In China, HIV & HCV transmission through blood still occurs

Dr Wang Shuiping says better quality and safety controls are needed before expanding plasma collection

I am Wang Shuping, and, as a doctor and epidemics researcher, I was the one who first discovered Hepatitis C virus and HIV contamination in plasma collection stations mushroomed in China in the 1990s. 

Hundreds of thousands of innocent people became infected as a result. Twenty years have passed since those frightful discoveries, the current state of blood safety in China, to my dismay, still presents an alarming picture of continuing transmission of HIV and HCV through blood. On World AIDS Day today, I would like to call attention to the matter to raise the public’s awareness and warn the policy makers.
China currently has over 780,000 AIDS/HIV patients and 40,000,000 HCV virus carriers. Most of them have been infected through blood, and the root of blood contamination can be traced all the way back to the emergence of for-profit plasma collection stations across China in the 1990s. Specifically, infection can occur through any of the three following routes:
    1.    In plasma collection stations where blood is contaminated by virus-carrying donors;
    2.    In hospitals where patients are infected when receiving contaminated blood;
    3.    Use of contamination of blood products.
In recent years, there have been scattered reports in Chinese media on the spread of HIV and HCV through blood transmission.
HCV and HIV transmission in connection to blood giving:  A 2005 survey of blood donors in southern Jiangsu province found that 43.24% (797/1843) were HCV carriers, while the percentage among non-blood donor group was 3.05% (48/1572). According to Wei Wei, who tested 604 paid blood donors in 2006, found the HIV and HCV carriers were 8.94% and 40.89% respectively, much higher than non-blood giving population. Yinchuan News Online reported on January 20, 2010, that more than 80 people were infected with HIV when they received blood transmission in a hospital in Dayan, Hubei province. In a paper published in 2006, researchers studied 1,180 villagers aged two and older in a village with high rate of AIDS cases via blood transmission in central China, and found HIV infection rate was 15.34% (181/1180), but among people who have been paid blood donors, the rate was as high as 38.3% (167/430). In a paper published in 2011, the author Wei Wei points out that, in 1995, all 32 HIV carriers in the city of Xinyang, Henan, had been infected in the course of blood donation. Over the years, there have been more cases of sexual transmission and fewer cases of blood transmission, but as recent as in 2010, still 28.86% of HIV infections was transmitted through blood.
In August 1, 2011, authorities in Guizhou province closed down 16 Plasma Collection Stations. People gave conflicting reasons for the closure, but an interviewee told People’s Daily Online that some hemophilia patients he knew were infected with HIV from use of plasma products. Normally, government shuts down blood stations out of health concern. In Guizhou’s case, officials gave no explanation for the shutdown, but the province has been seeing higher number of HIV infections in recent years.
Infection among hemodialysis patients: In November, 2009, 19 patients receiving hemodialysis in Huoshan, Anhui province, were reported to have been infected with HCV during hospital treatment, or 32.76% of all hemodialysis patients. According to a Xinhua report in January, 2010, of the 77 patients receiving hemodialysis in Yicheng Hospital, Hefei, 39 were found HCV positive. Doctor Yang Bin at the Third People’s Hospital in Chengdu investigated 423 hospitals for HCV infection among hemodialysis patients between March 10 and April 10, 2010, and found 7.01% (1506/21470) were HCV positive. Before, in July, 2006, Dr. Yang had reported that, his study of 40 patients, who had been receiving long-term hemodialysis, found the HCV infection rates are 11%, 27.7% and 50% respectively for those in treatment for one year, two years and three years, an exponentially increasing risk for long-term patients.
Infection from unsafe injection:  In November, 2011, Xinhua News Agency reported that, in a rural town in Bozhou, Anhui province, 56 people, mostly children, were found HCV positive who had shared the same syringe. In connection to the incident in Anhui, 104 people in Yongcheng, Henan province, were found HCV positive around the same time. In a township in Heyuan, Guangdong, 242 people were found HCV positive over the course of four years. The same report pointed out that, from 2005 to 2011, the number of HCV positive had gone up nation-wide, while Xinhua reported in July, 2011 that 40 million in China were HCV positive, about a quarter of total infections around the world. My estimation is that these reports are merely the tip of the iceberg. Since there are a large number of people who have been carrying HCV and/or HIV since the 1990s, the viruses can spread very fast among healthy people, just like Hepatitis B did, if no emergency measures are taken to prevent it.
Infection from use of contaminated blood products: During the 1990s, multiple blood products reported HCV contamination, including human normal immunoglobulin, placental globulin, plasma albumin, fresh plasma, and plasma immunoglobulin (my own study).  It remains unknown as how many adults and children were infected with HCV through use of blood products.
In 1995, the director of a plasma collection station in Shenqiu, Henan, told me that there were several cases of HIV positive in the plasma they had sold to Shanghai RAAS Blood Products Co., a Chinese-American joint venture. Fortunately Shanghai RAAS performed test on their purchasing and caught the contaminated blood, but they made no report on the contamination. In 1996, HIV was found in the albumin sold by China’s Air Force Blood Product Factory based in Zhengzhou, Henan.
At the time, most of the blood product makers did not screen for HIV, including Shanghai Institute of Biological Products Co., China’s largest blood product maker. In Shanghai in early 1990s, 55 hemophilia patients were infected with HIV  after using the company’s freeze-dried human coagulation factor, but as the report pointed out, no one knows how many of China’s 120,000 hemophilia patients in China have been infected with HIV.
In January, 2007, several liver transplant patients in Beijing Chaoyang Hospital who had been tested HCV negative were found HCV positive after operations. The hospital zoomed in on the human immunoglobulin for intravenous injectionmade by Guangdong Baiyi Pharmaceutical Co. Testing found that, of the 47 patients who had used the injection, 6 were positive before use, 1 whose sample was not collected for some reason, and the rest—40 of them—all tested positive. The product was subsequently recalled, and the government investigated the case. But it was unclear how many hospitals and how many patients across China had used blood products from this maker.
In the 1990s, Henan province alone had about 400 plasma collection stations, and following the HIV epidemic, 378 were closed down. Nationwide, there could have been over 10,000 stations at one point. Currently, China has about 33 blood product makers and 145 plasma collection stations, according to multiple sources.
In Guangdong and elsewhere, plasma collection stations are being re-opened in rural areas.
But such control has been relaxed.  The Ministry of Health issued a notice in January, 2012, to “encourage the establishment of plasma collection stations nationwide, especially in the east part of the country,” to ease shortage of blood products in China.
Based on information I have found and presented in this article, HIV and HCV spread through blood transmission is still very serious in China, and the new round of development of plasma collection stations is of great concern to me. Incidentally, China saw a 10% hike in HIV infection this year from last year.
Given the medical conditions in current China, I believe it is a wrong policy to expand plasma collection. I am also concerned with possible abuses where, as in the 1990s, plasma collection once again becomes a profit-seeking route for some unscrupulous health officials and medical professionals on local levels, thus having devastating consequences for some of China’s most vulnerable people.

