China medical news roundup: Monday 11 November

New health minister Li Bin calls for self criticism, rectification and reform

China's newly formed National Health and Family Planning Commission has held a special review meeting to plot its future direction.
Health minister and Commission secretary Li Bin (李斌)chaired the meeting stressed the need to take the topic of democratic life as a starting point, with a focus on rectification and reform implementation, to establish a new system of work, She said it was important to have rigorous thinking so that standards are not reduced, reform intensity is not weakened, and to ensure good educational practice.

    She said the Party attaches great importance to the National Health and Family Planning Commission. It must be fully prepared with in-depth study and improved thinking. Party members have been appointed to make serious systematic study of the central provisions of the the Party's 18th report and General Secretary Xi Jinping’s series of important speeches, for ideological foundation. 

 In her speech, Li Bin stressed the need to pay close attention to the implementation of rectification, addressing outstanding problems, strengthening institutional innovation, and comprehensively promote systems and mechanisms to promote scientific development outcomes. Teamwork and unity are needed to create a new situation in health planning, to achieve the great rejuvenation of the Chinese dream, she said.
Source: Central People's Government

RSV vaccine urgently needed to tackle severe pneumonia

Respiratory Syncytial Virus is responsible for one in four cases of life threatening cases of pneumonia in Chinese children, a study from Suzhou has found.

In a review of 297 cases of children admitted to an intensive care unit with RSV-associated severe pneumonia, researchers found RSV was confirmed in 57% of all children with severe or very severe community acquired pneumonia  and accounted for 24% of all PICU admissions (171/707) during the three year study period. Other viruses identified were influenza (19%; 56/296), para-influenza (5%; 33/707) and adenovirus (1.4%; 10/707). The study found that the mortality rate was 3.5%, with congenital heart disease and Trisomy 21 the main factors associated with death. In most cases the children were under six months of age, all children needed supplemental oxygen and 22% had respiratory failure that required mechanical ventilatory support.

“RSV is a significant cause of life-threatening acute respiratory illness, particularly in the first year of life in this population. Passive immunization is too resource intensive to be feasible preventive strategy for RSV illness in this population. RSVvaccines are under investigation and are urgently needed to protect the very young infant,” the study authors concluded.

Read the full study: BMC Research Notes 

Zhuhai mental health patients dumped by hospital at bus station

Seven female mental health patients, suspected to have been abandoned by their mental hospital at a bus station for more than 25 hours, returned to the hospital in South China on Wednesday afternoon, Guangdong-based Nanfang Metropolis Daily reported.

The hospital head said two medical workers transporting the alleged recovered patients home accidentally "lost" them in the station, and in a flurry, forgot to report the missing patients to police. One patient denied that account.

According to the report, surveillance video shows that at 2 pm Monday, seven people came into the waiting room of the Nancheng Bus Station in Dongguan city of Guangzhou province. No one was seen escorting them. The patients, all in night-gowns and slippers, acted naturally at first and constantly looked at the ticket office. Later some of them began searching for food in the trash can or grabbing food from passengers walking by. They stopped delirious behaviors when someone in uniform appeared, didn't hurt others and slept on the floor, causing no harm but indeed attracting attention, the report said.

A patient in relatively good condition, named A Ying, said the group came from a hospital in Zhuhai, a city in Guangdong province. She said doctors told them they were recovered and could go back home. Medical workers took them to Dongguan city by bus before they left the patients in the waiting room and went to buy tickets. The workers said they were to meet them in the waiting room, but didn't show up again.

With this information, Dongguan police continued their investigation and found that the patients were from Zhuhai-based Baiyun Rehabilitation Hospital.

The hospital said its doctors confirmed they were in sound condition and checked the patients' home addresses before sending medical workers to send them home.

The report said the hospital didn't record any discharge procedure for the seven patients.

The two nurses who sent them to Nancheng Bus Station, Wang Ni and Fan Hong, said they didn't find the patients in the passenger exit, where they had left them when they returned within 30 minutes with tickets and food. The waiting room where the patients were staying is less than 100 meters from the passenger exit, the report said.

Source: China Daily

Cholesterol remains uncontrolled despite use of statins

Only about half of patients treated with statins are achieving heir lipid lowering goals, a Beijing study has shown.

In a cross-sectional study, researchers from Peking University People's Hospital enrolled 25,397 consecutive outpatients aged 45 years and above who had received at least 3 months of lipid-lowering therapy from 120 various tiers of hospitals across China.

Treatment goals for LDL-cholesterol and total cholesterol were assessed based on the Chinese Adult Dyslipidemia Guideline 2007. In an interim analysis of 6386 20% had sedentary lifestyle and 14% were smokers.

The study found that only 62% and 49% of patients reached LDL-cholesterol and total cholesterol goals, respectively, with goal attainment rates decreasing as CV risk increased. Women and patients with diabetes, cerebrovascular disease or CHD were more likely to fail LDL-C goal attainment after adjusting for other patient characteristics.

About 86% patients received statin monotherapy, with simvastatin (37%) and atorvastatin (34%) being the most commonly prescribed. The most common statin potency was equivalent to simvastatin 20-40mg/day. More than half of all patients were considered high or very high CV risk, with hypertension, coronary heart disease (CHD) and diabetes being the most prevalent comorbidities

 “Despite use of lipid lowering drugs, a large portion of patients, particularly those at greater CV risk had persistent lipid abnormalities. There is still an important need to optimize therapy to further bridge the gap between guideline recommendations and current Chinese practice,” the researchers concluded.

Read the full study: European Heart Journal

Distrust of doctors will drive away talent

by Feng Yu

Recent news about doctors in China has not been positive. Medical staff have become victims of violent assaults, sometimes fatal, carried out by patients and their families.

This week pictures of doctors and nurses learning and practicing taekwondo and other self-defense skills at two prominent hospitals in Shanghai drew further public attention to the long-running issue. This is just the latest action implemented following a series of hospital-patient disputes nationwide.

On October 17, an intensive care unit in Shanghai's Shuguang Hospital was smashed and destroyed by the angry family members of a patient.

