China healthcare headlines - June 2015

Beijing to ban smoking in public place 

Smoking will be banned in public areas of Beijing such as restaurants, offices and on public transport from 1 June, but enforcement is in doubt. According to the new anti-smoking rules, smokers will face
fines of 200 yuan ($32.25) for smoking near hospitals and schools, while business can be fined up to 10,000 yuan ($1,600) for failing to enforce no-smoking areas.

Doctor killer executed

The man who stabbed a doctor to death at a Wenling hospital in a dispute over  surgery outcomes has been executed in Zhejiang. The man called Lian Enqing murdered an ENT specialist in October 2014 because he was upset about the poor results of surgery on his nose.

Air pollution triggers hospital admissions

Hospital admissions for respiratory problems increase dramatically when air pollution PM2.5 particle levels exceed a threshold of 200 µg/m³ according to researchers from Shandong.

Lian Enqing was sentenced to death last year for a fatal attack on an an ear, nose and throat specialist in Wenling, in the eastern province of Zhejiang. He attacked the doctor because he "felt displeased with his nose and claimed to be suffering respiratory problems", the official news agency Xinhua said - See more at: http://www.straitstimes.com/news/asia/east-asia/story/china-executes-patient-who-stabbed-doctor-death-over-nose-operation-report#sthash.mIPzSQ7W.dpuf

Lian Enqing was sentenced to death last year for a fatal attack on an an ear, nose and throat specialist in Wenling, in the eastern province of Zhejiang. He attacked the doctor because he "felt displeased with his nose and claimed to be suffering respiratory problems", the official news agency Xinhua said - See more at: http://www.straitstimes.com/news/asia/east-asia/story/china-executes-patient-who-stabbed-doctor-death-over-nose-operation-report#sthash.mIPzSQ7W.dpuf

Private hospitals blocked by public hospital chief

Despite being encouraged by central, the development of private hospitals is being blocked by the all powerful managers of major public hospitals, according to an article in Caixin. Analysts say that public hospitals are effectively operating as for-profit monopoly providers and they are loathe to give up their staff or patients to private newcomers.

Health minister's book published by Elsevier

Former health minister Chen Zhu is having a book publichsed by international medical publisher Elsevier. The book entitled Healthy China 2020: Strategic Research Report, is an in-depth review of China's past present and futre healthcare developments, with contributions frm many leading healthcare figures.

China's hospital league tables published

A league table of China's best hospitals, ranked by department, has been published by the China National Medical Information Center. The ranking tables put hospitals in the three major cities of Beijing, Shanghai and Guangzhou at the top of most lists, according to criteria for 19 different specialities.

Alibaba Health, iKang, Online consultations, Tobacco advertising ban, Antibiotics in food, HIV discrimination

by MICHAEL WOODHEAD

Hello and welcome to another week of China Healthcare. As China makes headlines around the world for its slowing economy, few have remarked that China's entrepreneurs are taking a different and more rosy view by re-focusing on healthcare. This week the Alibaba internet billionaire Jack Ma has issued a $2.5 billion vote of confidence in the prospect for online pharmacy in China by transferring his pharmacy e-commerce section to Alibaba Health ("Ali Jiankan" or alijk.com).  According to the WSJ, "Alibaba said the deal would position it to sell prescription pharmaceuticals should China’s reforms allow retailers to move in that direction".

At the same time, Forbes has profiled another internet millionaire who has made his fortune by turning to health. Zhang Ligang made his first fortune by founding the travel booking site e-Long, but he is more famous for building a chain of private clinics under the banner iKang. And if China really does shift to a more private healthcare system, companies like iKang should be at the forefront of the wave.

The NHFPC has banned online medical diagnosis. In a statement this week the health ministry said medical consultations cannot be conducted online as there have been too many cases of unqualified people offering medical advice, purporting to be experts. The ban does not seem to apply to accredited hospitals that have approved programs. What this means for online doctor apps such as Spring Rain (www.chunyuyisheng.com) remains to be seen.

Children in China are exposed to a wide variety of antibiotics in food, which may promote resistance. A study in Shanghai that tested the urine of more than a 1000 children aged between 8 and 11 years of age found that as most had traces of at least one antibiotic and many had several antibiotics in their system.  Altogether 18 different antibiotics were found in the urine of Shanghai children, reflecting the high levels of antibiotics used in food production in China. This was confirmed by another report out this week which noted that the Chinese food and livestock industries use 100,000 tons of antibiotics  a year to promote growth in animals reared for their meat.

