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

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

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

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

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

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

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

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.

Corruption crackdown targets doctors running clinical trials

by Michael Woodhead
Senior doctors who accept drug company money to run clinical trials are to be reined in by new health ministry regulations that aim to clean up the potentially unethical and corrupt practices and make clinical research more ordered and accountable.
The National Health and Family Planning Commission has released a new position statement entitled "Administrative Measures for the Clinical Study Projects of Medical Institutions" which will force clinical trials to be run under the auspices of hospital research committees rather than individual doctors or their departments.
The new rules stipulate that to clinical trials will be co-ordinated by a Clinical Study Administration Committee in hospitals, and funding  for trials from industry will be channelled through hospitals rather than a particular department or individual doctor.
The study committee will have to set standards and procedures for administering clinical trials and  maintain constant supervision of studies. Each trial will need to have a full record and documentation of its aims, protocols and the researchers involved. There will also be strict rules about the financing of trials and bans on having industry paying for or accepting "expenses".

Chinese prefer foreign brands - especially when it comes to medical journals

One of the more provocative articles in the China-themed Lancet this week is a brief letter from two orthopaedic surgeons in Xian. 

Dr Yang Junsong and Dr Hao Dingjun complain about the quality of medical journals in China and how Chinese clinicians invariably prefer to be published in foreign medical journals. This is because of the publish-for-promotion phenomenon which I touched on last week - to gain promotion in a Chinese hospital, a doctor needs to acquire a list of published research, and the greater the Impact Factor of the journal the better.

As Drs Yang and Hao remark, there has been a tidal wave of medical journal articles published by Chinese clinicians in recent years, and yet medical publishing is in crisis. Why? Because most of it is crap. Scholarly articles are not being published to to be read or to further scientific knowledge, but to be listed and to obtain the magic piece of paper that counts towards career advancement.

Well, you might say, this sort of things happens to all academics and clinicians  and you'd be right. But the scale of the problem in China - and the sheer numbers involved - means this is distorting medical publishing and also drowning out the genuine research and academic discussion that deserves to be published but which struggles to reach the most suitable audience.

Another problem noted by the doctors from the Medical College of Xi'an Jiaotong University is that most doctors in China don't read English language journals. They may only have access to Chinese language journals and these are poor in quality because they being neglected by Chinese researchers - and they are also often profit seeking rather than having any sense of collegiality. As the authors note, Chinese doctors deal with 4 billion patient consults a year and they depend on Chinese medical journals as their main source of medical information - if this is rubbish, where can they get good quality research,  evidence and discussion from to inform their practice?

"Rebuilding a scientific and reasonable assessment system for medical research would be an essential step for the Chinese government," the authors conclude.

This isn't the first complaint about medical publishing in China. The Economist touched on the  problem of poor quality - and sometimes fake - medical research publications last year. Other bloggers have also highlighted the bizarre practice of bonuses paid to researchers in China in proportion to the impact factor of journals they get published in: $300 for a low impact journal, and the jackpot of $30,000 for getting a paper in Science or Nature! This reminds me of Chiang Kai Shek's system or rewarding his air force pilots with dollar bonuses for every enemy aeroplane they shot down.

I can only agree with this article by a frustrated academic: "We must stop the avalanche of low quality research..."

Today's Top 10 China medical news stories

1. China is to launch a national cervical cancer screening program to test 10 million Chinese women annually, the National Health and Family Planning Commission says. The move follows concerns about increasing rates of cervical cancer, especially in women under 35. China has 130,000 new cervical cancer cases a year and up to 30,000 deaths a year due to the disease.

2. Vaccination rates have fallen as much as 30% since the hepatitis B vaccine safety scare over the deaths of 17 infants, immunisation experts say. They said the drop in vaccination rates could put up to 500,000 infants at risk of serious vaccine-preventable diseases.