Source: Seeing Red in China

Video shows Hebei medical staff protesting against 'barbaric' patients

A video has been uploaded showing what purports to be a demonstration by doctors and nurses in Handan, Hebei, against "barbaric" and rude patients. 
Source: Liveleak

China intensifies quarantine to block Yellow fever

Chinese travellers urged to have Yellow fever vaccination

China's top quarantine watchdog on Thursday urged intensified efforts to prevent the entry of yellow fever from Sudan.
A total of 329 suspected cases, including 97 deaths, have been reported in Sudan as of Nov. 11, the General Administration of Quality Supervision, Inspection and Quarantine said in a statement on its website, citing a World Health Organization report.
The administration asked local authorities to boost body temperature monitoring and other medical inspections for travelers from Sudan.
Travelers from Sudan must inform China's entry-exit inspection and quarantine institutions if they develop related symptoms, such as fever and jaundice, the administration said in the statement, adding that infected travellers should be isolated immediately.
The administration also urged local authorities to step up quarantine inspections over vehicles and containers coming from Sudan to prevent the spread of yellow fever.
Yellow fever is a disease spread by mosquitoes. Symptoms take three to six days to develop and include fever, chills, headache, backache and muscle aches.
Chinese travelers to Sudan are advised to get vaccinated against yellow fever and to take steps to prevent mosquito bites, according to the statement.
Source: CRI

China clinical news in brief

* IV alteplase improves stroke outcomes in Chinese patients if given within the 'golden window' of four hours.   
Read more: CNS Neuroscience and Therapeutics

* Eradication of schistosomiasis in China may not be as straightforward as expected.  
Read more: Parasites and Vectors

* Emotionally abused Chinese children more likely to have ADHD.  
Read more: PLOS One

* Oral Supplementation with vitamin D (cholecalciferol) ameliorates albuminuria in Chinese Type 2 diabetes patients .  
Read more:PLOS One

National Lung Cancer Gene Library Alliance launched in China

The alliance aims to prolong the survival of patients with advanced lung cancer

The National Lung Cancer Gene Library Alliance of China was launched in October in Guangzhou.
It has been set up by the State Key Laboratory of pulmonary diseases, the 1st Affiliated Hospital of Guangzhou Medical University and BGI Genomeic Research Institution.
More than 20 3A-hospitals from all over China joined in this alliance as the first members.
“The objective of this alliance is to prolong the overall survival of advanced stage lung cancer patients”, Prof. Jianxing He, one of the initiator of the alliance said, “The first approach is to find the sensitive gene target of chemotherapy and targeted therapy and make an individually effective strategy for each patient. Then we will focus on researches on finding out the cause of lung cancer genomically, which may control the incidence in the very beginning”.
“It is a new progress in China.” said Professor Jian Wang, dean of BGI Genomic Research Institute, “Although there have been 19 tissue banks established in China, none of them shares the same standard or allies with each other. Therefore they cannot share their precious data or tissues. The alliance is to connect all the hospitals which have the probability to collect and build up the tissue bank to share the data and tissues.”
“With more tissues and data being shared, it will surely improve the possibility to find out the genomic cause of lung cancer”. Professor Wang added.
However, we are just keeping up the pace, according to Prof. He, “National gene alliances have been established in many developed countries. China has the largest lung cancer population with which we would have achieved more. Those data are too precious treasures that it would be a big loss for lung cancer research if we just let it be there. Chinese medical personnel should also consider making contributions to the world’s medical and health career”.
The tissue collection is undergoing voluntarily among patients after gene sequencing. Tissues will be used to analyze the homogenesis of same kind and heterogenesis of different kind, which may describe the sketch of gene causes in lung cancer.
Source: Journal of Thoracic Disease

In China, medical students face mid-course crisis

The transition from academic to clinical training causes psychological stress for medical students

by Michael Woodhead
Medical students in China go through a peril of severe stress because they are unprepared for the transition from academic to clinical training, a study has found.
In a study of almost 1700 medical students, researchers from the Centre for Medical Education at China Medical University, Shenyang found that students showed major impairments to "psychological health and social relations" in the third year of their studies.
They say this may be because third year students face greater academic pressure, with longer hours of lectures and practical work  compared to those in other academic years. The third year represents the transition to the clinical years in China but students have more academic courses and little education about communication with patients and end of life issues.
"At this time they are experiencing contact with real patients for the first time and yet they do not have enough knowledge and skills to interact with patients, especially dying patients. Therefore, medical schools need to take measures to give more support for third year students," they suggest.
"Medical educators could carry out curriculum reforms that introduce problem-based learning (PBL), integrated courses and early exposure to clinical training.  These reforms would relieve students’ academic load through balancing the curriculum of basic science and clinical medicine in different years. It is also very important that we give students more support, which includes enhancing student competency in communication and professionalism and giving students the necessary tools and instruction on how to relieve stress and strain during their medical training. All this could reduce the impairment in physical and mental health of medical students.
The study also found that medical students from rural areas were also found to have poor psychological health and social relations. This may be because they have had to leave their homes and adapt to new life in the city,  facing "urban culture shock". Students from poor rural areas tend to have lower self-esteem and problems in dealing with social relationships, and they may feel that their experience scope is more limited and that their living situations may be more difficult.
Rural students are also less wealthy and may struggle financially.
"Medical schools need to pay attention to showing concern for their psychological problems and give them the necessary psychological counseling and financial support."
Source: PLOS One

Four new projects in cancer genome research in China

Projects will identify genomic drivers for colorectal, oesophageal, liver and nasopharyngeal cancers

The International Cancer Genome Consortium (ICGC) today announced four new projects in China to identify the genomic drivers in colorectal, esophageal, liver and nasopharyngeal cancers, helping lay the foundation for developing treatments tailored to patients' individual needs. 
China is a founding member of the ICGC, having launched a gastric cancer project in 2008.
The Consortium leads worldwide efforts to map the genomes of both common and rare cancers and has the goal of identifying cancer-causing mutations in more than 25,000 tumours representing more than 50 types of cancer of clinical and societal importance across the globe.
The Chinese Cancer Genome Consortium's collaborative projects span a network of more than 200 researchers with expertise in next-generation genetic sequencing and have the bioinformatics skills to uncover the complex causes of cancer. Investigators for the four new projects are distributed among 20 hospitals and institutes (listed below) in 13 cities, including Beijing, Shanghai Guangzhou, Shenzhen, and Hong Kong.
The new projects emphasize cancer types that are more common in China than the rest of the world. Examples are gastric cancer, esophageal and liver cancers, which occur more than twice as often in China as the rest of the world. Nasopharyngeal cancers occur 70 per cent more often in China.
Dr. Xuetao Cao and Dr. Xuemin Zhang will oversee the four new projects which will be scientifically steered by Dr. Youyong Lu and Dr. Huanming Yang. Dr. Xiuqing Zhang will coordinate the projects in collaboration with prominent scientists from universities/institutes and medical centers in China.
Cancer is now the leading cause of death in China, implicated in nearly a quarter of all deaths countrywide, and the incidence of cancer in China has been increasingly rapidly. Currently, about 2.7 million people are diagnosed with cancer annually and 1.9 million patients die of the disease. The significant investment in cancer genomics in China will enable researchers to mine genetic and lifestyle differences between Caucasian and Asian cancer patients. Comparisons will be possible with current ICGC projects in esophageal, liver and colorectal cancers led by teams in France, Japan, the United Kingdom and the United States.
"It is our great pleasure to solidify China's important role in the ICGC. We believe that more genomic data from Asian cancer patients will augment the work of existing ICGC cancer projects and promote progress toward making cancer a manageable condition," said Dr. Huanming Yang of the Chinese Cancer Genome Consortium.
Read more: Newswire

