Shanghai hospitals to ban antibiotic infusions for coughs and colds

by MICHAEL WOODHEAD
Not before time, some of the more advanced and enlightened provinces of China are to ban the widespread practice of giving patients antibiotic infusions for common colds.

Visit any emergency department or outpatient department in a major Chinese hospital and you will see row after row of patients hooked up to IV infusion lines. These are people who have coughs, cold and fevers and are given intravenous antibiotics as routine therapy. In most other countries this would be seen as an absurd, unscientific and harmful overtreatment, but in China it is the norm. There is an almost superstitious belief among Chinese people that an infusion is a panacea.

Many doctors have spoken out against the practice but until now hospitals and health authorities have done nothing to curb the practice. That may be all about to change. The Jiangsu health department has put hospitals on notice by saying that from 1 July 2016 infusions will no longer be permitted as routine therapy in outpatient departments of major hospitals (2nd and 3rd level). This will include city hospitals in cities such as Shanghai.

In a recent interview with People's Daily, Xuzhou Medical College Professor Wu Yunming said the most appropriate treatment for a cold was to take a simple antipyretic such as aspirin, rest and drink plenty of fluid.

"Sick people going to hospital for an infusion has become a long established bad habit, which is one of the important factors for antibiotic drug misuse," he said.

Professor Wu said it was a practice that must be stopped but it would require a change of thinking among the public as well as among the medical profession.

He said strict rules were needed to ban infusions because although doctors were aware that they were inappropriate, self regulation and guidelines had failed to curb their use. Professor Wu said it was typical for an outpatient department to have 200 patients in a morning having infusions - and not unknown for up to 700 patients a day receive such treatment. This was highly profitable for hospitals, which charged 100-200 per infusion, he said.

"Hospitals are businesses and infusions represent a significant source of revenue for them," he noted.

A reporter who visited a major hospital found that healthcare staff were sceptical about the planned ban. They say their was widespread patient expectation and demand for infusions, and if tertiary hospitals did not offer them then patients would simply go to smaller hospitals or local community health clinics that would still provide them.

Professor Wu said rational use of antibiotics was an important issue because antibiotic infusions could cause anaphylactic reactions, increase resistance and also cause other major side effects on the kidney and liver. Infusions also wasted a lot of workforce capacity and resources as nurses had to set up and monitor infusions. He said there needed to be a system-wide plan and implementation of the infusion ban, with an emphasis on social responsibility for hospitals and professional responsibility for doctors.

A spokesman for the Jiangsu department of health said it would be issuing a 'blacklist' of more than 50 medical conditions for which infusion was not permitted.

If you think Dr Google is bad ... 'Dr Baidu' leaves woman 30,000 RMB out of pocket for botched operation

by MICHAEL WOODHEAD

[This is a long article explaining how Baidu paid search has contributed to the proliferation of a wide network of shonky clinics for 'sensitive' conditions such as STDs, Infertility and Gynaecology].

A Shanghai media outlet has exposed what it says is the all-too-common practice of dodgy hospitals paying large sums of money to get the top Baidu search rankings - and then overcharging patients for shonky treatments. The IT News cites the case of a woman called "Snow" who paid 30,000 yuan ($5000) for an operation to treat uterine fibroids at the Shanghai 85 Hospital after seeing it came top of the rankings when she Baidu'd her symptoms. However, after her condition worsened and the woman went to another public hospital, she found that she had been grossly overcharged for unnecessary and harmful treatments.

The article then reveals that  dubious private clinics and hospitals such as the 85 Hospital pay Baidu as much as 90,000 yuan ($15,000) a day to be listed as the top result for 'gynaecology hospital' on China's most popular search engine.

The article says its undercover reporter discovered that the 85 Hospital had set up 13 different Baidu accounts to pay for the top result ranking for various medical keywords. The information accompanying the search results claimed that the hospital was one of Shanghai's most prestigious institutions with a history of 66 years. In reality, however, the '85 Hospital' was just one floor of a PLA-run hospital that had been leased by the Putian Group of private clinics.

The trouble for the 43-year old Ms Snow started in 2014 when a routine work medical revealed she had uterine fibroids and an ovarian cyst.  When she searched on Baidu for these symptoms she saw the 85 Hospital had the top ranking and its gynaecology department was supported by many glowing testimonials.