On October 25, a doctor in First People's Hospital of Wenling in neighboring Zhejiang Province was stabbed and killed by a disgruntled patient who had undergone unsuccessful surgery on his nose in March 2012. Another two doctors were also injured in the attack.

The shocking incident sparked reaction across the country and even drew media attention worldwide.

In the following days, medical staff in Wenling and other cities in Zhejiang gathered in local squares to mourn the deceased doctor and protest violence targeting doctors. On the day of the doctor's funeral, mourning activities nationwide were organized by various medical organizations for people to express their condolences to the doctor's family and their anger toward the attackers.

Hundreds of doctors from Shanghai's Zhongshan Hospital gathered in front of the statue of Sun Yat-sen, after whom the hospital was named, to mourn over the death of their peer in Zhejiang. Some said that conditions are so bad for doctors that they need psychological counseling.

As it turns out, being granted permission to express their emotions publicly was more than what some doctors in Shanghai were allowed. According to anonymous sources, doctors at another major hospital were informed the day before that they would not be allowed to participate in a similar rally in order to maintain stability and harmony at the hospital. In the message, the hospital management warned of possible disciplinary punishment if any staff disobeyed the directive.

We can only imagine how disappointed the doctors at the latter hospital felt.

The different responses of the management at Shanghai's hospitals reflect the difficulties medical staff are currently facing.

A doctor friend told me that quite a number of physicians live with stress. Media reports about extreme examples of corrupt doctors have tarnished the reputation of the profession as a whole and created general public distrust toward hospitals. Doctors are scorned as hongbao receivers, pharmaceutical kickback takers and criticized for being indifferent toward patients. Hospital-patient relations have deteriorated to a very poor level.

My friend told me that with or without hongbao, doctors try their best to save or cure a patient. But the friend also admitted that many doctors are not firm enough to reject hongbao.

At the same time, recent reform of the public health system which encourages hospitals to support themselves through drug sales also plays a negative role in burdening patients, who then direct their discontent and anger at the doctors who treat them. To some extent, doctors are scapegoats of a flawed medical system.

It's therefore understandable that hospitals have organized self-defense classes for staff. Although the burden shouldn't fall on them, unfortunately, doctors are increasingly feeling the need to know how to protect themselves.

Survival tips online recommend that doctors don't leave their back to the door, and, if there is potential trouble, doctors should remove their white lab coats and hide amongst a crowd.

Being a doctor is a respectable and decent career. Only the best and brightest can shoulder the responsibility of healing the wounded and rescuing the dying. Even when a procedure fails or a patient dies - as is sometimes unavoidable - doctors still deserve respect for trying to help others. If being a doctor becomes an unfavorable career choice and elite talents spurn the profession, who will treat us when we are ill? Disgruntled patients should not bite the hand that heals.

What can be done to restore the public's faith in our physicians? Structurally speaking, a good environment is needed to guarantee that doctors can concentrate on medical research and practice. Their income level should match their efforts and expertise. Their earnings shouldn't be tied to the amount of drugs they prescribe. At the same time, doctors ought to practice strict self-discipline when it comes to hongbao or kickbacks.

The media also shouldn't focus solely on negative stories while neglecting the majority of positive cases.

Finally, the general public must be understanding of the pressures and challenges medical staff face and realize that they cannot cure every ailment.

Source: Global Times

China to build a new "multi-functional healthy city" for a million people

An International Health Forum and the 2013 symposium of the chief editors of the “Medical Encyclopedia of China” took place on Friday at the Great Hall of the People in Beijing.

With the goal of discovering a healthier lifestyle for all, the forum attracted hundreds of industry leaders, experts, and government officials from the travel, urban planning and medical industries to draw up a blueprint for a better life.

The meeting consisted of six sub-forums, and the topics included “the development of health from the perspective of humanities”, “the internationalization of Chinese traditional medicine”, “a better medical security system”, “trends in health services”, “a new model for the medical neighborhood” and “a new model for a healthy city”.

During the sub-forum entitled “a new model of a healthy city”, Professor Zhou Muzhi of Tokyo Keizai University, world renowned Italian architect and designer Mario Bellini and Zhu Xiaoming, mayor of Zhenjiang City in China delivered speeches.

According to Zhu Xiaoming, Zhenjiang, an city on the east coast of China, is planning to build the first neo-ecological region in the country. The project began last year, and the region plans to build a pioneering ecological city of 220 square kilometers with a population of one million.

The new city applies modular city planning theory to solve the common problems of cities around the world and create a new type of city that is livable, productive, and environmentally sustainable.

Chief planner of the Zhenjiang neo-ecological city, Professor Zhou, explained the concept behind the plan. “[We are building] a multi-functional healthy city, equipped with a mature health care and social security system. Citizens who live in the city will not need to worry about transportation, the environment, medical care or education. All their needs can be met efficiently.”

Mario Bellini, the chief designer of the new plan, agreed with Professor Zhou. “In a healthy city, there is harmony and balance between the citizens and nature. They should both be nefit from each other,” he said, “although there are no ideal cities in the world at the moment, why not try to build one, to improve people’s lives?”

Source: china.org.cn

Hebei doctor caught on camera accepting bribes from drug rep

A Hebei doctor caught on camera accepting cash from pharmaceutical sales representatives is now being investigated by the police. Video of the doctor leaked online yesterday, showing a physician in a white lab coat taking a large stack of bills from men dressed in black. The footage appeared to have been taken from an unseen camera in a room of Baoding First Hospital, located in Hebei’s Baoding city. Members of China’s online community identified the room as a vascular surgeon’s office, and these claims were later verified by Baoding First Hospital disciplinary staff. Investigations into the matter revealed that the doctor caught on camera was a 40-year-old deputy director of vascular surgery who had been receiving bribes from medical representatives in exchange for prescribing specific drugs and promoting pharmaceutical companies in the hospital. The money exchanged exceeded 20,000 yuan (HK$25,000). The doctor, who was only identified in media reports by his surname Wang, was described by his peers as a key member of hospital staff. “He’s a backbone of the hospital,” a member of Baoding First Hospital’s disciplinary staff told The Beijing News. “His medical ability is very strong and he’s worked here for six years. I never expected him to break the law.” Hospital staff confirmed that the Baoding police department had begun ongoing investigations into the extent of Wang’s bribery. Wang is currently still working at the hospital, but has been demoted to reviewing medical records and has received a substantial pay deduction. The bloggers that first identified Wang in the leaked video footage condemned his actions and “bad behaviour,” but also lamented that bribery in China’s hospitals “had become commonplace.” Frequent overcrowding and stressful working conditions have prompted many Chinese doctors in recent years to begin taking kickbacks, or bribes, from pharmaceutical companies in an effort to increase their salaries. Hospital violence has also been on the rise, and a 2013 study by the China Hospital Association revealed that out of 316 surveyed hospitals, 60 per cent said that their staff had been physically injured by angry patients.

