Wuhan surgeon attributes success to playing Counter Strike

Dr Jiang Bin says playing Counter Strike helped his manual surgical skills

Post 80's generation Chinese (people born on and after 1980) get a lot of flack in China for being a group of entitled children. The reasoning behind this scorn for the post 80's generation partially has to do with the fact that they were born during a time when China first started economic reforms and haven't really had to deal with any hardships such as the "Cultural Revolution".
Another issue is supposedly that this generation, which grew up with video games and systems such as the Nintendo Famicom (NES), are weak and self absorbed with everything handed to them. Well one post 80s Chinese surgeon has proved the stereotypes wrong by placing in the top three of a national surgery contest. And, he claims it was all due to countless hours playing Counter Strike.
Thirty one year-old Wuhan surgeon Jiang Bin placed third during this year's national "basic medical skills" competition this year. Not only did Dr. Jiang place third in the nation, he was also the youngest contestant to compete.
The competition comprised of various basic surgery skills including non-invasive surgery. Stacked up against some of China's best doctors, Dr. Jiang said he was very nervous but was confident in his skills, skills that he claims he gained because of his past playing Counter Strike!
Dr. Jiang says that he used to play lots of Counter Strike when he was in college and that many of the skills in CS such as fast and steady hand eye coordination were essential to becoming a good surgeon. During the surgery portion of the competition Dr. Jiang scored amongst the highest, with a 4.7 out of a possible 5.
Taking Dr. Jiang as an example, I guess Chinese parents can't really say playing video games is a waste of time anymore can they?
Source: Kotaku

Pharma company behind China's first guidelines for hepatits B

Hepatitis B guidance released by Bristol-Myers Squibb

China accounts for 55 percent of the 500,000 new liver cancer cases reported worldwide each year and 90 percent of the new cases stem from hepatitis B, a medical forum said yesterday.
Antiviral therapy is the most effective treatment for hepatitis B, however many Chinese patients fail to receive proper treatment.
The forum learned that the nation's first health guidance for hepatitis B patients will be issued jointly by the Wu Jieping Medical Association and the US pharmaceutical giant Bristol-Myers Squibb.
"Appropriate antiviral therapy for hepatitis B can delay the deterioration of the disease and reduce the possibility of cirrhosis and liver cancer," said Dr Wei Lai, director of the Chinese Medical Association's liver disease branch.
Currently, there are nearly 30 million hepatitis B patients in China.
Source: Shanghai Daily

Army general is new president of the Chinese Medical Association

New CMA president General Zhang Yan Ling says he will try to rebuild doctor-patient trust

by Michael Woodhead
A military physician, PLA general Zhang Yan Ling, has been elected as president of the Chinese Medical Association.
General Zhang, who was previously vice president of the CMA, is well know for his work in the front line of fighting the SARs outbreak in China in 2003.
A native of Hebei Province, Zhang Yan Ling was  born in 1952, joined the army in 1970,  became a Party member in 1973 and in 1978 graduated from the Xi'an Fourth Military Medical University. Since then he has worked as a military physician and medical educator.  During the SARS outbreak of April, 2003 he was appointed by the Central Military Commission as director of the Xiaotangshan "SARS" emergency hospital, where he worked round the clock to help contain the outbreak.
He has also been director of medical education at the National Defense University, vice minister in the PLA General Logistics Department of the Ministry of Health and in 2006 he was appointed president of Second Military Medical University. In July 2005 he was promoted to the rank of major general and in 2008 he was appointed Minister of General Logistics Department of Health.
Founded ten years ago, the Chinese Medical Association was  has developed into 39 local associations and 51 secondary specialised branches for physicians, surgeons and other specialists. President Zhang  says he hopes the CMA will bring together government departments and people from all walks of life and act as a bridge to feedback grassroots opinion for physicians. He wants the CMA to gain cooperation of the media to  fully reflect the feelings and aspirations of the majority of physicians, and the advances being made by healthcare He says he wants strong policy support for learning, and work-life balance for physicians, a positive atmosphere of public opinion and a good social environment.
　　He also said he will also resolutely resist the adverse social atmosphere against doctors and hospitals and hopes to win widespread social respect and trust for doctors in China, and he will strive to build a harmonious relationship between doctors and patients, and shaping a good image of the health industry. He says the CMA will strive to safeguard the legitimate rights and interests of doctors, in particular, the effective protection of human dignity and personal safety of doctors in practice through maintenance of normal medical order.
　　Zhang Yan Ling said the CMA also needs to vigorously promote the standardisation of residency training, medical humanities training and legal regulations training in the clinical use of drugs. Doctors also need to continuously improve scientific management and there needs to be in-depth implementation of the code of conduct for medical institutions, improved physician practice qualifications and specialist technology access.
Source: CMT

The stakeholders in China's hospital reforms

Ministry of Finance won't help hospitals

As 2012 draws to a close, the two most impactful reforms China has set in motion within the healthcare space are the ongoing expansion of the country’s insurance plan and attempts to reform its hospitals. 
The latter is one of the more complex and multi-faceted aspects of China’s overarching objectives as part of its 2009 investment and 12th 5 Year Plan.  Hospital reforms in China draw together several different stakeholders with many times differing objectives.  As one example, the Ministry of Health’s desire to change how hospitals generate revenue (away from drug prescriptions) has not been matched by increased funding by the Ministry of Finance.
Among the many insights offered by the Anhui Pricing Model is that even if the central government as supported by the Ministry of Health wants to pursue more sophisticated HTA protocols for evaluating prices versus efficacy, if this desire is not supported by supplementary funding from the Ministry of Finance, the provincial authorities will take liberties in how they make up any budgetary shortfalls.  In late November the South China Morning Post (SCMP) wrote, “hospitals in China resist bid to reform drug sales.”  The specific reforms that have caused the most problems for China’s hospitals include the attempt to eliminate the 15% mark-up hospitals could charge for drugs.
According to the SCMP article, “Although more than 300 county-level hospitals have implemented the price reform since Chen announced it at the beginning of the year, only a dozen city-level hospitals – including two in Beijing and 10 in Shenzhen – have stopped charging the mark-ups.”  (emphasis mine)  Why do hospitals resist this reform?  As the SCMP points out, “Drug sales usually make up half the average mainland hospital’s income while government subsidies account for another 8 to 10 percent.”  I am aware of one think-tank study that suggests in rural areas, drug sales account for up to 90% of a rural hospital’s revenue.
This back and forth perfectly captures the complexity of reforming China’s hospital system, and it is worth unpacking what each stakeholder’s concerns are.  First, the concerns of the MoH who wants to make sure drugs are not being over-prescribed.  Their concerns range from poor use of limited funds on the part of the Chinese people to over-prescriptions resulting in drug resistant viruses.  Not to mention the ethical quandaries and reputational damage done to China’s current group of doctors who have been complicit in this over-prescription.
Second, the MoF wants to see China’s hospitals be as self-sufficient as possible.  Many of the legacy issues China’s hospitals face are the direct result of diminishing government (MoF) funding for the last 30 years, which has made them reliant on things like drug prescriptions to supplement their meager payments from the central government.  This tension was perfectly obvious in the SCMP article which added, “Hospital chiefs said implementing the reform without the corresponding government support would force hospitals to seek other sources of revenue, such as in ordering patients to undergo more check-ups.”  Make of that comment what you will, but let me suggest one thing it suggests:  these Chinese hospital administrators have little confidence they will get the necessary funding to make up for the anticipated shortfalls if they were to implement the prescription mark-up reforms.
Third, how patients view these reforms.  While outsiders see the benefit to reforming how Chinese hospitals generate revenue, patients may bristle at what they perceive as lost treatments.  Keep in mind that healthcare consumers in China, especially in rural areas, still suffer from a general lack of education.  If previously a patient with particular health problems went in and received a particular drug regimen and diagnostics (even if a large part of both were costly and un-necessary), only now to get significantly less of both, what will an unsophisticated healthcare consumer make of this?  Not properly explained, many of these reforms may fail unless Chinese consumers quickly recognize benefits as part of the broader body of reforms taking place.
Fourth, where does industry fall into this body of reforms (and, it should be noted, is their view different if they are domestic versus multinational pharma)?  Ideally, the Anhui Model proves to have limitations that industry can exploit.  Already we are seeing pushback both in terms of the development of alternative, and more sophisticated plans for the national formulary.  In addition, the implications to the broad adoption of the Anhui Model work against some of the economic development goals specific to life sciences that constitute important parts of the 12th 5YP.  Yes, industry wants access to the Chinese market.  But the trade-off between volume and margin now has a third factor:  technology transfer.  Industries in China have been through this before (aviation, chemical precursors, IT, etc.); but the precise interplay between how the MoH will guide policy reform, where the MoF will supplement hospital’s revenue so industry has some confidence the motivation for hospitals to mark drugs up has changed, and how the Party wants to see a domestic life science industry evolve remain significant issues that will need to be resolved.
Obviously no one knows how this will shake out.  In the short term, there are likely to be more problems such as those set in motion by the Anhui Model.  We may find that sales practices by pharma have been compromised due to many of the same issues Chinese doctors have faced when over-prescribing.  Inevitably, one of the technology transfer relationships an international pharma company engages in will create problems in its home market.  But, at the end of the day, the immense opportunity to sell into, and develop within, the Chinese market will hopefully keep the focus of industry.  When you consider that these concerns from so many different stakeholders all go back to an effort to reform how Chinese hospitals fund themselves, a sense of just how complex this whole process is likely to be takes on additional meaning.
Source: Asia Healthcare Blog