A total ban on tobacco advertising n China has been urged by the WHO. The head of the China office of WHO said China had a treaty obligation to phase out tobacco advertising, and should start to do so at retail points of sale. However, the powerful state-owned tobacco industry might baulk at that. The relative power of the health and tobacco industry was shown this week when health minister Li Bin noted that new graduates could earn twice as much in the tobacco industry compared to medical graduates working in hospitals. She made the point that the basic salary for a university graduate working in the tobacco industry was 4571 yuan a month compared to only 2100 yuan a month for a junior doctor. Li Bin said there was a need to learn from Adam Smith and pay the market rate for medical graduates - and this would mean patients being prepared to pay higher medical fees.

And finally the question arises of whether anti-HIV discrimination still exists in the China's hospitals. A patient at the Sichuan University Huaxi Hospital says he was refused surgery when doctors discovered his HIV positive status. The man said he had been scheduled to have surgery for haemangioma but it was cancelled and he was told that he would instead be kept 'under observation' instead. The hospital rejected the discrimination claim, saying that it was standard practice to keep patients under observation before going ahead with surgery for this condition.

When it comes to health, for China the numbers are staggering

by Michael Woodhead
In western countries hardly a week goes by without some disease condition being put in the spotlight in a press release saying "Condition X affects Y million people a year and costs Z million dollars". 
If industry has a stake in the matter then this is usually followed by a statement saying that the Condition X is underdiagnosed and undertreated and if only we used Drug A or Test B then we would avoid prevent much suffering and save the health budget in the the long run.
This sort of thing is now happening with health conditions in China, except the numbers are bigger by a factor of ten or even a hundred. Take osteoporosis, for example. An analysis published this week shows that there are about 2.3 million osteoporotic fractures a year in China, costing $10 billion in health costs. And if you think that's bad, wait until you see their projection for 2050 - the researchers estimate that with the ageing population there will be 6 million fractures a year costing $25 billion. And as predicted, the report's authors say that "screening and intervention policies must urgently be identified in an attempt to minimize the impact of fractures on the health of the burgeoning population as well as the healthcare budget."

A similar dire warning was made this week for hypertension and diabetes in China. An article in the Journal of the American College of Cardiology said that China was facing a cardiovascular disease epidemic as three out of four Chinese people are in poor cardiovascular shape due unhealthy eating, smoking and obesity. On a similar note, a study from Shenyang showed that 50% of older adults had hypertension and poor cholesterol levels. And a report in The Lancet this week shows that China has 300 million smokers and that tobacco causes 1 million premature deaths a year. The numbers are so big they are incomprehensible. And yet at least the Lancet offers a workable solution: cigarette taxes. It says that if cigarette taxes were raised by 50% this would result in 231 million years of life gained over 50 years and also produce an additional US$703 billion in extra tax revenues from the excise tax. The overall effect would be to relieve financial burden on the poor by avoiding diseases such as lung cancer and the consequent medical bills and time off work. But does Xi Jinping have the gumption to increase cigarette taxes?

For yet another set of mind boggling numbers turn to the example of cervical cancer. With no Pap test screening program, tens of thousands of Chinese women develop this disease and die of it each year, even though it is preventable. Western countries have long had screening programs and are now tackling cervical cancer with the HPV vaccine for young women. Some health economists have crunched the numbers for China and estimated that a national vaccination program of HPV vaccine for 9-15 year old girls, between 2006 and 2012 would have prevented 381,000 cervical cancer cases and 212,000 related deaths. They say that a HPV vaccination program could be implemented in China at a cost of about $50 per girl for the whole set of vaccinations and program costs. In total this would cost China about $160 million, but would ultimately prevent hundreds of thousands of deaths from cervical cancer - and also be cost effective.

A final example: stomach cancer. This causes  hundreds of thousands of deaths in China every year. And yet researchers have found that regular use of low dose aspirin could reduce the risk of stomach cancer (and other common cancers such as colorectal cancer) by as much as 40%. In other words, if Chinese people took a regular dose of aspirin they could avoid many fatal cancers, not to mention the protective cardiovascular benefits against stroke and heart attack. Whether these would be outweihed by increased bleeding risk remains to be seen.

I think what I am trying to say here is that when it comes to ill health in China, the numbers are often too large to be imagined. But that also means that measures that produce only modest reductions in rates of disease can also have major impacts on the absolute numbers of illness.