Source: SCMP

Breaking news: epidemic fears after fourth case of H7N9 reported in Zhejiang

A new human case of H7N9 bird flu has been confirmed in Zhejiang province, the fourth on the mainland in three weeks, but scientists said it was too early to know whether they represented a major outbreak.
Hong Kong's Centre for Health Protection has been notified by the National Health and Family Planning Commission that a 64-year-old woman became ill on October 30 and was in critical condition.
No public announcement about the case had been made by the commission or state media as of last night. The World Health Organisation said it had been notified of the new case from the health commission.
"We expect to continue to see a small number of sporadic cases. To date, there is no evidence of sustained human-to-human transmission," said Dr Bernhard Schwartlander, the WHO representative in China.
Schwartlander said whether the H7N9 virus could actually cause a pandemic was unknown, although "in principle, [it] carries a risk".
The third new human H7N9 bird flu case, a three-year-old boy in Dongguan who was confirmed as having contracted the virus on Tuesday, was in a stable condition and expected to be discharged from hospital soon. He had not developed a fever.
The child had gone to a wet market with poultry stalls, but did not have contact with the fowl.
Sixty-three people who were in close contact with him have been put in quarantine for a week. To date, the mainland has confirmed 138 human cases of H7N9 bird flu, 45 of them fatal.
Ben Cowling, associate professor at the University of Hong Kong's school of public health, said it was too early to say if there would be a major outbreak during the flu season this winter.
Cowling has published a paper in the medical journal The Lancet stating that H7N9 may follow a similar seasonal pattern to H5N1 bird flu, and predicted it would reappear this autumn and potentially cause a major epidemic this winter.
Professor Xu Xiaoyuan of Peking University's department of infectious diseases, said no significant genetic mutation had been detected in the virus, meaning there was a very low chance of a community-wide outbreak or human-to-human transmission. He said it was possible there would be sporadic cases in the winter flu season.
Professor Yuen Kwok-yung, a microbiologist at the University of Hong Kong, said imported H7N9 cases were possible because two Hong Kong residents had previously developed H5N1 infection after visiting wet markets on the mainland.
He said the possibility of a human or poultry outbreak in Hong Kong was not high, as all imported poultry was sampled and tested.
Source: SCMP

China medical news roundup: Friday 8 November

 FPG a poor screening tool for metabolic syndrome

 Researchers from Xian have shown that HbA1c is  a better screening tool for metabolic syndrome and prediabetes compared to fasting plasma glucose in Chinese patients.

In 2009, a unified definition of metabolic syndrome (MetS) was proposed, of which, the glycemic component is defined on the basis of fasting plasma glucose (FPG) level. Recently, the American Diabetes Association recommended the use of glycated hemoglobin (HbA1c) as an alternative to FPG to define prediabetes. Dr Sun Xingxing and colleagues at the Fourth Military Medical University, Xi’an aimed to compare the performance of HbA1c and FPG in the definition of glycemic component of the MetS among Chinese adults. They conducted a cross-sectional analysis of 7641 Chinese adults. Overall, 1136 (14.9%) of participants had metabolic syndrome according to FPG >= 5.6 mmol/l, and 1640 (21.5%) had metabolic syndrome according to HbA1c >= 5.7%. Compared with individuals with FPG-based diagnosis of metabolic syndrome, individuals with HbA1c-based diagnosis of metabolic syndrome were older, had higher levels of LDL-cholesterol, magnesium, and transferrin, and lower levels of uric acid. Of those found to have metabolic syndrome according to either FPG or HbA1c, overlap between HbA1c- and FPG-based diagnosis of metabolic syndrome was limited (n = 768, 38.2%).

“We note limited overlap and poor agreement between FPG- and HbA1c-based diagnosis of metabolic syndrome. Screening for metabolic syndrome through introduction of HbA1c in addition to FPG could contribute to identification of more people with metabolic syndrome,” the researchers concluded.

Full study: BMC Public Health

New medical graduates wary of working as doctors

Wang Jun, who is studying for a master's degree in clinical medicine, is confused about his future career and will soon have to make major decisions about his life.

"I was depressed by the mounting prejudice against doctors and the deep distrust held by the public. I even began to doubt my decision to study medicine," the 25-year-old second year student said.

Wang, like many other medical graduates, is worried about pay, workload and the deteriorating working environment.

More than 600,000 medical school students have graduated each year over the past few years, but only 20 percent of them have become clinicians, said Li Ling, a professor in health economics of the National School of Development at Peking University.

"The phenomenon is not accidental and has been getting increasingly serious based on our survey across the country," Li said, adding that "educational resources have been wasted as a large amount of medical talent has flowed out of the industry."

Wang Jun said he will go abroad to get a job in a hospital after graduating from Shandong University next year.

"It's hard to give up what you've been working on for a few years," he said. "It's true that the overseas medical industry is very competitive, but the overall environment probably will make me feel better."

Li Ling attributes the outflow of medical talent to the worsening environment of the industry.

"Those who chose to become a doctor as their profession are somewhat idealistic with the aspiration of healing the wounded and rescuing the dying," Li said. "However, some of them gave up their medical career as they disagreed with the profit-oriented operation in hospitals."

Liu Yanhua, who became a doctor at the NO.89 Hospital of the People's Liberation Army two years ago, said only five out of the 55 medical graduates in her class became clinicians. The rest are either pursuing further education, in pharmaceutical sales or switched to other sectors.

Doctor-patient tension is another reason why the profession is less attractive.

The incidence rate of medical disputes in China has increased annually by 22.9 percent since 2002. Patient-doctor conflicts have escalated into violent or even fatal attacks.