Public hospitals in Beijing, Shenzhen raise doctor fees

Public hospitals are to raise doctor frees to compensate for lower medication fees

by Zan Xin
Public hospitals in two major cities have announced increases to doctors' fees and steps to lower medicine costs. However, one expert says the central government should let the market set fees for physicians.
Two years ago the State Council took steps to lowers costs in the public health care system, largely funded by sales of prescription drugs. Now, two governments are announcing major reforms on their own.
In May, Shenzhen and Beijing raised doctor fees while announcing new guidelines to cut prescription drug costs. Hubei, Shaanxi and Jiangsu provinces are also mulling plans to raise physician fees.
Across-the-board increases for physician services were first implemented in Zhejiang Province last year.
Beijing raised doctor fees from a standard 14 yuan per session to up to 100 yuan for specialists. A session with an associate chief doctor now costs 60 yuan while a chief doctor visit is now 80 yuan.
In Shenzhen, the fee to visit a doctor rose 12 yuan on average.
Song Ruilin, executive director-general at the Research Center for Medicinal Policy at the Chinese Pharmaceutical Association, said the central government should let the market set the prices for doctors' fees.
The two governments also announced they would not allow hospitals to mark up prescription medicines anymore. The central government allows hospitals to mark up drugs 15 percent. 
 
Capital University of Medical Sciences Professor Cui Xiaobo said eliminating the mark-up will not stop hospitals and doctors from receiving commissions from pharmaceutical companies.
Source: Caixin

Shaanxi 'nail house' hospital attacked by thugs over demolition dispute

A hired mob caused damage to the hospital and attacked people

Twelve suspects involved in vandalism attacks at a hospital in northwest China's Shaanxi Province have been arrested yesterday, according to local police.
A group of masked men had been smashing the Century Hospital in Xianyang, Shaanxi Province in northwest China three times from September 13 to October 7. Many medical facilities were destroyed.
"We have lost almost 100 thousand yuan (around US$13,000) just in terms of property," said Wang Dongjun, vice president of the hospital. "Three staff on duty were also injured."
Wang said the hospital was smashed because it didn't agree with the demolition conditions provided by the property developers.
"We invested over 20 million yuan into construction of this hospital, but the developer only plans to compensate 1.4 million yuan for demolition."
Zhao Zhengyong, head of Shaanxi province pledged to examine the issue in October. Apart from the 12 arrested, the local police are after those at large at this moment.
Source: Sina

Lobby group says China's crackdown on counterfeit medicines is working

The Partnership for Safe Medicines says it has seen great results in China's fight against fake drugs

 A US advocacy group says Chinese crack down on counterfeiters is starting to work and that new Beijing unit will help. 
The Partnership for Safe Medicines – a not for profit campaigning group whose members include PhRMA and the WHO – gave its review of the situation late last month at the launch of its PSM China initiative. PSM China Bai Huiliang chairman said: “China’s resolve in protecting its citizens from the dangers of counterfeit drugs has yielded great results and shows tremendous potential for the future.”
He cited the Chinese Government’s August arrest of 2,000 people suspected of being involved in the production of fake drugs and its seizure of $182m worth of counterfeits as evidence of the progress being made.
Huiliang added that: “With the help of our partners, PSM China will support the Chinese Government’s efforts to enhance drug safety and improve public health.”
PSM China will focus on raising awareness of the potential harm caused by fake drugs and on informing patients, physicians, manufacturers and distributors of these dangers. The group will also teach people how to spot fake drugs.
The launch was welcomed by Eli Lilly CEO John Lechleiter who said: “The biopharmaceutical industry applauds the PSM China initiative as an innovative solution to protect patients and improve drug safety.”
“Make no mistake: pharmaceutical counterfeiting – and drug safety in general – is not China’s problem, or the task of any one country.  It is a shared global public health priority, and, therefore, a domestic concern in the United States, EU, China, and many other countries all over the world.  And one resounding lesson is that we can all benefit by working together.”
PSM China is the second international initiative the US advocacy group has established.
In December 2010, the organisation set up PSM India.
Source: In-pharmatechnologist.com