And while talking of high rates, let's return to my favourite bugbear about healthcare in China - the infusion. I have been guilty in the past of blaming backward thinking among the Chinese masses for insisting on having an infusion for every ailment. I hope I haven't hurt the feelings of the Chinese people and perhaps I owe them an apology. A study from a bog standard Hubei hospital shows that a staggering 96% of antibiotics used in the hospital wee given parenterally (ie by injection or infusion rather than orally). The authors of the report contrast this with the rates of about 30% of IV antibiotic use seen in European hospitals.

However, they blame the profit motive among hospital managers for the widespread use of antibiotic infusions - noting that hospitals depend on drug sales for a major part of their income. Therefore it will be interesting to see what happens when the Chinese government tries to eliminate this source of income for hospital by introducing cost price pharmaceutical billing this year (ie not charging a markup).  How will hospitals  fund their services? The government only covers about 20% of their running costs. There are already predictions that costs will be shifted to medical procedures - and trigger even more overservicing.

At least there is some discussion taking place of these kinds of problems and some in the government are acknowledging that there is still a long way to go in health reform. This week a very frank and bleak account of the ills of rural Chinese health system was published. Doctors and hospital managers said quite bluntly that the rural healthcare system in China is being hollowed out - older doctors are retiring, and nobody is taking their place. Young doctors do not want to work in rural hospitals, partly because the ban on commissions from pharmaceuticals means they can make only a tiny income. And patients do not want to be treated in them. And so the county and township hospitals are becoming ghost hospitals - deserted compared to the overcrowded city hospitals, where rural Chinese flock when they have a serious health problem.

Fact of the week: Chinese primary care (community health centre) doctors earn only 3000-4000 yuan a month. Primary care doctors account for only 4% of doctors in China.

Medical comic strips | Anti-smoking laws weakened | No support for Orphan Diseases

A female doctor in Shanghai draws weekly comic strips and posts them on WeChat to try demystify medical jargon and improve doctor-patient relations
Dr Chen Haiyan, a cardiac ultrasonographer at the Shanghai Zhongshan Hospital has used the comic strips to explain conditions such as heart defects and high blood pressure in easy-to-understand ways. She also tries to explain the daily life of medical staff and show they are human in an effort to defuse the major tensions that have triggered many recent violent attacks against hospital staff.

Health experts have expressed disappointment that Beijing's proposed anti-smoking regulations have been watered down. The latest draft legislation only bans smoking in "shared indoor public places," compared to a previous draft that banned smoking in all indoor public areas, said Professor
Wang Qingbin, a legal expert at the China University of Political Science and Law,
"By banning smoking only in 'shared' indoor public areas, the legislators are giving officials with their own offices a chance to smoke, which is against the spirit of equality," Wang said, adding that it will only make law enforcement all the more difficult.

China lacks adequate health systems to deal with rare 'orphan' diseases such as Duchenne Muscular Dystrophy, medical experts say. At a recent conference on rare diseases at the Children's Hospital of Fudan University experts called for legislation and policies on the prevention and treatment of rare diseases that affect more than 10 million people in China."Related regulations should be created to help provide better support to patients with rare diseases and their families," said Li Dingguo, chairman of the rare disease branch of the Shanghai Medical Association.

Smoking cessation prospects poor | Bleak outlook for foreign-owned hospitals | 500 children die of rabies every year

Smoking cessation efforts are doomed to fail in rural China unless the culture of  giving cigarettes as gifts can be broken, say researchers from the Ministry of Health in Jinan, Shandong. Their study found that although many people in rural China attempted to quit at the advice of other family members, relapses were common and few were able to quit completely because they were culturally expected to share cigarettes. The study also found that village doctors did not smoking cessation advice to all patients and there were few if any smoking cessation programs in rural areas.

Allowing foreign companies to set up and operate hospitals in China will not make much difference to overstretched health services, a leading health official says in Caxin. Lian Xinbo says the real barriers are in employment and insurance regulations which mean that foreign companies will find it difficult to attract talented doctors and also to offer services that are reimbursed by health insurers.

More than 500 Chinese children die of rabies every year, and tragically most of the deaths could have been avoided if children had received correct treatment, say clinicians from the National Institute for Viral Disease Control and Prevention in Beijing. Most of the rabies cases occur in rural areas and are due to bites by domestic or stray dogs. However, few children with rabies get the recommended treatment of post-exposure rabies injections or even adequate wound care.

