of-the-art Colour Doppler ultrasound scanner. However, when the machine was delivered it turned out to be an out-of-date model that was worth only 160,000 Yuan. It was not clear what had happened to the rest of the money donated from Macau. Dr Lan said she was so angry she left the old machine from the warehouse.

When the reporter tried to put these questions to the hospital management, he was told the hospital director Wang Yanming was not available. However, a deputy director, Feng Jianjun, tried to answer some of the questions.
First of all he rejected Dr Lan's claim that a cardiac pacemaker was not needed for the patient with varicose veins. He said it was usual for patients with vascular disease who needed surgery to have an atropine test. If the patient's heart rate was below 90 beats per minute then this indicated that they needed a pacemaker. In the case  raised by Dr Lan, the patient's heart rate was 60 per minute, showing that a pacemaker was clinically indicated, the hospital deputy director said. The pacemaker was needed to prevent the patient from having an adverse outcome during surgery, he said - so how could this be construed as overtreatment or inappropriate treatment?
Dr Lan ridiculed this claim, saying that it didn't make sense for a patient to be sent for tests after they had been deemed as ready for surgery - this was upside down, as pateints were alsways tested before being referred for an operation, she said.

The reporter sought comments on Dr Lan from other doctors at the hospital. An anaesthetist at the hospital said 'overtreatment' was a grey area and even clinical experts often disagreed strongly on what was the most appropriate treatment for a patient. Therefore, Dr Lan could be right or wrong.
Several doctors said Dr Lan was a hardworking and honest doctor, but with a stubborn individualistic streak and an obsessive personality. Some said she was  a loner who did not communicate or consult well with other doctors. One doctor described Dr Lan's self-image as the only 'pure' doctor as naive, while another said she was known to have strong and unbending opinions about subjects outside her area of expertise. A doctor in the obstetrics department said Dr Lan had often seen his patients and made treatment decisions on obstetrics matters that he did not agree with. She did not accept or understand that ultrasound was an ancillary branch of medicine and that it was inappropriate for her to criticise the diagnosis and treatment decisions of doctors outside her area.
Some doctors told the reporter that Dr Lan was the author of her own troubles, and that it was a joke that she chose to 'practice' in a corridor for two years. For this reason she had become know as "Dr Crazy" by some.
In Mianyang, authorities including the local health department said in a statement that they were now mounting multiple inquiries and audits into the claims made by Dr Lan. The inquiries would look in detail at her claims that patients were being overtreated only to generate income and that unnecessary and inappropriate treatments were being regularly used. As part of the investigation, authorities are  to review all CT scans and ultrasounds of patients for the last three years and check whether the treatments matched the diagnosis.

Beijing hospitals switch to new yellow receipts: more info, less counterfeiting

by Michael Woodhead
Beijing hospitals have switched to a new receipt system that provides more individualised information on billing and also offers more protection against counterfeiting.
According to a report in the Beijing Daily, the hospital have abandoned the old blue receipts that has a tear off slip, and now offer new yellow receipts that have more space for individualised billing information. The new receipts give separate and more detailed information on medical registration fees, medication fees and medical test and treatment fees. The new receipts also have a 10-digit barcode to make them more difficult to counterfeit, and they also include personal ID card details to deter switching of receipts. The billing system has also been likened to the tax department database, so users can go online to check that the receipts are genuine.

Chinese Alzheimers research may be example of academic 'black market'

by Margaret Munro
Some of Canada’s top brain specialists have apparently been duped by shady operators in China.
The Canadian doctors approved and recently published a scientific report on Alzheimer’s disease that came from a “flourishing” academic black market in China, according to a report released Thursday.
“China’s publication bazaar,” as it is described, allows unscrupulous scientists to pay big money — up to  $26,300 — to become authors of scientific papers they didn’t write.
They don’t do any experiments or research either, according to the report in the U.S. journal Science that adds a creative, if disturbing, twist to research misconduct.
“It’s new to me,” says Dr. Robert Chen, at the University of Toronto, who is now investigating the origins of the suspect Alzheimer’s report.
It surfaced last year in China’s “flourishing academic black market involving shady agencies, corrupt scientists and compromised editors — many of them operating in plain view,” according to Science. It says that several scientific papers advertised under “authorship for sale” by Chinese brokers and editing shops have later appeared in established journals — including the Alzheimer’s report published this year in the Canadian Journal of Neurological Sciences.