China reveres the author of its first Hippocratic Oath

Sun Simiao

He is the author of China's first medical textbook and of its code of ethics. Produced in AD 652, "Qianjin Yaofang," or "Essential Prescriptions Worth a Thousand Pieces of Gold," was a milestone in the history of traditional Chinese medicine. Its title reflects a firm belief of its author, Sun Simiao (circa 581-AD 682), known as China's King of Medicine.
Sun once said: "Human life is of paramount importance, more precious than a thousand pieces of gold; to save it with one prescription is to show great virtue."
Sun was born in a place called Huayuan in today's Yaoxian County, Shaanxi Province in northwestern China. However, it was not a healthy place in which to live at that time, as many locals contracted unusual illnesses.
Sun's father was afflicted by night blindness and his mother suffered from a swollen thyroid gland. Sun himself did not escape ailments and was a sickly child.
Surrounded by so much illness, the boy studied hard as he was determined to become a doctor to help treat his parents, relatives and neighbors in his home village.
In addition to various Chinese classics, the young Sun dug deep into every medical treatise he could lay his hands on. He also traveled to various places to collect folk and family medicine recipes and study the medicinal effects of thousands of herbs. He was particularly interested in the identification and preparation of herbs. Sun began his medical practice at the age of 18.
In time, thanks to his exceptional skills and the deep care he showed his patients, Sun was able to cure his parents and treat many other people in his home village.
As Sun's renown spread, it earned him the name King of Medicine and he began work on the 30-volume traditional Chinese medicine encyclopedia "Qianjin Yaofang."
The book contains a total of 5,300 prescriptions and covers topics such as gynecology, pediatrics, cold-induced disorders, internal diseases, detoxification, diet therapy, acupuncture and herbs themselves.
In addition, "Qianjin Yaofang" contain commentaries on clinical practice and treatises on how to keep in good health. Handy hints include tips for a healthy diet and exercises such as combing your hair, rolling your eyeballs and walking.
Sun's "Qianjin Yaofang" not only summarized all pre-Tang Dynasty (AD 618-907) medical achievements, but also laid the foundations for traditional Chinese medicine ethics.
In the first volume, Sun detailed his views on TCM ethics in an essay called "Dayi Jingcheng" or "Absolute Sincerity of Great Physicians."
Sun wrote: "When a great physician treats patients, he must maintain his inner serenity, pay no attention to personal desires or demands and feel great sympathy for the patients."
"He should vow to save people from their sufferings, no matter whether they are nobles or ordinary people, rich or poor, old or young, attractive or unattractive, friends or enemies, Chinese or foreign, educated or uneducated. He must treat them all on equal grounds and as his own close kin."
Later, Sun's views on medical ethics were recognized as the first code of conduct for physicians in China.
Soon after finishing "Qianjin Yaofang," Sun went to live in seclusion on Panyu Mountain in his home province in northwest China. The mountain later became known as Medicine King Mountain.
There, Sun studied Taoism, and later integrated Taoist principles with Buddhism and Confucian doctrines.
Years later, summing up his clinical experiences and medical classics, Sun wrote a second medical book, entitled "Qianjin Yifang" or "Supplement to the Prescriptions of a Thousand Pieces of Gold." This second book, also written in 30 volumes, contains about 2,000 recipes for medicines.
The two books were later translated into many other languages and were once used as textbooks in Japanese medical schools.
Source: People's Daily

Patient dies after ambulance stuck in Beijing traffic

Ambulance got stuck in Beijing's gridlock traffic

A cyclist who was injured in an accident in Beijing died en route to the hospital after vehicles in rush-hour traffic didn’t yield to the ambulance carrying him, the Beijing Evening News reported.
The victim, a man in his 50s, was critically injured after a collision with a heavy truck in west Beijing on Dec. 7, according to the newspaper. The ambulance crew performed emergency resuscitation and was transporting him to the nearest hospital about 3 kilometers (2 miles) away when they encountered heavy traffic, the newspaper reported, citing the accompanying doctor surnamed Wang.
The journey took 40 minutes because all but four vehicles yielded to the ambulance despite repeated sounding of the siren, the newspaper reported. Most motorists also didn’t give way when the ambulance driver tried to get back in line after trying the bicycling lane and finding the path blocked by an illegally parked car, according to the report.
Beijing’s municipal government said in August it plans to build a system for imposing road-congestion charges on motorists, adding to caps on vehicle registrations as China’s capital seeks to ease traffic jams.
Source: Bloomberg

Contaminated instruments kill five patients at Beijing hospital

 Acinetobacter baumannii infection was transmitted from an inadequately-cleaned bronchoscope

by Michael Woodhead
At least five patients have died at a Beijing hospital with a 'superbug' infection from a dirty bronchoscope that doctors were sterilising themselves.
An outbreak caused by multidrug-resistant Acinetobacter baumannii  affected 12 patients being treated at the intensive care unit of a 1200-bed hospital in Beijing.
An investigating team led by Dr Xia Yukun of the Department for Hospital Infection Control & Research at the Institute of Disease Control & Prevention of PLA, Academy of Military Medical Sciences  traced the outbreak  to inadequate sterilisation techniques used to clean the ICU's bronchofiberscope.
The researchers found that there was only one bronchofiberscope in the ICU and bronchofiberscopy was performed once or twice each day for secretion clearance, tracheal intubations, and bronchoalveolar lavage. Usually, the bronchofiberscope  was sterilised thoroughly by professional staff in the hospitals' disinfection unit according to according to the appropriate guidelines for endoscopy cleaning and disinfection However, when the bronchofiberscope was used in an emergency situation it was cleaned  manually by a doctor in the ICU after use. During the outbreak period, 12 patients were infected with the multidrug-resistant Acinetobacter baumannii, which is hard to eliminate because it survives on many surfaces and has extensive resistance to many of the currently available antibiotics, including cephalosporins, aminoglycosides, quinolones, and carbapenems.
Five patients died of the infection during the outbreak.
The researchers say the bacteria might have been transmitted through direct contact with the bronchofiberscope or transmitted through healthcare workers’ hands during other medical procedures.
"In our investigation, most of the [bacteria] were isolated from the healthcare-associated environmental surfaces including the bed sheets, bedrails, dispensing table and nurses’ desk," they note.
"Our findings emphasize that bronchofiberscopy must be performed with appropriate infection control measures ... strict bronchofiberscope reprocessing should be performed after each procedure and at the end of the day according to the published guidelines. It might be wise to increase the number of bronchofiberscopes available in each ICU to guarantee professional bronchofiberscope
reprocessing," they conclude.
Source: BMC Infectious Diseases

Almost one in ten Chinese children have been sexual abused - study

Survey of schoolchildren in six Chinese cities finds that 8% have been sexually abused

A study has found that 8% of Chinese children have experienced sexual abuse at some time in their life.
Researchers from the Department of Social Work and Social Administration at the University of Hong Kong made the claim after surveying 18 341 students in grades 9-12 from 150 randomly sampled schools during November 2009 through July 2010 in six Chinese cities. The children they surveyed had an average age of 16 and were equally divided into males and females.
They found that the overall lifetime prevalence of child sexual abuse was 8% and the prevalence of abuse i the previous year was 6.4%. The study also found that boys were more likely to report child sexual abuse than were girls. Apart from having experienced other forms of child victimisation, several characteristics were associated with greater risk of child sexual abuse: being a boy; being older; having siblings; having divorced, separated, or widowed parents; or having an unemployed father.
"This study provides reliable estimates of child victimisation to facilitate resource allocation in health care settings in China, the researchers conclude.
"The strong associations between child sexual abuse and other forms of child victimisation warrant screening for additional forms of child victimisation once any one of them has been identified."
Source: Journal of Pediatrics

Hong Kong health providers allowed to set up mainland institutions

Hong Kong hospitals will be able to set up health institutions on the mainland next year

Hong Kong and Macao health service providers can set up institutions on the Chinese mainland starting from January 1, 2013, the Ministry of Health said on Friday.
They can set up health institutions wholly-owned by themselves, jointly-invested ones and cooperative ones partnering with mainland health establishments or enterprises.
Except for wholly-owned hospitals or senior houses, other forms of entities established by Hong Kong and Macao investors will be subject to administrative approvals of health authorities at provincial level, rather than national level, meaning simpler procedures, the Ministry of Health said.
The plans are based on agreements of the Closer Economic Partnership Arrangements between the mainland and Hong Kong and Macao. Supplemental agreements were signed this year.
The Ministry of Health said the arrangements signal greater liberation of the health sector on the mainland. It will also provide opportunities for Hong Kong, Macao health professionals to practice on the mainland as well as for the health industries of Hong Kong and Macao.
Source: China Daily

China's new infection and employment regulations

Employees who develop infection diseases must be reported to health authorities and stay off work