3. In a landmark study, Shanghai clinicians have shown that pulse oximetry is a simple and accurate method for detecting major congenital heart disease in newborn babies in China. Writing in the Lancet, they say the method should be used in all maternity hospitals.

4. Salmonella in China is becoming resistant to most antibiotics including ciprofloxacin, ceftriaxone and azithromycin, "posing huge threat to public health and infection control" say clinicians in the journal Antimicrobial Agents and Chemotherapy.

5. A Beijing doctor was punched by the husband of a pregnant woman who said the doctor had pinched her stomach and threatened to kill her. The woman admitted she had first cursed the doctor when she believed she had been ignored by him.

6. Seven leading hospitals in China have signed an alliance agreement to for a National Team to tackle difficult diseases.

7. Kindergartens in Beijing have been struck by the norovirus gastro bug and dozens of children are showing symptoms such as diarrhoea and vomiting.

8. Young Chinese people do not wish to pursue a career in the medical sector, as jobs in medical services were ranked lowest in a survey of desirable careers by recruitment site zhaopin.

9. Complaints about fake drugs and medical devices being sold online are the most frequent calls to the China Food and Drug Administration hotline.

10. Hospital clinics in Shanghai are overflowing with three-four hour waiting times and yet community clinics are sitting almost empty and 'general practitioners see few patients because the public has little confidence in the level of services provided, according to an article in China Daily.

Daqing strikes gold with diabetes prevention study

by Michael Woodhead
The oil town of Daqing in north China is now becoming famous for something quite different - preventing diabetes. 
Results from a 23-year study conducted in the city have show that people at risk of diabetes can avoid progressing to the disease and almost halve their risk of death by adopting a healthier diet and doing more exercise.
The findings from the study, published in the Lancet Diabetes & Endocrinology this week have been hailed as a breakthough by international experts because they answer many of the difficult questions about how diabetes may be prevented and its harms minimised.
The study started in 1986, when 577 people with impaired glucose tolerance were assigned to either an intervention group that received advice on diet and/or exercise, or a control group. The lifestyle coaching sessions lasted for six years during which participants received regular encouragement to eat more vegetables and consume less sugar and alcohol, and encouraged them to do more physical activity in their spare time.
Now after more than 20 years of follow up, researchers have found that the people who received the lifestyle advice had a cardiovascular death rate of 1% compared to 20% in the control group. The overall death rate was 28% in the lifestyle group compared to 38% in the control group. Rates of progression to diabetes were 73% in the lifestyle group and 90% in the control group.
"These findings emphasise the long-term clinical benefits of lifestyle intervention for patients with impaired glucose tolerance and provide further justification for adoption of lifestyle interventions as public health measures to control the consequences of diabetes," said lead study author Professor Li Guangwei of the Department of Endocrinology at the China-Japan Friendship Hospital, Beijing.
Commenting on the findings, Professor Nicholas Wareham of Cambridge University said the study was a "real breakthrough, showing that lifestyle intervention can reduce the risk of long-term cardiovascular consequences of diabetes." He said the study showed that lifestyle change could be achieved in the real world and it was notable that the effects were particularly strong in women.

HIV strain is more aggressive in China - professor

HIV may be more aggressive in China because many infections are caused by a more virulent strain of the virus seldom seen in other countries, Beijing researchers say. Professor Li Taisheng, an infectious diseases specialist at the Harmony Hospital in Beijing say the average time to progression from HIV to immune failure and AIDS is eight years in western countries, but as little as four years in China. The reason for this appears to be a special strain of HIV with a factor known as CRF01, he told the Jinghua Daily. He said a newly published study involving more than 200 HIV patients from across China showed that the more virulent virus was found in almost half of people with HIV.
"CRF01_AE, a predominant HIV-1 subtype in Chinese HIV-1 sexually infected patients, tends to be associated with fast progression to AIDS and advanced immunodeficiency, which might be ascribed to high proportion of X4 tropism. Further investigation of these risk factors may have significant implications to clinical practice and policy-making," his study published in the journal AIDS concluded.