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

Pre-cancerous cirrhotic liver

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

Why China's new anti-smoking campaign will fail

by Michael Woodhead
The Chinese government has recently announced sweeping measures to ban smoking in public areas of government facilities such as offices, schools and sports grounds. Government officials have also been ordered to take the lead in promoting smoking bans. This is a welcome and long overdue move, but without enforcement it won't work. In the past China has enacted many laws and regulations against smoking but they have not been enforced. People smoke with impunity in 'no smoking' areas because there are no inspectors to enforce the rules. There is very little publicity given to the dangers of smoking and the health benefits of quitting - and very little promotion of smoking cessation. China has also lacked smoking cessation services to cater for those who do want to quit.
Tobacco control experts from China and Hong Kong have said that the new measures will require a huge workforce of anti-smoking inspectors to enforce compliance. Take Hong Kong as an example. The city has 650,000 smokers and has needed 100 full-time enforcement officers issuing 8000 fine tickets a year to adequately enforce its 2007 anti-smoking legislation. Based on these figures, with a population of 300,000,000 smokers, China will need 46,000 full-time enforcement officers and about 4 million penalty tickets issued annually to enforce smoking bans. Writing in the American Journal of Epidemiology, Dr Lam Tai Hing and Dr Yao He say China will also need to put funds into publicity and enforcement of anti-smoking campaigns. At present, the ratio of Chinese government expenditure on tobacco control to annual tax revenue is 20 million Yuan to 424 billion Yuan, or 0.005%, which is one of the lowest in the world.
Until more funding and enforcement of anti-smoking measures are implemented, China's smoking cessation clinics will continue to be empty.

Eight medical stories from China you should read

by Michael Woodhead

1. Beijing will start to enforce new anti-smoking laws with 200 yuan on-the-spot fines (up from 10 yuan) for people who smoke in public indoor shared areas, and institutional fines of 30,000 yuan (up from 5000 yuan). Cameras will be used to compensate for the lack of enforcement officers, especially after hours, the city government says.

2. The Chinese government has been accused of withholding medical care from dissidents. An article by Sophie Richardson in the WSJ says civil rights campaigner Cao Shunli is now in intensive care because she was denied access to medical care while detained for her efforts to promote a civil society.

3. A link has been found between damp housing in Shanghai and rates of asthma in children. Researchers from the University of Shanghai for Science and Technology say asthma symptoms could be reduced by 25% by simply keeping a child's window open at night.

4. A vaccine against enterovirus 71 developed by Sinovac Biotech has proved effective against EV71-associated hand, foot, and mouth disease or herpangina in infants and young children, according to a study in 5000 children done by the Jiangsu Provincial Center for Disease Control and Prevention, published in the New England Journal of Medicine.

5. Eating shark fin is not only cruel and bad for the environment, it is also a health hazard because of high mercury levels in the product, researchers from Zhejiang have shown. After testing samples of shark fin they found that up to 33% contained toxic levels of mercury.

6. Antibiotics are widely overused by parents in rural China, with more than 60% dosing their children with antibiotics bought over the counter, Shanghai researchers have found. Most parents were ignorant about how antibiotics worked and had little idea hat they do not help viral infections.

7. Migrant workers have little access to healthcare and many of them put off seeing a doctor for illness, a survey in Shanghai has found. Two thirds of migrant workers said they had never had a medical check up and nearly 40% said they had ignored symptoms because they couldn't get to see a doctor.

8. Health workers in Guangdong have completed a successful pilot trial of a cervical cancer screening program using the ThinPrep cytological system. The program offered Pap test cancer screening to more than 40,000 women, and found that improvements are needed in basic education regarding cervical cancer screening for young and poorly educated women.

My top10 medical stories from China for Saturday 22 February

1. Smoking with a water pipe confers a 'profound' risk of chronic obstructive pulmonary disease (COPD) among people in south west China and also carries a high risk from passive smoking, researchers have shown.

2. Patients with pneumonia of unexplained origin should be promptly investigated for H7N9 risk factors such as exposure to poultry and they should also be given pre-emptive antiviral treatment such as Tamiflu, the Beijing health department has ordered.

3. About 85% of Chinese doctors experience burnout, with those who are younger, unmarried and working in emergcncy medicine having the highest risk of serious burnout, a study shows.

4. Fertility clinics in China need to become more patient-friendly as they are perceived as too impersonal and lacking in transparency and respect for patient informed consent, researchers say.

