Chinese rush to buy non-prescription drugs overseas

As more Chinese tourists travel overseas, they are also bringing back non-prescription drugs and vitamin supplements purchased on their trips, the Chinese-language Guangzhou Daily reported.
Many people in China are firm believers in taking drugs and supplements for their health, which is why such products often appeared on their shopping lists when they go abroad, the newspaper said.
Vitamin supplements sold in Europe are highly sought-after, such as Altapharma products, which can be found in several supermarket chains in Germany, the newspaper said. Another popular European drug is Fluimucil A, which is used to treat wet coughs.
Besides vitamins, most medicinal products bought by Chinese visitors to Japan are those used for children, including cold medicine, cooling sheets for children with a fever, and seirogan — a drug used to treat digestive problems.
Japan is also well-known for selling a vast variety of patches that ease muscle soreness, including those that create a cooling effect and those which produce a warm sensation. Compared with similar products in China that often give off a bad odor, the Japanese versions are easy to peel away and are scented, the newspaper said.
Several drugs sold in Thailand are also popular among Chinese visitors, including Siribuncha's and Povidone-lodine's solution for treating burns and cuts, and Ya Hom Powder of Five Pagodas Pharmacy, which can be used for treating stomach ailments and motion sickness.
Another popular product sold in several Southeast Asian countries is Tiger Balm, an ointment used for treating bug bites, headaches, a stuffy nose, motion sickness and sore muscles as well as sundry other purposes.
Source: Want China Times

Ketogenic diet helps reduce seizures in Chinese children with epilepsy

by Michael Woodhead
One in three Chinese children with epilepsy reduced their rate of seizures when they tried the ketogenic diet, a study conducted in Shenzhen has shown.
Dr Suo Chenqu and co-researchers at the Shenzhen Children's Hospital conducted a trial of the high-fat, low-carbohydrate dietdiet which has been used to treat refractory epilepsy in childhood internationally.
Between 2004 and 2011, the researchers assessed the diet in 317 children with refractory epilepsy and followed them up for at least a year. After 3, 6 and 12 months, 63%, 42% and 24% of children remained on the diet, and at these times 35%, 26% and 19% of children respectively showed at least a 50% seizure reduction.
These improvements included 21%, 14% and 11% of children who remained seizure free while on the diet. The researchers found that the starting age for the diet influenced efficacy. Children aged over ten when they started the ketogenic diet showed a worse response than the under 10 age group. Other variables such as duration of epilepsy at the start of the diet, seizure types and aetiologies showed no significant influence on efficacy. Outcome was measured by seizure frequencies before and after the diet, change in anticonvulsant use and adverse effects. Common complications of the diet included GI disturbance, food refusal and hypoproteinaemia.
"The ketogenic diet is a safe and efficacious therapy for intractable childhood epilepsy in Chinese children," the researchers conclude.
Source: Seizure Journal.

China clinical news in brief

Infant gastro infections may trigger convulsions

Benign convulsions may occur in infants with mild gastroenteritis, Chinese paediatricians have shown.
Dr Wang Yunfeng of the Department of Pediatrics at the Sino-Japan Friendship Hospital, Beijing says that benign convulsions are now recognized as a distinct clinical entity in many countries, but its occurrence in China has not yet been widely recognized by Chinese pediatricians.
In a retrospective study  in 48 infant patients with benign convulsions they found that the typical age of onset of gastroenteritis was between 13 months and 24 months. The episodes of convulsions occurred at a distinct autumn/winter peak, and the seizures mostly occurred within the first five days of gastroenteritis, especially within the first three days, peaking on day 2 (39.58%).
They found that in 80% of cases the infants had clustered seizures in their episodes. Most episodes were symmetric, generalized tonic-clonic  and brief. The seizures were induced by pain and/or crying in 40% of infants. Stool culture was positive for rotavirus in 54% of the patients. Almost half the infants still had clustered seizures after the administration of a single anticonvulsant drug. The seizures persisted even after the administration of two combined anticonvulsants in a quarter of episodes. All patients exhibited normal psychomotor development.
"Benign convulsions with mild gastroenteritis are not rare in China, and rotavirus infection is a major cause," the researchers conclude.
Source: World Journal of Paediatrics

MSG linked to snoring and sleep disordered breathing

People who consume MSG with their food are more prone to snoring and sleep disordered breathing, researchers from Nanjing have shown.
An analysis of data from 1227 Chinese people who participated in the Jiangsu Nutrition Study found that MSG intake was positively associated with snoring and a high probability of sleep disordered breathing such as sleep apnoea.
However, the association was not seen in in overweight people, according to Dr Shi Zumin and co-researchers at the Department of Nutrition and Foodborne Disease Prevention, Jiangsu Provincial Centrr for Disease Control and Prevention, Nanjing.
People who had higher intakes were twice as likely to snore and three times more likely to have sleep apnoea, the study showed..
Source: Nutrition Journal

One in three people with diabetes have chronic kidney disease

Almost one in three Chinese people with type 2 diabetes have chronic kidney disease and albuminuria, a Nanjing study has found.
Dr Lou Qing-Lin and co-researchers from the Diabetes Care and Research Centre at the Jiangsu Province Institute of Geriatrics conducted a study of more than 15000 patients with type 2 diabetes in Nanjing between January 2008 and December 2009.
They found that the frequency of CKD and albuminuria was 31% and 29%, respectively.
Hypertension, anaemia and duration of diabetes were significantly associated with CKD.
"In conclusion, chronic kidney disease is common in the urban Nanjing Chinese with type 2 diabetes. Strategies to prevent or delay progression of kidney disease in diabetes should be carried out at the early disease course of type 2 diabetes," they conclude.
Source: Diabetes and Metabolism Journal

Forced IUD contraception faces criticism in China

Women are coerced into having IUD contraception through threats of witholding hukou