When she consulted a doctor there, at a cost of several thousand yuan, she was told that the fibroids and cysts were worse than she had been told, and that she also had other pelvic problems. However, the doctor told her not to worry and reassured her that these could be cured with surgery. She went ahead with the surgery, being billed 17,000 yuan, of which she could only claim 3000 on her state medical insurance. (She was told beforehand that it would only incur 2000-3000 yuan out of pocket costs). Ms Snow was also called back for repeat follow up treatments to diminish inflammation, at a cost of 800 yuan per session. Her total outlay was 32,000 yuan.

Two months later, Ms Snow still had bad pelvic symptoms and went for a second opinion to the reputable Fudan University hospital gynaecology department. The doctor there told her she had premature menopause, and the condition was likely brought on by her recent operation. He was unable to judge on the appropriateness of her treatment because she had no medical records. However, when she mentioned the 85 Hospital he shook his head and said it sounded like a private  'contract clinic'.

When Ms Snow looked back on her experience at the 85 Hospital she began to suspect it was strange - as she had had to register in a separate office from the usual public patients - and all the offices and clinics were separated on the 4th floor. She had been accompanied by a nurse the whole time  to pay for treatment, and had been prevented from mixing with other patients. However, it was odd that she she had not been offered overnight recovery time at the hospital, which is usual practice for such a serious operation.

The doctor explained that gynaecology clinics were known as 'gold and silver' clinics to unscrupulous operators because women were embarrassed to talk about such complaints treatments and were easily persuaded to have unnecessary treatment.

When the IT Times followed up her case, it discovered that all the gynaecology keywords in Baidu automatically led to the "85 Hospital". It found that visitors to the 'public hospital' were asked about Baidu and then directed to the 4th floor where they were registered at a separate office from public patients. In the waiting room, the undercover reporter met other women who said they had been charged large amounts of money - typically 7000 yuan - for simple treatments that would usually only cost 2000 yuan in a public hospital. All of them had been directed to the clinic from Baidu and many had already spent several thousand dollars. They believed the clinic was reputable because of its high Baidu ranking and the testimonies there.

The undercover reporter was seen by a female Dr Huang, who had several professional certificates on the wall. After a cursory examination, Dr Huang referred the female journalist for an ultrasound, which shes aid showed major pelvic abnormalities. The treatment would involve surgery and the undercover 'patient' was advised to make a booking. However, when these scan results were taken to another hospital, the doctors said the scan was normal.

When the IT News reporter tried to make a complaint about the 85 Hospital at the city health department, she was told that the hospital was PLA controlled, and the department had no supervisory role over the hospital or the staff who worked there.

The reporter then investigated why the hospital came top of the Baidu listings, and found that the listings were all marked as 'promoted', meaning that they were effectively paid advertisements.  Strangely, there were many listings under different addresses but all led ultimately to the 85 Hospital website and 'information inquiry' hotline.

A 'WHOIS' search on the different web addresses showed that the registrant was a group know as the 411 doctor's group, which in turn was linked to the PLA 411 Hospital. An admin address was traced by a reporter to a backstreet cosmetic surgery clinic called the "Meilian Beauty Centre". These clinics were in turn linked to an investment group know as the Shanghai MingAi Group. Undercover enquiries about employment opportunities with this group were refered back to the parent company in Taizhou, Jiangsu.

According to the company records, the shareholders are Ling Fengyu and Sun Jinping. They were linked through another company, Shanghai Venus, with someone called Lin Chunguang. This in turn is listed as the same address as the Putian Medical Company boss. Further checking showed that all the former clinics and hospitals are listed as Putian subsidiaries.

This situation resembles the 2007 incident over a 'fake' Harmony Hospital. At that time a Shanghai Harmony Hospital was set up, which many assumed to be a branch of the renowned Beijing Harmony Public Hospital. However, it turned out to be a privately run venture recently set up by Putian's Lin Chunguang. The hospital was de-registered after it was found to have been providing overdiagnosis, overtreatment and overcharging of female patients at its Fertility Clinic. At that time Putian's Lin Chaungwang was spending hundreds of thousands of yuan on advertising for his clinics. All that has changed in the last eight years is that he is now channelling this advertising through online sources such as Baidu.