Antibody vaccine for H7N9 is more effective than Tamiflu, say Shanghai researchers

translated by Michael Woodhead
Shanghai researchers say traditional inactivated vaccines cannot be developed against H7N9 but they have developed a gene vaccine which is more efficacious than Tamiflu against the virus.
According to an article in the Workers Daily, an antibody therapeutic vaccine that is effective against the current strain of H7N9 has been developed by Shanghai researchers and is now about to start  clinical trials. Researchers at the Shanghai Public Health Clinical Centre Infectious Disease Research Institute said they had developed antibodies that were effective against H7N9 in vitro and they are now starting tests in humans.
Professor Xu Jianqing of the Infectious Disease Research Institute said that work on the vaccine began in April last year after the first major H7N9 influenza virus outbreaks.  He said the team had made a breakthrough with a gene vaccine in December when they injected the vaccine into 30 mice infected with H7N9. After 30 days none of the mice had died and none had signs of H7N9 infection, which represented the first real proof of efficacy.
Professor Xu said many other research groups in China were doing H7N9 vaccine research but using  traditional inactivated vaccines. However, he said experiments had shown time and again that compared to other influenza viruses, the H7 influenza virus was not amenable to being incorporated into an inactivated vaccine, as it was deformed by the chemicals used, rendering the immune response inadequate. Similar efforts by Dutch researchers to develop a vaccine against the H7N3 virus strain in 2003 were also a failure for a the same reason. This showed that inactivated vaccine technology was not going to catch on for the H7 virus, he said.
The Shanghai researchers had therefore taken the bold step of taking the most important genetic material from the H7N9 virus and implanting it into a mature vaccine carrier. This was the equivalent of putting it into a safe and inserting this into a cell, said Professor Xu. And because the virus structure was not destroyed by putting it into an egg albumen, it elicited a good immune response, he added.
Professor Xu said the new vaccine would be suitable for people at high risk of H7N9 such as those working in live poultry markets and household members.
Within Shanghai's R&D community the new H7N9 vaccine was seen as a breakthrough after an audacious attack. Xu Jianqing said the immune system of H7N9-infected people produced antibodies, and the sooner the body produced antibodies the better the prognosis. He added that Tamiflu was effective if given within the first few days of viral infection, as this was the 'empty' window before the body had started producing its own antibody.  But after more prolonged infection Tamiflu quickly became ineffective,  and drug resistance appeared quickly. Researchers were inspired to try using exogenous antibodies during this initial 'empty window' period when there was no natural H7N9 antibody being produced. The observed effects of the gene vaccine were clearly better than Tamiflu during this period, said Xu Jianqing. In fact, in 2003 during the SARS outbreak, there had also been small scale treatment models of experimental antibody treatment that were successful in curing a patient.
It is reported that at present the H7N9 antibody treatment has already successfully completed two phases of in-vitro testing and it is estimated that Phase 3 testing will be complete within one month. From among the 100+ types of antibody currently in testing the best will be selected for clinical use.