by Lin Meilian
A woman's body does not really belong to herself. It can belong to the State in some cases. Deng Yanqin, mother of a newborn son in Jiangxi Province, discovered this when she was told by the local residential community's administrator that she would not get a hukou, or household registration, for her firstborn unless she placed an intrauterine device (IUD), a contraception ring, inside her womb.
"How could they do this to me?" Deng asked, "And more importantly, do they have the right to do this?"
This question has been asked by thousands of couples all over the country who encounter the same problem. The answer, according to a group of 13 lawyers who called on China's top family planning authority to abolish forced IUD implants earlier in December, is "No".
"There is no law that forces Chinese women to undergo contraception surgery when applying for her firstborn's hukou," Zhang Lijuan, one of the appeal's initiators, told the Global Times.
The IUD is one of the most widely used forms of birth control in China, especially in rural areas. According to the Ministry of Health, 7.8 million women underwent IUD surgery in 2009.
Forced IUD implants, which were widely used in the 1980s to prevent women from having a second child, have been relaxed in recent years. Now, women living in big cities such as Beijing and Shanghai can make their own decisions about birth control. However, it has since been linked with other measures such as applying for hukou registration or land to build property.
Deng and her husband wrote to the local family planning authority asking for an explanation. They were told it was because "they have not proved they were using any long-term effective contraception measure", so the authority could not issue them the documents they need.
"Women have the right to choose what kind of contraception they want," Zhang said. "As a female lawyer, I feel like I need to stand up and fight for them."
In September last year, three months after her baby girl was born, Li got a call from the local family planning authority at her village in Hubei Province asking her to come for a physical check.  Thinking it was a routine examination, she went along. They then took her to a clinic to see if she was able to undergo IUD surgery.
"I told the doctor again and again that I know about birth control measures, and they can't force me to do it," she said. But the family planning official told her if she refused, they would not assist her in obtaining documents she would need in the future.
"It sounded like a threat, so I had no choice but to do it," she recalls.
Women's freedom to choose contraception does not seem to matter when it comes to the family planning policy. The policy, which was applied in 1979, restricts urban couples to having one child, while allowing rural couples, ethnic minorities and couples who are both only children themselves to have additional children. It is estimated that the policy has prevented over 400 million births from 1979 to 2011.
However, the policy is controversial both within and outside China, as cases of forced abortion and sterilization have been repeatedly reported by the media. Earlier in June, a widely circulated photo of a woman lying next to her baby's corpse sparked outrage on the Internet. Feng Jiamei from Shaanxi Province was reportedly forced to have an abortion in the seventh month of pregnancy because she could not pay the fine for having a second child.
The 2009 novel Frog, by this year's winner of the Nobel Prize for literature, Mo Yan, chronicles the lingering pain that has haunted many Chinese women for three decades.
In the novel, Frog's aunt helped deliver 10,000 children before the implementation of the family planning policy in his village. After the policy was adopted, Frog saw his aunt become haunted by the forced abortions she witnessed.
"The family planning policy is a basic condition of China dealing with the most conservative element of traditional culture. It touches the sorest points and most delicate parts of the souls of millions of Chinese people," Mo was quoted by Sina.com as saying.
Xie Juan, 30 and mother of a 1-year-old daughter from Guangdong Province, managed to avoid the IUD surgery.
"I managed to get a doctor's note to prove my health condition was not suitable for the surgery," she told the Global Times. "But I am afraid they will force me to do it through other methods."
Back in the 1970s when the policy was adopted, male sterilization was encouraged. When a man had the operation, villagers would march to his place, beating gongs and drums to celebrate his "contribution" and provide him with rich food.
Now it is the women who take the risk, often because they do not want their breadwinner husbands to risk getting infections or complications.
Compared to Chinese women's unwillingness to place a contraception ring inside their wombs, studies have shown that more American women are choosing IUDs for birth control.
In 2009, 8.5 percent of American women using birth control chose an IUD or implant, with the large majority going with the IUD, 4 percent higher than in 2007, according to the journal Fertility & Sterility.
With the devices, it's estimated that between 0.2 percent and 0.8 percent of women will have an unplanned pregnancy within a year. By contrast, with contraceptive pills and condoms, the unintended pregnancy rate is about 9 percent per year, it said.
Some unmarried women even bring it up in conversation with doctors, but get rejected because "they are not in a relationship."
Even though IUDs are believed to be one of the most effective forms of reversible birth control, it is still far from popular in the US and way behind birth control pills and condoms.
There are also concerns that some poorly designed devices might result in infections or even death.
American women's concerns seem well-founded. One month after being forced to undergo IUD surgery, Li found that there was something wrong. She went to see the doctor and was told she had a vaginal yeast infection.
The doctor insisted it had nothing to do with the IUD surgery and that she could be cured. After 10 months of fruitless treatment, she decided to examine the device. But another problem emerged. To do this, she needed official permission from the family planning authority.
She went through a number of procedures to get the letter and had her device checked. It turned out there were indeed problems. The device had been poorly installed and had now become stuck to her body.
But to remove it, she needed another permission letter. She scrambled around and collected the documents she needed. Later, the doctor told her she had to wait until the vaginal yeast infection had gone.  Another letter was required to get the medicine.
"I remember I stood there and started crying like a baby. I felt sorry being a woman in China," she said.
Kong Xingxing, a former researcher at Nanjing University and now a family planning authority official in Shandong Province, calls these women the "silent group." There is no official number of how many women are facing complications from contraception surgery, because most of them don't talk about it.
"We can't just focus on the glorious achievements of the past three decades and ignore their consequences," she told the Global Times.
"These rural women in their 50s are the victims of State policy. They are scattered around different villages and don't know how to protect their rights," she added.
Through her research and interviews with rural women, Kong found that the majority of them chose to deal with the problem by themselves.
"Most of them would buy painkillers rather than see the doctor or tell their family," she said. "Crying is the only way to let out bad feelings."
Some are afraid of taking the IUD out themselves, as in some places, family planning officials will check the ring. If they find it has gone, the women face a fine, Kong said.
The medical malpractice committee under the family planning authority determines whether a woman faces complications from contraception surgery. If approved, the woman receives compensation. But Kong questions its credibility.
"It is just like asking a murderer to admit he or she is guilty," Kong said.
Some people, like Zheng Zhiyuan from Zhejiang Province, cannot sit back and watch his wife suffer. He said his 36-year-old wife felt sick right after she had the sterilization surgery after giving birth to their second child in 2008.
"She couldn't even stand still after the surgery. I had no idea what was wrong so I asked the doctor.  He just told her to rest at home," Zheng told the Global Times.
A year later, she was diagnosed with amyotrophic lateral sclerosis in Beijing, a debilitating disease characterized by rapidly progressing weakness and muscle atrophy. She has difficulty speaking, swallowing and walking.
There is no evidence to prove that this is a result of complications from contraception surgery, but Zheng believes that the poorly conducted surgery was the cause. He petitioned the local family planning authority in 2009 but was beaten up by security guards. He contacted the medical malpractice committee asking for compensation, but was rejected.
Over the years, eye contact has become their only method of communication. Every time he goes home, he looks in her eyes and tells her, "I will never give up on you."
Source: Global Times

Anhui medical student arrested over axe murder

An Anhui Medical University student who killed another student with an axe was arrested today, prosecutors in Hefei, capital of Anhui Province said yesterday.
A local newspaper, Xin'an Evening News, said the senior student surnamed Hu had a dispute with the victim, a junior student surnamed Tan, over the same girlfriend. They had several quarrels and Hu decided to kill Tan.
He bought an axe from an online shop in late November and took the weapon to the classroom on December 19 to wait for Tan to appear. When Tan showed up at about 8am, Hu hacked at him repeatedly and killed him on the spot.
Hu was apprehended by the school's security guards immediately.
Read more: Shanghai Daily

COPD patients at high risk due to poor treatment: study

About one in three men with COPD continue to smoke

by Michael Woodhead 
Patients with chronic obstructive pulmonary disease in China are highly vulnerable to exacerbations because many continue to smoke and few take medications appropriately, a Jiangsu study shows.
Dr Lou Peian and other researchers from the Xuzhou Center for Disease Control and Prevention in Jiangsu Province, Xuzhou, China interviewed 2825 male and 2825 female patients with COPD living in rural areas.
They found that 30% of  men were still smoking and 11% of women were current smokers, despite smoking being a major risk factor for poor disease control. In addition, 32% of men and 75% of women were using fuel such as coal in the house, despite this being know to exacerbate their COPD.
In terms of COPD medication, 26% of male patients and 16% of the female patients did not take theophylline regularly when their disease was stable. During acute exacerbations, 66% of the male patients and 40% of the female patients took theophylline or similar drugs.
The researchers estimated that COPD would reduce life expectancy by 1.76 years for men and 1.18 years for women. The disease also imposed an indirect economic burden was 11,158 yuan for men and 7481 yuan for women. The quality of life was worse in female patients than in male patients.
"We found that patients with COPD were vulnerable and that factors determining vulnerability were different for men than for women. Therefore, we recommend adopting different measures for men and women when attempting to prevent, control, and treat COPD, rehabilitate these patients, and improve their quality of life," they conclude.
Source: International Journal of Chronic Obstructive Pulmonary Disease.