Among the 34 attacks against doctors involving patients or their relatives that happened from February 2012 to September 2013, five doctors were killed, a microblogger in the medical circle wrote on his Sina Weibo account.

In addition, the heavy workload and relatively low income has also contributed to the outflow of medical practitioners.

"It's common to work around the clock when there are plenty of patients, moreover, mental stress is even heavier than physical fatigue," said Xiao Jinyi, who has been working in a Beijing hospital for four months.

However, the heavy workload has failed to bring doctors attractive salaries. Xiao said new staff like her earn no more than 5,000 yuan (821 U.S. dollars) each month.

"Doctors in our hospital have left because of intense pressure or bleak career development prospects," Xiao added.

The supply of medical graduates has outstripped demand thanks to China's college enrollment expansion drive since 1998, which has also led to the outflow of medical talent.

Source: China Daily

Harsh working conditions for doctors

Working conditions are poor for doctors in China. They often have to work overtime, but still can't satisfy patients' needs and are frequently criticized for seeking personal profit.
"While 80 percent of Chinese patients live in villages, 80 percent of high-quality medical resources are in cities," said Han Xuejun, director of the Medical Disputes Mediation Committee of Shanxi Province. "This makes it expensive and difficult for people to see doctors, which is the underlying cause of the frequent conflicts between patients and doctors."
Every year, a huge number of patients swarm into big cities to see doctors, which increased their workloads. According to a survey conducted by dxy.cn, China's largest medical study website, more than one quarter of Chinese doctors are prone to cardiovascular diseases; the possibility of male doctors aged 35 years and above having high pressure is twice that of ordinary people; and more than 70 percent of doctors suffer neck and back pain.
However, the harsh working conditions for doctors have evoked little public sympathy. Patients are increasingly discontent with the medical system, complaining that public hospitals are too profit-oriented and often ask patients to undergo excessive examinations and unnecessary treatment or simply transfer those with complicated symptoms to other hospitals.
On the other hand, the doctors feel they are not understood. "The public demands on doctors and nurses are too high, but they know little about how to diagnose or cure diseases," said Liu Yang, a director of the Shanxi Provincial Health Department.
Doctors worldwide are currently only know the causes of about one quarter of the diseases humans beings suffer from. Of these diseases, only one tenth can be cured, while for the rest, doctors can only reduce the symptoms.
Wang Jie, who was injured during the knife attack in Zhejiang, said he could understand the patients' anxiety to be cured. "It's the wish of all doctors to cure patients' diseases, but not everything is possible."
The grave situation for doctors has meant fewer and fewer medical students are willing to work in hospitals, especially rural hospitals. Every year, Chinese universities enroll about 600,000 medical students, but only one sixth of them will become doctors, said Li Ling, a professor at the National School of Development at Peking University.
According to Bai Jigeng, director of Shanxi Provincial Children's Hospital, it takes too many years for a medical student to become a real doctor. Before working in hospitals, medical students have to study theory for five to eight years. But that alone is not sufficient. They have to spend another 10 years gaining firsthand experience in a hospital. When they finally become competent, they are too often too old to work in clinical departments or perform surgeries.
"What we need are skillful therapists, not doctors with just a high level of education," Bai said.

Source: Women of China

Test developed for dapsone hypersensitivity in leprosy

Dapsone is used in the treatment of infections and inflammatory diseases. The dapsone hypersensitivity syndrome, which is associated with a reported mortality of 9.9%, develops in about 0.5 to 3.6% of persons treated with the drug. Currently, no tests are available to predict the risk of the dapsone hypersensitivity syndrome.

Dr. Fu-Ren Zhang and colleagues from the Shandong Provincial Institute of Dermatology and Venereology, Jinan performed a genomewide association study involving 872 participants who had received dapsone as part of multidrug therapy for leprosy (39 participants with the dapsone hypersensitivity syndrome and 833 controls), The analysis showed that SNP rs2844573, located between the HLA-B and MICA loci, was significantly associated with the dapsone hypersensitivity syndrome among patients with leprosy (odds ratio, 6.18; P=3.84×10⁻¹³). HLA-B*13:01 was confirmed to be a risk factor for the dapsone hypersensitivity syndrome (odds ratio, 20). The presence of HLA-B*13:01 had a sensitivity of 85.5% and a specificity of 85.7% as a predictor of the dapsone hypersensitivity syndrome, and its absence was associated with a reduction in risk by a factor of 7. The researchers say HLA-B*13:01 is present in about 2-20% of Chinese people, but is largely absent in Europeans and Africans.

“HLA-B*13:01 was associated with the development of the dapsone hypersensitivity syndrome among patients with leprosy,” they concluded.

Read the full study at NEJM 

Methadone program cuts HIV in Hubei

The introduction of methadone maintenance treatment (MMT) clinics for drug abusers in Hubei province from 2007 to 2011, has reduced the incidence of HIV. The proportion of HIV infection among drug abusers decreased relatively quickly from 12% to 2%. However, the methadone program had a high drop-out rate and poor information management was also identified as a particular problem that now needs to be addressed.

“Drop-out from MMT programs may reflect social issues the clients encounter, and consequently, sustainable MMT development requires incorporation of social measures that help MMT clients return to society without discrimination, especially through family cooperation and employment opportunities,” researchers concluded.

Full study at: Substance Abuse Treatment, Prevention and Policy

 

Shanghai hospital denies using celebrity pictures to promote cosmetic surgery

A Shanghai hospital that was ordered to compensate a Taiwan celebrity for using photographs of her without permission yesterday reiterated claims that it’s all a case of mistaken identity.

Singer and actress Annie Yi took legal action against the Shanghai Wanzhong Hospital after she discovered it was using her picture on its website to promote plastic surgery.

In the first trial, Shanghai Wanzhong was ordered to pay Yi more than 144,000 yuan (US$23,640), after its claims that the pictures were of someone else were rejected.

But yesterday at the Shanghai No. 1 Intermediate People’s Court, the hospital insisted again that the photographs were of a woman called Rao Dongdong.

It said the photos had all been digitally processed to ensure they had a consistent likeness.