Investigations by IT News found that the 85 Hospital is paying about hundreds of thousands of yuan in fees to Baidu trough 13 different advertising accounts for the medical keywords related to gynaecology problems. For every click by a consumer on a keyword, the company must pay several hundred yuan (145-212RMB). In addition, the 85 Hospital has paid Baidu for a prestige 'verified' title  on listings, which costs an additional 5600 yuan per title.

When the reporter asked about this 'V' verification procedure with Baidu's Zhendao and Guojing Information agencies, she was told that PLA and Armed Police institution were not allowed to undergo such verification, but this could be worked around.

On the Baidu site the reporter scrolled through seven pages of search results for 85 Hospital without finding a single negative review. All were fulsome in praise for the 85 Hospital. However, from the 8th page onwards it was continual negative reviews of the hospital by users. This is an example of Baidu having its search results  customer weighted. Interestingly, the 'promoted' 85 Hospital has 3000 reviews saying that it is a '5 Star" institution, whereas the non-promoted Fudan University hospital has only 51 reviews.

Baidu says its star rating system is automated and resistant to human manipulation. However, one internet rating and review 'specialist' said fake reviews were offered for 1.1 yuan per review. Another internet services company contacted by the reporter said they had offered similar review 'paid review. services to other private clinics. They said they could offer website setup and hosting quite cheaply, but Baidu search result manipulation would cost a lot more. He said the price for setting up a  search manipulation service would be about 90,000 yuan a month for top health sites such as hospitals. His financial model was to start with a monthly spend of about 50,000 yuan, which would get a 1:1 return, increasing over a year to about80-90,000 yuan a month, with a return of 1:3.5 on investment for a hospital.

All this may be about to change after the now famous spat between Putian and Baidu over 'compensated search' advertising for Putian network clinics. Putian clinics said that they were halting all advertising in protest at being overcharged by Baidu, but the search engine said it was cleaning up its search results to eliminate unauthorised health clinic advertising. Nevertheless, when IT News tried entering search terms synonymous with Putian clinics such as  "men's illness" [STDs], "Fertility Clinic" and "Gynaecology Clinic" all the top results were still for private clinics of the Putian chain. It seems the advertising boycott proclaimed for 1 April has yet to start in reality.

In 2013 the party secretary for Putian city said the healthcare companies based in the city spent 1.3 billion  on internet advertising for their national chains of clinics and hospitals, which represented about half of Baidu's revenue. They also represented the biggest source of patients to the clinics. According to Baidu, its  revenue from online advertising and paid search was 3.2 billion yuan, of which healthcare was just one five main areas that contributed to 54% of revenue.  In 2014 Baidu CFO Li Xinzhe said he expected healthcare to be one of the top contributors to revenue. This year so far Baidu has increased its revenue by 34% on the previous year. Draw your own conclusions.

Dodgy doctors or innocent victims of patient violence?

by Michael Woodhead
In Australia hardly a week goes by without a report in the media of a 'dodgy doctor' - a male medical practitioner who has sexually assaulted a female patient. You don't hear much of this kind of thing from China but coincidentally today there are two reports in which doctors have been accused of inappropriate behavior towards female patients. Are they genuine or are these yet more instances of China's wave of violence against doctors in an overloaded/corrupted system?
In the first case, a doctor in Nanjing was bashed by the drunken husband of a woman who claimed he had acted 'immorally' to lift her clothing to perform a cardiac exam. The doctor had been trying to perform an electrocardiogram test on the women for cardiac function. As anyone who's had an ECG knows, this involves the placing of up to 12 electrodes on the skin of the chest - there's no avoiding contact. The female patient objected to this, called her husband and he hit the male doctor so hard he broke the doctor's nose. The second case is from Gansu, where a woman took exception to a doctor examining her back, despite her seeking help for a suspected fractured coccyx. She accused the doctor of inappropriate manipulation and called her husband - almost identical outcome to the first case - the husband arrived and set about smashing the doctor around the head with a metal stool, leaving him battered and concussed.
 In both cases medical staff say the doctors were behaving appropriately and carrying out the recommended and necessary routine tests on women to investigate their medical problems. If taken at face value, these reports differ from those seen in western countries, where typically a male doctor will perform inappropriate examinations on women in private. It might be that the Chinese medical staff are covering up for their colleague, but personally I doubt it. While I feel sympathy for the women and their sense of being treated inappropriately, it sounds like the system is to blame here rather than lecherous doctors. In western countries like Australia it is now standard operating procedure to have a female chaperone present (or at least available on request) if a male doctor is to perform any kind of sensitive examination of a female patient. Another 'safeguard' with primary care-based systems is that you can see the same personal 'family doctor' or one of a familiar team on each visit, and so trust is built up in the treating doctor. In China's hospital-based system it's often a case of  'wait three hours to see a doctor for three minutes' and the doctors are strangers. The hugely overloaded Chinese healthcare system does not allow women the option of choosing to see a female doctor, and there may not usually be the option of a female chaperone.
As China develops and expectations about healthcare and personal 'human rights' increase, expect more of these kind of complaints and violent reaction to male doctors. And it could become a particular problem in China's western provinces with a high Muslim population. But what of the rights of women who really are being abused by medical staff? With the growing concern about violence against doctors (and the increasing emphasis on punishing those who take matters into their own hands) there is a risk that the bad doctors will get off scot-free.