Chinese government policy and legal guidelines for handling infectious diseases among the workforce have recently undergone major revisions and are now relatively straightforward and unambiguous.
Those diseases serious enough to require isolation and quarantine are clearly identified, and any employee suspected of having such an infection would need to be reported to the relevant health authorities and removed from the workforce.
The notion that that there are laws mandating the provision of special, segregated dining facilities for employees infected with communicable diseases remains unconfirmed and of doubtful validity. This belief may have arisen from the prevalence of the Hepatitis B virus (HBV) in the Chinese population and the historical misunderstanding about its communicability. Some employers or organizations may have felt compelled to respond to widespread fear and may have segregated HBV carriers from the rest of the workforce during dining or when providing them with lodging. These informal practices may be the foundation for the belief that employers are required to provide special dining facilities to Chinese employees infected with certain diseases.
When there is concern that an “infectious disease” is present among the workforce, Chinese law mandates that the concern be immediately reported to Chinese health authorities for assessment in order to determine if isolation and quarantine are required (see Law of the PRC on the Prevention and Treatment of Infectious Diseases). Infectious diseases requiring immediate quarantine include HIV or AIDS, measles pertussis, rubella and dengue fever.
If an employee is found to be infected with one of these diseases and is isolated and quarantined, note that the employer remains responsible for the employee’s remuneration and may not terminate the employee. The employee would be placed on leave. Once an employee has recovered from the infectious illness, the employer may only terminate the employee by following the procedures outlined at the end of this article, in the section titled “Termination of Recovered Employees.”
Although scientific research has demonstrated that the Hepatitis B virus, the virus that causes the liver disease Hepatitis B, can only be transmitted through the exchange of bodily fluids or from mother to child, there has been widespread belief in China that the virus can be spread through casual contact during dining or co-habitation. The confusion has been exacerbated because of fear arising from the epidemic rate of HBV infections in China and because of previously misguided government health policies. There are an estimated 90 million to 130 million people in China infected with HBV. About 30 million Chinese have developed acute Hepatitis B, which is accompanied by severe medical symptoms and may easily lead to death. Many Chinese may have been originally infected as children in the last century through the use of needles shared during mass vaccination programs for tuberculosis, tetanus, and encephalitis. The infection could then be passed from mother to child.
Because of fear of the virus and misunderstanding about its potential impact on public health, prior Chinese laws restricted the ability of HBV carriers from obtaining government employment or working in certain public industries such as healthcare services or food services. However, there has been growing awareness recently of the true characteristics of HBV transmission, which has led to new government policy and legislation. Recent laws have sought to reverse the policies of the past in an attempt to protect the rights of HBV carriers to obtain employment.
Legally speaking, it is now improper to discriminate against HBV carrier applicants for employment, except in a few rare cases. In 2007, the Standing Committee of the NPC passed a law explicitly forbidding discrimination in hiring against any “person based on their carrying the pathogen of a contagious disease.” In the same year, the Labor and Social Security Bureau issued the Regulations on Employment Services and Employment Management, which clearly provides that employers may not mandate the use of HBV medical testing in hiring, except in a few specialized professions. There is a RMB1,000 fine for violation of the provision.
Further strengthening these measures, the NPC Standing Committee passed the Food Safety Law in 2009 – revising the provision in the Food Hygiene Law forbidding pathogen carriers from working in direct contact with ready-to-eat foods. Under certain circumstances, HBV-positive individuals may now no longer be prohibited from employment as cooks or in similar positions. Since the passage of these laws, all local governments have eliminated civil service requirements that discriminate against HBV-positive individuals.
However, due to weak enforcement of these new anti-discriminatory laws and continued widespread fear and discrimination in employment, some activists have sought recourse in the courts by way of private legal action. There have been a few relatively high-profile lawsuits by HBV carriers against discriminatory employment practices and the issue has been making its way into the mainstream Chinese media, including in articles in the China Daily such as “Hepatitis B carriers call for equal rights.”
In a final note, please consider that there are some industries legitimately requiring pre-employment health screenings, including in the food service and cosmetic production industries. In such industries, the presence of “infectious diseases” other than HBV would disqualify the infected employee. However, in cases whereby an employee contracts such a communicable disease subsequent to employment, the employer may not terminate the employee but rather shall adjust the employee to other positions that do not threaten the health of the public.
After the medical treatment period has expired, if the employee is able to perform the duties of his original work, he may remain employed under the original labor contract terms. If the employee is either unable to carry out the duties of his original position or is unable to perform alternative work arranged by the work unit or employer, then he shall be processed through the “working capability appraisal process” conducted by the Labor Appraisal Committee with reference to the Standards for Appraising Industrial Injuries and Disabilities Caused by Occupational Diseases.
If the employee is appraised as between Class 1 through Class 4, then he or she shall withdraw from his position, agree to dissolve the labor relationship, and pursue the formalities for retirement or resignation by reason of diseases or non-work-related injuries and enjoy the treatment corresponding to that of retirement or resignation.
If the employee is apprised as between Class 5 through Class 10, the work unit or employer may dissolve the labor contract with the employee and pay economic compensation and medical treatment allowance in accordance with the relevant legal provisions.
Source: China Briefing

Oncologists and palliative care doctors meet to discuss dying with dignity

"Death with dignity has been almost absent in the final stage of medical treatment in China."

by Zhou Heyang
A group of top doctors in the fields of oncology and palliative care have gathered in Beijing Oncology Hospital to discuss the future development of hospice care in China. One important issue on their agenda is publicizing the idea of hospice care and death with dignity to the general public.
When the final curtain call draws, how should you greet it? Some patients in the last phases of a fatal disease choose to not receive final treatment and plan a peaceful and comfortable farewell to the world. This decision is called death with dignity.
The term applies to a doctor's actions in agreeing to withhold medical treatment from a terminally ill patient. The patient can decide on details, such as to spend the last days at home and who should be present. A written agreement called Advanced Care Planning is signed in such situations in many Western countries. In other cases, this decision is made by a family member.
Ning Xiaohong, Doctor of Internal Oncology at Xiehe Hospital talks about this blank that needs to be filled in China:
"We see severe pain in cancer patients, such brutal pain inflicted on the human body that it makes us doctors feel their pain, too. Death with dignity has been almost absent in the final stage of medical treatment in China. Modern medical methods cannot alleviate the suffering in many of these cases. Doctors don't have a protocol to follow. And the public does not know death does not always have to be so painful and scary. The public needs to know it is an option."
Death is seen as a taboo subject that people are afraid to face or even discuss in China. In fact, death with dignity focuses on bringing comfort, self-respect, and tranquility to people in the final stage of their life. Patients' symptoms and pain are controlled, goals of care are discussed and emotional needs are supported.
Chen Zuobing, after discussing the issue with his severely ill father who preferred death with dignity, decided to fulfill the old man's wish. His father returned to his hometown and lived his final days without the disturbance of modern medicine.
"There is no right or wrong in making this decision. If the person receives full-scale treatment to the last moment, it is great that his family can hold on to him for another second. But if one refuses the extensive treatment, he can pass without the pain brought by medicine and in a dignified manner. Isn't it better this way?"
Death with dignity should not be confused with euthanasia which is the intentional termination of the person's life with consent to relieve pain. Death with dignity allows natural death without medical intervention during the last stage of a fatally ill patient.
Doctor Liu Duanqi at Beijing Oncology Hospital is an oncology expert says 99 percent of patients who suffer from last stage pancreas or liver cancer pass away. He explains that death with dignity touches on the core of medical care.
"Doctors and medicine are only capable to help and assist the patient. In many terminally-ill medical cases especially the chronic and consumptive diseases, doctors can't change the course of nature. The preoccupation is for the doctor to act according to the will of the patient."
Death with dignity is about giving the patient back the freedom of choice to decide on what treatment to receive at the final moment. In this way, dignity is upheld for the sufferer. It includes a written agreement stating the patient's decision prior to treatment. Such a document is called an Advance Care Plan, which is not formally introduced in China yet. It includes a living will and the durable power of attorney for health care. It allows another person to have a say in the health care treatment one will receive if one is too sick to speak for him or herself. By discussing and documenting one's wishes, the family and health care team will be better able to act on the person's behalf.
When one's wishes are fulfilled, one can wave goodbye without regret. Family and friends will feel less distress as well.
Source: CRI