Baidu and government partner to combat fake medical information online

by Liau Qun Ying
Chinese search engine Baidu and the China State Food and Drug Administration (SFDA) have partnered to fight fake medical information online.
Baidu will display results from China State Food and Drug Administration in medicine-related searches.
A Sina Tech report Monday said SFDA opened up three major databases to Baidu, which will offer three new search functions for certified drugs, the wiki entry of a medicine's instruction manual, and certified Internet drug stores.
The three major databases SFDA allowed access to include the SFDA drug database which has information of about 180,000 local and important medicine, instruction manuals for 6,000 over-the-counter drugs and Chinese traditional medicine, and the database of Web sites certified to sell drugs online.
The report said users can search for information on drugs via Baidu using the medicine's brand or generic names, as well as approval number. The search results will include information from SFDA'S database.
In addition, when users search for online drug stores, Baidu will show a "certified" tag next to online stores which have been certified to sell drugs. SFDA's database of instruction manuals for medicine also will be included in Baidu's Wiki, the report added.
It noted that Baidu since 2010 had worked with various government organizations, including SDFA, to fight fake information online. The search giant said it busted 201 businesses promoting counterfeit drugs last year.
In 2011, Baidu and other Chinese search engines were slammed by a state television station which alleged the search engine promoted Web sites which offered counterfeit drugs.
Source: ZDNet

Chinese "herbal" slimming pills contain thyroid extract and cause hyperthyroidism

Chinese herbal slimming pills sold over the counter and via the internet have been found to contain dangerous levels of thyroid tissue. 
Australian path lab scientists made the discovery after a woman developed hyperthyroidism from taking the slimming pills she had bought online from a Chinese supplier. She presented to her doctor after collapsing and showed typical signs of hyperthyroidism such as palpitations, sweating, tremor and weakness of the arms and legs. Her thyroid tests showed she had hyperthyroidism and she admitted to taking a Chinese medicine "Qian Zhi Su" for three months. Analysis of the pills showed they contained thyroid-like tissue, possibly from pigs.
Source: Pathology

Medical device company goes bust - directors missing with $400 million

China Medical Technologies HQ does not look like that of a multimillion dollar company

Liquidators of China Medical Technologies, a maker of medical testing equipment that was once listed on Nasdaq and is now bankrupt, are alleging that around $400 million in cash the firm raised in stock and bond sales has gone missing. The allegations are in a complaint that the liquidators filed late last month to the Hong Kong police and the FBI.
In the complaint, the liquidators say that the CEO’s wife gambled substantial sums at the Wynn and Bellagio casinos in Las Vegas. They are also looking into some properties in Hong Kong registered to the wife of the firm’s former finance director. And they add that both the CEO, Wu Xiaodong, and the ex finance director, Sam Takyung Tsang, have evaded the liquidators’ attempts to contact them.
China Medical was a large and well-regarded public company, with top-tier investors and advisors. The liquidators do not yet know much about what happened. They have spotted that funds from China Medical’s bond sales allegedly went into a Hong Kong bank, and back out again. China Medical said the money would be used for “general corporate proceeds” and acquisitions. But the liquidators say that “most of the fund raising proceeds do not appear to have been invested in the PRC [People's Republic of China] subsidiaries.” Citing Chinese government records, they report that China Medical’s subsidiaries in mainland China only ever reported around $60 million of registered capital.
In their complaint, the liquidators add that they visited China Medical’s Chinese offices. “The liquidators’ observations of the premises of the PRC subsidiaries during their site visits indicate that these premises are not the result of an investment nearing $400 million.”
Could some of the money be in Las Vegas? Without saying where they got the information from, the liquidators allege that Bi Xiaoqiong, the wife of China Medical CEO Wu Xiaodong, “has maintained accounts with at least two casinos in Las Vegas (Bellagio and Wynn) and has undertaken gambling activities which involved substantial amounts in these two casinos as late as July 2012.” Liquidators say they cannot find much out, because they cannot track down China Medical’s top executives.
Read more: Quartz

Hunan transplant surgeon jailed in iPhone-for-kidney case

Surgeon Song Zhongyu, who carried out an illegal kidney transplant operation, was sentenced to three years

