Will China go bust with new major illness medical insurance scheme?

By Michael Woodhead

In a major feature in today's Beijing News, health economists warn that China faces many problems in widening its medical insurance schemes to cover serious and catastrophic illness. These schemes will cover major illnesses such as cancer where the large medical expenses can often result in families falling into penury. Serious disease medical insurance schemes are currently being pilot tested in 27 provinces and 130 cities, but experts say the existing schemes are very varied in their operation, have mixed results and are often poorly managed, with little commitment from local authorities. The Chinese State Council has recently recommended that implementation be speeded up and has ordered all provinces to have serious illness medical insurance pilot programs up and running by June.
At present, almost 290 million Chinese people are theoretically covered by such catastrophic illness schemes that have funds of more than 600 million yuan. Under existing medical insurance programs the reimbursements for serious illness are meagre and not enough to cover even the most basic costs of treatment. The average reimbursement for urban residents is 258 yuan and for rural residents it is 148 yuan. Health economists say there is a danger that if not managed effectively, a more extensive insurance scheme could simply be like "throwing a cup of water on a blazing woodcart". They point to the widespread 'leakage' in the current medical insurance schemes, in which little of the government funding actually gets to benefit the patient. When the government introduced widespread basic health insurance a few years ago the funding was absorbed by hospitals and practitioners who inflated their fees and carried out unnecessary treatments that would attract reimbursements from the government funds.
Therefore experts say that any new scheme must come with strict supervision and conditions to ensure that providers and insurers do not abuse the scheme. Otherwise there is a danger that any such national scheme would become a bottomless pit into which money was poured but with little benefit.
They say current pilot schemes have proved disappointing, with many of them being incomplete and incompatible with other schemes in neighbouring areas. Many still offer inadequate reimbursement to patients with serious illness and many are underfunded to provide sufficient benefits.
There also needs to be provision for rare and expensive to treat illnesses such as Gaucher's Disease, they warn. Without this, patients and their families will still face ruinous expenses when someone becomes ill.

"China's Top 10 Hospital" Awards are fake and can be bought for 28,000 RMB

[translated by Michael Woodhead]
China's national broadcaster, CCTV, has exposed a scam in which an official-sounding organisation known as the China Hospital Management Society has been selling hundreds of 'Top 10 Hospital' awards for 28,000 Yuan apiece.
The expose on national television showed that the CHMS had made millions by 'selling' awards and it claimed to have connections with government bodies such as the National Health and Family Planning Commission. However these bodies have now issued a denial of any involvement and have called for a full investigation into the society and its fake awards.
On its webpage (now unavailable) the CHMA claimed to be a non-profit public organisation operating under the auspices of the NHFPC and the Ministry of Civil Affairs.
Just a few days ago the CHMA website was publicising the launch of its "2014 China Hospital Outstanding Manager Award" and also a "2014 Chinese Health Consumer Hospital Satisfaction and Trust Award".  However, it did not say what the requirements or criteria for these awards were, only the closing date for nominations - April 8th.
In January, the CHMA convened a conference in Beijing entitled the "2013 China Hospital Management Science Award Ceremony", the main purpose of which was to award participants with prizes and awards. The conference prospectus states that the society's honorary office bearers hold leadership positions in many important official bodies. Reporters verified these names and the fact that they attended the ceremony in question. A sponsor of the awards commented that these heavyweight leaders required payment  of expenses to attend.
The participation of these 'heavyweights" attracted many other organisations and individuals to attend the awards ceremony.  According to the "Roll of Honour" there were 321 medals awarded. Administrative staff told CCTV that the awards organiser took in more than 10 million yuan per ceremony, and these awards have been offered twice a year for 4-5 years.
According to CCTV, participants who were willing to pay more could get more prestigious awards. Among the ten or so higher awards were the "All-China Top Ten People's Satisfaction and Trust Hospital" award and the "Top 10 Most Trusted Pharmaceutical Company" award.
A CCTV reporter attempted to follow the process of such award by enrolling in the awards system. Despite missing the entry date he received an official confirmation letter, confirming that his 'hospital' had won a "Top 10" award. To collect the prize trophy, certificate and medal he was told he had to pay 28,000 yuan.
There were about 300 participants in the awards of varying sizes. Some received one 'award' , others received several. The organiser said "if you say you are advanced you can be advanced, if you want to be outstanding, you can be outstanding, it can be rubber stamped if you pay more money."
The CCTV report said some winners of the 'awards' auctioned them off to others.
Those who bought the prizes said they had many uses, and could be put on display to fool the public. They said the ceremony allowed them to have their photos taken with the influential 'heavyweights'  who were in charge of important departments and held high office, and would help them win tenders. Others said they bought many smaller awards for 4000 yuan at the ceremony and then sold them on to smaller subsidiary hospitals for a profit.
The  China Hospital Management Society claimed to be operating under the supervision of the NHFPC, but there is no record of it on the NHFPC website. The NHFPC announced that the CHMS was not linked in any way to the department and it was not a legitimate assessment or rating organisation. The department said all bodies that conducted assessments, ratings and commendations in healthcare had to strictly adhere to standards and supervision. The so-called CHMS awards for top hospitals and outstanding performance were all invalid, it declared.