Beijing man jailed for trying to evade $28,000 kidney dialysis fee

Man who faced 5000 yuan a month dialysis fees faked payment stamp

A Beijing man was sentenced to three years in prison with a four-year reprieve by a local court Friday for using a fake hospital stamp to avoid 172,000 yuan ($27,608) in medical fees for his wife's kidney dialysis treatment over four years.
Liao Dan, a 41-year-old unemployed man, was sued by the prosecutor's office of Dongcheng district in July after he defrauded the Beijing Hospital by using receipts with a forged seal so that his wife, Du Jinling, could receive dialysis. Liao could not afford the monthly treatment costs of 5,000 yuan.
He initially faced a sentence of up to 10 years for defrauding the hospital, but his case triggered an outpouring of public sympathy.
Donations totaling 500,000 yuan, enough to cover 10 years of dialysis, were raised by the public for the family, the Beijing Evening News reported Friday.
Liao used part of this money to repay in full his outstanding medical fees.
Liao welcomed Friday's verdict, the most lenient expected, handed down by the Dongcheng District People's Court. "The medical treatment for dialysis has been paid for by the donations. I won't rule out a kidney transplant operation for my wife as long as there's a match," he said.
Liao's wife Du, who is from Hebei Province, was unable to get her medical expenses reimbursed because she does not have a Beijing hukou, or household registration permit. Liao and his wife live on a monthly subsidy of 1,700 yuan as low-income earners.
Experts reached by the Global Times labeled the ruling as appropriate and reflecting humane judgment within the rule of law.
"When handing down criminal sentences, the judiciary department tends to show greater leniency when humanity is involved," Liu Tao, a law professor from the Beijing-based Chinese People's Public Security University, told the Global Times, noting that the State did not suffer any substantial economic loss as all money owed was repaid.
Feng Yujun, a law professor from Renmin University of China, told the Global Times that Liao "would not have defrauded the hospital" if his wife "had access to medical insurance."
Chen Lihao, a member of the Zhuhai Committee of the Chinese People's Political Consultative Conference, who has helped Liao's family, posted on his Sina Weibo, "The sentence has made [Liao's] wish of continuing to take care of his family come true."
Chen noted that the isolated case to some extent highlights problems with China's current medical insurance model.
Five central government agencies released a circular on August 30 that stipulates urban and rural residents with medical insurance coverage can be reimbursed for at least 50 percent for medical expenses related to critical illnesses.
Source: Global Times

Sub-optimal diagnosis and management of Parkinsons disease in China

Treatment of Parkinsons is often by general physicians with little training in how to best manage the disease

by Michael Woodhead
The diagnosis and management of Parkinsons disease in China is often sub-optimal and not done in accordance with best practice guidelines, Shanghai researchers say.
   Writing in the journal BMC Neurology, they say there are at least two million patients with Parkinson’s disease in China, accounting for two-fifths of all Parkinson's patients in the world.
In a study of how the disease is diagnosed and treated, they found that the lack of movement disorder specialists and clinics in China meant that the condition was often treated by general physicians or neurologists with limited expertise in Parkinsons disease.
   The findings come from a survey of Parkinson's disease diagnostic methods and management carried out by Dr Chen Wei and colleagues from the Department of Neurology & Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine.
   Their survey showed that most doctors involved in treating patient with Parkinsons disease were aware of the Chinese Parkinson's disease guidelines; however CME activity in the area was very low and few of the doctors surveyed had published Parkinson's disease-related articles.
   With respect to diagnostic methods for Parkinson's disease, the standard oral levodopa test and conventional MRI were commonly considered for suspected patients in routine practice, whereas other recommended diagnostic tests such as susceptibility weighed imaging, transcranial sonography and functional neuroimaging were less used.
   The researchers say that in China, relative expensive functional neuroimaging methods, such as PET scans are not covered by Chinese medical insurances, and few patients would like to choose them. Additionally, because of lack of knowledge and shortage of transcranial sonography experts in many hospitals, transcranial sonography is rarely accepted as a regular method.
   There was a relatively high level of knowledge on therapeutic strategies for Parkinson's disease  among movement disorders specialists and those from tertiary hospitals. However, a discrepancy between best practice guidelines and clinical practice still exists in management of non-motor symptoms among all of the clinicians surveyed. Up to 46% of doctors selected olanzapine to treat Parkinsons patients with psychosis, only 23% of those prescribed clozapine. For treating Parkinsons with dementia, the most often prescribed treatment was donepezil, not rivastigmine, as recommended in guidelines.
   "Based on these observations, great efforts should be made on CME programs for physicians and general neurologists," the study authors conclude.
Source: BMC Neurology

Killing of doctor is latest of 14 such cases of attacks in China

Patients feel frustrated about access to and the cost of healthcare, while doctors are overworked

A patient in the hospital affiliated with Tianjin Chinese Medicine University threw an axe at his doctor, Kang Hongqian, an acupuncture specialist and a breast cancer victim. This occurred on the 29th of November inside Kang’s office.
In 14 separate cases in China patients killed their doctors after receiving treatment, a statistic which makes this well-recognized profession into a dangerous one.
The growing anger held by patients toward their doctors first came to light in March, when 17 year old Li Mengnan in the hospital of Haerbin Medicine University rushed into the hospital with a sharp knife. One assistant doctor, Wang Hao, was killed and three other people were seriously injured.
In November, four similar cases occurred in different hospitals throughout China; in Beijing, Tianjin and Anhui.
The risk of lethal attack is becoming a part of life for every Chinese doctor. For many, it’s difficult to understand the trend of hospital violence.
Asked about their point of view, patients say that it is so hard to get good health care from a doctor. Because all of the good hospitals are in the big cities like Beijing and Shanghai, hospitals in the county or in small towns do not always provide the best service or have the best equipment. Since the best doctors are at the best and largest hospitals in the cities, patients have to travel great distances and, often, wait in long lines to be treated.
As a result, patients compete against each other for health care services. Patients who have Guanxi, or influence, in hospitals are more likely to receive treatment, resulting in justifiable complaints from patients. Some patients have been reported blocking the hospital’s door or verbally abusing doctors.
Many patients expect good treatment since the price of medical care is so high, however doctors in large hospitals shoulder heavy workloads and often don’t have time to provide quality service with enough personal care. This leads to patient dissatisfaction and anger, as revealed in the recent cases of hospital attacks in China.
Lin Can, a master’s student in one of the medical schools in Shanghai explained the doctor’s perspective. As a 26 year old man, he is still a student without any income. He can’t support himself and doesn't have time to spend with his family. He regrets the way his family has to suffer while he prepares to become a doctor, and wishes that frustrated patients understood his perspective.
A qualified doctor has to undergo a series of tests and obtain at least a PhD, which takes a very long time and lots of hard work. Patients expect doctors to cure every disease, which can be unrealistic since doctors are human, just like everyone else.
Doctors expressed frustration with patient irrationality: If a patient is cured quickly, they take their recovery for granted. If recovery takes longer, patients will blame their doctor, assuming that their doctor is keeping them in the hospital to increase the expense of their visit. If there is no cure for a patient’s illness, patients blame the treatment and kill their doctor.
One doctor said that if he had it to do over again he would never be a doctor.
In China, anyone can go to a hospital whenever they want to. Doctors usually have to work over-time to respond to the steady, heavy flow of patients. Doctors often complain they are not paid very well in light of such heavy workloads and patients think doctors are money driven, and don’t deliver quality health care service. The result is the current system – one where both doctors and patients are unhappy and feel unsafe.
In July of this year, The Affiliated Hospital of Honkong University opened its first clinic in Shenzhen. The scheduling procedure in this hospital mirrors those used in western countries, which has attracted the public’s attention and may be a model for the future.
Source: GB Times