In Guangzhou, HIV treatment group tests the waters of reform

by Dan Levin
As he waited to give blood for an H.I.V. test one recent afternoon, Le, a 25-year-old marketing professional, explained why he was there. “I was aware of the consequences” of not using a condom, he said, “but somehow I didn’t know how to say no.”
Le, a gay man who would give only his first name, was being tested at the Lingnan Health Center, an organization run largely by gay volunteers, whose walls are adorned with red AIDS ribbons and a smiling condom mascot. In the past, Le went to hospitals to be tested, he said, but the stigma of being a gay man in China made the experience particularly harrowing.
“I’d always be concerned about what the doctors would think of me,” Le said. “Here we’re all in the same community, so there’s less to worry about.”
Le is one of thousands of gay men in this bustling city of 13 million people who are benefiting from a pioneering experiment that supporters hope will revolutionize the way the Communist Party deals with non-government groups trying to stop the spread of AIDS and other sexually transmitted diseases.
Encouraged by the new slate of leaders who came to power in November, civil society activists hope the model taking shape here in the prosperous southern province of Guangdong, which has long served as a petri dish for economic reform, will be replicated nationally, not just in the fight against disease but also on issues like poverty, mental health and the environment.
While China’s Center for Disease Control and Prevention has allowed community organizations across the country to participate in disease testing programs since 2008, in practice those efforts remain patchy. But in November, just before World AIDS Day the following month, the grass-roots movement received a high-profile endorsement from the incoming prime minister, Li Keqiang.
At a meeting with advocates for AIDS patients, Mr. Li, a large red ribbon pinned to his jacket, promised more government support and shook hands with H.I.V.-positive people. The image resounded in a society where those infected are routinely turned away from hospitals and hounded from their jobs. “Civil society plays an indispensable role in the national battle against H.I.V./AIDS,” he said, according to the state news media.
Activists remain wary, however, noting that the government has made similar promises in the past. And despite the high-level support and a policy in Guangdong allowing grass-roots groups to register directly with the government — instead of being forced to find an official sponsor, as in much of the country — many organizations say they still are stymied by dizzying bureaucratic hurdles or rejected for missing unannounced deadlines.
Tao Cai, the director of AIDS Care China, which provides support to 30,000 H.I.V.-positive people nationwide but remains unregistered, believes the obstacles come from local officials who are trying to prevent nonprofit groups from competing with their fiefs. “In China,” he said, “we say reform never gets out of Zhongnanhai,” a reference to the walled compound for senior leaders in Beijing.
There is little doubt that public health officials need help. Through October, nearly 69,000 new H.I.V. infections were reported in China in 2012, a 13 percent rise from the same period in 2011. Almost 90 percent of those cases were contracted through sexual intercourse, with rising numbers involving gay men. Medical experts also worry about syphilis, which has returned with a vengeance after being virtually wiped out during the Mao era.
Reported cases of syphilis, known in the south as “Guangdong boils,” have increased more than tenfold in the last decade, according to national statistics. As with H.I.V., gay men and sex workers are particularly at risk. Local health experts estimate that 5 percent of men who have sex with other men carry H.I.V., while around 20 percent test positive for syphilis.
The Chinese authorities have long tackled the rise in communicable diseases among gay men with all the sensitivity of a swinging billy club. In raids on bars, bathhouses and parks, police officers and health officials often force those detained to hand over their IDs and submit to blood tests.
Grass-roots health groups have been frequent targets of official harassment as well. In most provinces, they can legally register with the Bureau of Civil Affairs only if they are sponsored by a government agency. But advocates say few agencies are willing to vouch for groups focused on politically fraught issues like homosexuality, prostitution or sexually transmitted diseases.
In the face of such constraints, the majority of China’s estimated 1,000 H.I.V. organizations operate in a legal purgatory that deprives them of tax benefits and makes it risky to accept foreign donations, usually their main source of support.
Mr. Li, the incoming premier, has a spotty record when it comes to H.I.V. In the 1990s, when he was the top official in central Henan Province, a botched blood-collection program there infected hundreds of thousands of people with H.I.V. Critics say Mr. Li was more interested in covering up the problem than dealing with its causes. Even as he was holding court with AIDS groups, over a hundred of those infected in the scandal marched in Beijing to the Ministry of Health demanding justice.
Mr. Li’s views appear to have changed. In November, social media erupted over the case of a 25-year-old man seeking treatment for lung cancer who was turned away from two Beijing hospitals because he was H.I.V.-positive. A hospital in nearby Tianjin finally removed the tumor — but only after he altered his medical records to conceal his H.I.V. status from doctors. As a battle raged online between those condemning his actions and those sympathizing with his plight, Mr. Li ordered the Health Ministry to prohibit hospitals from rejecting AIDS patients.
For the vast majority of Chinese, AIDS remains a fearful issue. People who get infected with H.I.V. often become social outcasts, a situation made more perilous by the absence of legal protections for those who lose their jobs or their homes.
After he came out as gay and H.I.V.-positive on Chinese television in 2005, an artist who goes by the pseudonym Da Wei was promptly fired. Then he was evicted from his apartment by his landlord — a doctor — who showed up at his door with printed images of his face from TV. “He said he had no problem with my health condition, but what would the other tenants think?” the man recalled in a phone interview.
Even medical professionals who work with AIDS patients are not immune from discrimination. “Other doctors are afraid they’ll catch H.I.V. from my lab coat,” said Chen Xiejie, the vice director of infectious diseases at the Guangzhou No. 8 People’s Hospital. “If I go to their offices they say, ‘Don’t sit down.’ They won’t even shake my hand.”
The Lingnan Health Center, a comfortable space decorated with couches and a fish tank, strives to be more welcoming toward the dozens of gay men who come each day to roll up their sleeve and learn their fate. If they get bad news, patients can return for counseling and information on medical treatment.
“We want it to feel like home, not a hospital,” said Meng Gang, Lingnan’s founder.
The center’s employees say unsafe sex is all too common among those tested, a result of deeply closeted lives.
“With gay men the sex is all underground,” said Xiao Mi, a Lingnan staff member.
According to Mr. Meng, most gay men will forgo condoms rather than challenge a partner who says he is not infected with H.I.V. “It’s an issue of face,” he said.
Mr. Meng founded Lingnan five years ago as a health-focused offshoot of his gay advocacy organization, Guangtong, which offers services like sex education, counseling on coming out, and online dating through its Web site, which receives around three million visitors a year.
Guangtong delves into a realm the Chinese government prefers to keep shrouded. Homosexual characters are banned from television, gay film festivals cannot advertise, and the police often force lesbian and gay organizations to cancel programs during politically delicate events.
Despite the state-sanctioned prejudices, Chinese health officials say cooperation with grass-roots organizations is beginning to transform the government’s approach to such issues.
“The fight against S.T.D.’s is not just about public health,” said Yang Bin, the director of the provincial sexually transmitted disease control center. “It’s a political issue, too.”
Source: NYT

China's health market to exceed a trillion yuan

The scale of China's medical market reached to 926.1 billion yuan (US$149 billion) in 2012 and is expected to race forward to 2.3 trillion yuan (US$369 billion) in 2020 as the country's population ages, according to the Chinese Academy of Social Sciences.
The country's medical market will grow annually by 12% from 2013 to 2020, reaching 1 trillion yuan (US$160 billion) in 2013. Beijing, Shanghai and Tianjin have contributed the most to the market, said the organization.
Supporting the burgeoning number of elderly and the country's increased purchasing power has augmented the demand for medicine, it added.
The combined growth rate of China's medical market had reached more than 20% from 2005 to 2010 because of fewer pharmaceuticals and the strong influence of government policy in the market, said the organization.
Multinational pharmaceuticals have accounted for a large proportion of medicine supply among high-tier hospitals. An insufficient number of domestic suppliers will mean continued reliance on foreign medicine. The government controls almost completely controls the distribution of medical supplies.
Source: Want China Times

Getting to the heart of China’s public health crisis

by Elizabeth C. Economy
A new book Governing Health in Contemporary China by CFR writer and renowned public health expert Huang Yanzhong details Beijing’s efforts to tackle one critical and politically explosive issue—health care—and helps us understand where and why the country has succeeded and failed, and what more needs to be done.
The statistics are startling. China has one-third of the world’s smokers and suffers around one million tobacco-related deaths annually; the cardiovascular disease death rate is higher in China than in the United States; and close to one hundred million Chinese are believed to suffer from diabetes. Public anger over poor care, rising costs, and corruption in the health care system triggered over 17,000 violent attacks against hospital doctors and health care workers in 2010. Moreover, horrific stories of tainted food and drugs have further undermined the Chinese people’s faith in their government’s capacity to provide an effective health care regime. As Huang notes, over the past ten years, the Chinese people have come to refer to health care as one of the Three New Mountains—health care, education, and social security—modeled after the old Three Mountains (imperialism, feudalism, and bureaucratic-capitalism) that the Communist Party deployed to bring down the government of Chiang Kai-Shek.
Huang takes the reader on a fascinating journey through the twists and turns of the various efforts by Chinese leaders from Mao Zedong through Hu Jintao to tackle the country’s health care crisis. He explores the political battles surrounding three of the most pressing health care challenges the country faces: provision of good and affordable health care for all Chinese citizens, managing health care crises such as HIV/AIDs and the outbreaks of SARS and Avian flu; and developing an effective regulatory and enforcement system for food and drug safety. In each case, Huang finds evidence that Chinese leaders have learned from experience and from the outside world how to improve their practices. As a result, he can point to a number of advances in areas such as health insurance coverage or the strengthening of grassroots health care providers.
Yet as Huang amply demonstrates, these remain changes at the margin. He quotes a senior official from the Ministry of Health as noting that the most recent set of reforms launched in 2009 have not “solved the fundamental, systematic and structural problems [in China’s health sector].” Even president-elect Xi Jinping’s pledge to bring higher levels of health care to the Chinese people, coupled with increased investment in the health care sector (according to a recent McKinsey & Co. study, Beijing plans to triple its health care investment to $1 trillion by 2020), will not be enough to make the kind of difference in the country’s public health system that China’s leaders desire and its people demand.
Real change needs a far more radical set of political and institutional reforms that address how health care policy is made, financed, delivered, and evaluated. For Huang, that means health care policy “by fiat” cannot continue. What is needed, instead, he proposes, is reform in Beijing’s relations with local governments, greater democratic participation, a robust civil society, the rule of law, and a true market economy. Without such reform, Beijing will never get at the heart of its public health care crisis.
Source: Council on Foreign Relations