Western expats find Chinese doctors unsympathetic

Tessa Thorniley found pre-natal care to be brusque and costly

A British woman living in China has described how she found pre-natal care high on cost, low on compassion
When she went to hospital for  investigations to see whether she is expecting a second child, Tessa Thorniley learned that Chinese doctors do not consider it their job to spare your discomfort or stress – they simply present the medical facts as they see them.
"A few weeks ago, suspecting that I might be pregnant, I visited one of the doctors at a well-known foreigner-friendly private clinic in Beijing.
I say “suspecting” because I was not sure whether to trust the China-brand test kit I had purchased for the equivalent of £2 from a medical stand in a shopping mall, or my translation of its instructions.
At this very early stage, the doctor I sat down with, a Chinese Ob-gyn who attended the top medical school in the country and had also studied at Yale Medical school, suggested that we try a scan. This a good money spinner for the clinics, as it costs anywhere between CNY 370 (£37) and CNY 1700 (£170) per scan – and what woman faced with the chance to see the first movements of her tiny baby would turn it down, especially when it is covered on insurance.
I was not remotely surprised when the radiologist said that she couldn't find a heartbeat. She suggested that there was a sack, which could indicate a pregnancy at around six weeks, but she could not see anything inside.
I returned to the doctor's room for his verdict. He sat me down, stared down at me and said: "It's probably a miscarriage. There is no heartbeat. You should go away and we'll check again in 10 days.”
Ten whole days not knowing if I had a baby growing inside or I had already miscarried. I was shocked. Couldn't he do a test, a blood test, another pregnancy test? Something?
"No", he said firmly. "If you have miscarried, the pregnancy hormones might still show up. A test won't determine whether you are still pregnant. You have to come back."
With that, he closed my file. Our little discussion had cost RMB 700 (£70).
I left feeling down and angry. Why didn't he simply say that they couldn't see a heartbeat and leave it at that? Why put me through unnecessary stress by suggesting I might have miscarried? Wasn't it far more likely that the foetus was too small to be picked up by the monitor?
On my way home, I thought about the doctor's response and decided that it was very typical of everything I have read and experienced of Chinese doctors. It is not that Chinese medics don't know their medicine - they do – but, when it comes to bedside manner, they have a very different approach to overseas doctors. It is not their job to spare your discomfort or stress; it is their job to present the medical facts as they see them.
One of my friends, a pregnant mother who goes to the same clinic, suggested incompetence might to blame for the prognosis, because the radiologist had failed to read the scanner properly. My friend had also been told that she had probably miscarried at an early stage in her pregnancy, and she had ended up flying to her doctor in Japan for confirmation that she was, indeed, pregnant.
I also considered going elsewhere for a second opinion, but I decided against it, as I was convinced that scanning for a heartbeat at six weeks was a waste of time.
Then, gradually, day by day following the appointment, I felt worse and worse physically, with nausea and overwhelming tiredness, which filled me with hope.
It has now been 13 weeks, and I have had three scans, the last one showing a fine looking, somersaulting foetus.
I have racked up over a £1,000 of medical bills, including CNY 580 (£58) for an HIV test - standard procedure, but a costly one; CNY 435 (£45) to tell me my blood type (which I already knew); and a charge of CNY 675 (£68) for something entitled “Established Patient Detailed”.
I have also switched doctors, in favour of the head of department, when I can get an appointment with him, who trained at Charing Cross hospital medical school in Hammersmith, and is rather more sympathetic in his dealings with patients.
As this baby is my second, my husband and I have considered finding out the sex. But it turns out that the rules have changed since the last time I was expecting, and doctors are no longer permitted to tell anyone - foreign nationals included - the sex of their child before birth.
There are obvious reasons for this rule inside China. Sex-selective abortion, while illegal, is so widespread that it has contributed to the country's skewed sex ratio of 108 men for every 100 women, as reported by the UN. Estimates suggest that by 2020, there will be 30 million more men than women reaching adulthood and entering China's mating market.
But it makes no sense to apply this rule to foreign couples. It is not as if our China-born babies have the option of becoming citizens of China, should we want that for them, so they will never be part of the statistical problem.
Of course, since finding out the official rules, I have also uncovered the unofficial solution.
I have been reliably informed that, although doctors will not tell you the sex of your child, should you ask, most helpful radiologists will circle the relevant portion of their screen and suggest you look closely for the presence or absence of certain parts.
Read more: Daily Telegraph

Reputation of pharmaceutical industry sinks further

In China, drug quality scandals and corruption have tainted people's view of the pharmaceutical industry

The pharmaceutical industry’s reputation is improving in most countries - except China.
According to the latest Ipsos Reputation Snapshot for the Pharmaceutical Sector, the pharma industry’s reputation has improved significantly in the US and other countries. In China, however, people have a lower opinion of the pharma industry today than four years ago.
Among all countries surveyed, China’s perception of the drug industry has soured the most in the past four years, even as pharma made strides in the US. Taken against China’s higher regard for top pharma companies, what accounts for the discrepancy? “Many recent drug scandals in China have been the result of safety issues and corruption associated mostly with local brands,” says Nicolas Boyon, co-author of the report. Global companies, by juxtaposition, stand out because their western origin provides Chinese consumers with reassurance as to the safety and efficacy of their products.”  One such scandal involved the use of chromium, a known carcinogenic, found present in the local manufacture of gel capsules.
In addition, Boyon notes that DTC advertising, while illegal in China, “could benefit from companies leveraging the assurance of quality their trademarks represent as branded medicines.”
Recommended priorities for companies in pharma expressed by citizens around the world were closely aligned, and nothing particularly new to industry ears: innovation, safety, and improved access via financial assistance for patients. What will be interesting to see is how China’s ascent to status as the world’s second largest market for pharma will shape industry’s global reputation. The role and visibility of branded generic firms from China –and other key emerging markets –will begin to attract more attention, raising important questions about the scope of cross-border regulation and inspection.
Source: PharmExec

In China, influenza-like illness is caused by many different viruses

In the Chinese winter flu season, human coronavirus is a common cause of influenza-like illness

by Michael Woodhead
Influenza-like illness is a common cause of diseases and disability in China but little is known about the causative viruses in China.
Therefore Dr Huo Xiang and colleagues at the Jiangsu Provincial Center for Disease Control and Preventionin  Nanjing screened almost 500 patients with influenza-like illness over a one year period  in Nanjing.
In their study, viruses were detected in samples from half the patients with influenza-like illness, and the viruses detected most frequently were influenza A (23%), influenza B  (8%), influenza C 30 (6%) patients, and rhinovirus (6%).  All other viruses such as human coronaviruses and respiratory syncytial virus (RSV) were found in less than 5% of patients.
Interestingly, the predominant types of viruses seen in influenza varied by season. Rates of influenza A and human coronavirus illness were much higher during the  winter peak 'flu season' than during the summer and other months. Co-infections were seen in 12% of patients.
"This study confirmed that multiple respiratory viruses may circulate concurrently in the population and account for a large proportion of influenza-like illness.
And the proportion was much higher in January (67%) than in June–August (33%), which was consistent with other findings indicating that respiratory viruses are more likely to be associated with influenza-like illness peak in winter rather than peak in summer.
The influenza-like illness peak in summer may be due to other respiratory pathogens including bacteria, chlamydia, or mycoplasma, the researchers say.
Also of interest was the observation that RSV was rarely a cause of influenza-like illness in China, as it is the most common cause of lower respiratory tract disease and the leading cause of hospital admission among young children worldwide
 "In the present study on outpatients with influenza-like illness, RSV was common in children up to fifteen but was not detected in other age groups, which may be attributed to the developing immune state and vulnerability to infections," the researchers note.
"In conclusion, this study confirms that multiple respiratory viruses may circulate concurrently among the population and account for a large proportion of influenza-like illness. In addition to influenza A, human coronavirus may be associated with the influenza-like illness winter peak in Nanjing, China, 2011."
Source: Journal of Medical Virology