It also said the two websites that used the pictures were not Wanzhong sites, but those of business partners.

After discovering nine unauthorized photographs in June last year, Yi demanded that the hospital remove the pages, apologize and pay compensation. Wanzhong took down the pages but refused the other demands, saying the woman in the photographs was Rao. Yi then brought a law suit, accusing Wanzhong of infringement and demanding compensation of more than 1.54 million yuan (US$252,616), plus a public apology. In the first trial, the court ruled that the woman in the photographs didn’t resemble Rao.

“After the photos were posted online, people asked Yi if she had undergone plastic surgery, which had a negative effect on her image,” Yi’s lawyer told Shanghai Daily.

The court didn’t return a verdict.

Source: Shanghai Daily

Call for government to beef up security to prevent hospital attacks

Dozens of members of the National Committee of the Chinese People's Political Consultative Conference (CPPCC) submitted a proposal to the committee on stepping up security against attacks on hospital staffers by patients and visitors, in a bid to control the rising menace of such assaults, The Beijing News reported on Wednesday.

Ling Feng, director of the neurosurgery department of Beijing's Xuanwu Hospital and a CPPCC member, along with 30 other CPPCC members, had submitted the proposal on November 1 and sought an emergency response system for victims.

Ling said that there should be "zero tolerance" for violence against medical practitioners and security regulations in hospitals should be improved. He also suggested that hospitals should be managed by the government as public places and their security should be handed over directly to the police rather than make them the responsibility of private security guards hired by hospital management.

"Currently, the security standard in hospitals is lower than that of public places. If a person disturbs order in a public place that person could be detained," Deng Liqiang, director of the legal department at the Chinese Medical Doctor Association (CMDA), told the Global Times on Wednesday.

"But according to regulations at hospitals, people will only be punished if they physically hurt or kill someone."

Over the past few years, incidents involving violence against doctors have been on the rise as reported from various parts of China, at least six cases since October.

A doctor in Wenling, East China's Zhejiang Province, was stabbed to death by a patient on October 25, in a recent such case. Two other medical practitioners were also injured.

Ling said in an interview with China Central Television (CCTV) on October 31 that she felt obliged to initiate the proposal after the Wenling incident.

"I feel sad for my colleague and the murderer should be punished by law," Ling said in the interview.

The proposal said the "fundamental solution" to clashes between patients and the medical fraternity is to speed up healthcare reform. The violence hurts the morale of medical workers, the proposal added.

"The key issue here is that the government needs to invest more, not only to improve the working environment for medical practitioners, but also to step up security in hospitals," a practicing doctor from Beijing told the Global Times, on condition of anonymity.

In his survey conducted at hospitals across 11 provinces in August, Yin Dakui, head of the CMDA, found that 78.01 percent of doctors said they did not expect their children to take to their profession in future, CCTV reported.

Source: Beijing News

US volunteer medics say Chinese lack health literacy

China needs effective campaigns to educate its public about basic healthcare knowledge immediately, according to an American volunteer medical team working in Northeast China's Jilin Province.
Tom Yeh, a heart physician from the Garfield Medical Center and the volunteer team leader, said that American doctors have offered free clinics in China for decades, but not always in the same way as Chinese American doctors from the Garfield Medical Center,  who have been doing so at their own expense for more than a decade.
Yeh went to Northwest China's Xinjiang Uyghur Autonomous Region for his first volunteer activity in 2001. He said the current Chinese healthcare system can be improved by enriching medical resources in rural areas and opening up to private hospitals.
He believed that there is great potential in the Chinese medical market once more private investment can be put into the field to provide more medical facilities.
Another problem lies in the unbalanced development in the Chinese medical system, as medical facilities and treatment are sophisticated in big cities while those in towns and villages remain poor, said Yeh.
Members of the volunteer group agreed that the most pressing issue for the Chinese medical system is to popularize healthcare knowledge among the public, which could be of great help in disease prevention and treatment.
David Chu, a surgeon also from the medical center, said the mortality rate of breast cancer patients is low in the US because of good education and dissemination of knowledge, but the breast cancer rate is on the rise in China, partially attributable to the absence of effective outreach campaigns to disseminate related healthcare knowledge.
Su Xiaojian, a recovery nurse, said that many patients know nothing about prevention, and have no awareness of preventing diseases from their daily meals. For example, some high blood pressure patients take medicine for treatment and eat salty food at the same time, Su added.
The difference in medical systems between China and the US has led to a divergence in nursing styles.
Li Mingmei, head nurse of the medical center, said American nurses provide both medical and mental care for patients while Chinese nurses take care of patients according to the doctors' instructions.
The medical team also noticed some progress in the Chinese medical system, such as senior citizens over the age of 70 being able to see doctors without registration, and being able to call an ambulance 24 hours a day and be sent to hospitals for free.
Li Xuhua, a respiratory doctor also from the Garfield Medical Center, said ambulance costs, unlike China, are very high in the US and some Chinese-Americans will not call 911 unless the situation is extremely serious.
Erik Jiang, Chief Business Development Officer at Garfield Medical Center, said that their medical volunteer team has regularly organized at least two activities overseas every year since 2001.
The team has been to some poor and remote areas in China, including the Xinjiang Uyghur Autonomous Region, Qinghai, the Tibet Autonomous Region, Guizhou, Sichuan, Yunnan in China, and also Peru, Chile, Nepal, India and Cambodia, said Jiang.

Source: Global Times

China medical news - Thursday 7th November 2013

Call for crackdown as 'black' clinics flourish

Illegal 'back street' clinics are thriving in many urban and rural areas despite law enforcement authorities' prohibitions, a Xinhua investigation has found. A survey has shown that the success of illegal clinics is being driven by high profits and demand from a mobile population and lack of medical services in many rural and peripheral urban areas. Law enforcement is weak and this is the main reason for the persistence of illegal medical practice, and the resulting incidents that have occurred, according to the Xinhua investigation.  Illegal practice "chronic illness" urgent by raising the cost of illegal, optimizing allocation of medical resources, the formation of regulatory efforts to cure such manner.

　　A reporter found a wide variety of covert and rampant illegal medical practices in  new development zones where migrant workers gather, .