China: medical procedures are now dictated by fortune tellers

by Michael Woodhead 
In the west, patients often do their ‘homework’ by consulting medical books and websites before seeing a doctor – but in China patients are doing their homework with fortune tellers. A new report shows that patients are relying on fortune tellers to decide what date they will have an operation, when to have a caesarean section and even to guide cosmetic surgery for a more ‘fortunate’ face.
At a Liaoning Hospital, head of nursing Ren Yumei says about 80% of women choose to have a caesarean section birth, and many of them are done so they can select the ‘auspicious’ date and time selected for their child’s birth from fortune tellers consulting the books of the “Great Immortals’.
“Many women and their families demand not just the day but the hour of birth according to horoscopes, they won’t accept any deviation,” she says.
In Anshan, head surgeon Wang Yongshen says the same thing is now happening with patients requiring elective surgery. Patients demand a specific time for the operation – sometimes even in the early hours of the morning.
“Even when they know that surgery in the middle of the night is likely to be less safe and effective they opt for it because of the influence of the fortune tellers,” he says. And when hospitals refuse these unscientific requests, patients turn to smaller private clinics that are happy to cash in on the new fad for ‘auspiciously timed medical procedures’, even though their medical standards are often suspect.
Obstetric nurse Ren Yumei says she is concerned to see mothers and families putting their baby’s health at risk by forcing an early delivery just to have a ‘lucky’ birth timing. She says the health risks of premature birth are well known, including respiratory and developmental problems as well as blood and cardiovascular risks.
A surgeon at a cosmetic clinic in Shenyang says he even sees patients who wish to change their appearance based on advice from fortune tellers. He had one young man who insisted on having surgery to give him a bigger chin because this would make him appear more bold and daring, in accordance with his horoscope, according to an adviser. He went ahead with the operation despite medical advice that it would restrict his jaw movement.
Professor Zhang Bao of the Tianjin Institute for Social Sciences says the new trend is anti-scientific and a remnant of ‘old thinking’ superstitious ignorance. He said the two schools of thought could not co-exist and there would be a collision between the two.
He said many ‘fortune tellers’ were in business for personal gain and they made extravagant claims that had no regard for the welfare of the patient. He said such practices should be strictly supervised and exposed for what they are. If they continued to provide harmful advice fortune tellers should be prosecuted and punished, he said.
The original report is published by Xinhua.