China has jailed seven people including a surgeon over the case of a teenager from one of the country's poorest areas who sold his kidney and bought an iPhone and an iPad 2, state media reports.
High school student Wang Shangkun, 18, suffered renal failure after receiving an illegal transplant operation in April last year, Xinhua news agency said.
He had agreed to sell one of his kidneys after meeting the gang through an online chatroom and received 22,000 yuan ($3350) for the organ, although it was sold on for almost 10 times that amount.
A total of nine defendants were found guilty of intentional injury, although two did not face punishment because of their minor roles in the crime, Xinhua said.
He Wei, who organised the illegal transplant, was sentenced to five years' jail on Thursday.
Surgeon Song Zhongyu, who carried out the operation, was sentenced to three years with a reprieve of five years, the agency said.
He and Song both received more than 50,000 yuan each through the transplant.
Wang's mother, Ou Linchun, had previously told Beihu district people's court in the city of Chenzhou, Hunan province, that her son did not sell his kidney specifically to purchase the Apple devices.
"My son was tempted by the illegal organ traders and might have been afraid of getting caught with such a large amount of money, so he bought a cell phone and a tablet PC," she said, according to local media reports.
The defendants, who did not check Wang's age before the operation, paid him compensation worth more than 1.47 million yuan, Xinhua reported, which added to the court's leniency in sentencing.
Authorities said in August that Chinese police had arrested 137 people, among them doctors, suspected of trafficking human organs in a nationwide crime ring that profited from the huge demand for transplants in China.
Read more: SMH

Shenzhen hospital boss on trial for accepting bribes

A former president of a hospital in Shenzhen, in South China's Guangdong province, stood trial on charges of accepting bribes from bidders.
Zhang Deren, president of Nanshan Hospital from 2007 to 2011, is accused of accepting bribes of HK$100,000 ($12,900) and 700,000 yuan ($112,000) from two companies bidding to provide medical equipment to the hospital in 2007 and 2008. The hospital bought two X-ray machines from the companies. The trial is continuing.
Read more: People's Daily

Chinese quack buster wins international prize

Fang Shimin has been awarded the Maddox prize for his work exposing scientific fraud and quackery in Chin

The Chinese science writer and sceptic Shi-min Fang is one of the two inaugural winners of the John Maddox Prize.
Sponsored by Nature and the Kohn Foundation, and stimulated and organised by the UK-based charity Sense About Science, the prize commemorates a former Editor of Nature, John Maddox. John was distinguished for his championing of robust science. The prize rewards individuals who have promoted sound science and evidence on a matter of public interest, with an emphasis on those who have faced difficulty or opposition in doing so.
China’s rush to modernise and the communist government’s celebration of science and technology have firmly embraced scientists and scientific achievements, sometimes uncritically. And into that permissive milieu has walked a plethora of opportunists ready to take advantage of the situation with padded CVs, fraudulent and plagiarized articles, bogus medicines and medical procedures carried out without clinical evidence.
In 2000, Shi-min Fang started to expose these escapades in his New Threads website. As an outsider, trained as a biochemist but turned science writer and commentator, he has done much of what the scientific community aims, but often fails, to do — root out the fakers.
For example, Fang called into question DNA supplements that were widely advertised as a means to rejuvenate the tired, the pregnant and the old. Eventually, the government issued warnings about the supplements. Fang seemed to especially relish smacking down powerful or popular scientists. He even challenged official support of traditional Chinese medicine. But his targets fought back, in one case with particular hostility. In the summer of 2010, thugs hired by a urologist attacked Fang with a hammer and, according to Fang, tried to kill him. Fang had previously challenged not only the efficacy of a surgical procedure developed by the urologist, but also his CV.
Fang imposes transparency on an opaque system. He has opened a forum for criticism and debate in a community that is otherwise devoid of it.
In an interview with New Scientist, Fang Shimin said he was "thrilled and honoured" by the award.
He said the reason science fraud was such a problem in China was "the result of interactions between totalitarianism, the lack of freedom of speech, press and academic research, extreme capitalism that tries to commercialise everything including science and education, traditional culture, the lack of scientific spirit, the culture of saving face and so on. It's also because there is not a credible official channel to report, investigate and punish academic misconduct. The cheaters don't have to worry they will someday be caught and punished."
Read more: Nature