　 　In these black clinics, the office "doctor" operates without registration and charges only one-tenth the price of formal medical institutions. Reporters followed law enforcement officers investigating an illegal pharmacy whose owner was administering injections for fevers, colds and flu. The owner said he saw dozens of patients a day and charged ten yuan for IV fluid infusions whereas the regular clinic injection fluid needs more than 100 yuan,

　　Law enforcement personnel, say the black clinics offer cheap but often counterfeit or substandard drugs. They also do not ensure sterilization and use cheap and substandard medical equipment and other necessary supplies, which are very profitable for them. The majority of illegal medical practitioners have no formal medical education, and are likely to provide incorrect diagnosis, resulting in patient injury or even death. Nevertheless, their low costs and ease of access means these illegal practices are used by the general population with limited financial resources and fixed residence.

　　Law enforcement against illegal medical clinics is a big headache.

　　as the offenders play cat and mouse with the health authorities and Public Security Bureau. When a clinic is detected, investigated, prosecuted and closed down, another will soon spring up nearby. Despite repeated penalties, the clinics are difficult to monitor and can soon re-emerge as they have low costs and law enforcement is weak. Staff shortages in health authorities are very common, and in one district two law enforcement officers are responsible for the supervision and inspection of hundreds of dispensaries, medical institutions, as well as infectious disease monitoring, disinfection products and supervision work. 

　　Grass-roots law enforcement officials say China's current laws and regulations on penalties for illegal medical practice do not form a sufficient deterrent. Penalties for the illegal practice of medicine are less than 100,000 yuan. These fines are too low to deter highly profitable black practices,  where illegal  practitioners dare to take the risk.

　 　Recently, the State Development Planning Commission, Ministry of Public Security and other six ministries jointly launched a special action to combat illegal medical practices. The law enforcement and public security program will to develop a long-term mechanism to increase the penalties for illegal practice and also boost judicial deterrence. Meanwhile, adjustments in regional health planning will encourage and attract formal medical institutions to enter the urban-rural interface, new development zones. Migrant workers will have access to more flexible health insurance policies, and improvements will be made in the level of community medical services in rural areas, for disadvantaged groups.

Source: Xinhua

Guangdong child has  H7N9 bird flu

The boy, a Sichuan-born native living in a village in Dongguan City, tested positive for the virus at the Dongguan City Center for Disease Control and Prevention. This followed routine monitoring of flu-like cases in Changping Hospital on Monday afternoon and was confirmed by the provincial CDC yesterday morning, Guangdong Province Health and Family Planning Commission said. It is the third H7N9 case confirmed this autumn in China, following two infections in Zhejiang Province on October 15 and 23. The boy is receiving treatment in isolation at the People’s Hospital of Dongguan City. He is in a stable condition without fever, while other flu-like symptoms he has are not serious, said officials. Meanwhile, on Monday, the National Health and Family Planning Commission announced that it is including H7N9 in its infectious disease reporting system. This will enable better monitoring, prevention and control of this potentially fatal disease, the commission said.

As the live poultry industry — a source of transmission —  is still widespread and winter and spring are peak seasons for respiratory infections, experts expect more cases. China’s mainland had reported 134 H7N9 bird flu cases by the end of August, resulting in 45 fatalities.

Source: Shanghai Daily

No more transplant organs from executed prisoners

China is putting a stop to its widely criticised practice of using the organs of executed prisoners in medical transplants. The practice is being phased out from November. Senior official Huang Jiefu, from the National Health and Family Planning Commission, announced a resolution that’s to improve China’s organ transplant system.

Under this, 169 Chinese hospitals currently licensed for transplant procedures, must ensure the organs come from ethical sources. And related organizations are to work together under the China Organ Transplant Response System, or COTRS, to allocate the organs "equitably and transparently".

COTRS is a computer system that allocates organs based on medical urgency and time spent on the waiting list. The resolution also sets out a timetable for reviews, and hospitals and doctors who do not follow the regulations will have their license revoked.

Source: CNTV

Strict new quarantine rules for cholera

a move to prevent the spread of cholera, China's quality watchdog said on Wednesday that local authorities must implement medical inspections and disinfection routines on persons and vehicles from countries with cholera.

From September to October29 this year, Mexico reported 176 cholera cases causing one death. The virus found in a Mexican patient was similar to that in Haiti, Dominica and Cuba, according to a recent World Health Organization report. The General Administration of Quality Supervision, Inspection and Quarantine (AQSIQ) said people who have been to those countries and have symptoms such as vomitting and diarrhea should inform local AQSIQ bureaus  immediately. Travellers in these countries should avoid possible contaminated water and food. In addition, the AQSIQ requires local bureaus to intensify inspections and make medical treatment a priority on any patients infected with cholera.

Source: China Daily

Liver disease a problem for Taiwan

Every year in Taiwan  13,000 people die of liver disease, and one person dies of liver cancer every 40 minutes according to the "Liver Foundation" 

At a press conference to promote "Save the liver" program, survey results from the Liver Prevention and Treatment Research Foundation showed that one in five people in Taiwan are hepatitis carriers,  and 64% of patients do not know they are infected. The Liver Foundation has since 2007 been promoting the "Save the liver"  township screening program, and now has Taiwan 4890 outlets, through which the free screening services are offered for early detection and treatment.

Source: Beijing Daily News

China medical news - Wednesday November 6, 2013

Trace element test ban for children

Medical institutions are not to conduct non-medical trace element detection for children, the National Health and Family Planning Commission said on Wednesday.
It said in a circular that standard operations should be employed when such detections are for medical use, and that the equipment used for blood collection should be authorized by food and drug authorities.
The detection of children's trace elements should not be listed as items of routine health examination, especially for children under six months old, the statement added.
The commission did not explain why the ban was issued. In China many young parents tend to give their children dietary mineral supplements, believing those are beneficial to body development. Commercial services featuring trace element detection sprang up as a result.
The commission asked local health authorities to enhance supervision and management of medical institutions and punish violators in accordance with law.
Source: Xinhua