Wuhan medical staff on trial for organ trafficking

by Michael Woodhead
A gang of 12 organ traffickers including surgeons, anaesthetists and nurses on on trial in Wuhan accused of selling organs for up to 360,000 yuan ($58,000).
In a case know as the "undergound kidney trafficking network" the 12 are accused of buying and selling kidneys in a million-yuan scheme scheme in which donors were paid 30,000 yuan ($5000). According to the Anhui News, the gang performed six commercial organ transplant operations between 2012 and 2013, for which they charged between 170,000 and 360,000 yuan ($27,000-58,000), which was divided up between the participants. The gang included a surgeon called Dr Chen, an anaesthetist Dr Peng, an assistant surgeon Dr Yao, two surgical nurses, and two follow-up nurses. There was also a group of 'fixers and 'agents who bought medical equipment and drugs and who set up the deals and arranged premises in the Jiangxia district in which to perform the illegal operations.  Other gang members arranged transport and liaised between medical staff and buyers and sellers. Eleven members of the gang have already pleaded guilty to the offences. The ringleaders of the gang were an agent called Deng and Dr Chen. Deng set up the deals through the internet, making contact with people looking for an organ and also contacting people who were willing to sell one of their kidneys. Deng said he received 34,000 yuan ($5500) for each deal. One donor in the court said he could now put his heart at rest. he said he greatly regretted his disastrous decision to sell one of his kidneys when he was deeply in debt. now he said he was easily tired and had lost all his strength after the operation.
Xinhua report does not say at which hospital the doctors worked or who the buyers of the organs were, nor what the outcomes of illegal organ transplant surgery were.

Xian parents say government has suppressed findings of side effect damage from kindergarten antivirals

by Michael Woodhead
One of the top Xinhua stories this week is a report from Xian claiming that the local government in the city has suppressed or manipulated the results of health checks on children dosed with antivirals by kindergartens.
The report is a follow up on the shock discovery that two local kindergartens had been routinely dosing children with antiviral medication. The so-called "Yao Er Yuan" [药儿园] scandal (a pun on the Chinese name for kindergarten - You Er Yuan 幼儿园 - replacing one character with that for drug) was supposedly about schools dosing kids with antivirals to prevent them getting colds and to improve their attendance (and performance) at the schools. The practice was strongly condemned by health authorities, with the National Health and Family Planning Commission (NHFPC) issuing a warning that this kind of practice was strictly prohibited, and calling on all local authorities to conduct checks on kindergartens. 
The children attending the kindergartens involved were referred to local hospitals to undergo checks to ensure that there had been no untoward effects from having being exposed to the antivirals. However, some parents are now saying that the checks have been a sham and the results of health checks have either been fabricated or suppressed. One parent quoted by Xinhua is a Mr Zhu, who says that his five year old daughter had suffered from renal impairment and haematuria from the antivirals, but this had not been picked up by the official hospital checks. He took his daughter to another hospital for a check up and they found significant kidney damage, but this was not reported by the official hospital. Further investigation by Xinhua reporters found that there were several hundred children whose tests showed that had experienced adverse health effects from the antivirals, but the official government figure was just 65. Further investigation revealed other anomalies. Many of the tests results were identical, suggesting they were not genuine but just copies. Discrepancies were also seen in ultrasound scans of children, which experts again said were not genuine. One parent reported that when he took his child for a scan he was given the 'result report' even before she had undergone a scan.
A Xinhua reporter put these claims to the local government in Xian, which responded by saying that the investigation into adverse effects had not been concluded and any figures released were premature. They said the concerns raised by parents and the media would be referred to higher authorities, which would take the feedback as part of its ongoing investigation into the antiviral dosing of kindergarten children.
[Editor's note: it might seem odd that a Chinese government newspaper is highlighting apparent government malpractice ... there may be more than this than meets the eye, or perhaps it is genuine attempt to expose wrongdoing as part of Xi Jingping's campaign against 'formalism' and 'poor working styles'].

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.