Clinical news in brief

Malnutrition and anaemia are rife in Shaanxi infants

One in three infants in impoverished rural Shaanxi have anaemic and malnutrition, a study has found
Researchers from the Maternal and Child Health Centre of the First Affiliated Hospital of Medical
College in Xi’an sampled 336 infants in 28 rural villages from two counties of Shaanxi province. They found that 35% of infants in suffered from anemia, 32% had malnutrition, stunting or
wasting. Anemia was linked with malnutrition, while low birth weight, having more siblings, less maternal education, low family income, crowded living conditions, and inappropriate complementary food introduction significantly increased the risk for infant anemia. Serum concentrations of iron, zinc, and retinol (vitamin A) were significantly lower in anemic infants, they study showed.
"Health education focusing on feeding practices and nutrition education could be a practical strategy for preventing anemia and malnutrition in young children.," the researchers suggest.
Source: BMC Public Health

Vaccine against tooth decay

Wuhan researchers have developed a vaccine that could make tooth decay - and visits to the dentist - a thing of the past.
The researchers from Hubei have shown that an anti-caries DNA vaccine induced salivary secretory immunoglobulin A (S-IgA) antibodies to Streptococcus mutans (S. mutans) the main causative agent for dental caries.
By stimulating the production of the antibodies, the vaccine  was effective in preventing adhesion of the S. mutans bacteria to a tooth model.
"These results demonstrate that the anti-caries DNA vaccine induces the production of specific S-IgA antibodies that may prevent dental caries by inhibiting the initial adherence of S. mutans onto tooth surfaces, thereby reducing the accumulation of S. mutans on the acquired pellicles," they say.
Read more: Acta Pharmacologica Sinica.

Tamiflu resistance emerges in China

Two new mutant forms of influenza virus detected in China are resistant to neuraminidase inhibitors drugs such as Tamiflu that are the only option for treatment.
Researchers from the National Institute for Viral Disease Control and Prevention at the Chinese Centre for Disease Control and Prevention, Beijing, tested more than 600 influenza B virus samples collected in 2010 and 2011 for susceptibility to oseltamivir and zanamivir. They found four influenza B virus samples showed reduced susceptibilities to oseltamivir, but not zanamivir, while another showed resistance to both.They say that "[antiviral] drug resistance is a public health concern" and that "this report underlies the importance of continued influenza antiviral susceptibility surveillance globally, even in countries where the use of neuraminidase inhibitors  has been low or non-existent."
Read more: Antiviral Research

National smoking control laws on NPC agenda

China's top legislature is considering the country's first national tobacco control law, according to a report released Wednesday.
It is "quite necessary" to enact laws to control the dangers of smoking, says the report adopted at last Friday's closing session of a bimonthly meeting of the National People's Congress (NPC) Standing Committee, adding that such laws should be included in future legislation work plans after proper preparation.
China is the world's largest tobacco-producing and -consuming country, with more than 300 million smokers and another 740 million people exposed to second-hand smoke, according to official statistics released in May.
However, only a few provinces and cities have enacted local legislation on public smoking bans, and no special law has been adopted at the national level.
During the NPC's plenary session in March, 90 NPC deputies submitted three bills on drafting a law on the prevention and control of tobacco hazards, according to the report from the Education, Science, Culture and Health Committee (ESCHC) of the NPC.
It also specifies that 139 deputies put forward another four bills calling for new laws on smoke-free public areas.
The ESCHC suggested that central administrative authorities in charge of related issues carefully study the bills and promptly carry out the research and investigation work necessary for drafting, it says.
China ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2003, pledging measures to curb tobacco use.
Read more: Shanghai Daily

The central government has pledged to introduce a public smoking ban in its 12th Five-year Plan (2011-2015) period.

Smoking makes CABG a waste of time - Shanghai study

Smoking cessation even a year prior to coronary artery bypass grafting (CABG) surgery does not fully normalize the changes smoking has made to the saphenous (leg) veins used for the surgery and may lead to later graft failure, according to a study published in The Annals of Thoracic Surgery.
Sun Yongxin, MD and colleagues from Zhongshan Hospital at Fudan University in Shanghai, China, analyzed heart surgery outcomes in 208 patients undergoing elective CABG surgery. After dividing the patients into six groups based on the current quantity smoked and previous smoking status, the researchers found that heavy smoking noticeably increased matrix metalloproteinase enzyme levels in the saphenous vein. These enzymes have been linked to vein graft failure.
The researchers also found that while dysregulation of enzymes may gradually normalize after smoking cessation, a noticeable vein recovery needs at least 6 months, and vein enzymes do not completely return to normal levels even after 1 year.
"Although recovery after smoking cessation appears somewhat disappointing, it illustrates exactly the importance of prompt smoking cessation for patients who will receive CABG," the researchers wrote.
Read more: News Medical

Beijing's top hospitals can't cope with increasing patient demand

In some Beijing hospitals, doctors are overwhelmed by demand, and see up to 60 patients per shift

by Zhang Wan.
As Beijing is experiencing the coldest winter in 30 years, hospitals across the city are dealing with more patients. The long existing problem of medical service shortage is getting prominent again. Patients complain it so hard to get registration in these top level hospitals in the capital, while doctors are under the huge pressure of extra workload.
The authorities have been working hard to solve the problem and more effort is needed this year. 


In some top level hospitals in Beijing, many patients complain it's hard to get a chance to see senior doctors. 

"It's very hard to get registered to see senior doctors at the hospital. Early every morning, I started to wait in front of the registration office, but I still could not get registered. Finally, I had to spend several hundred yuan to buy a registration ticket from a scalper."

"To get a registration ticket in the hospital is extremely difficult. The number of doctors is far from adequate."

When patients complain about their difficulty in getting medical services, doctors say they are under great pressure of increased workloads. Lu Hai is a senior doctor at Beijing Tongren Hospital. He usually receives more patients than he can see. 

"Actually chief doctors like me are required to see 15 outpatients within half a day, but, I have to see more than that, as there are many more extra registrations from the patients. It's very common for me to see 50 to 60 patients."

According to chief nurse Zhou Lijuan, Lu's colleague, although doctors like Lu Hai have to do so much extra work each day, it still falls short of meeting the demands of patients.

"These patients who failed to get registration tickets often get angry and ask us why we didn't give them extra registration opportunities, and many of patients complain because they have no idea about the doctors' work and schedule. For example, today doctor Lu receives outpatients in the morning, but in the afternoon, he is scheduled to carry out three inpatients operations. As these inpatients are asked to stop eating and drinking several hours before the operation, the doctor has to be on time for their operations, that's why he has to finish his consultation with outpatients on time at noon."

In order to ensure the operations are done on time in the afternoon, Lu Hai stays in his consulting room from 8:30 am right through to 2:30 pm. 

Wang Dongxuan, an intern doctor in the hospital says many doctors in the hospital don't drink water when they receive patients, so that they can avoid going to the toilet and save time for more patients. 

Beijing has 25 percent of the country's medical resources, and patients from all over China come to Beijing to seek medical treatment. That only makes the situation worse. 

How to make better use of the limited medical resources in these top level hospitals? Medical reform is absolute necessary. 

Beijing has begun implementing its program of public hospital reforms since July 2012. The Beijing Friendship Hospital eliminated its 15 percent drugs mark-up, and introduced a medical care service fee which various according to the seniority of doctor. The measure aimed to encourage more patients seeing general practitioners, rather than senior physician or specialist with rising cost. 

The Peking Union Medical College Hospital, another renowned general hospital in Beijing, has started a 24-hour appointment registration service since August 2012, to ease the morning stress of high numbers of registrations. 

In addition, there are also some top level hospitals strengthening cooperation with the lower level hospitals or community healthcare centers, so that patients with chronic diseases could get medical treatment in these institutions near their home, rather than competing for medical service with those patients in critical condition in top level hospitals. 