Multiple drug resistant TB spreads in China

One in four cases of recurrent TB in China are drug resistant

Those fighting tuberculosis (TB) say it is better not to treat the disease than to treat it badly, because doing so just produces more powerful, drug-resistant bacteria, making the world's second-most fatal disease stronger by the day.
The mainland has more cases of multiple-drug-resistant TB (MDR TB) than any other country, with 120,000 new cases each year. Poor case management and a lack of new drugs makes the fight against the disease extremely difficult.
Dr Zhao Yanlin, director of the National TB Reference Laboratory, has said that the mainland has a "serious epidemic" of drug-resistant TB, but the situation "could easily be much worse".
Also deputy director of the National Centre for Tuberculosis Control and Prevention at the Chinese Centre for Disease Control and Prevention (CDC), Zhao contributed to a paper published in The New England Journal of Medicine in June about a mainland-wide survey of drug resistant TB.
The survey found that 5.7 per cent of new TB cases and a quarter of previously treated cases were multiple-drug resistant.
Drug-resistant TB emerges when patients fail to follow treatment regimens, which takes six to eight months and use a cocktail of drugs, or stop treatment too soon.
Some patients stop taking medicine after one or two months of treatment, when the coughing stops and the symptoms are gone, but the bacteria are not eliminated and the symptoms will come back. When the TB bacteria is not fully eliminated, it can mutate, re-emerging later as a strain resistant to the small range of drugs able to fight the disease. Other people can then be infected with MDR TB.
Wang Weibing, an associate professor in the school of public health at Shanghai's Fudan University, said the improper treatment of TB patients played a large part in the prevalence of MDR TB but that patients were not the only ones to blame.
"We can't always blame patients who do not follow the treatment regime," he said. "They should not be held entirely responsible, because of the side effects, such as nausea. We need to invent a much shorter or better treatment regime."
In the mainland-wide survey, more than 40 per cent of patients with MDR TB who had previously had treatment for TB had not completed their last treatment course.
The paper said a quarter of TB patients treated in the public health system received inadequate treatment because they had MDR TB but were still given first-line TB drugs as part of standard treatment.
"Addressing MDR TB in China will require selection of treatment regimens on the basis of testing for initial drug resistance," the paper said. "It is also important to improve treatment in TB hospitals and enhance the continuity of treatment after patients leave the hospitals."
Mainland TB patients receive treatment at either local disease control and prevention centres or designated TB-treatment hospitals. Hospitals provide limited outpatient follow-up, while the CDC system does a better job because it is responsible for monitoring patients with TB in the community.
Patients being treated at local TB clinics should be tested for drug resistance before the start of treatment, with treatment options based on the results, but such tests are not routinely performed at TB hospitals. Furthermore, 11 per cent of patients with new cases of TB in the survey reported that they had been given TB drugs in the past, even though they had never been diagnosed with TB. The paper said such patients had a higher risk of developing MDR TB.
Professor Xu Biao, director of Fudan's TB Research Centre, said county-level hospitals were not following national guidelines when treating TB patients, resulting in increased drug resistance.
"The use of second-line anti-TB medicines was found in newly diagnosed TB patients without bacteriological confirmation and the prescription of the second-line medicines mainly depended on the treatment history of the patients rather than the patients' drug resistance profiles," she said.
"It may have to do with poor TB training or simply wanting to see a quick improvement, but the side effect is that it leads to a high rate of drug resistance or even extensive drug resistance."
A former CDC official said the mainland's treatment protocol was only strictly followed in 41 cities involved in a co-operative project managed by the Global Fund to Fight Aids, Tuberculosis and Malaria and mainland health authorities. According to a Ministry of Health treatment guideline, each patient should receive individual diagnosis, treatment and case management, but she said a lack of funding and shortage of staff meant it was followed poorly in other areas.
"We need really professional doctors with extensive experience in treating TB, but only provincial-level hospitals can guarantee that," she said.
All these problems point to the importance of quick diagnosis tools, more effective drugs and a shorter treatment regimen.
TB is mostly diagnosed through a combination of X-rays, liquid culture, microscopic examination and the TB sensitivity skin test, but these methods have flaws in terms of sensitivity, specificity and speed.
In 2010, the World Health Organisation recommended the use of GeneXpert, a tool that can detect TB and drug resistance in less than two hours.
Even though the Swiss NGO Foundation for Innovative New Diagnostics has negotiated a concessional price of US$17,000 for the equipment and a fee of US$10 per test, the savings were not yet apparent on the mainland.
"So far no government agency has taken the lead in negotiating the concessional price," said Huan Shitong, senior programme officer with the Bill & Melinda Gates Foundation's Beijing office.
The foundation invited bids from more than 100 companies in September to develop and produce a similar but cheaper version of GeneXpert in China.
Source: SCMP

Healthcare reform in China: keep calm and carry on

Prof Wang Shang, president of PKU

On the KPMG Global Healthcare Conference from October 10 to 12 in Rome, Wang Shan, President of Peking University (PKU) People’s Hospital, delivered a well-received speech named “Opportunities & Challenges on Chinese Healthcare System”.
In the speech, Wang Shan introduced the challenges Chinese public hospitals are facing during the current reforms of Chinese Healthcare System and the whole society, as well as the opportunities.
He also shared PKU People’s Hospital’s experiences of fine management on multiple levels, which gained praises from international counterparts.
At the end of the speech, Wang pointed out that public hospitals should “Keep calm and keep moving”, which then became title of a related report on The Economist. The report, published on its Leviathan blog of public policy, regarded Wang’s positive slogan applicable to all global healthcare systems under opportunities and challenges.
The KPMG Global Healthcare Conference’s theme was “Something to teach, something to learn: A new vision for healthcare”. It was focused on optimizing healthcare systems’ functions by using new technologies and new management concepts.
About 40 experts from the United States, the United Kingdom, Canada, Japan, Brazil and other countries attended the conference. They found that similar challenges are encountered by different countries, although their healthcare systems have great differences. New concepts and methods are emerging all over the world, bringing feasible ways of solving the challenges. Among these, China’s Healthcare System reform and coping mechanism are illuminating the world.
Source: PKU News

Hospital says "Yes Minister" to perform liver transplant

Professor Huang Jiefu, China's Vice Minister of Health, performing a liver transplant operation