Doctors in China believe in professional values but don't uphold them

Chinese physicians hold positive attitudes to professionalism principles, but their behaviour is inconsistent with their attitudes, especially in the areas of competence, quality improvement, and self-regulation. In a study from Tongji Medical College in Wuhan, more than 90% of 300 clinicians surveyed agreed with statements about medical professional principles. However,  80% of respondents reported that they usually or always participated in quality improvement activities and 48% reported that they usually or always participated in peer evaluations of colleagues' quality of care. Some 48% had encountered incompetent colleagues and 18% had encountered significant medical errors caused by colleagues. Among those who had encountered incompetence or significant medical errors, almost two thirds had never reported their concerns to the hospital or other relevant authorities. Half of the physicians did not obtain enough continuing medical education credits. Physicians' professional reported behaviors were influenced by their personal and professional characteristics, professional attitudes, and assessment of hospital internal management constitutions. For example, participation in decision-making had a significant role in professional reported behaviors of protecting patient confidentiality, improving quality of care, and self-regulation, with those sometimes or often participating in decision-making indicating higher levels of reported behaviors than those who seldom participated.
Read full study at Social Science and Medicine

C-Reactive Protein and urate predict diabetes complications

CRP and uric acid are associated with increased risk of albuminuria in type 2
diabetic patients, Shanghai researchers have shown. In a study involving 1162 type 2 diabetic patients, there was an interactive effect of CRP and uric acid on albuminuria. The study researchers from Fudan University said combined assessment of CRP and uric acid might be helpful in the

risk prediction of diabetic nephropathy and identifying diabetic patients who may require intervention to prevent or delay kidney injury. Their study also "provided evidence that increased CRP and hyperuricemia may be the targets of the treatment of type 2 diabetes," they said. 
Read the full study in Chinese Medical Journal

Y10 billion private health fund to build hospitals

The CITIC Trust Company has issued the first fund in China's healthcare industry, following the State Council's recent call to boost the development of the nation's healthcare industry.
The fund, the first of its kind in China, aims to benefit its investors mainly by constructing and operating the "Jialize International Health and Wellness Center" in Kunming, Southwest China's Yunnan Province. Investors can also use the center's services after it is completed. The fund's overall size is expected to reach at least 10 billion yuan.
Three leading healthcare organizations in the UK and one from France are expected to cooperate with CITIC.
"The UK has rich expertise in e-health technology. UK organizations will make sure that the UK model, especially the national health service (NHS) model, will be adapted to China's situation," Brian Gallagher, commercial counselor of Trade and Investment for China at UK Trade & Investment, told the Global Times Thursday.
"China is facing a problem of an aging population. However, the corresponding public healthcare service for the aging population is inadequate," Fan Shibin, healthcare expert from Chinese Medical Doctor Association, told the Global Times Thursday.
Building a new healthcare model to meet the complex demands of China's healthcare services is urgent, Fan noted. China's aging population reached 194 million as of last year, occupying 14 percent of the total population, according to official statistics.
"By investing in the healthcare industry, the trust companies should be cautious about how to balance making profits and satisfying customers, cost control and good management system," Zhong ­Hongyue, a healthcare sector expert at consultancy Frost & Sullivan, told the Global Times Thursday.
Source: Global Times

High altitude illness database set up

Sichuan clinicians have set up a database of acute high-altitude illnesses that is world leading in terms of the number, variety, and source distribution of samples, the People's Liberation Army (PLA) Daily reported on Tuesday.
The database was established by Xinqiao Hospital of the Third Military Medical University in Southwest China's Chongqing, the newspaper said.
The 20,000-strong set of body function data and blood samples was collected by more than 60 doctors and professors from the hospital who had been monitoring people traveling from the Chengdu Plain to the Qinghai-Tibet Plateau in various vehicles since 2011.
The database features extensive distributions with samples collected at an elevation of as high as over 6,100 meters.
The database will facilitate research in dramatically reducing the morbidity and fatality of acute high-altitude illnesses.
Source: China Daily

COPD: Five reasons why new GOLD classification won't work for China

Commentary by Nina Sheng in The Lancet says the new 2013 GOLD criteria are unsuitable for China and other developing countries because:
1. Many doctors have a low level of training and may not be aware of guidelines or lack skills to implement them.
2. Clinicians in China are very busy seeing up to 80 patients a day and may nt have time to apply GOLD diagnostic questionnaire criteria.
3. Spirometry not widely available.
4. Patients do not self manage COPD exacerbations well - over-reliance on antibiotics, underuse and misuse of inhalers/steroids.
5. Medications are expensive - only the wealthy can afford them.

Tick bites a common cause of fever of unknown origin in China

Rickettsioses are more common than previously realized and may be associated with misdiagnosed causes of fever, researchers from north east China say. In an article in NEJM they describe 251 patients who had recent tick bites sought treatment at Mudanjiang Forestry Central Hospital. None of the patients presented with rash, which is considered to be a typical sign of infections with species of rickettsiae of the spotted fever group in China. Thus their conditions were initially misdiagnosed, and they received penicillin G, leading to a prolonged hospitalization for approximately 20 days.
Read the full study at NEJM

Lancet study shows high incidence of HIV among gay men in China

Study from Peking University finds that among 5800 gay men there were 484 (8·3%) prevalent cases of HIV infection and 293 (5·1%) prevalent cases of syphilis. Among 3178 gay men who were HIV negative at enrolment and who had also completed at least one follow-up interview, 387 infections were observed in up to 5467 person-years of follow-up, implying an incidence of 7·1 per 100 person-years, with median follow-up of 1·7 years and an average retention rate of 84% per 6 month interval.
Read the full study at The Lancet

Promoting baby formula banned in public hospitals

by Wang Qingyun
Hospitals are banned from accepting gifts, sponsorship or kickbacks from baby formula companies, authorities said on Tuesday.
Companies producing baby formula are also prohibited from promoting their products in hospitals.
The decision was jointly made by the China Food and Drug Administration, the National Health and Family Planning Commission and the State Administration for Industry and Commerce.
Hospitals and their members of staff are also banned from promoting baby formula to families of newborn babies, said the statement issued on the website of the China Food and Drug Administration.
The move came more than a month after the National Health and Family Planning Commission issued a similar statement in response to a scandal in which Danone was discovered to have bribed medical workers in hospitals in Tianjin to give babies its infant formula products under the brand of Dumex.
On Oct 14, the Tianjin government said that Dumex China paid 116 workers in 85 hospitals in the city to promote their infant formula by handing out pamphlets and giving lectures to parents.
The government said it has confiscated the money these medical workers received and 13 were penalized.
Read more at People's Daily