Research requirement corrupts junior doctors, meeting told

translated by Michael Woodhead
Top doctors have called on hospitals to drop the requirement for would-be doctors to take part in medical research to qualify for a position, saying it is a waste of resources and leads to corruption.
At a meeting of the Chinese Peoples Political Consultative Committee (CPPCC) in Guangzhou, leading doctors told the meeting that the academic research requirement was superfluous and prevented front-line doctors from doing useful clinical work.
Professor Hu Xueqiang, head of the neurology department at the Sun Yatsen University 3rd Hospital said academic research was a waste of time for doctors who spent their careers doing surgery and treating large numbers of patients for everyday complaints.
"To work at our hospital young doctors need to have written papers and show they have done some research for their professional evaluation, but we have 50-year old doctors at primary level hospitals who are excellent at their job who have never had to do this. They are steadfast workers, the backbone of the system," he said.
He was supported by Dr Zhai Ziwen, director of the respiratory department at the No 1 Renmin Hospital in Guangzhou, who said: "It doesn't matter hospital you want to work at, the requirements are for research papers. But which primary level hospital needs clinicians with research skills? And anyway, 90% of this so-called research submitted with applications is fraudulent," he said.
Many other doctors at the meeting strongly agreed, with some saying that the academic research requirements led to academic corruption as would-be doctors needed connections ('guangxi') with professors to get a research project. "This diverts funds and resources from real research," they said.
Dr Zhao said there was a need for a more balanced system, allowing major academic hospitals to continue using the current system but also permitting basic level hospitals to drop the requirements for academic research. "The one size fits all system is not suitable for primary level hospitals," he said.
Other doctors told the meeting that the current system was biased against smaller hospitals and was leading to systemic corruption.
Guangzhou deputy governor Lin Shaochun told the CPPCC meeting that he appreciated the depth of the problem and would work towards an effective solution in conjunction with the provincial health department human resources department.
Source: Sohu

Bayer enters three year research partnership with Peking University

Bayer HealthCare and Peking University (PKU) have signed a collaboration agreement on a three-year strategic partnership to promote translational research for drug discovery. The two partners will establish a joint research center at Peking University under the name Bayer HealthCare/Peking University Center of Translational Research for Drug Discovery (BPC/TRDD).
According to Bayer, the collaboration will focus on applying basic research to drug discovery in the therapeutic areas of cardiology, oncology, hematology, and gynecological therapy, as well as technological research along the drug-discovery and -development value chain.
Bayer HealthCare will provide funding for collaborative research projects and sponsor a Bayer Professorship and Bayer Investigator Awards.

Shanghai pioneers mental health laboratory

Shanghai has set up a key mental health research laboratory to intensify efforts to diagnose and treat severe mental illnesses, which affect nearly 1 percent of China's population.
"Over the past 20 years, there has been little progress in the field," Xu Yifeng, president of the Shanghai Mental Health Center, said in a recent interview.
"The question of how to combine basic science and clinical research has not been solved."
The new lab, opened in November, will focus on solving a bottleneck in the study of severe mental illnesses through a combination of multiple disciplines, such as molecular and cell biology, brain imaging and bioinformatics, a method for processing biological data using computer science and mathematics.

Beijing clinicians find changes in cause of infective endocarditis

Beijing researchers have clarified the underlying heart disease and microbiological pathogens associated with infective endocarditis in Chinese patients.
In a study of 115 adult patients admitted with infective endocarditis to Peking University First Hospital, Dr Li Xiangyan and co-researchers found that the most common underlying heart diseases were congenital heart disease (24%) followed by degenerative valvular disease (17.4%).
Aortic (44%) and mitral (43.5%) valves were most frequently affected.

Workload and authorship criteria deter Chinese clinicians from doing research

Letter from Dr Zhang Han of the Second Military Medical University, Shanghai in The Lancet:

"With a growing burden of surgical procedures and very large numbers of patients, Chinese surgeons should have an important role in seeking consensus on global strategies through participation in international collaboration. However, many obstacles are hindering their enthusiasm for joint studies, including considerable extra workload in clinical research besides a heavy clinical burden, difficulties in participant enrolment due to the deteriorated doctor—patient relationship, language barriers, and limited opportunities to communicate and cooperate with international colleagues.
We appeal to health administrators in China for an increased awareness of the importance of collaborative research and for supportive policies. For instance, appropriate assessment of the achievement of these research collaborations is an important issue. The present academic evaluation system in China recognises and rewards the position of first and corresponding authors for published studies, and the contributions of other participants tend to be neglected. Hence, how to encourage the active participation of more surgeons in future international research collaboration is an issue worthy of discussion for health policy makers in China and worldwide."

Source: Lancet

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.