Mao Yu, deputy director of the Beijing Hospital Authority says results at these public hospitals are looking good so far.

"First, through public hospital reform, patients' expenditure for qualified medical service has been lowered. Second, patients have become more satisfied with the medical service, as communication between patients and medical workers has been increased. In addition, big changes have been seen in hospital management, such as position management and performance management being implemented in public hospitals."

Although these efforts have seen some results, it's far from cutting the queue of patients in top hospitals.
Source: CRI

Community clinics could reduce Beijing hospital overload

80% of patients don't need to be seen in hospital

Zhang Changrong's favorite treatment in a community clinic in Beijing's southern suburb involves soaking her feet in hot water that contains traditional Chinese herbal medicines.
It takes the 59-year-old woman, who has had a rapid heart beat for years, just five minutes to walk from her home to the clinic for the treatment, which is believed to help improve blood circulation.
Compared to big, crowded hospitals, "seeking service here is much easier and sometimes enjoyable," said Zhang, a long-time resident of the Guiyuan Residential Community in Daxing District.
"We don't need to queue up for hours to see doctors. Doctors here know us well and the communication process is nice," she said.
The clinic, which covers some 250 square meters, offers basic medical services such as injections, medical examinations, massage and acupuncture. Patients can get prescriptions for about 300 of the most frequently used medicines for less than what a big hospital would charge.
In China, strain on the doctor-patient relationship has continued to worsen, as many patients are dissatisfied with their poor access to treatment.
People have to wait overnight in long queues for a registration ticket to see a renowned doctor in some popular public hospitals. However, the diagnostic process is always too brief to allow for further consultation.
China's urban doctor-patient ratio was 2.8 doctors per 1,000 people in 2011, according to statistics released by the Ministry of Health.
Meanwhile, doctors are overworked and underpaid. Many work more than 10 hours a day and might examine more than 100 patients per shift, according to a study by Peking University.
Experts say 80 percent of outpatients in the country's big hospitals don't need to have their first diagnosis in big hospitals.
Fang Laiying, head of the Beijing Health Bureau, said people should seek medical treatment from lower-level hospitals and community clinics before swarming into larger hospitals.
"Expanding grassroots medical service institutions is the key to tackling the chronic imbalance in supply and demand," said Liu Jun, professor at the Central University of Finance and Economics.
The grassroots healthcare system began to take shape after the People's Republic of China was founded in 1949. However, following China's transformation from planned economy to market economy, medical resources gradually poured into public hospitals, which saw an excessive number of patients but left lower-level hospitals with insufficient business, according to Liu.
Huang Jiefu, vice minister of health, said the uneven distribution of medical investment, resources and talent causes patients to crowd into larger hospitals.
The Chinese government initiated the reform of medical and healthcare systems in the 1980s. The reform was sped up in 2003 after the country won the fight against SARS, and in March 2009, a new round of reform was launched.
Statistics from the Beijing Health Bureau show that by the end of 2011, there were 9,699 grassroots medical institutions in the city of 12.77 million permanent residents, including 1,744 community-based clinics.
Daxing District has developed a three-tier medical service system comprising a number of prominent public hospitals, 19 community-based medical service centers and 129 subordinate clinics, according to Li Jianguo, vice director of Daxing's community healthcare office, which is affiliated with the health bureau of Daxing District.
"Getting fundamental health services and receiving medical treatment for minor illness at grassroots clinics could effectively alleviate big hospitals' workloads and lead to the improvement of patient satisfaction," said Li.
In addition to meeting residents' basic needs, lower-level medical institutions also offer a helping hand during emergencies.
Doctors with the Yizhuang community healthcare service center in Daxing saved a woman and her twins who were prematurely delivered on the way to the hospital two years ago, according to Zheng Jinjing, vice president of the center.
Doctors quickly set up a makeshift maternity ward in the woman's car, cut the first infant's umbilical cord and then helped with the early delivery of the second baby.
"The mother was unprepared and the situation was critical. A few minutes' delay could have led to unfavorable results," said Zheng.
In addition to regular services, the center has established health archives for contracted residents and provides family-doctor consultation assistance. It has also set up a referral system along with some higher-level hospitals, helping patients with various health conditions find appropriate treatment.
There were about 918,000 grassroots medical service institutions across China by the end of 2011, including 26,000 community-based health centers, 38,000 township-level hospitals and 663,000 village clinics, according to a white paper on the country's medical and health services released on Dec. 26, 2012.
The disparity between urban and rural medical resources has been narrowed in recent years, as the three-tier rural medical service network that covers counties, townships and villages has expanded farmers' access to medical treatment.
The white paper says more than 80.8 percent of rural residents can reach medical institutions within 15 minutes.
However, it is still difficult for farmers in some remote mountainous areas to see a doctor.
In Wumeng Mountain of southwest China's Yunnan Province, villagers have to walk for hours to get to a village-level clinic due to the area's underdeveloped traffic system.
But Chen Jinzheng, a rural doctor, has managed to cut the distance by walking along rough mountain paths to see patients over the past 12 years.
The 42-year-old doctor has treated about 2,100 patients and walked more than 10,000 km of rugged roads, wearing out 50 pairs of shoes.
Many rural doctors like Chen are working hard to address the loopholes in China's rural medical service network, and more farmers have joined a new rural insurance mechanism.
The system, which took shape in the 1990s, was put into pilot operation in selected regions in 2003 to ensure farmers' access to affordable medical treatment and reduce disease-triggered poverty.
By 2011, more than 1.3 billion Chinese people had joined the three basic medical insurance schemes that cover both urban and rural residents, meaning that China has built the world's largest basic medical security network, according to Zhang Mao, vice minister of health.
The Chinese government has announced that it will establish a sound basic medical and health system covering both urban and rural residents by 2020, in order to ensure that everyone can enjoy access to basic medical and health services.
Source: Xinhua

Bird flu, swine flu, now South China has canine flu

Guangdong scientists have published the first systematic surveillance of H3N2 canine influenza virus, which may pose a  a public health threat if it causes human infections.
The study was conducted on two H3N2 CIV A virus strains Guangdong province – one collected at a dog farm in Guangzhou and the other from a dog farm in Shenzhen. Sequence and phylogenic analysis showed that the viruses were mostly similar to the newly isolated H3N2 strains found in dogs and cats in Korea and China. The strains most likely originated in birds.
The authors said that H3N2 may be becoming a common pathogen for pet and farmed dog populations in southern China and said that further in-depth study is needed because the virus poses a potential public health threat should it start causing human infections. Outbreaks continue to appear in Guangdong province, which is located in near Hong Kong, and are most frequent in areas that are densely populated and participate in the animal trade.
The study determined that the H3N2 infection rate of avian-origin canine influenza among farmed dogs is approximately 12 percent and approximately five percent among pet dogs. The data suggests that transmission occurred between the populations as a result of relatively recent close contact between infected dogs, ScienceDirect.com reports.
The authors of the study are from South China Agricultural University and Lanzhou Veterinary Research Institute.
Read more: Infection, Genetics and Evolution.

Anti-obesity campaign falters in a country accustomed to famine

Older people in China remember the Great Famine of 1958-61, when 15 million to 45 million people died of hunger and related causes.
Today, nearly every street corner in Beijing and many other cities seems to boast a McDonald's. There are KFC outlets in almost every Chinese city, 3,700 in all. Meanwhile, newly minted members of the Chinese middle class have rushed to buy cars, leaving bicycles that were once a major source of exercise rusting on the street. Pizza Hut is considered a fancy date-night restaurant, T.G.I. Friday's has several branches in Beijing, and cans of Coca-Cola are sold at every corner stand.
With fast food and rising affluence, a country only a generation removed from hunger is getting fat. How fat? According to the World Health Organization, the percentage of adults who are overweight and obese rose from rose from 25 percent in 2002 to 38.5 percent in 2010 in a population of 1.37 billion. Urban dwellers account for much of this. WHO projects that 50 to 57 percent of the Chinese population will be too heavy by 2015. (By comparison, 69 percent of Americans age 20 and older are overweight or obese.)
There's a standing joke, notes Lyn Wren, a physician with International SOS Beijing Clinic, that "Chinese waistlines are growing faster than the GDP."
Given how impoverished the country was not long ago and how impoverished parts of it still are, "having a problem where people are eating too much — it can seem a little churlish to complain about that," says Paul French, the Shanghai-based author of "Fat China: How Expanding Waistlines are Changing a Nation." French and co-author Matthew Crabbe found that even as recently as five years ago, obesity wasn't recognized as a problem by health professionals in China.
The Chinese Health Ministry has said it encourages healthful eating programs in schools and the construction of more playgrounds to promote exercise. And the Chinese Center for Disease Control and Prevention makes vague references to "health promotion" and providing "scientific guidance for healthy diets," but nationwide campaigns about eating healthfully and exercising are not evident.
In fact, pushing the population to lose weight, exercise and cut back on unhealthful foods seems to strike a discordant note to some inside the government, French says. "When I talked to government officials, their argument was: Right now we're trying to tell them to do and not do a lot of things," such as not spitting on the street, not dropping trash everywhere and not driving "like complete idiots."
"They know they can only tell people to do some things . . . before they get fed up."
Read more: Washington Post