Rural doctor training plan released

China has set targets for its nurturing of trained doctors in order to better serve the country's huge rural population, according to a plan publicized on Monday by the National Health and Family Planning Commission.
The plan, which was jointly issued by several government departments, urges improvements to the country's education and training system for rural doctors, in a bid to ensure that 60 percent of such doctors hold degrees from secondary technical schools or above by 2015.
In addition, all rural doctors are expected to be qualified as medical practitioners by 2020, under the plan.
The number of rural health workers in China reached 1.2 million by the end of 2010, marking an 18.1-percent jump in comparison with the number in 2000, according to the commission.
The plan also called for the creation of a strict training mechanism for rural doctors in order to improve their education level.
Source: People's Daily

Hospital capacity limited by public system - Caixin

China now has 10,000 private hospitals in operation, accounting for 40 to 50 percent of the total number of hospitals. Yet these hospitals treat fewer than 10 percent of patients. Their impact on the market is minimal.
This problem will not be solved as long as resources remain concentrated in the public system, and it continues to be treated as the star of China's healthcare structure. In this environment, private capital simply cannot compete and help raise overall industry standards.
Read more at Global Times

Exodus from the public hospital system

by Liu Dong
After a successful career as a doctor in China's public hospital system for 20 years, 47-year-old Zhang Qiang made a bold decision to quit his job and go private. Almost one year on, he said he has never felt so close to his original dream.
Ten months ago, Zhang announced his high-profile resignation on his personal Sina Weibo, drawing thousands of reposts and comments online and widespread attention among his colleagues and patients. For Zhang, the decision not only meant giving up a 400,000-yuan-a-year job ($65,560) at a top hospital in Shanghai, but also meeting the very practical challenge of survival.
Today, Zhang works under contract for two major private hospitals in Beijing and Shanghai. He said his goal is to build China's top vascular surgery brand within five years.  
Zhang is not the only doctor to take the plunge. A number of young doctors like Zhang have made, or are considering making, the decision to leave public hospitals to pursue new possibilities. They might not be the most experienced or famous doctors, but they are all distinguished in their field and have a new understanding of how to practice medicine today.
These doctors chose to rid themselves of the system's constraints because they long for a brighter career, a more relaxed working environment, more income earned through legitimate work, and most of all, to better serve patients and earn the respect that comes with being a doctor, which is why they initially chose to take up this profession.
Read full article at Global Times

Mercenary healthcare risks doctors' lives

by Sun Xi
Over the past month, at least six attacks on doctors have been reported within 10 days, leaving one dead and several others badly injured.
On October 27, staff at the No. 1 People's Hospital of Wenling City, Zhejiang Province, took to the street to protest the killing of Dr Wang Yunjie, a colleague. They guarded Wang's body and refused to disperse in a stand-off with police. Some doctors staged a sit-in, raising placards denouncing violence against medical workers.
It all started two days earlier, when a disgruntled patient who believed his surgery had been botched stabbed three doctors at the Wenling hospital.
The dramatic sight of doctors guarding the body of their slain colleague reminded people of the stunts often performed by families of patients who died after treatment. To wring higher compensation from hospitals, relatives occasionally exhibit the bodies of patients they claim died as a result of medical malpractice.
The spate of deadly attacks has caused heightened concerns by authorities. But concerns alone are not enough, for similar attacks keep taking place, a sign of patient-doctor strife.
Although the authorities and media have been calling for less antagonism and more trust, it is obvious that the distrust between doctors and patients runs deep and increasingly is boiling over into murderous anger.
The discord is rooted in the healthcare system itself. 
Read the full article at Womenofchina.cn

China is groping its way through another ‘airpocalypse’

by Zhang Yansuang

The cold weather has come, the coal-powered heating has been switched on, and China’s north is once more swathed in thick smog. Air pollution has been a worsening problem in China in recent years, and a problem that has sparked huge public protest on Chinese social media. But has anything been fixed? Residents of Harbin would likely say “no”.
Two years ago in December 2011, a nation-wide debate over air pollution on Sina Weibo - China’s most popular microblogging service - focussed public attention on the scientific term “PM 2.5”. PM 2.5, or particulate matter 2.5, refers to tiny particles or droplets in the air that are 2.5 microns or less in width.
Exposure to fine particles can affect lung function and worsen medical conditions such as asthma and heart disease. Studies also suggest long term exposure to fine particulate matter may be associated with increased rates of chronic bronchitis, reduced lung function and increased mortality from lung cancer and heart disease.
But why was the Chinese public so interested in such an obscure term?
Read the full article at The Conversation

Chinese medical staff risk burnout

by Wang Hongyi
Zhou Zhenghao always presents a smile when talking about his daughter, but his face grew tight when the talk turned to his daughter's career choice in the future.
“I will never let her become a doctor in the future. Furthermore, I will also never agree to let her to marry a doctor,” said the 31-year-old man who is a dentist at a large hospital in Tianjing municipality.
“People will never really know how hard and tough the job is, except when you are in the middle of it,” he said.
Zhou works for about 10 hours each day, with as many as 30 patients a day at peak times.
Like Zhou, a large number of medical staff across the country believe that they are working in an unsatisfying environment with less understanding of their patients.
A survey said about 74.2 percent of medical staff in Shanghai have job burnout, cited by Labor Daily, a newspaper under Shanghai Municipality Labor Union.
The survey conducted by the Shanghai Medical Labor Union, which polled about 170,000 medical staff in the city, tried to discover their occupation and living conditions.
The survey said about 72.5 percent of polled medical staff showed occupational strain caused by high-stress work, and more than 80 percent said “they are very tired.”
And nearly 60 percent said the trust between doctors and patients was not high. Medical costs, communication, treatment result and service attitude were the main factors contributing to the result.
Source: China Daily

In case you were wondering ....

Still going, just a bit quiet. I've moved back from UK to Sydney, so taking time to get settled. May continue with this site if there is sufficient interest ...