On November 21, 2012, when Professor Huang Jiefu, Vice Minister of the Ministry of Health, was attending the Chinese Hospital Association Conference in Guangzhou, he was informed that there was going to be a DCD (Organ Donation After Cardiac Death) transplant operation in Lingnan Hospital of The Third Affiliated Hospital of Sun Yat-sen University. 
On hearing this, Huang decided to brave the rain and perform that liver transplant operation personally. He commented that this very operation was his support of the innovative reform taking place in Guangdong's public hospitals where the state-owned central hospitals shall gradually expand their services to the grassroots level. He also considered it as a practice of the appeal for voluntary organ donation after death, proposed by the Red Cross Society of China and the Ministry of Health together.
   "It is a real coincidence that I come across this operation.” A woman in her fifties passed away that morning. Based on her own willing and her family’s consent, her organs would be donated to a liver transplant recipient, two kidney transplant recipients, and two cornea transplant recipients. Before stepping into the operating room, Huang readily accepted the interview. He extended his reverence to the voluntary donor by concluding: "One life passed away, but it ended up saving another three. It will also help another two to see the world again. This very devotion is filled with lofty spirit.”
Huang entered the operating theatre around 10 o’clock and got himself prepared for the surgery. After preparation, Huang cooperated well with the team led by Professor Chen Guihua at the Transplant Center of the Third Affiliated Hospital of Sun Yat-sen University. The surgery finished up in success in the afternoon.
   "I pledged to perform an operation personally when the hospital becomes well developed at the launching ceremony. That is why I came here today to honor that promise.” “The Eighteenth National Congress of the Communist Party of China emphasized that we must provide our people with high quality medical services to ensure their happiness and offer the best treatment to the patients in need. This is our responsibility.” Huang made an analogy that if we could not establish a public organ donation system in China, the transplant operations would become “water without the source”. The cause of organ transplant demands wide understanding and support from the public. The concerted effort made by our people can pave the way for the sustainable development of organ transplant cause in China. Huang said: "Chinese culture advocates love, harmony, devotion, sympathy and saving life. Showing the glory of human nature, the tradition will be inherited and carried forward.”
It is learned that, there are already a large number of potential donors who are willing to donate their organs after death. Since the Ministry of Health and the Red Cross Society of China initiated the pilot project on March 2nd, 2010, the 38 pilot stations have received 465 cases of organ donation. Among them, Guangzhou station is the most exceptional one, with an incredible number of 126 cases.
   On the 8th of last October, when Lingnan Hospital in Luogang District was officially handed over to The Third Affiliated Hospital of Sun Yat-sen University, Huang Jiefu also attended its launching ceremony. He extolled this move as “a superb example of China’s public hospital reform”. "The Luogang Government built the houses, and Sun Yat-sen University provided the medical expertise and technology. They collaborated and helped the locals solve their health issues”, he remarked.   
   Today when Vice Minister Huang Jiefu heard that the daily number of outpatient services has reached 1,300 persons per day and more than 70% of the 500 hospital beds are being used on average, he further approved this reform by adding:”So far, it is the best mode of expanding public services to the grassroots level which is currently advocated by the party group of the Ministry of Health.”
Source: Sun Yat-Sen University

China's doctors: overworked and underpaid?

A new law allows doctors to practice in multiple institutions - but has few takers

by Dai Lian
On the first week of a new law issued by the Ministry of Health which permits doctors to practice at multiple medical institutions, not a single doctor applied to register at the Beijing Municipal Health Bureau.
The new law, released on March 7, is meant to provide stronger incentives for better quality healthcare through offering doctors more flexibility in their sources of income. Reforms began in 2009, when the Ministry of Health revised a long-held rule under the Medical Practitioners Law that a doctor is only permitted to register for work at one medical institution at a time.
But the reality has proven to be less than encouraging.
Long before the law was issued, well-known doctors at major hospitals said they would recognize each other at large airports on the weekends as they flew off to their other jobs. This phenomenon is particularly common in Beijing and Shanghai, where the best-trained doctors tend to cluster.
According to the new regulations, one essential piece of paperwork when applying to practice at multiple institutions requires permission from both the hospital director and medical affairs office.
Dr. Wang Xiaomin, director of the Peking University Dental Hospital stated that, while called "public hospitals," only a very small portion of funding for these hospitals comes from the government. Hospitals rely on income from drug prescriptions and medical examinations and have been reluctant to see their doctors find work at other institutions.
Additionally, since 2005, all doctors at public hospitals have had to purchase malpractice insurance, and this is tied to the hospital at which a doctor practices. There are no malpractice insurance requirements under the new regulation for secondary or third-practices set up by doctors.
Some specialist physicians have clearly stated that they won't opt to practice in multiple locations because they are simply overworked. Many doctors are currently working at full capacity. In the city of Beijing, China's medical center, doctors are particularly overworked. From November 15, 2010, the Beijing municipal government has pushed for citywide weekend outpatient services, which has alleviated wait times for patients – but created a strain on the schedules of doctors.
Zhao Ping, president of the Chinese Academy of Medical Sciences, said that the work efficiency of Chinese doctors is high enough. "There are on average 1.4 doctors to a bed, which is probably the lowest in the world," Zhao said. "If doctors are unwilling to work multiple jobs, if there is money to be made that they don't want to make it, then that is only because they're too exhausted."
But Yin Jia, director of Beijing Union Medical College Hospital's allergy department, said that the new multiple-job policy encourages doctors to crossover to county-level hospitals or community clinics. The policy won't be attractive to the country's top doctors, especially because there isn't a different in compensation. "Registration fees and treatment costs are basically the same as at Beijing Union. When they are already overworked, these doctors won't be motivated to travel for the same pay."
During the most recent legislative sessions in Beijing, a Chinese People's Political Consultative Conference (CPPCC) delegate said that nationwide drug sales commissions are as high as 45 billion yuan last year.
"That so many people are getting kick-backs indicates that our system of ‘drugs support the hospital' and ‘examinations support the hospital' has problems. One important reason is that doctors now can't live a dignified life commensurate with the value of their labor on their legitimate income alone,'" Yin said.
Asclepius (Ailibi) Consulting Inc. Chairman Eric Chong said that this phenomenon reflects contemporary culture's indifference to the value of knowledge: the intangible knowledge and abstract experiences of doctors can only be reflected in tangible things, such as medication and examinations.
But Peking University School of Government Professor Gu Xin told Caixin that the problem lies in the contracts that doctors are permitted to negotiate.
In most countries, doctors are not confined to practicing for their hospital, and there are several options for practice arrangements. Gu said that behind these different practice models are different types of "contracts" between hospitals and doctors. But most doctors in China are not eligible to negotiate for other types of contracts with hospitals.
"To reach a fair contract, doctors should have the freedom to practice where they choose," Gu said. "Under this, there should also be a direct employer-employee relationship between hospitals and doctors." Gu said that the current healthcare system keeps doctors unnecessarily tethered to one hospital, likening it to birds trapped in a cage.
Gu said that if doctors aren't allowed to move freely between medical institutions, the reform to promote doctors working at multiple practices will simply "turn one birdcage into two or three."
Source: Caixin

Guangzhou gong for Brum doc

Prof KK Cheng of Birmingham University

The government of Guangzhou has named University of Birmingham public health researcher Professor KK Cheng as an honorary citizen.
The prestigious honour was bestowed by Mr Wan Qingliang, Party Secretary of the CPC Guangzhou and Mr Chen Jianhua, Mayor of Guangzhou at an official ceremony in the city last week.
Professor Cheng has a longstanding and active relationship with Guangzhou and has led the University’s academic interests in its most significant engagement in China to date - The University of Birmingham Guangzhou Centre, a landmark partnership between the University and the Guangzhou Municipal Government.
For over 10 years, Professor Cheng has been at the forefront of a pioneering public health project in Guangzhou. The Guangzhou Biobank Cohort Study (GBCS) is a collaborative research project between the Guangzhou Number 12 People's Hospital and the Universities of Birmingham and Hong Kong, which is following up 30,000 men and women over 50 in Guangzhou.
This project is recognised internationally as an important platform that supports research on the role of genetic, lifestyle, occupational, environmental and life course factors in common chronic diseases.
Since 2006, the study has produced over 80 papers and has made important contributions to policy making in China and beyond. The main long-term aim of the study is to examine the effects of genetic and environmental influences on health and chronic disease development (particularly circulatory disease, chronic respiratory disease, cancer and dementia).  In addition to being a fruitful scientific study, it has provided a strong launch pad for the University's development in Guangzhou.
Source: Birmingham University