13 clinical research centres launched with $16 million funding

In a Lancet editorial published today, Yang Zhe, Deputy Director-General for the Department of Science and Technology for Social Development, Ministry of Science and Technology, China, says the launch of the National Clinical Research Centres program will see 13 new clinical research centres launched with  initial funding of $16 million:

 "Over the past 5 years, China has increased its investment in scientific research by 20% annually, with funding of more than US$160 billion (1 trillion Renminbi) in 2012. In the Outline of the Twelfth Five-year Plan for National Economic and Social Development, the State Council declared that overall 2·2% of gross domestic product will be spent on scientific research. The Chinese Government's funding for medical research has increased accordingly, resulting in notable achievements. However, investment differs between biomedical and clinical research. In 2011, government funding for biomedical research was about $1 billion (6 billion Renminbi), but only $250 million (1·5 billion Renminbi) for clinical research. The investment in clinical research has lagged at a time when such knowledge is needed to address China's many health challenges—the growing burden of non-communicable diseases, soaring health-care costs, a rapidly ageing population, and changes in health behaviours and local environments.

Tsinghua develops cancer biomarker

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

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

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

Source: Peoples Daily

Researcher rejects “air pollution causes black lung" story as urban myth

by Michael Woodhead

Health experts have dismissed online rumours that the recent spate of air pollution in China may cause lungs to turn irreversibly black within six days.

The claims have been made on microblogging sites and state that a Fudan University study in animals had shown that exposure to a week of high levels of small PM2.5 particles could turn the lungs black. The story was said to originate from a study by  Fudan University Professor Song Weimin .The story also claims that the black lung changes are irreversible without expensive and time-consuming medical treatment

According to the claims, which were forwarded by thousands of microblog site users, the academic study in rats found that the irreversible ‘black lung’ syndrome was mediated by release of inflammatory cytokines.

However, Fudan University School of Public Health Professor Song Weimin told news reporters that he had never done any rat inhalation experiments leading to black lung.

He said his study had actually collected PM2.5 on a filter and then these had been applied artificially to rat lungs in vitro.

He said the test conditions represented PM2.5 concentrations that were thousands of times higher than those experienced in the real world. He said his study did not show that the particle turned lung tissue black, nor were the changes seen irreversible.

"The argument that ‘haze for six days turn fresh lung black’ is not correct,” he said.

Source: China Medical Tribune

Young Chinese doctors under pressure to publish

by Heng-Feng Yuan, Wei-Dong Xu,  Hai-Yan Hu, Second Military Medical University, Shanghai
In recent medical job fairs, most large hospitals in China have considered articles listed in the Science Citation Index (SCI) as a must or priority for candidates. SCI articles are also the key to a large bonus or rapid promotion. It seems that SCI articles are controlling the fate of young doctors in China, whose goal is to be a research superpower by 2020.

As young doctors, we feel under great pressure to publish. However, basic scientific research is difficult, being almost outside the scope of our profession, and clinical research requires long-term follow-up or large case numbers, which are not easy to achieve for a young doctor. In our graduate careers, many of our classmates spent a large amount of time in the laboratory doing unfamiliar experiments, just so that they could publish SCI articles. Even in the hospital, SCI articles are still an important indicator of success for a department or doctor. Is this really more important than clinical competence?

Such a requirement is unreasonable and completely unnecessary. Not only does the pressure to publish take up too much energy and time, with little professional help, it can also lead to an inappropriate medical atmosphere. Young doctors should be paying more attention to the accumulation of medical experience and improving their communication skills with patients. Academic articles are welcome, but they should be mainly for the purposes of communication, and should be non-mandatory and derived from clinical practice. Moreover, articles should not be distinguished simply by whether or not they are cited by SCI.

Young Chinese doctors are encountering more and more challenges. China's health-system reforms should remove the SCI article burden, and build up a healthy assessment mechanism for these doctors.

Source: Lancet