Lilly bribed Chinese health officials - with cigarettes

Earlier this month, the Securities and Exchange Commission (SEC) announced the settlement of the Eli Lilly and Company’s (Lilly) violations of the Foreign Corrupt Practices Act (FCPA).
The enforcement action details a number of bribery schemes that Lilly had engaged in for many years in multiple countries. Indeed Lilly used four different styles of bribery schemes in four separate countries; all of which violated the FCPA. In China, corrupt payments were falsely called reimbursement of expenses. In China, Lilly employees used the classic system of submitting inflated expense reports and using the excess reimbursements to pay bribes. More ominously, not only did the sales representatives engage in this tactic but their supervisors did and also instructed subordinates to do so as well. The list of gifts that were provided to Chinese government officials was as wide ranging as it was creative. There were gifts consisting of specialty foods, wines and a jade bracelet. There were paid trips to bath houses, karaoke bars and spas. There was money paid to purchase “door prizes and publication fees to government employed physicians.” It was even noted that bribes were paid consisting of cigarettes. In the SEC complaint it stated that “Although the dollar amount of each gift was generally small, the improper payments were wide-spread across the [China] subsidiary.”
Source: JDSupra Law News

Shanghai cord blood bank claims successful treatment in hundreds of patients

Shanghai Cord Blood Bank has collected 20,000 samples

A five-year-old boy with a serious blood disease is expected to receive an umbilical cord blood transplant today, setting a record of 200 cord blood transplants — an increase of 47 percent — in the city this year.
The patient, surnamed Zhang from Jiangxi Province, had a fever of unknown origin in September. After a 10-day treatment with antibiotics was ineffective, the local hospital found he had acute and severe aplastic anemia.
The disorder is a result of a patient’s bone marrow not making enough new blood cells.
The boy was transferred to Shanghai Children’s Medical Center on October 11 for treatment. Doctors helped him find a matched donor from the China Bone Marrow Bank.
“However, the donor refused to get an additional health check, which is a must for a transplant,” said Zhang Jiaqin, an official at Shanghai Cord Blood Bank. He said a donor’s privacy is protected.
The boy was transferred to Shanghai No. 1 People’s Hospital for treatment in November.
Failing to find a matched donor from the bone marrow bank, the patient’s family turned to Shanghai Cord Blood Bank and found a matched sample in mid-December.
Umbilical cord blood, collected during a baby’s delivery, and donated bone marrow are both used for blood and immunity disease treatment. The key factor is stem cells, which develop into other types of cells. Stem cells from umbilical cord blood are less mature than those from adult bone marrow, less prone to rejection and more active in developing into other cells.
Shanghai Cord Blood Bank has collected over 20,000 samples and has fulfilled over 600 transplants since being established in 2004, making it a key supplementary service.
Source: Shanghai News

Orphans to get free medical care

Orphans in Fujian, Liaoning and Hainan, as well as Tibet and Ningxia will be covered for critical illnesses

Nearly 30,000 orphans received health insurance contracts to cover the treatment of 12 critical illnesses on Monday.
"It's our best new year gift for the children and I hope more people can join in our efforts to help them," said Dr. Heidi Hu, managing director of the China Children Insurance Foundation (CCIF).
Orphans from the provinces of Fujian, Liaoning and Hainan, as well as Tibet and Ningxia Hui autonomous regions, are benefiting from the expansion of a joint insurance program sponsored by the Chinese Ministry of Civil Affairs (MCA) and the CCIF.
The insurance, paid for with donations, will be accessible for one year starting from Jan. 1, 2013. It is designed to benefit children of poor families and MCA-registered orphans under the age of 18.
Each child is insured for 100,000 yuan (16,091 U.S. dollars) at a premium of 50 yuan a year.
The 12 major illnesses covered by the insurance program include malignant tumors, illnesses requiring organ or stem cell transplants, acute kidney failure, aplastic anemia, acute hepatitis and infantile paralysis.
Since the insurance program was launched in July 2009, the CCIF has distributed nearly 650,000 insurance contracts to children in 20 provinces and regions, from the quake-hit southwestern province of Sichuan to the plateau areas of Qinghai and Tibet.
"It's the third year we have been able to offer such insurance to orphans in Tibet, Fujian, Liaoning and Ningxia. For those in Hainan, it's the second year," Hu said.
Hu said the organization received more small-scale donations this year, mainly through the Internet. Previous years' donations were mainly made by large enterprises.
"We opened a donation center on Taobao, China's version of eBay, this year to expand our search for donors. It has really helped to keep our project sustainable," Hu said
"We will continue to work with civil departments across the country to search for possible insurants and renew our beneficiary list every year. Our current goal is to help all 712,000 registered orphans in China," Hu said.
To guarantee transparency in the insurance program's operation and management, the doctor said all donation-related information can be checked and verified online at baoxian.cctf.org.cn, a website hosted by the China Children and Teenagers' Fund, the parent foundation of the CCIF.
Source: CCIF

AstraZeneca invests in R&D into Chinese herbal medicine

AstraZeneca will fund Shanghai research into Herba Leonuri

AstraZeneca has signed a research collaboration with Fudan University, a leading Chinese academic institution in cardiovascular disease research.
The research agreement focuses on pre-clinical studies to understand the mechanism of action of leonurine, a compound derived from Herba Leonuri, a herb used as a traditional Chinese medicine.
Understanding the role of leonurine in cardiovascular diseases such as chronic heart failure, ischemic stroke, and atherosclerosis may ultimately help in the development of novel medicines.
With over 100 million people with heart disease, China is the ‘diabetes capital of the world.’ Cardiovascular diseases are a major complication of diabetes; about 65 percent of people with diabetes die from heart disease and stroke.
“We’re delighted to be collaborating with AstraZeneca, a world-leader in biopharmaceutical innovation,” said Principal Investigator for the research at Fudan University, Professor of Pharmacology and Dean of the School of Pharmacy, Dr Yi-Zhun Zhu. “Understanding the structure and properties of natural substances may open doors to potential drug targets and provide innovative pathways to explore in the fight against major health burdens including cardiovascular disease,” he added.
Under the terms of the agreement, Fudan University scientists will work in collaboration with teams from AstraZeneca’s Cardiovascular and Gastrointestinal Innovative Medicines group over the next two years.
“Partnering and collaborating with scientists, biotech companies and best-in-class academic institutions like Fudan University brings our Asia R&D strategy to life by helping us harness the increasing levels of innovation we see coming out of China and other emerging markets,” said Dr. Steve Yang, AstraZeneca’s Head of R&D for Asia and Emerging Markets.
Source: Asian Scientist

Beijing hospital staff accused of using ambulances for personal errands

by Ernest Kao

Beijingers claim that ambulances are being used by hospital staff for private trips