5. The stigma of mental illness in Chinese culture means that patients with schizophrenia often do not understand their medication and are unwilling to take any anti-psychotic medication, according to a study from the Guangzhou Psychiatric Hospital.

6. H. Pylori infection rates are over 90% among people in their thirties in Jiangsu, which may explain high rates of gastric cancer in the region, say researchers from Nanjing.

7. Babies in Shenyang have increased rates of neurodevelopmental deficits because their mothers were exposed to high levels of organophosphorous pesticides during pregnancy, according to a study in PLOS One.

8. Adenovirus has emerged as a significant cause of serious pneumonia in China, with a study showing that 5% of cases are attributable to the virus.

9.  People with tuberculosis are also at high risk of HIV, with rates of around 3% in groups tested in TB patients from Guangxi, Henan and Sichuan, say Chinese researchers.

10. A mediation service for patients involved in medical disputes with hospitals is to be launched in Shanghai and it will be open to patients where compensation claims exceed 30,000 yuan ($2900) regardless of whether the hospital refers them.

Medical news - seven China links

1. With more than 10,000 new cases of HIV a year, Yunnan is to fund more NGO anti-HIV programs and improve healthcare for people with the infection.

2. New regulations on genome sequencing are to stop clinics ripping off consumers by offering the sequencing as part of routine health checks or to help predict children’s potential abilities, officials say.

3. Malnutrition is still a major problem in some parts of rural China, with one in every five children under the age of five years in poor areas needing better nutrition. Local governments have been set a benchmark of 29 kg per capita meat consumption standard to benefit children in underdeveloped region.

4. Pilot schemes have been set up in 27 provinces to allow rural migrants to claim medical insurance benefits away from their home town.

5. About 13 million deaths from smoking-related illness could be avoided if China adopted WHO recommendations on tobacco control, a paper in the BMJ says.

6. Adverse effects from drugs - and especially antibiotics - are a major health burden for hospitals in China and also cost thousands a of yuan a year for hospitals and patients alike in extra care costs, a study has suggested.

7. Only 9% of boys and 2% of girls in China get the minimum amount of physical activity per week to maintain health, a study carried out in 11 cities has found.

TCM fails for migraine | Quit advice ineffective | Rural migrants need HIV help

Chinese herbal medicines ineffective in migraine
Chinese herbal patent medicines are used by about 60% of people in China with migraines, but satisfaction rates with the effects are low, and western medicines prove much more effective, a study from Guangzhou has found. In a survey of 219 patients with migraine, researchers found that 58% had used Chinese patent medicines to treat acute attacks, but only 28% reported being satisfied with the results. About 35% reported being unsatisfied. In contrast, about 60% of patients were satisfied with the response they got from western medicines such as NSAIDs for migraine.  The most commonly used Chinese herbal medicines were ones containing L. wallichii, Dahurian angelica root, and G. elata. Interestingly, few Chinese migraine patients used the triptans, which are recognised internationally as being the most effective treatments for migraine, according to the article in Pain Medicine.
 
Quit advice not working
 Smoking cessation counselling is effective for Chinese smokers who have developed COPD but has little influence on asymptomatic smokers, research from Changsha has found. After receiving smoking cessation counselling, smoking abstinence rates at six months were 40% for people with COPD but only 10% for asymptomatic smokers, according to a research group from the Department of Respiratory Disease at the Second Xiangya Hospital, Central South University, Changsha.

Rural migrants missed in HIV prevention
HIV is likely to spread in China via migrant labourers and housemaids, who have low levels of knowledege about the disease and high rates of unsafe sex, researchers from Fudan University in Shanghai have warned. In a survey of 2700 rural migrants they found that more than 40% were ignorant of the facts and risks of HIV, and  6.2% had engaged in high-risk sex in the past 12 months. Only 3% of migrant workers had access to free HIV screening. Writing in BMC Public Health he researchers said migrants must be targeted with tailored educational programs pitched at a level they can understand. Rural migrants should  also be given free condoms and given access to HIV testing and antiretroviral treatment, they urged.

"Fake" GPs in Shanghai | 5-in-1 vaccine shortage | Appointments by WeChat: China medical news for Friday 14 February

Shanghai appears to lead China in the introduction of family doctors, but many of the so-called general practitioners (GPs) are fake, says Zhu Shanzhu, the chairman of the Society of General Practice, Chinese Medical Association. In an article in Global Times, Dr Zhu says that Shanghai is on target to have a GP for every resident by 2020, when people will be able to register with a family doctor working out of their local community health centre. However, Dr Zhu says many of the family doctors assigned to the health centres are not true GPs because they are specialists such as surgeons. Shanghai must therefore commit to training doctors in family medicine, she said.