Guangdong hospital mocked for celebrating 40,000 patient admissions

Microbloggers have poured scorn on a hospital that displayed a banner celebrating its 40,000th inpatient admission.
The People’s Hospital in Wuchuan displayed a large banner on its outside wall proclaiming: “Warmly congratulate our hospital on breaking through [over] 40,000 hospitalised patients in 2012.”
The banner was noticed by a microblogger called Ming on Sina Weibo, He said that he'd noticed the banner while visiting his sick mother on November 29.
Ming told the local paper that the banner was in poor taste and made him “feel sad and discontent,” so he decided to snap a picture and post it on Weibo.
His post was forwarded by thousands of people online and many called it callous and insensitive.
Within days, as the news of stye banner spread, it was taken down and instead  banners proclaimed:  "Congratulations to our hospital to the success of this year to exceed two hundred cases of laparoscopic surgery cases," "Congratulations to the hospital IT department for setting up outpatient workstations", and  "Congratulations to our hospital for cataract the free surgical cases breakthrough nineteen hundred people. The Wuchuan City People's Hospital "propaganda" department  said the number of hospital admissions had risen from 12,000 in 2006 up to 35,800 people in 2011.
Source: Southern Farmer's Weekly (Nanfang Nongcun Bao)

Dementia drugs shown to be effective in Chinese clinical trial

Donepezil and galantamine improved cognitive function

 by Michael Woodhead
Acetylcholinesterase inhibitors such as galantine and donepezil are effective in improving cognitive function in Chinese patients, a new study has shown.
The drugs are already considered standard of care for Alzheimer’s disease in western countries. Galantamine is an acetylcholinesterase inhibitor that may also act via allosteric modulation of nicotinic acetylcholine receptors. Therefore, it may provide benefits compared with other acetylcholinesterase inhibitors. Therefore, researchers at the Department of Neurology of Peking Union Medical College Hospital compared galantamine with donepezil in a double-blind trial involving 233 patients at nine hospitals in China.
The patients with mild to moderate Alzheimer’s disease were treated with either galantamine or donepezil for 16 weeks.
 Alzheimer’s cognitive symptoms  scores improved significantly from baseline in both groups of patients, with a significant difference in favour of galantamine in the “language”  area. Significantly more galantamine-treated patients responded to treatment and showed better cognitive scores. Both treatments were well tolerated, although fewer galantamine-treated patients experienced gastrointestinal adverse events compared with donepezil (30% versus 48%).
The researchers conclude that cognitive function improved significantly in subjects with mild to moderate Alzheimer’s disease treated with galantamine or donepezil, and both treatments were generally well tolerated. Significant benefits for galantamine over donepezil were observed for language and response to treatment."
Source:  Neuropsychiatric Disease and Treatment

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

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

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

New program to cover selected medical treatment costs for poor

New program will cover treatment of cancers, liver disease and diabetes treatment

 A new program launched by China Association of Poverty Alleviation and Development (CAPAD) will help subsidize the medical costs of people suffering from tumors, liver diseases and diabetes, allowing them to receive payments ranging from 1,000 yuan ($160.4) to 50,000 yuan.
The new medical aid pro¬gram will target self-employed businesspeople, employees of small- and medium-sized enterprises and migrant workers, the Xinhua News Agency reported.
The head of the program, Shen Laihao, said that the program aims to help alleviate the heavy burden of medical expenses and difficulty in receiving medical treatment.
The program has more than 200 designated hospitals, including top level hospitals with specialized technologies, and hospitals of the People's Liberation Army and the People's Armed Police Force.
Shen said patients who receive financial aid from the program can also enjoy the benefits of the new rural cooperative medical system and medical insurance.
Patients can apply for the program for a subsidy by calling a hotline or logging onto the program's website.
Source: Global Times

Cervical cancer more common in China than previously thought

New review shows high rates of high risk HPV infection and pre-cancerous CIN lesions in Chinese women

by Michael Woodhead
New findings show a high prevalence of high risk-HPV infection and precancerous lesions (CIN2+ ) in Chinese women, suggesting that the cervical cancer burden in China is much greater than previously thought, and that comprehensive screening and HPV immunisation efforts are warranted.
Researchers from the Cancer Institute/Hospital at the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, say that estimates of cervical cancer rates in China have been based on a small and potentially unrepresentative pool of women in relatively affluent and developed urban areas such as Beijing.
Therefore they reviewed HPV and CIN rates in studies involving 30,207 women throughout China who had HPV testing and liquid-based cytology.
They found that the overall high-risk HPV prevalence was 17.7%. The study also showed high prevalence of every grade of CIN among Chinese women. Nearly 2% of women in the study harbored CIN3+, "an elevated prevalence that is most probably explained by the inadequacy of past and current cervical cancer screening practices in China, particularly among rural women," the researchers say.
Rates of high-risk HPV prevalence were similar in rural and urban areas but showed declines in women aged 25–29  in rural areas and at age 35–39  in urban women. These transient declines may be because the period of childbearing in China and elsewhere tends be accompanied by stronger family ties and fewer extramarital sexual affairs. The earlier dip in high-risk HPV prevalence in rural women may  be explained by the fact that age at first intercourse and first birth were 3 and 4 years earlier, respectively, for rural women compared to urban women. Furthermore, more rural women reported having two or more lifetime sexual partners (22%) than urban women (16%).
In rural and urban women, the CIN2 prevalence was 1.5% and 0.7% respectively and CIN3+ prevalence was 1.2%  and 0.6%, respectively. The prevalence of CIN3+ steadily increased with age, peaking in 45- to 49-year-old women. The steady rise of CIN3+ up to the age group of 45–49 is attributable to lack of lesion removal through screening.
The combined prevalence of CIN2 and CIN3+ in Chinese women (∼3%) was higher than the corresponding prevalence in other Asian countries, where it ranged between 0.5% in Thailand and 1.6% in Mongolia. In addition, the maximal prevalence of combined CIN2 and CIN3+ was observed in Chinese women older than 40–44 years, which was later than the maximal prevalence of CIN2+ in a recent meta-analysis of Asian women.
"Our findings document the inadequacy of current cervical cancer screening in China while indirectly raising the possibility that the cervical cancer burden in China is under-reported," they conclude.
"The high prevalence of CIN2+ in middle-age Chinese women should inform cervical cancer screening policies in China and other low- and intermediate-resource countries. Current cervical cancer screening recommendations are that women between the ages of 35 and 40 years be screened at least once  ... however, our findings show that Chinese women aged 40 years or older should also be screened as they harbour a substantial proportion of precancerous cervical lesions that accumulated over time and may still be the target of life-saving treatments," they suggest.
Read more: International Journal of Cancer

China's middle classes are not buying private health insurance

Wealthy Chinese are not taking up medical insurance plans marketed by western companies