With sirens wailing, a Beijing ambulance headed for the hospital was not rushing a patient back at all. It was returning from a noodle restaurant where staff members had dinner that night.
It was Friday evening in Beijing and along Haidian Dong San Jie, an ambulance could be seen hurtling down the street – the vehicle's blue and red lights flashing and sirens wailing.
The ambulance from the Beijing Emergency Medical Centre in Haidian was not rushing a sick or injured patient to the hospital, however. In fact, it was not carrying any patients at all.
The ambulance crew was heading back from dinner at a nearby noodle restaurant. Onboard were other hospital staff, all dressed in their white medical coats.
A netizen who claimed to be in the area snapped a photo of the ambulance as it returned to the hospital and reported the incident on his Sina Weibo account @BG2RHY.
“I frequently see ambulances from the Haidian hospital parking lot drive over to a restaurant for meals. They will then turn on their sirens and head back to the hospital. I’d like to ask 1) aren’t these ambulances under the management of the hospital? 2) Are these acts even allowed?”
His post spread across social media, sparking debate over emergency-staff work ethics and non-compliance issues.
As of Monday morning, the thread “should [drivers] give way to ambulances?” has been trending on weibo, racking up more than 7.8 million mentions and  more than 3,300 shares.
“So even doctors lack ethics and discipline now...this is sad,” wrote one user on weibo.
The Haidian hospital acknowledged the incident and launched its own investigation.
"Only in the case of an emergency would the use of a siren be permitted...ambulances are not 'privilege cars' and any private use would prompt investigation," one hospital official told the Beijing News on Sunday.
The hospital announced its findings at a news conference on Monday and, on its official weibo account, said the ambulance crew would be handed the “appropriate punishments”.
The Haidian hospital does not have a cafeteria, and staff members frequently went out to dine at nearby restaurants.
Beijing’s emergency services have become the subject of much public attention recently, especially after a woman died in the back of an ambulance in early December, when a supposedly short three kilometre trip to the hospital took more than 40 minutes in the city’s manic rush hour traffic.
Source: SCMP

Sex hospital opens in Wuhan for infertile couples

Despite the plethora of sex videos and DIY tomes on the art of conceiving, some couples face huge problems when it comes to having babies. Now an enterprising hospital in Hubei has introduced its "second nuptial chamber" to aid those affected.
Each room in the Songziniao hospital in Wuhan, Hubei province, comprises 538 square feet of matrimonial bliss - red lamps, sex toys, automatically adjustable double bed and diagrams.
Sex-skill videos, nurse and air hostess uniforms are available on request.
Huazhong Normal University sex professor Peng Xiaohui highlighted the magnitude of the problem.
He once treated a couple who failed to conceive after three years of marriage. The reason - the husband had mistaken his wife's belly button for her privates.
A session in the nuptial chamber does not come cheap - couples will have to fork out 880 yuan (HK$1,093) per night.
Source: HK Standard

Clinical news from China: Journal Watch

Researchers from Shandong University identify the enteroviruses responsible for  causing hand foot and mouth diesease in children (PLOS One).

About 60% of children have high levels of pyrethroid insecticides in the blood, possibly because of the use of mosquito repellants, according to a study by researchers from Fudan University, Shanghai. (Chemosphere).

Water supplies and soil near farms in China contain high levels of antibiotics such as sulfonamides, tetracyclines, fluroquinolones, macrolides and trimethoprim, a study from the Guangzhou Institute of Geochemistry has found. (Science of the Total Environment).

The diagnosis of Parkinson’s Disease can be differentiated from essential tremor in Chinese patients by assessing sense of smell and ultrasound abnormalities of the substantia nigra, say researchers from the Department of Neurology at Ruijin Hospital, Shanghai. (Translational Neurodegeneration).

Cryptococcal meningitis is relatively uncommon but highly fatal disease in China, according to researchers from Shijiazhuang. They say clinicians should consider the infection as a potential cause for pediatric meningitis in children, particularly boys from rural areas, who have had contact with birds/bird droppings or saprophytes and in children who did not receive prompt medical attention.
(BMC Infectious Diseases).

Central venous catheter-related bloodstream infections are more likely to occur in intensive care patients who have multiple lines and in those who have already been treated with antibiotics prior to having a line inserted, a study from the Chinese Medical University in Shenyang has found. (Journal of Critical Care).

Honey from Zhejiang contains toxic levels of arsenic, a study conducted by the Zhejiang University of Technology, Hangzhou has found. (Food and Chemical Toxicology).

Some men with HIV in China have antibody responses that neutralise a wide range of HIV subtypes, suggesting it may be possible to develop a ‘broad spectrum’ anti-HIV vaccine.
(PLOS One).

From Omaha to Shaanxi: US doctors help develop rural health

by Paul Goodsell

US doctors on exchange in Shaanxi says Chinese doctors are just as knowledgeable, but work in a different system

Hooked to an IV, Zhu Qingli sat on a wooden bench and watched television in an outpatient room in a small hospital deep in the Chinese countryside.
The 28-year-old, wearing a basketball jersey and shorts in the purple and gold of the Los Angeles Lakers, was getting treatment for bronchitis. His once-heavy cough was gone and he was feeling much better, but he still needed a few more days of antibiotics.
The hospital was primitive by U.S. standards, with cracked concrete walls and ill-fitting doors in the outpatient room. But the young man's treatment was more modern and sophisticated than it would have been in this rural area even a few years ago — partly because of training provided by Nebraska doctors.
China's leaders have been open to such help because they want to modernize the country's health care system and reduce the wide gap in medical services that exists between the country's rich cities and its poor rural areas.
“Take every disparity in the United States and multiply it times 10, and you've got China,” said Jeffrey Harrison, a family medicine professor at the University of Nebraska Medical Center.
But in the past three years, China has poured $125 billion into an overhaul of its health care system. Rural doctors in Xunyang and other remote areas are better trained than they used to be, and rural hospitals are getting better equipment.
China's efforts have been aided by UNMC physicians like Harrison who have traveled to China or welcomed visiting Chinese doctors and professors who go to Omaha to learn about primary care medicine and rural health strategies.
“We do family medicine and primary care and rural health pretty well,” Harrison said.
The UNMC effort in China is partly altruistic, reflecting doctors' desire to educate and improve care. But it also is driven by the self-interest of Nebraska and its university.
Deeper ties with China — also including student exchange programs — open the door to joint research projects and other collaboration that help UNMC, university officials say.
More broadly, as Nebraska makes more connections with China, they open doors to better trade opportunities in agriculture, irrigation systems and other Nebraska goods and services.
“At the 30,000-foot view, we're there because it's good for the state of Nebraska,” Harrison said. “The Chinese are very relationship-oriented. They're going to buy goods from their friends.”
In fact, UNMC's work stemmed from contacts made during Nebraska trade missions to China. And during Gov. Dave Heineman's trip there last summer, officials formalized an extensive partnership that has been developing between UNMC and Chinese academic institutions.
UNMC officials are good ambassadors for the state's economic development efforts in China, said Joe Chapuran of the Nebraska Department of Economic Development.
“It makes us stand out,” said Chapuran, who organizes the state's trade missions.
For rural doctors in Xunyang and elsewhere in Shaanxi province in central China, the Nebraska connection involves UNMC doctors who have gone to China to teach about primary care and about developing relationships with patients.
In China's health care system, people with ailments typically go to large hospitals, take a number and wait to see a specialist rather than starting with a family doctor. They don't always see the same physician on repeat visits, and they often get little ongoing, preventive care.
UNMC has been providing guidance to the Chinese on how to shift to a family medicine approach.
The Chinese government has been retraining its rural doctors. Doctors from far-flung parts of Shaanxi province are brought to the capital city of Xi'an for four months of classroom work followed by eight months of observing experienced physicians in modern hospitals.
Typically, eight UNMC professors have gone to Xi'an annually since 2008 to give lectures and training in family medicine and rural health care. Starting in 2010, the faculty members also have gone to Shanghai.
“The students get very excited because they know they have American doctors to help them,” said Chunli Wu, a nurse who was trained in the U.S. and is coordinator of the rural doctor training program in Xi'an.
At first, Harrison said, he and his colleagues thought they would be teaching medicine to the Chinese doctors they instructed. But they were soon humbled to realize that the Chinese were just as proficient as the Americans in medical knowledge.
“They do the same things we do. They know the same things we know,” Harrison said. “It's just teaching them a different system, that this is the model of care we use.”
Dang Giangrong, a rural doctor from another city who has been through the program, said the UNMC doctors gave him a new approach.
“To be patient with them,” Dang said. “To treat them not as a disease, but as a whole. They showed me how to talk with the patient nicely, and also educate the patient.”
Zhang Li An, who heads the Ganxi Central Medical Care Center in the outskirts of Xunyang, said the retraining efforts have made a difference at his hospital, a nearly four-hour drive from Xi'an on twisting mountain roads.
When Zhu Qingli came in with his bronchitis, Zhang said, his doctors talked to him about his lifestyle. They are trying to determine the cause of the illness, not just provide treatment.
In addition, he said, they were able to do a chest X-ray using modern equipment that the government upgraded recently.
Even so, he said, rural health care in China remains less advanced than in bigger cities.
“We still have a long way to go,” Zhang said.
Source: World Herald