A second death has been reported from the novel influenza strain H10N8 in Jiangxi. According to Shanghai Daily, a 75-year-old man died in Nanchang. Health authorities have urged the public to stay away from live poultry.

Shortages of the popular paediatric 5-in-1 combination vaccine have been reported due to transport congestion and delays ove the Chinese New Year. The imported vaccine, made by Sanofi, immunises against diphtheria, tetanus, pertussis, polio and Haemophilus influenza Type B and costs around 600 yuan for each of the four doses. Parents prefer it over free domestic vaccines because it reduces the number of needles their child has from 12 to four.

Hospitals in Beijing are offering appointments and medical results via WeChat, ECNS reports. The social media service is being offered by 21 municipal hospitals to patients who sign up and obtain a password.

A Shaanxi woman claims one of her kidneys was secretly removed during an operation she had more than 20 years ago. The woman made the shock discovery that she was missing a kidney when she had a hospital scan for back pain. The only possible explanation was that it must have been removed when she had an operation on her ovaries 26 years previously, she told TV reporters. The woman returned to the hospital where she had the operation but they rejected her claims and denied all responsibility for the incident.

A hospital in Hainan is pioneering a new model of "treat first, pay later" care. The hospital in Haikou has dropped the usual registration system in which patients pay a deposit ahead of treatment. the hospital managers say the new system is more convenient, but relies of the trust of patients to pay for their treatment afterwards. Non-payers will be put on a black list and refused further treatment, they said.

A Beijing academic has called on the government to stop the tobacco industry's deceptive marketing of "low tar, less harmful" cigarettes. Professor Yang Gonghuan of the Department of Epidemiology and Statistics, Institute of Basic Medical Science, Chinese Academy of Medical Science, says the claim that low tar cigarettes are less harmful is incorrect. However the slogan is used by industry to encourage smokers to stay with the habit. Writing in Tobacco Control, he urges the government to "stop the execution of this deceptive strategy for tobacco marketing".

And a kidney specialist in Guangzhou has been praised in the Chinese media for continuing to work despite being confined to a wheelchair. Reports say Dr Ke continued seeing 20 patients a day at the PLA 458 Hospital over the Chinese New Year despite having broken her patella and being unable to walk. Patients praised the doctor but she said any of her colleagues would have done the same thing.

Vaccine for H7N9 | No smoking in medical centres | Cosmetic surgery boom among young Chinese

Vaccine developed for H7N9
Shanghai researchers say they have developed a "gene vaccine" for the H7N9 avian flu virus for humans that has succeeded in primary animal tests, according to Shanghai Daily. The claim was made by officials at an infection disease research body under the Shanghai Public Health Clinical Center

Now influenza H6 is a threat to humans
Yet another kind of avian influenza virus has been found to pose a threat to human health in China - this time it is H6. Researchers from Lanzhou tested samples from live poultry markets in southern China from 2008–2011 and found that among the 257 H6 strains tested, 87 viruses couldbind to human receptors. They found that there were 30 different H6 genotypes, showing that these viruses are actively circulating and reassorting in nature. "Our study demonstrates that the H6 avian influenza viruses pose a clear threat to human health and emphasizes the need for the continued surveillance and evaluation of the H6 influenza viruses circulating in nature," they concluded in the Journal of Virology.

Subway station radiation not a health threat
Operators of subway stations in cities such as Beijing and Chengdu say the radiation from security scanners poses no threat to human health. The doses from a typical security scan are equal to around 0.007 mSv per year if a person is scanned daily. This is lower than the safety standard of 1 mSv per person a year. Most X-rays are contained within the machines by protective curtains that block X-rays from escaping," and environmental expert told the Beijing Daily.

No smoking rule for medical centres
Doctors have been advised to deliver stronger anti-smoking messages to their patients ,according to ECNS. According to the report, doctors have been told by the National Health and Family Planning Commission to inquire and record the smoking history of patients during their initial diagnosis to help smokers quit. The NHFPC also says that there should be no smoking in medical establishment and medical workers are also asked not to put ashtrays in their offices. The NHFPC also recommends that smoking clinics be set up.