Most health insurance analysts concur that China's high-income earning population are not likely to buy comprehensive health insurance in the short term. 
Many of the health insurance companies that have invested in developing on-shore solutions for health coverage continue to see varied results. While some insurers are re-figuring their China strategy, others continue to develop new products to further test the market.
Earlier this month and after little success, ICBC AXA eliminated its ‘China Executive Plan’ that was launched in December 2011 and targeted high-income Chinese nationals. The ‘China Executive Plan’ featured benefits that were below more typical expatriate policies but higher than domestic Chinese policies. One particular point of interest was that the plan had options for covering preexisting conditions, an option readily available with many health insurance policies.
As a way to control costs, the plan limited treatment to only inside China and excluded coverage at High Cost Providers (HCP). This move was thought to be a good option to control costs, especially since hospitals and clinics that are marketed to the expat market have been the main cause of rapid inflation in the international Private Health Insurance sector in China over the past decade.
The cost of treatment in many of these HCPs rival those of the most expensive hospitals in the world. ICBC AXAs reasoning to not include coverage at these facilities is that Chinese nationals do not face the same language barriers as expats in China, and there are many other hospitals and clinics that offer high levels of care for Chinese-speaking individuals that are of much lower cost than the HCPs. With these facts in mind, ICBC AXA were hopeful that the China Executive Plan would be well suited for the market, as the country’s growing upper- and middle-class families would look for better healthcare options for their families. Yet, the plan did not prove to be successful.
Another indicator that questions the current situation for private health insurance providers in China refers to Bupa International’s latest moves and some of the new restrictions placed upon their plans. In previous years, Bupa allowed for children to be insured under their plans independent of their parents. However, Bupa has now eliminated this option and while the plan still exists, it has undergone many changes so that premiums, benefits and underwriting are now much more selective. While the child-only plan was very popular, it did not have a very high success rate financially.
With these findings, analysts at Globalsurance believe that Chinese nationals are aware about the policies that are available, but have not fully grasped the idea and benefits of insurance. They see the purchase of health insurance solely as a financial transaction. In their view, if they will be able to claim more than they would pay in one year, why not buy? Yet at the same time, if they are not able to claim as much as they would pay in one year, why buy a policy? Analysts agree that the Chinese nationals may not have greatly considered the risk and financial implications of a serious accident or long-term illness and the benefits of purchasing a health insurance policy.
Analylsts also argue that there could be issues regarding how to educate and inform potential clients as to why they should invest and purchase health insurance policies. Many agree this is a prominent shortfall and will take a while to fix. With distributors often motivated by profit margins and returns, it can take a long time, even many years, to build up a medical portfolio. While already facing some challenges, adding the need to educate a new consumer base on the benefits of the product on offer creates greater hurdles for insurers looking to expand in China.
Despite the hurdles, many are optimistic about the future of the health insurance market in China, it is just a question of getting the timing right. Analysts agree that eventually there will be high consumption of health insurance products within China’s emerging upper- and middle-classes in the next 10 years.
Hoping to get their timing right, Cigna has established a partnership with CMC in China and is making the right moves so far to become one of the leading competitors in the country. They will soon be announcing a new plan that will launch in December, 2012. Details regarding the plan and how it will be marketed remain unknown, but if the plan is successful, Cigna could be an example for other companies looking to tackle the challenging and unique China health insurance market.
Source: Globalsurance

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

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

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

Breast cancer more aggressive and has earlier onset in Chinese women

Breast cancers have a younger age of diagnosis in China

 by Michael Woodhead
Screening for breast cancer in China may need to start earlier because breast tumours are more aggressive and strike earlier than in western countries, Beijing clinicians say.
Researchers from the Department of Pathology at the Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College analysed the pathologic character of female breast cancers treated in seven tertiary hospitals in China between 1999–2008.
They found that on the whole breast cancers in Chinese women were similar in character to those seen in other Asian countries. However, breast cancers in Chinese women showed a younger age at diagnosis, larger tumor size, later tumor stage, than those typically seen in western countries, the researchers found.
They say the  lack of breast cancer screening in China might explain some of the difference as this would reduce the chance of early diagnosis.
Apart from  environmental and social economic factors, the differences of pathological features and biological markers between the Western and Chinese population may also reflect the magnitude of background breast cancer risk and differences in genetic background such as oestrogen receptor alpha gene polymorphisms.
"Our results suggest that Chinese women need breast cancer screening at an earlier age and that Chinese invasive breast cancer may be more aggressive than in western counterparts and need more specific therapeutic models," they conclude.
"Our study provides new findings showing that breast cancer can vary between different ethnic populations due to the magnitude of background breast cancer risk, genetic and/or environment discrepancies. We also [show] the urgent need to employ race-specific breast cancer screening, diagnosis methods and therapeutic models in China."
Source: International Journal of Cancer

Chinese Christians jailed after running medical clinics and evangelising

Nine Christians were detained for evangelising and holding medical clinics near Tongliao

Nine Christians providing medical services in rural areas of Inner Mongolia were detained by local police who also confiscated medical equipment and sentenced two of the Christians to labor camp. 
 
On July 26, six Christians set out from the city of Tongliao in Inner Mongolia for rural parts of the autonomous region, stopping in places such as Jarud Banner, Tuquan County in Hinggan League,  and the village of Shumugou, in Alide Sumu (township), in the Horqin Right Front Banner, where they held free medical clinics and evangelized among those who came for medical attention. 
Five days later, on Aug. 1, they were in the hamlet of Zhongxinbu, in Shumugou village, Horqin Right Front Banner, in the city of Ulanhot, where they were providing medical services to the local people.  Around 4 p.m., a local resident warned them that the police might be coming and advised them to leave quickly, which they did.  However, they were stopped on the road by Domestic Security Protection agents of the Public Security Bureau, who detained them at the Horqin Right Front Banner police station and confiscated their van, medical equipment including an EKG machine and a laptop.  
At 5 p.m. on Aug. 3, the Horqin Right Front Banner's Domestic Security Protection agents notified the families of the detainees and said they were being held for engaging in illegal evangelism.  However, the Domestic Security Protection agents never provided the families with the legally required written notifications of their detention.  It was not until Aug. 22, when the wife of Chen Hong, one of the detainees, went to the Domestic Security Protection Squad that she was able to get hold of the formal detention notice, but the families of the other detainees still have not received the formal  written notifications.  The deputy squad head asked Chen's wife questions related to the religious beliefs of the detainees.  The reason given for their detention was that they were suspected of using cult activities to interfere with law enforcement. 
On Sept. 1, the Re-education Through Labor Management Committee of Hinggan League handed down its decision notification sentencing Ms. Sun and Ms. Ren to two years in a re-education-through-labor camp. 
Zhang Kai, a well-known Christian lawyer from Beijing, and several other local lawyers are jointly handling the case, and the six victims, including Ms. Sun, have submitted a request for an administrative review of their case. 

