Beijing stent success | COPD prevented | Private hospital investor reluctance | Generic companies head for the door

Coronary stent success in Beijing
Chinese cardiologists have come up with a novel answer to the perennial problem of late stent thrombosis with coronary stenting. To avoid  thrombus formation after the use of bare metal or drug eluting stents, Chinese researchers from the Department of Cardiology, Beijing Chaoyang Hospital, have tested stents coated with biodegradable polymers. In a three-year clinical trial whose results are published in the Archives of Medical Sciences they have shown that the stents were just as effective as durable polymer coated stents in reducing major  cardiac events and have the same rate of thrombotic event rates. Biodegradable stents may have the advantage of needing less antiplatelet drug use to prevent thrombus formation they write.

Chinese trial finds new compound to prevent COPD
Another groups of Chinese researchers have come up with a solution to the difficult problem of preventing exacerbations of COPD. In a one year clinical trial carried out at 34 Chinese hospitals they tested the effects of the anti-inflammatory compound N-acetylcysteine compared to placebo in over 1000 patients with COPD.  They found there1·16 COPD exacerbations per patient-year in the treatment group and 1·49 exacerbations per patient-year in the control group. Thus N-acetylcysteine reduced exacerbations by 22%. The treatment was generally well tolerated, according to the study results published in Lancet Respiratory Medicine.

No rush to invest in private hospitals
In the SCMP, Zhuang Pinghui writes that investment in private hospitals on the mainland is set to rise following the relaxation of regulations,  but don't expect a gold rush- there are still many obstacles. The article says the government wants to see more private investment but private hosptals have problems claiming health insurance rebates and getting permission to buy major items of equipment such as  scanners. This means private healthcare might become just a niche product for the China's rich.

China not attractive to foreign generic companies
In Forbes, Benjamin Shorbert looks at what made one the world's biggest generic manufacturers, Actavis, quit China's $82 billion drug market. He suggests it was due to the increasing pressure on drug prices and the Chinese government's favouritism for local companies and penchant for targeting foreign pharma companies for unpleasant attention. I know things have been tough for Actavis but I think it must be a typo when he says the company only made $7 profit in China last year.

China medical news headlines for Friday 17 January

Monitor and treat the best way for hepatitis B

Monitoring inactive chronic hepatitis B carriers is a cost-effective strategy for China, a study shows. The findings published in Hepatology, also show that increasing treatment, monitoring and adherence to therapy are necessary to achieve significant health benefits at the population level.
Shanghai researchers compared the current strategy of not monitoring inactive chronic HBV patients to a monitor and treat strategy which included twice-yearly assessment of HBV and ALT levels. For active HBV cases the researchers suggest treatment with the antiviral entecavir, which evidence shows to be a cost-effective antiviral therapy in China.
The study found that there were 1.5 million adult HBV arriers of HBV in Shanghai, of whom 63% were hepatitis B virus e antigen (HBeAg) positive. The number of active cases of chronic HBV, were 258,139 in the eAg-positive group and 152,384 in the HBeAg-negative group. A monitor and treat strategy would reduce liver cancer by 70% and reduce mortality caused by chronic HBV by 83%, according to News Medical.

China too hard for US generic drug maker

One of the world's biggest generic drug manufacturers has quit China, saying it is too hard to do business there. The US generic maker Actavis has said it will exit China because the business climate is just 'too risky' according to its CEO.
“It is not a business friendly environment,” CEO Paul Isaro is quoted as saying by Bloomberg.

Beijing wants foreign medical city

Beijing is to set up an International Medical Service Zone in Tongzhou District in 2014, Xinhua reports. The 15 square kilometre zone is intended to be a model of medical reform that will integrate social and foreign investment. Beijing hopes the zone will attract doctors and medical experts from Beijing's top public hospitals as well as draw in international medical institutions to set up shop in a healthcare hub. The aim is to have world-class medical facilities, education institutions, medical research personnel, rehabilitation and nursing homes and health management facilities all in one place.

TCM a leading cause of liver failure

Traditional Chinese Medicine is a major cause of acute liver failure in China, according to a report in PLOS One. In a review of 177 Chinese patients with liver failure, 17% had received herbal remedies, and TCM was believed to be a more frequent cause than any other factor, the Global Times reports. Of all the patients diagnosed with acute liver failure 44% developed the condition due to drug or herbal remedy toxicity, and herbal remedies, accounted for more liver failure than paracetamol.

China's Essential Drug Program: a good idea badly implemented?

Fierce price competiton for basic drug contracts means quality and supply may suffer

 According to a report in the Shandong Health News "the original intention of the national introduction of the basic drug system was very good, but the system has been introduced in too much of a rush, resulting in many problems and loopholes ."
A reporter who investigated the 'grassroots situation' often heard similar opinions voiced.
According to some in the health industries, the lack of oversight means that  the essential drugs program is open to abuse by a few. He said the basic medications tenders are "too cheap" and this attracts low quality bids and deters successful good quality manufacturers.
Due to the vague criteria  not being objective enough, this does not encourage product quality, lead to inter-company fierce price competition. Due to the low prices, many companies that win tenders  are not enthusiastic about drug production, leading to the  frequent often out of stock situation of drugs.
In Yanzhou there are 523 medical institutions that use 300 basic drugs, but some drugs  are simply not able to be purchased, such as Shandong Luoxin Pharmacy cephalexin capsules and Sinopharm compound liquorice tablets.
An industry source said the low prices of essential drugs and high distribution costs means many companies are reluctant to bid for distribution of essential medicines. The lack of supply of products such as such as sodium chloride injection, glucose injection  means companies can not guarantee hospital transfusion services normal supply of stock.
Why is there such a problem?
Part of the blame is on pharmaceutical companies that in order to seize the market,  bid blindly without considering whether the company has sufficient production and distribution capabilities. Also, medicines and other material prices continue to rise, and other factors affecting the cost of drug production, and the cost of management and quality control costs have been increased. With little or no profit, some companies stop the production of essential drugs, resulting in hospitals having no drugs available;
There is also a lack of oversight of supervision of the companies that win tenders. In the tender process for centralized procurement of essential drugs, health authorities should not only take into account the bid price of the company, but should also examine whether there it is qualified to produce the drugs. The authorities also need  to establish a strict regulatory regime after a winning bid, to supervise distribution and usage of essential drugs and to ensure the quality of the medication supplied.
Local protectionism may also affect the distribution of essential drugs, with direct distribution by the provincial pharmaceutical companies or stronger pharmaceutical companies.
Source: China Healthcare