Cosmetic surgery rates highest in young people
Cosmetic surgery and other cosmetic procedures such as ear piercing have become very popular with young people during the holiday period, according to Xinhua. Many stalls in a Shenyang market offered ear, lip, tongue, nose and belly button piercing over the New Year holiday. The operators claimed to be trained nurses but failed to produce any medical license.  A cosmetic surgeon said that there had been a rise in young people undergoing minor surgeries too, with children as young as eight or nine getting double-eyelid surgery to give them the appearance of larger or "Western" eyes.

China medical news for Saturday 1 February

Light news day today as most Chinese are no doubt at home enjoying (or enduring) the New Year with family...

Ambulances must not refuse penniless patients
The Global Times reports that ambulance and first-aid teams will be forced to treat patients regardless of whether they can pay. A new regulation on management of emergency medical services was adopted by the National Health and Family Planning Commission which bans emergency services from refusing or delaying treatment because the patients cannot pay. The new rules also prohibit ambulances being used for purposes other than offering emergency medical service.

Indemnity insurance to be mandatory
The Chinese government is also said to be planning a move to make medical indemnity insurance compulsory for all doctors. The head of the China Insurance Regulatory Commission, said one goal this year would be to promote compulsory medical liability insurance, with medical institutions and doctors required to purchase such cover. This would ensure that victims of medical malpractice can be assured of compensation, thus stamping out violence in medical establishments.

Say no to cigs
Health groups in China have urged people not to give cigarettes as gifts this New Year and to refuse them if offered. Groups including the Chinese Center for Disease Control and Prevention and the Chinese Medical Association made the plea just prior to the arrival of the Year of the Horse, according to CRI.

H7N9 explained
In the New Scientist Debra McKenzie explains the background to the H7N9 avian influenza virus outbreaks at a molecular as well as epidemiological level. She also provides some ideas of what the solution to possible pandemics might be.

China's medical news headlines for Sunday 19 January

Hepatitis B vaccine given the all clear

The Shenzhen Bio Kangtai hepatitis B vaccine that was linked to the deaths of 17 infants has now been given the all clear by the Chinese state drug authorities. After an investigation the China Food and Drug Administration and the National Health and Family Planning Commission said the vaccine could be used again as no problems have been found with the hepatitis B vaccine. Authorities tested more than 1300 vaccine samples from six batches that were under suspicion. According to the People's Daily, the CFDA said all samples met the quality standards. The NHFPC said the 17 infant deaths were due to other problems, including severe pneumonia, kidney failure and suffocation.

In Guizhou, retired doctors asked to work in rural clinics

Retired medical specialists in Guizhou are being urged to lend their expertise to rural area clinics, according to China Daily. Professor Sun Fa of Guiyang Medical University told a meeting of the Chinese People's Political Consultative Committee that there were about 600 retired doctors from the province's five top hospitals of whom half were healthy enough to work in rural clinics.
He said they could help the more than 40,000 medical staff in township clinics, many of whom have only medical qualifications from secondary colleges or no degree at all.

Guangdong plans for baby boom

The new two-child family planning policy will not pose a big challenge to public services such as medical care, a top health and family planning official from Guangdong province has said.
Zhang Feng, the former director of the Guangdong population and family planning commission, said 1.1 million to 1.2 million babies are  born in the province each year. and the new policy will see about 130,000 more babies each year. "The baby boom will bring little social impact," he said at the province's annual legislative meeting.

China's smoking ban is unrealistic, says NBC report

A report by Ed Flanagan of the American NBC News says that the recent anti-smoking measures announced by the Chinese government may be as unsuccessful as previous attempts. The article says China has 350 million smokers and the habit is deeply ingrained in society. Previous attempts to curb smoking resulted in "No Smoking' signs being put up but they were widely ignored, says Flanagan. He says the Chinese media have given no details of how the new policy will be enforced. The move also face resistance from the powerful tobacco industry in China, he adds.

 New Yorker profiles China's gene factory BGI in Shenzhen

The New Yorker has an in-depth profile of the gene factory B.G.I., (Beijing Genomics Institute), which is said to be the world’s largest genetic-research centre, located in Shenzhen. The report by Michael Specter says BGI has 178 machines to sequence DNA, and produces at least a quarter of the world’s genomic data. This could help provide new solutions to disease and other areas such as agriculture, he writes.