Gansu girl goes from barefoot doctor to 'angel on horseback'

Dan Zhengcao provides free medical treatment to people in rural Gansu

Nicknamed the 'angel on horseback', Dan Zhengcao has ridden through the Chinese countryside bringing much needed medical treatment to remote rural villages for twelve years. If providing free medicine to those who would otherwise do without, Dan also saved over 20,000 yuan in order to set up a scholarship in Sanke Township in Gansu province.
In 1973, when she was just 16, Dan dropped out of school, but was fortunate enough to do so just as a 'barefoot doctor' scheme was being set up in her home county. She was given basic medical and midwifery training, and took it upon herself to study physiology, nursing and clinical science on the side. Returning home to rural Gansu, Dan was appalled at the level of medical care available to the local peasants, many of whom still depended on fortune tellers and traditional Chinese medicine practitioners.
Dan began travelling around Gansu, providing medical treatment to anyone that needed it, for free if they could not afford it (she also accepts non-traditional forms of payment, such as sheep or pigs). In order to access the most remote areas of the province, Dan travelled by horseback, using one of the oldest forms of transport to deliver state-of-the-art modern medicine. She only stopped travelling twice a year, during which time she attended training in rural hospitals to improve her medical knowledge and skill.
Now Dan is being recognised for her charity and hard work, she has been nominated as part of Xinhua's 'Most Moving Stories of 2012'.
Source: Shanghaiist

Medical officials sacked for unethical GM rice clinical trial

Clinical trial was run without informed consent by officials from the Zhejiang Academy of Medical Sciences

Three officials who had approved and conducted a controversial test of genetically modified (GM) rice on school children in central China's Hunan Province had been sacked, authorities said on Thursday.
The officials were punished for "violating relevant regulations, scientific ethics and academic integrity," according to a statement jointly released by Chinese Center for Disease Control and Prevention (China CDC), Zhejiang Academy of Medical Sciences, and Hunan provincial CDC.
The officials include Yin Shi'an from China CDC, Wang Yin from Zhejiang Academy of Medical Sciences and Hu Yuming from Hunan provincial CDC.
Earlier, the Ministry of Health ordered China CDC to investigate whether dozens of children in Hunan were used in 2008 as test subjects in a U.S.-China joint research project that included GM food Golden Rice.
Greenpeace broke the news on the controversial test in late August this year, saying that the joint research involved feeding Golden Rice, which is genetically modified to be rich in beta carotene, to 25 children aged between six and eight in Hunan.
It cited a paper published in the August edition of The American Journal of Clinical Nutrition.
The paper claimed that Golden Rice is effective in providing vitamin A to children.
The research, approved by the National Institutes of Health of the United States in December 2002, was led by Tang Guangwen, director of the Carotenoid and Health Laboratory of Tufts University in the United States. It was intended to explore ways in preventing deficiency of Vitamin A in children.
Tang conducted the research in cooperation with Yin Shi'an from China CDC and Wang Yin from Zhejiang Academy of Medical Sciences.
In 2008, the test was conducted on 80 pupils in Hengnan County of Hunan Province, with 25 of them being fed 60 grams of Golden Rice on June 2.
The research team had informed parents of the tested children about the experiment but withheld the truth that GM rice would be used.
Source: China Daily

China's biotech boom

The  government has set up biotech zones across China

In September, U.S. medical technology company Medtronic announced a $755 million merger with Chinese Orthopaedic devices manufacturer KangHui. In a press release, Medtronic’s executive vice president Chris O’Connell described China as “one of the fastest growing medical device markets with significant scale opportunities.”
The Medtronic merger follows a series of other M&As in the Chinese biotech sector. According to the Centre for Asia Private Equity Research, in the first half of the current year, private equity investments in the Chinese healthcare sector amounted to $489 million, double that of last year. The centre attributed this sudden rise to the increased spending by the Chinese government, and its reforms measures.
   Significantly, in its 12th Five Year Plan from 2011 to 2015, Beijing has allocated $3 billion on innovative medicine, the cultivation of new varieties of genetically modified organisms, and the prevention and control of infectious diseases. The government’s efforts to promote the industry also include legal and regulatory reform measures. For example, in 2011, it relaxed certain restrictions in respect of foreign investment in hospitals and diagnostic centres.
   The Chinese government is also setting up biotech zones across the country to support for new drug innovation, which until now has been a weakness of the Chinese biotech industry. According to Richard Bird, counsel at Freshfields Bruckhaus Deringer, China has been relatively slow in this area, and there are currently not many promising products and technologies in the pipeline, he says.
The foreign pharmaceutical companies too have made investments mostly in their own R&D and biomedical centres. In November 2009, the U.S. pharmaceutical giant Novartis announced an investment of $1 billion over a period of five years. This money is going into its Chinese research facility, and also the expansion of the Novartis Institute for BioMedical Research in Shanghai.
Read more: Asian Legal Business

Chinese screening tool is an accurate alternative to spirometry for COPD

Nine-point questionnaire as accurate as spirometry

by Michael Woodhead
Guangzhou respiratory specialists have developed a simple and inexpensive alternative to spirometry for diagnosing COPD in Chinese primary care settings.
Writing in the Journal of Thoracic Disease, Dr Cui Jiangyu and colleagues at the Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, say that although spirometry is the “gold standard” for COPD detection, it is underused in primary care settings, particularly in China because it is expensive, requires skill to operate and is unfit for some patients. They have previously shown that in China, only 6.5% of patients with COPD had ever been tested by spirometry.
"Thus, it is of great value to develop a simple and economical method which can be used as an alternative option for spirometry to screen COPD and to predict the COPD stage in primary care settings.
They therefore developed a nine-point screening tool based on data from 243 COPD patients and 112 non-COPD subjects from a COPD survey in urban and rural communities and local primary care settings in Guangdong Province, China. The nine factors used to test for COPD included age, gender, smoking, body mass index, occupational exposure, living environment, wheezing, cough and dyspnoea.
In testing the model they found that the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, accuracy and error rate of the function model to discriminate COPD were 89%, 82%, 4.94, 0.13, 87% and 13%, respectively.
They conclude that "Our study tentatively developed a discriminant function model consisting of nine variables which can be applied to screen COPD as an alternative option in areas where spirometry is unavailable. To our knowledge, no previous study used a discriminant function model to screen for COPD, though the same way has been used in the diagnosis of other diseases."
The researchers say that compared with spirometry, the short screening questionnaire of nine variables is much simpler, easier and economical. It also seems to be a more sensitive method to screen COPD than the scoring system of the COPD diagnostic questionnaires
"In addition, our discriminant function model can also be used to predict the stage of COPD, with an accuracy of about 70%," they add.
"In conclusion, the discriminant function model reported here is a first attempt of its kind to develop an alternative method for the COPD screening in Chinese settings. We believe that it may help diagnosis early enough a great number of COPD patients who may not be diagnosed otherwise and the early diagnosis can allow them to have a timely medical treatment."
Source: Journal of Thoracic Disease