Source: China Aid

Chinese medics avoid HIV infections from occupational exposure

There were no cases of HIV transmission due to occupational exposure in China last year

by Wang Qingyun
China had 1,043 cases of occupational exposure to HIV last year, although none resulted in an infection, according to Chinese experts.
“We haven’t found any infections through occupational exposure in the past few years,” said Wu Zunyou, director of The National Center for the Control and Prevention of AIDS and Sexually Transmitted Diseases. “Of course, the exposure does put huge mental pressure on medical workers, while the preventive medicines can make them feel very uncomfortable.”
“[Side effects of anti-HIV prophylaxis] can include headaches, fevers, nausea and discomfort of the alimentary canal,” explained Zhao Yan, deputy director of the national center’s office of treatment and care. “They fade when someone stops taking the medication, but it’s possible individuals can suffer impairment to organ functions.”
She said the center has been working on a plan on how to assess and compensate for occupational exposure to HIV, ever since Premier Wen Jiabao suggested the country should add exposure to blood-borne viruses to the list of occupational diseases as soon as possible.
A surgeon in Beijing, who did not want to be identified, said he would prefer that guidance on post-exposure response was posted in operating rooms for every surgeon to see, as well as specific standards for when preventive medicines cause serious side effects or fail to work.
“Different surgeries need different plans to lower the risk of exposure,” he said. “For example, HIV is rarely transmitted through tears, and there is little bloodshed in eye surgery. However, in brain surgery, where we need to drill through a patient’s skull, bone and blood will fly into the air. If a patient has a high viral load, it’s easier for surgeons to get infected.”
He emphasized that such standards are not just for dealing with operations on HIV carriers. But people with other conditions, such as SARS, hepatitis and tuberculosis.
However, regardless of the type of virus, Fu Yan, a head nurse at Beijing You’an Hospital, which provides anti-viral treatment for HIV, insisted that universal precautions are needed to prevent medics from being exposed to patients’ blood and other bodily fluids.
“The emergency response and compensation guidance show that government cares,” she said, “but taking precautions is the most important thing.
“I don’t want any of us to have the chance to ‘enjoy’ such policies.”
Source: China Daily

Rise in medical tourism from China

About 74% of Chinese say they would like to travel overseas for cheaper medical treatment

by Liu Jie
The number of medical tourists from China is rising because of cheaper costs and better services overseas.
Talking about her recent trip to Thailand, Wang Jingxian said it was "really worthy as well as comfortable and happy".
The 35-year-old Beijing white-collar worker traveled to Bangkok in October for skin laser surgery to rejuvenate her appearance at Bumrungrad International Hospital, one of the world's top 10 multiple-specialty medical centers targeting patients globally.
"I appreciated the environment and services of the hospital. And it's affordable, even cheaper than the private medical institutes in Beijing," Wang said.
It has become a trend in China for middle-income and affluent people to travel abroad for medical care services.
An online survey conducted by Ipsos, a France-based market research company, shows 74 percent of Chinese respondents said they would look outside the country for cheaper healthcare services.
According to the poll covering 24 nations, 59 percent of respondents in the Asia-Pacific region would consider traveling to another country to receive medical or dental care if the costs were significantly lower than in his or her country. In Latin America the figure was 64 percent. In the Middle East and Africa it was 63 percent.
The findings shed light on medical tourism, an increasingly popular worldwide phenomenon that is becoming a formalized industry in many countries.
Chinese people's interests in overseas medical tourism might be attributed to limited and competitive medical resources in the domestic market, the high-quality and considerable number of services in well-known foreign private hospitals, relatively low costs overseas and the added value of travel, according to Hu Bo, chairman of Ciming Health Checkup Management Group Co Ltd.
Wang said she spent around $1,000 for surgery and hospitalization in Bangkok. With flight tickets and some incidental fees, the 10-day trip cost her $2,000.
"The hospital's lobby was like a five-star hotel offering concierge-style services. The medical practitioners were patient and nice. The food was really fantastic. All of these things were impressive," she said.
Hu said that most Chinese middle-class health travelers are eyeing Southeast Asian nations, such as Thailand and Malaysia, while some of the richer ones are going to developed markets such as Switzerland for anti-aging therapy using sheep placentas and Germany for general health checkups and health improvement.
Malaysia is attracting Chinese people with a six-month visa brought into play last year. Chinese medical tourists to the nation rose 48 percent year-on-year in 2011.
South Korea is well known for its plastic surgery services. A source in the South Korean embassy in China said it issued 1.07 million visas to Chinese medical travelers last year, up 386 percent year-on-year. At the same time, there were 2.05 million visits by Chinese people to the East Asian country, an annual increase of 23.6 percent.
Read more: China Daily

China shows HIV treatment-as-prevention reduces transmission in couples

Antiretroviral treatment prevents HIV transmission within couples

by Michael Woodhead
Antiretroviral therapy should be offered as a "treatment for prevention" to HIV-positive people who have an uninfected partner, Chinese researchers have shown.
In a study of almost 39,000 HIV 'serodiscordant' couples, Prof Shao Yiming and researchers at the Chinese Center for Disease Control and Prevention in Beijing found that "treatment-as-prevention" reduced HIV transmission by a quarter, which they says suggests it  is a feasible public health prevention strategy.
In their study they found that rates of HIV infection were 2·6 per 100 person-years among the 14 800 couples who did not receive antiretrovirals, compared to 1·3 per 100 person-years among the 24 000 couples who received antiretrovirals.
The reduction in transmission was around 26% and was seen across almost all  subgroups except for couples in which the HIV-positive partner was infected by injecting drugs.
An accompanying editorial in the Lancet said the results were encouraging but it remained to be seen whether treatment-as-prevention could be implemented on a national scale.
"Can community, regional, national, and international expertise and resources be mobilised to offer testing to all at-risk people at least yearly, link all infected people to care, and offer antiretroviral therapy to a much higher proportion of infected people than receive it at present, alongside expanded combination prevention activities?Can we ultimately reverse the HIV pandemic with the treatment-as-prevention approach, by offering antiretroviral therapy at coverage far greater than has been achieved up to now? Answers to these questions depend on rigorous research into implementation and programme deployment, so that we can succeed in bringing programmes to scale," it says.
Read more: Lancet

Eradication regimens have poor efficacy against H. pylori in China

Most of the first and second line eradication drug regimens have poor efficacy against H. pylori infection in Chinese patients, a study from Nanjing has shown.
Researchers from the Department of Gastroenterology at the First Affiliated Hospital of Nanjing Medical University assessed the efficacy of standard sequential therapy for H pylori (five days of treatment with a proton pump inhibitor [PPI] and an antibiotic such as amoxicillin followed by five days of treatment with the PPI and two other antibiotics such as clarithromycin and tinidazole) and the efficacy of levofloxacin-containing triple therapy and levofloxacin-containing sequential therapy.
Their study showed that the H pylori eradication rate was 83% for the standard sequential therapy compared to 81% for levofloxacin-containing triple therapy and 87% for levofloxacin-containing sequential therapy.
The researchers conclude that : "standard sequential therapy and seven-day levofloxacin triple therapy produce unacceptably [low] therapeutic efficacy in China. Only levofloxacin-containing sequential therapy achieved borderline acceptable result. None of the regimens tested reliably achieved 90% or greater therapeutic efficacy in China."
Read more: Helicobacter

Defence chief's death prompts VIP medical plan for elite

Following the death of Luo Yang, VIP health insurance will be given to elite defence and economy managers

Chinese authorities are to introduce a premium health care package for experts working in important fields, according to a circular made public on Sunday.
Full consideration is required of the health of experts working on the front lines of sectors that are important to the country, said a circular issued by the Organization Department of the Communist Party of China (CPC) Central Committee.
The document further identified the individuals to be covered by the package as those working on sectors of critical importance to national security and lifelines of the national economy, including defense and high-tech industries.
Quality healthcare will help them better serve the country, said the circular.
It urged party authorities at various levels to establish a sound system for routine medical examination, health management and an illness reporting for the experts.
Such people should also have priority in getting medical consultations and treatments, it added.
The release of the circular follows the death on Nov. 25 of Luo Yang, head of the production phase of China's new J-15 fighter jet. He suffered a heart attack after spending days observing tests of landing a jet on China's first aircraft carrier. He later died in hospital, aged 51.
Xi Jinping, general secretary of the CPC Central Committee, later extended his condolence and called Luo's death "a big loss to the Party as well as to the nation."
Source: Xinhua