Officials use loophole to retain 'unfair' free medical treatment

by Alice Yan

Officials to be reimbursed for losing access to free treatment

Civil servants in the eastern city of Nanjing will lose their privileged access to medical treatment next week, making it the last city in the Yangtze River Delta to implement a reform launched by the central government 14 years ago in an attempt to assuage public concerns about the unfair benefits given to officials.
The "free medical treatment" scheme, introduced in the early 1950s, allowed civil servants to receive assistance at public hospitals for little or no cost.
Unlike the employees of businesses, whose medical insurance contributions are deducted from their salaries each month, officials didn't have to spend anything.
Ordinary urban residents on the mainland have to pay about a third of their medical bills, while farmers living in rural areas have to meet half of their hospital expenses.
The central government said in 1998 that all civil servants should relinquish "free medical treatment" and instead join the basic medical insurance scheme used by the employees of urban businesses, making the same contributions and receiving the same level of benefits.
However, local officials in a quarter of the mainland's 31 provinces, municipalities and autonomous regions, and more than 300,000 officials in central government departments, are still hanging on to their unfair benefits.
Nanjing's 200,000 local officials will forfeit their "free medical treatment" cards next month and join the urban employees' basic medical insurance scheme, Modern Express reported following an announcement by the city government. Two per cent of each official's monthly income will be transferred to their insurance account and the department they work for will contribute another 9 per cent of their monthly income to the account.
On the surface, the medical treatment that Nanjing officials receive will be no different from that given to ordinary employees, as claimed by the authorities. But a remark by a senior official paints a different picture.
Chen Jianning , deputy director of Nanjing's human resources and social security bureau, was quoted as saying that besides the basic medical insurance scheme, officials were also entitled to join an additional medical insurance scheme, meaning that most of the money officials pay for medical treatment will be reimbursed.
Officials in many other cities, including Beijing and Tianjin , receive similar favourable treatment. One official from Beijing's municipal human resources and social security bureau who tried to explain the rationale behind the arrangement said it was designed to ensure that civil servants' medical benefits were not reduced under the reform.
The "free medical treatment" enjoyed by government officials has long been criticised by analysts as an unfair privilege. Some officials have even been rumoured to have used their "free medical treatment" cards to acquire free medicine for relatives.
The average medical expenses of a Beijing resident in 2009 were 4,200 yuan (HK$5,150), but the average expenses of a Beijing official were triple that. The capital implemented the reform of officials' medical insurance at the start of this year.
In Guangzhou, city authorities budgeted 1.4 billion yuan this year for the medical expenses for officials, but only allocated 615 million yuan to subsidise hospital visits by 2.1 million farmers, Yangcheng Evening News reported in June.
Civil service jobs, known as "iron rice bowls" on the mainland, have long been highly sought after because they offer stable, long-term employment, better medical insurance and higher pensions. Officials get pensions at least twice as big as other retired workers in their city, without having to make any contributions to a pension scheme at all.
In some affluent cities, a thousand applicants can compete for one civil service job.
With reform of officials' medical insurance benefits being introduced sluggishly and half-heartedly and pension reform stalled, the "iron rice bowl" is likely to maintain its allure for some time to come.
Source: SCMP

Taiwan gives green light to mainland medical tourism

Chinese with NT$200,000 can visit Taiwan for medical treatment

The regulations for Chinese coming to Taiwan for medical services have been eased to increase economic growth and boost the international competitiveness of the medical industry, the National Immigration Agency (NIA) announced yesterday.
The NIA said that Chinese citizens who are over 20 years old and have savings over NT$200,000 or have annual income over NT$500,000 can apply to visit Taiwan for health inspections or medical cosmetology with their relatives and spouses.
Hsieh Li-kung (謝立功), director-general of the NIA, said that this rule from the revised Regulations Governing the Entry Permission to Taiwan Area for the People from Mainland China will become effective tomorrow.
“With this revised regulation, Taiwanese health inspection and medical cosmetology industries will be able to compete internationally,” Hsieh said. “This can also attract more Chinese tourists to visit Taiwan.
“Allowing Chinese to come to Taiwan to enjoy great medical cosmetology services also demonstrates Taiwan's ability and development in the industry.”
According to the NIA, medical organizations can request that travel agencies apply with the NIA for business activities that involve Chinese coming to Taiwan for medical services.
Source: China Post

Blood shortage in China forces patients to turn to black market

The lack of donated blood in Chinese hospitals means patients have to buy it on the black market or get it from relatives

by Luo Jieqi
The tumor was growing, and the family of cancer patient Xia Jianqing was growing desperate.
Doctors at a military hospital in Beijing had warned Xia's family that he would die without the blood needed for a lifesaving operation. But the hospital had no blood to spare, forcing the family out of desperation to shop for blood on the street.

The patient's sister, Xia Guoqing, said they turned to one of the many criminals who roam Beijing hospitals, the local Red Cross of China Blood Center and even city streets offering bags of blood.
The family paid more than 10,000 yuan, she said, and doctors performed the operation.
There was nothing unique about the Xia family's early 2012 experience. Serious blood shortages at hospitals across the country have been pushing patients and their families to buy from illegal sellers every day since at least early 2011.
"Many relatives of patients who need blood for an operation have no choice but to come to us," said a seller who declined to be named standing outside the Red Cross center in Beijing.
Police have cracked down on the underground trade over the past year, arresting increasing numbers of "blood hawkers" in Beijing, Guangzhou, Wuhan and other cities.
Five hawkers were separately convicted of organized crime charges and illegal blood trafficking during the first six months of 2012 in Beijing's Haidian District Court.
And in July, in the largest blood-related trial of the year, the Haidian procuratorate indicted 12 people on similar charges, including men named Wang Haitao and Xue Shengkai whose customers several months earlier had included the Xias.
Authorities say some members of the Wang-Xue gang regularly solicited customers inside hospitals. Others scoured streets and the Internet for people willing to sell blood. Their arrests, which could lead to sentences of up to five years in jail, shut down the business. 
But as long as blood is in short supply and desperate patients are willing, officials say, the illegal trade is likely to continue.
"Do you need blood?" was the question posed by a man in his 30s, sporting a crew cut and a black tote bag, whenever someone passed him in the hallway of a respected, Beijing military hospital in October.
Coping Strategies
Shortages are commonplace in growing cities such as Beijing, Shanghai, Chengdu and Guangzhou. And the problem "is spreading across the entire country," said the director of Tianjin's Municipal Blood Center, Yang Wenling.
Beijing's citywide stocks on November 26 held only about 10,000, 200-milliliter units of blood, officials say, which is only about half of what the city's hospitals need.
To encourage Beijingers to donate, the Red Cross recently rolled out special policies offering preferential treatment to employees of companies and organizations that sponsor blood drives. Any of these employees who need blood would be first in line.
These preferential policies underscore the severity of the blood shortages, which have deepened in recent years. Since October, official websites for health agencies in Inner Mongolia Autonomous Region and Zhejiang Province, for example, have been urging people to donate any type of blood.
The central government's Ministry of Health says the amount of blood used in medical procedures across the country has increased up to 15 percent annually in recent years, far outpacing legal donations. Surgeries using blood rose more than 18 percent in 2010 over the previous year, but blood collections outside the illegal trade increased only 7.7 percent.
Under China's system, blood centers handle collections from voluntary donors. They're supposed to collect enough to meet the demands of hospitals and other health care facilities.
If supplies from pro-bono donations fall short of needs, the national Blood Donation Law encourages patients to organize personal blood sourcing, perhaps by persuading family members, friends, coworkers and neighbors to donate blood through a so-called "mutual aid" project. Few hospitals in China provide personal collection and storage services for people who want to bank their own blood.
Before 2011, mutual aid donations accounted for a small portion of all donations. Most sources were donors who rolled up their sleeves at Red Cross drives or on university campuses, and whose blood was processed, banked and distributed to hospitals on an as-needed basis.
But over the past two years, mutual aid donations have skyrocketed. A doctor working at a military hospital told Caixin that "because of the blood shortage in Beijing, almost every operation in 2012 required a mutual aid donation."
And the mutual aid system's loopholes are wide enough for plenty of illegal activity.
Read more: Caixin