Undercover teams bust Shanghai hospitals for violating new anti-smoking rules

About 7% of Shanghai's hospitals and health facilities have been found to be in violation of new anti-smoking policies in an investigation by undercover 'smoker detectives'. Secret visits to 437 health establishments in the city found that 29 were not complying with the new rules that stipulate a series of anti-smoking measures be put in place. The three main areas of non-compliance were lack of anti-smoking materials such as posters and signs; staff allowed to be smoking unchallenged in non-smoking public areas such as doorways and stairwells, and the lack of indoor designated smoking areas.
Source: Guangming Daily

Lancet welcomes China's new anti-smoking laws but questions whether they will be implemented

An editorial in the Lancet has welcomed the Chinese government's recent announcement of increased anti-smoking measures to be led by government officials. However, the medical journal queations whether the new rules will be effectively implemented given the large number of smokers and the way that smoking is embedded in everyday life in China. It also questions whether the Chinese government will be willing to forfeit the huge revenues from tobacco.
The next step is to introduce a full ban on smoking in indoor areas and increase taxes on tobacco, the journal says.

Party officials ordered to lead by example in anti-smoking efforts

by Michael Woodhead
Deng Xiaoping was famous for chain smoking Panda brand cigarettes, but if he was still around he'd be disciplined and subject to "criticism from the masses" under new regulations that require all Party officials to set a good example in fighting the "evil influence" of tobacco.
A new directive from the Communist Party Central Committee Office and the State Council orders Party members and government officials ('ganbu') to take the lead in enforcing smoking bans in public areas, government buildings and also during government business. Officials are expected to act as model examples and to strictly uphold no smoking policies to maintain the image  and reputation of the Party, the edict states.
The directive orders pubic officials to take serious note of the importance attached by the leadership to the non-smoking policies for public areas. As well as setting an example by refraining from smoking themselves, officials are also expected to actively implement and monitor programmes to enforce the smoking bans.
The no-smoking policies apply to public areas in schools, colleges, sports facilities, and cultural venues, as well as transport facilities such as airports. Officials are ordered to ensure that No Smoking signs are displayed prominently and that bans are actively enforced. Government officials are also expected to ensure that no smoking policies are implemented in government buildings - including areas such as corridors, bathrooms, stairways, reception halls and canteens.
The directive also forbids officials from smoking while on government business and from offering or supplying cigarettes to others or encouraging others to smoke while on government business.
Officials "at all levels" who fail to observe the new rules will be subject to disciplinary action and undergo criticism, the directive says. Officials can also expect to be subject to the 'supervision of the masses and public opinion", it warns.

China considers national indoor smoking bans

China is planning a national regulation banning smoking in public indoor areas, and it is expected to be enacted next year, the Beijing News said Thursday, citing an official.
Yang Jie, deputy director of Tobacco Control Office for the Chinese Center for Disease Control and Prevention, made the remarks at a news briefing on the Chinese version of the Tobacco Atlas (fourth edition), a comprehensive volume of research on tobacco and smokers.
Yang said the regulation, following the Framework Convention on Tobacco Control, will ban smoking in all public places, including public vehicles, indoor workplaces, Internet bars and restaurants. Specific penalties for violations will be included in the regulation, he added.
More than 10 Chinese cities currently have smoking control rules, all of which ban smoking in public indoor areas, but implementation of the law is unsatisfactory, mostly because there is a lack of enforcement and awareness about the law.
The Tobacco Atlas, published by the American Cancer Society, says more than half of Chinese males smoke, and 12 percent of deaths in Chinese males can be attributed to tobacco. Every year, 600,000 people die from exposure to secondhand smoke in China, most of them women and children, it said.
Source: Beijing News

Smoking cessation drugs are not available in China

Clinics to help smokers kick the habit are facing medication shortages.
A combination of behavioral intervention and medication can significantly increase the chances of a person quitting cigarettes, health experts said.
"Many can quit through just intervention, such as consulting a doctor or calling a hotline," said Fu Dongbo, a specialist with the World Health Organization.
"But for those heavily dependant, medication is an option, including nicotine replacement therapy."
Not many opt for the latter, though, judging by the 2010 Global Adult Tobacco Survey of China.
Based on 13,354 interviews nationwide, the study found 36.4 percent had tried to stop smoking in the previous 12 months, but less than 9 percent of them had used assistance, such as medication.
Part of the reason could be that Chinese smokers do not fully understand cessation therapy, according to a report by the WHO Collaborating Center for Tobacco or Health, based at Beijing's Chaoyang Hospital.