The cardiologist behind Project Hope is honoured in Shanghai

Dr John Howe collects his Magnolia Award

 A small-town boy from Maine who once rushed to the library to read the latest National Geographic has been honored with Shanghai's highest award to foreigners for the work of international medical charity Project Hope.
Dr John P Howe III, internist and cardiologist, has seen a lot of the world and helped a lot of people since becoming president and CEO of US-based Project Hope (Health Opportunities for People Everywhere) in 2001.
In September, Howe received the city's prestigious Magnolia Award for his contributions through the Shanghai Children's Medical Center (SCMC). It opened in 1998 with US$37 million in medical equipment from Project Hope.
Today the center is one of China's leading pediatric hospitals and one of the world's premier pediatric heart centers. Hope continues to donate equipment and sponsor SCMC doctors for overseas training.
Project Hope, founded in 1958, has programs and offices in 35 countries. Its most visible symbol at one time was the US Hope, a converted US Navy hospital ship that sailed the world, delivering badly needed medical treatment, training and health education. Today, its operations are land-based.
In 1983, Project Hope became the first international non-governmental organization to partner with China's Ministry of Health to improve the healthcare system. Today it has 13 programs in China and is involved in children's health and cardiac surgery, diabetes, HIV/AIDS and training of doctors, nurses and health professionals.
"As a doctor, you save people one by one, but in Project Hope, you can save a lot of patients," Howe said of the difference between being a doctor and being a CEO. He was interviewed by Shanghai Daily after receiving the Magnolia Award, given annually to a number of expatriates and foreigners.
"Of course, working for Project Hope is a tougher job," he said. "The hardest part is matching our resources with the needs of the world. Every day I am involved in fundraising."
Howe praised the work of Chinese and American healthcare professionals who contributed to the success of the Shanghai Children's Medical Center.
"The highly specialized, excellent care of young patients at SCMC is an indication of how Project Hope's mission of training local doctors, nurses and health professionals can help build stronger communities for generations to come," he said.
The hospital also shows how cooperation between US groups and Chinese leaders can create expertise and enhance public health in a rapidly emerging country, he added. "Before 1998, the hospital didn't exist. When the city decided to create a world-class children's hospital to meet its commitment to children's health, Project Hope decided to become the partner."
The children's medical center is one of Project Hope's biggest programs and every year it donates around US$1.5 million for equipment, training and academic exchange. It supports 16 training programs in diabetes, children's nutrition, child development, critical care medicine, cancer care and other areas. Project Hope also sends rural healthcare workers and professionals for training at SCMC.
Every year more than 3,500 children receive surgery at the hospital for congenital heart defects. That's more than any other hospital performs, said Dr Liu Jinfen, president of the medical center, which also specializes in leukemia treatment.
In 2011 the hospital was accredited by the Joint Commission International (formerly the Joint Commission on Accreditation of Healthcare Organizations) - the first Chinese pediatric hospital to receive such accreditation.
Project Hope also works in rural areas, training healthcare professionals and donating equipment to hospitals.
Read more: Shanghai Daily

Attacks on medical staff highlight dissatisfaction with health system

Many Chinese are unhappy with doctor-patient communication.

by Wang Heyan and Ren Bo
 In the wake of the second fatal stabbing at a hospital in six months, many in the public reacted with anger over growing perceptions that China's healthcare institutions are increasingly sites of poor treatment – in the degrading sense.
On March 23, a 17-year-old patient named Li Mengnan stormed into the First Affiliated Hospital of Harbin Medical University in China's Heilongjiang Province and attacked doctors, killing an intern named Wang Hao and seriously injuring three doctors.
Earlier the same day, Li was diagnosed with tuberculosis and a form of arthritis known as Bekhterev syndrome. The Harbin public security bureau said Li went to the doctor the same morning, and left believing the doctor refused to treat his illnesses.
"I told the police that doctors at the hospital had a terrible attitude and deliberately refused to treat me," Xinhua News Agency cited Li as saying.
The incident recalled a separate dispute in a hospital which also resulted in a violent stabbing attack. Last September, a 54-year-old man entered the Beijing Tongren Hospital and stabbed a doctor to death. The man accused the doctor of malpractice, after an operation on his throat cancer left him unable to work. In 2010, over 17,000 violent incidents occurred in hospitals, according to China Daily.
Health Minister Chen Zhu issued a statement on March 26, called on prosecutors to seek the death penalty for Li. The China Medical Women's Association also condemned the attack, stating that security systems must be upgraded throughout the country's hospitals.
However others were quick to question the source of rising tensions in the healthcare system. A poll on the popular microblogging website Sina.com found that 65 percent of 6,616 respondents said they were "happy" about the alleged revenge attack. Several blogs also saw an outpouring of anecdotes related to problems with medical treatment services.
Experts say frustration has mounted on the lack of communication between doctors and patients. Chinese Academy of Social Sciences researcher Zhu Hengpeng said such barriers create distrust in the patient-doctor relationship. Zhu added China currently suffers from a shortage of medical professionals and the cost of care remains relatively expensive.
For example, Li lived in a poor family with about 1,000 yuan earning per month, but his medical charge has cost tens of thousands yuan. Unfortunately, large portion of the charge is excluded in the health care system.
At a memorial for Wang, the chief of the Department of Neurology at Xuanwu Hospital Ling Feng said the tragedy could in part be traced to Li's inability to afford medical treatment.
Source: Caixin

Major Chinese path lab provider sees profits drop

Path lab company plans for expansion into rural Chinese hospitals

A leading provider of medical diagnostics and food safety testing in China, China Health Labs & Diagnostics has seen profits fall by 15% in the last nine months.
However, China Health says it has made progress in installing its 'total lab solutions' and delivering its proprietary products to new provinces and regions in China and expects steady growth in the near future.
Gross margins increased by 32% to $5.630 million and by 22% to $13.962 million for the three and nine months ended September 30, 2012, respectively, compared to the same period last year. Profit increased by 48% to $2.357 million and revenue decreased by 11% to $9.623 million for the three months ended September 30, 2012 compared to the same period last year.
Profit decreased by 15% to $3.837 million and revenue increased by 1% to $25.867 million for the nine months ended September 30, 2012 compared to the same period last year.
"The Company continued to show strong financial results and growth of its total lab solutions business into new provinces and regions in China. Since the beginning of 2012, the Company has installed or contracted its BK Clinlabs in six new provinces and regions, which shows significant progress of our marketing team as we were only in four provinces prior to 2012," said Wilson Yao, CEO of China Health.
For the nine months ended September 30, 2012, the decrease in revenue for the point of care testing (POCT) products was offset by an increase in revenue of 25% for the large urban hospital and labs sector. Revenue from POCT solutions and products is generally from large sales orders that are not placed evenly throughout the year.  The Company expects revenue from POCT solutions and products to increase in fiscal 2012, compared to 2011.  In fiscal 2011, revenue from large urban hospitals decreased by 6%, compared to the overall growth in revenue of 35% in fiscal 2011.  In fiscal 2012, the Company expects the large urban sector to grow due to expected increased sales in recurring revenue of reagents and consumables.
Research and development ("R&D") expenditure for the three and nine months ended September 30, 2012 increased by 427% to $0.585 million and by 160% to $1.174 million, respectively, compared to the same periods last year.  In March 2012, the Company launched four new products: Type C POCT Diagnostic Field Lab, Rural Emergency Rescue Medical Total Solution, BK Early Diagnosis System for Cardio-Cerebral Vascular Disease and BK Food Safety Rapid Test System.  These new products were developed to meet specific medical diagnostic and food testing needs of customers and based on the Company's knowledge of Chinese government policy and budget priorities. The margins on new products launched are generally higher than the existing products.
China Health says it is well positioned to expand its business for rural total lab solutions, POCT lab solutions and food safety lab solutions.  However, the Company may need to access additional debt or equity funding if it seeks to accelerate its growth, if it enters into an agreement for a large number of total lab solutions or if it pursues suitable acquisition opportunities. The Company believes that for the fiscal year 2012 it can continue its strong growth in revenue and profits and build on the leading position it has established in China in providing total lab solutions for rural hospitals and clinics, POCT solutions for military and emergency services, and food safety lab solutions, based on the size and growth of the Chinese market for medical diagnostics and food safety, the government support for the market and the Company's proprietary products and services and customer relationships.
In 2012, China Health intends to expand its business by focusing its efforts on expanding its sales network to additional Chinese provinces and cities in the areas where it has proprietary products and limited competition. Going forward, China Health expects revenue growth from its total lab solutions business lines to continue to be stronger than growth from its traditional business with large urban hospitals, and to comprise a higher percentage of revenue.
Read more: Equities