Hospital scalpers: where China's health system meets the black market

The southern Chinese city of Nanning in Guangxi province has launched a campaign against 'hospital scalpers' - the touts who offer patients and their families a chance to jump the very long queue for treatment. 
In a proclamation the city authorities said they had started a crackdown in order to "protect the security of the masses seeking healthcare treatment." In its official warning the Nanning City Health Inspection office said that hospital scalpers were swindlers who often hang about outside hospitals, on the periphery of clinics and also in public areas such as bus and train stations - and even in the lobbies of hotels near to major hospitals. The scalpers use deceptive and illegal means to lure victims into 'taking the wrong path' and avoid the long and frustratingly bureaucratic process by which patients must queue to get a registration number and then pay a deposit for a clinic appointment. According to the city health department, scalpers deceive patients and direct them into poor quality services often run from illegal clinics by unlicensed practitioners. Scalpers are also notorious for using threats, extortion and for overcharging, even to the point of robbing their victims. In the Nanning warning advice, city authorities give some examples of the scalpers' typical modus operandi.
Firstly, the scalpers target the busiest clinics and look out for gullible victims who appear to be in a hurry and unfamiliar with the system. The scalper is friendly and solicitous initially, advising the patients and family members that the official clinic is expensive and extremely busy and the service is poor. Sometimes they say the doctor on duty has a poor reputation or that the clinic is dirty and has poor hygiene. They then tell the victim that there is a better clinic nearby where they have connections and can get a quick appointment.
The scalper then personally escorts the victim to the nearby clinic, where the 'doctor' and staff do many unnecessary expensive tests and prescribes some very common and cheap medicine but charges a high price. These clinics often have signs claiming to be affiliated to military hospitals with a good reputation, and the staff say bad things about the genuine hospitals.
The advice from the Nanning health department is for patients to only attend genuine hospital clinics and to be wary of strangers around hospitals who make unsolicited approaches asking about illness and offering unsolicited medical services and personal introductions.

Infusion madness: patients in Nanchang hospitals consuming gallons of IV antibiotics

by Michael Woodhead
Health experts in Nanchang, Jiangxi have admitted that their city's hospitals are some of the worst offenders in China when it comes to the practice of allowing patients to unnecessary IV infusions. 
In a country where the average person consumes eight bottles of IV infusion fluid per year, Nanchang is above the national average. Dr Yuan Zhaokang, head of the Nanchang University department of public health, says 90% of people are not aware of the risks and harms of IV infusions and yet between 60-70% of people in outpatient departments are given them. Of these patients, 75% don't need the infusions and could be given oral medicines instead. Dr Yuan says China's rate of IV antibiotic use is10 times higher than the international average, meaning that most intravenous antibiotics given in China are unnecessary.
In theory, the public are told that they should not have an injection when an oral medicine will suffice, but in practice in China this order has been turned on its head, Dr Yuan says.
A Sichuan emergency medicine director, Dr Zhen Tao says he opposes routine use of IV drips for people with colds, but it is hard to change the public mindset.
"People believe that IV infusions are more effective and work faster than oral medicine - but they are wrong," he says. Given a choice, patients always demand "infusion first", and few are aware that this directly contradicts the WHO advice for "never give an IV infusion when an IM injection will suffice, and never given an injection when oral medicine will be sufficient".
While this message is slowly getting across to more educated adults, the situation for children is getting worse, says Dr Zhen. Whenever the weather gets cold or the season changes, the hospital's infusion room is crowded with children who have colds who are attached to IV infusion bottles.
A common cold is a minor viral illness - so why do all Chinese insist on having unnecessary antibiotics by intravenous infusion? Dr Zhen says one reason is the pressure from parents with 'inflexible' thinking and attitudes. Another reason is that hospitals make money from infusions.
"Families want a quick cure-all and hospitals want a quick profit. When these two factors come together the result is bad medicine," says Dr Zhen.
The craze for children to have infusions especially worries Dr Zhen because he says it can weaken their health. Antibiotics not only kill pathogens, they also kill the 'good' bacteria that children need for developing an immune system and digestive health, he says. This is especially so for children who have repeated infusions, which become a vicious circle, where more treatments are requested because the child gets sicker and more prone to infections.
As well as increasing antibiotic resistance, IV infusions of antibiotics often cause many other serious health problems, including life-threatening anaphylaxis and other allergic reactions, phlebitis and injection site reactions, circulatory overload and heart failure as well as pyrexia (high fever), Dr Zhen warns.
The only people who really need IV infusions are those who have swallowing disorders, gastric malabsorption problems and the acutely  critically ill patient, he said.

Shenzhen "black doctors" performed unnecessary abortion

A 17-year old Shenzhen women says her healthy baby was aborted by an illegal clinic staffed by unqualified staff (bogus or "black" doctors) who were only interested in making money for doing an operation. The woman went to a private clinic in Shenzen when she had minor bleeding during her pregnancy. The staff there did an ultrasound and told her the fetus was dead and that she should have an abortion. She did so, but was also told she needed additional surgery to have tissue removed. In total she paid more than 4000 yuan. However, her family became suspicious when they noted the 'doctors' at the clinic had the same names as other local doctors. When they investigated further, they found that the doctor who diagnosed' the stillborn fetus did not exist. An investigation by the local health department confirmed this - and found that some of the fake doctors involved in the incident had assumed the names of real doctors who had previously worked in Shenzhen. One doctor who did surgery proved to be genuine, but said she had acted in good faith, accepting the referral and the information from the fake was real. The fake doctors have since disappeared and the clinic they worked at was fined 3000 yuan and given 18 demerit points. The family of the girl complained that this was too lenient.