HPV linked to five fold higher risk of throat cancers

HPV is linked to many head and neck cancers

 A study by Beijing researchers has linked human papillomavirus (HPV) to a five times greater risk of laryngeal.
Researchers led by Dr. Xiangwei Li, from the Chinese Academy of Medical Sciences and Peking University Medical College in Beijing, analyzed 12 studies that compared cancerous and non-cancerous tissues from a total of 638 patients. They found the cancerous throat tissue had 5.4 times the odds of testing positive for HPV infection, compared to non-cancerous tissue.
The analysis was published last week in the Journal of Infectious Diseases.
Other researchers said that of all head and neck cancers, HPV seems to play the biggest role not in laryngeal cancer, but in cancer of the tonsils and back of the tongue.
However, they added, "the exposure is probably decades earlier. Someone who develops a base of tongue cancer when they're 50, they probably were exposed to the virus years before, in their teens or 20s."
At least half of sexually-active people get HPV at some point in their lives, according to the Centers for Disease Control and Prevention (CDC), but the virus is usually cleared by the immune system. Only some of the 40-plus HPV strains have been tied to cancer.
Based on the current findings, it's difficult to know how many of the laryngeal cancers in the original studies were actually caused by the virus, researchers said.
But Mendenhall said extending HPV vaccination to boys and young men, as the CDC has recommended, "will hopefully reduce at least some of these HPV-related cancers."
Source: Journal of Infectious Diseases

Study clarifies gestational diabetes diagnostic values for Chinese women

Fasting plasma glucose should be measured at the first prenatal visit, with 6.1mmol/L as the diagnostic cutoff for GDM

by Michael Woodhead
A major study has confirmed the value of screening for gestational diabetes in early pregnancy, but shows that international blood glucose level benchmarks for diagnosis are not appropriate for Chinese women.
Researchers at the Peking University First Hospital evaluated the value of fasting plasma glucose (FPG) testing at the first prenatal visit to diagnose gestational diabetes mellitus in 17,186 pregnant women who attended prenatal clinics in 13 hospitals in China.
They found that the fasting plasma glucose level at the first prenatal visit was strongly correlated with gestational diabetes diagnosed at 24–28 gestational weeks. The incidences of gestational diabetes were 37%, 53%, and 66%, respectively, for women with fasting plasma glucose at the first prenatal visit between 5.10 and 5.59, 5.60 and 6.09, and 6.10–6.99 mmol/L.
The researchers say diabetes is a major problem in China, with a prevalence of 8.8% for women and a prediabetes prevalence rate of 15% for women. And in addition, in 60% of women with diabetes, the condition had not previously been diagnosed.
"Early diagnosis and early intervention for diabetes are necessary to improve pregnancy outcomes. While not the gold standard for diagnosing type 2 diabetes, fasting plasma glucose  measurement at first prenatal visit or at the time of booking could be critical to screen for previously undiagnosed preexisting diabetes."
The researchers conclude that: "Based on our study, we recommend that a fasting plasma glucose test be performed for all pregnant women at the time of booking and first prenatal visit, that a fasting plasma glucose  value of 7.00 mmol/L be considered diagnostic of previous undiagnosed diabetes, and that women with fasting plasma glucose  between 6.10 and 6.99 mmol/L be treated as gestational diabetes mellitus  to improve outcomes of both mothers and offspring."
They suggest  that pregnant women (6.10 ≤ FPG < 7.00 mmol/L) should be considered and treated as gestational diabetes to improve outcomes; for women with fasting plasma glucose between 5.10 and 6.09 mmol/L, nutrition and exercise advice should be provided. An oral glucose tolerance test should be performed at 24–28 weeks to confirm or rule out gestational diabetes. Based on our data, we cannot support an fasting plasma glucose value ≥5.10 mmol/L at the first prenatal visit as the criterion for diagnosis of gestational diabetes.
"Two-thirds of the pregnant women with fasting plasma glucose of over 6.10 mmol/L at the first prenatal visit quite likely will progress to gestational diabetes without further intervention," they warn.
"If blood glucose is not controlled for this group, we probably will miss the opportunity for reducing
risks for poor outcomes."
However say they they do not recommend the international fasting plasma glucose cutoff of 5.10 mmol/L at first visit as the criteria to diagnose gestational diabetes.
"If we use 5.10 mmol/L as the cutoff value to diagnose gestational diabetes at any time during pregnancy, even more women will be diagnosed; this will not only burden the already overstretched health system but also create stress and psychological burden for patients, which in itself may not be good for their overall wellbeing during pregnancy."
Source: Diabetes Care

In Shenzhen, rent boys have safer sex and lower HIV rates

Among gay men, those who sold sex had higher rates of condom use and lower rates of HIV

 by Michael Woodhead
Gay men who sell sex to to other men have higher rates of consistent condom use and lower rates of HIV,  researchers in Shenzhenhave found.
They say HIV transmission among men who have sex with men  has become an increasing concern in China. Money boys are a subgroup of gay men who sell sex to men. Direct comparison of HIV prevalence and related risk factors between "money boys" and non-commercial men who have sex with men has rarely been done.
Therefore, researchers studied HIV rates in 850 "money boys"  and 801 "non-commercial" gay men  in Shenzhen They found that the prevalence of HIV was 4.5% in "money boys" and 7% in  other gay men. Although "money boys" tended to have more male partners than  gay men, they were more likely to report a consistent condom use in male anal intercourse, especially in commercial sex. Noncommercial  gay men were more likely to visit parks and saunas instead of bars, massage centres, recreational centres, and home-based venues.
Syphilis infection and type of 'pick up' venue were associated with HIV infection in both "money boys" and  gay men. Being from a hometown with a high HIV prevalence was a risk factor for HIV infection in "Money boys", and early sexual debut was a risk factor in non-commercial gay men.
The researchers conclude that "money boys" differ from  gay men in the rate of HIV infection and some sexual characteristics and behaviours. Different safe sex and HIV-prevention promotion interventions specifically targeting the two subgroups may be necessary, they say.
Source: Sexually Transmitted Diseases