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

Shanghai health bureaucrats to be held accountable for errors

The local health bureau will start calling in senior hospital administrators after major medical errors occur to find out what went wrong and what can be done to make sure they don't happen again, local media reported Wednesday.
The policy, which will begin as a pilot program next month, is the latest effort by the Shanghai Municipal Health Bureau to lower the rate of medical errors in the city.
It marks the first time that local health authorities are involving senior hospital administrators with issues related to medical errors, said Song Guofan, a press officer with the health bureau. "By calling in their senior administrators, the new policy will put more pressure on hospitals, thus making them pay more attention to preventing medical mishaps," Song told the Global Times.
Under the policy, the bureau will meet with hospital chiefs following a major medical error to discuss what caused it, how to punish the personnel responsible and how to insure it doesn't happen in the future, according to a report on the news website Eastday.com and a press release from the bureau. Authorities will also dispatch officials to make sure the changes are implemented.
Major medical errors are incidents that cause a patient's death or lead to a severe physical disability. They include leaving a surgical instrument inside a patient's body, operating on the wrong part of a patient and prescribing the wrong kind of medicine, according to the health bureau's website.
Local authorities last published figures on medical errors in 2007, when 149 cases were reported, according to the Xinhua News Agency.
The health bureau took on the issue of medical errors two years ago when it began doling out administrative punishments to hospitals.
Under that policy, a hospital department can be shut down if more than two medical errors occur within 12 months, so long as authorities determine that department personnel are "majorly responsible" for the error. In such cases, doctors and nurses can lose their licenses to practice.
The health bureau will inform hospital chiefs five days in advance before the meetings, according to the bureau press release. If administrators fail to show up to the meetings, their hospitals will forfeit their rights to apply for awards and honors for three years.

Read more: ECNS

Guangdong releases malpractice prevention guidelines

Today, the "Guangdong Province, medical malpractice prevention approach (third draft)" was released via the provincial Office of Legislative Affairs portal (http://www.fzb.gd.gov.cn /) for public comment.
The draft covers medical malpractice claims under RMB1 million by negotiated settlement; and states that claims of more than 10,000 yuan in the public sector shall not be handled through consultations with patients or their close relatives themselves. It is understood at all levels of public hospitals in Guangdong in 2010 reported 25000-30000 medical disputes, of which over 90% relate to medical malpractice in the doctor-patient consultations. However, many patients show distrust and suspect "cronyism care". Obviously, this draft regulations will lead compensation for medical malpractice via legal channels, but also to promote the "conditional prefecture level a trial of medical malpractice arbitration.
As well as previous arrangements such as patient- hospital consultations, administrative mediation and judicial litigation, the draft provides other channels such as mediation by commission, and provides ground level listed judicial and administrative departments of the people's government to guide the local establishment of medical co-ordinating committees, and the people responsible for the administrative area of ​​medical malpractice mediation work.　
In addition, the guidelines seek to establish a medical disputes prevention mechanism, standardized health administrative procedures and departments, and standard procedures for processing cause of death reporting, objections and regulations covering handling of corpses.

Hospitals censured and shut down for illegal stem cell practices

The Ministry of Health on Tuesday published a national circular to criticize two hospitals in northeast China's Jilin Province for illegal medical practices related to stem cells.The practices included illegal advertisement, employment of unregistered medical workers, disorderly management and using illegitimate names of medical institutes.Local health offices have revoked the license of one of the hospitals and ordered the other to suspend operation for rectification. The legal administrators of the two hospitals were also criticized in a notice within the province.The ministry said that flaws still exist in medical institutes and clinical research in stem cells needs further improvement.It also urged health offices at all levels to supervise hospital management more closely and deal with illegal medical practices in a timely manner.

Read more: china.org.cn