Editor's note: The CHMA appears to be a bogus version of the official Chinese Hospital Association whose website (cha.org.cn) and a list of genuine awards can be seen here. The CHA has published notices warning of the bogus CHMA.

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

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

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

About 50% of pig farmers in Guangdong have hepatitis E

Hepatitis E is endemic in the pig herds of Guangdong, and this is reflected in high rates of the infection among swine herders, a study shows. About 50% of pig farmers in Guangdong show serological evidence of hepatitis E infection, and 38% of the general population have been infected by the disease spread by the faecal route, according to findings published in PLOS One. The epidemiological study of Guangdong people bwas carried out by Dr Liang Huanbin and colleagues at the Ministry of Agriculture Key Laboratory of Animal Vaccine Development, College of Veterinary Medicine, South China Agricultural University, Guangzhou. It found that Hepatitis E infection rates were higher than in surrounding provinces such as Hunan (22%). The study also found that 60-90% of pig herds had the infection, which raised questions about the health risks of pork, the researchers said.

HIV strain is more aggressive in China - professor

HIV may be more aggressive in China because many infections are caused by a more virulent strain of the virus seldom seen in other countries, Beijing researchers say. Professor Li Taisheng, an infectious diseases specialist at the Harmony Hospital in Beijing say the average time to progression from HIV to immune failure and AIDS is eight years in western countries, but as little as four years in China. The reason for this appears to be a special strain of HIV with a factor known as CRF01, he told the Jinghua Daily. He said a newly published study involving more than 200 HIV patients from across China showed that the more virulent virus was found in almost half of people with HIV.
"CRF01_AE, a predominant HIV-1 subtype in Chinese HIV-1 sexually infected patients, tends to be associated with fast progression to AIDS and advanced immunodeficiency, which might be ascribed to high proportion of X4 tropism. Further investigation of these risk factors may have significant implications to clinical practice and policy-making," his study published in the journal AIDS concluded.

News in brief: Saturday 15 February

China's widespread misuse and overuse of antibiotics needs to be curbed, according to an article published in the BMJ this week. Dr Li Yan who works at Nottingham Trent University in the UK, writes that pressure from patients and perverse financial incentives are just two of many factors that have contributed a high rate of antibiotic use that is ten times higher than that of the US. Antibiotic overuse leads to resistance and causes numerous adverse events, she says. New regulations introduced by the Chinese health department need to be fully implemented, she adds, and there also needs to be a major public education campaign to improve awareness about antibiotics and reduce demand, she suggests.

A Hunan official has been found guilty of selling fake medical licences to six "black (bogus) doctors" who had not passed any medical exams. The records department workers sold the medical licences for 45,000 yuan to people who set up private medical clinics and pharmacies. The official was sentenced to eight months in jail and the medical licences were cancelled, Xinhua reports.

Almost 16,600 Chinese people died of infectious diseases in 2013, with HIV being the main cause of death, the National Health and Family Planning Commission has announced. There were more than 6.4 million infectious disease cases reported, of which AIDS, tuberculosis, rabies, hepatitis and hemorrhagic fever were the most deadly diseases, while hepatitis, tuberculosis, syphilis, dysentery and gonorrhea were the most prevalent, ECNS reports.

Family beat doctor and force him to kneel before dead patient's coffin

A medical dispute in Shaoxing took a bizarre turn when the relatives of a man who died of infection in hospital brought his coffin to the hospital and forced a doctor to kneel before it and kow-tow. The gang of family members then beat the doctor severely and also fought with police. Xinhua reports that the family brought the man into hospital suffering from a gallbladder complaint. He initially recovered slightly but then developed a severe infection and died. Family members blamed the hospital for his death and returned to hold a 'funeral' in the hospital reception area. The laid wreaths there and brought the coffin of their father. The family members caused a commotion, shouting and swearing, and they grabbed a doctor who they made to kneel down before the coffin for almost an hour. Then they beat the doctor so severely he required hospital treatment. The assailants also fought with police before they ran off. The incident has generated a lot of comment on social media sites, with some people saying they sympathise with the family but their violent actions were too much. Medical staff at the hospital are outraged and say the attackers must be caught and tried for their 'disgusting and brutal behaviour. Local law enforcement official shave told the family members to give themselves up.

Shenzhen "black doctors" performed unnecessary abortion

A 17-year old Shenzhen women says her healthy baby was aborted by an illegal clinic staffed by unqualified staff (bogus or "black" doctors) who were only interested in making money for doing an operation. The woman went to a private clinic in Shenzen when she had minor bleeding during her pregnancy. The staff there did an ultrasound and told her the fetus was dead and that she should have an abortion. She did so, but was also told she needed additional surgery to have tissue removed. In total she paid more than 4000 yuan. However, her family became suspicious when they noted the 'doctors' at the clinic had the same names as other local doctors. When they investigated further, they found that the doctor who diagnosed' the stillborn fetus did not exist. An investigation by the local health department confirmed this - and found that some of the fake doctors involved in the incident had assumed the names of real doctors who had previously worked in Shenzhen. One doctor who did surgery proved to be genuine, but said she had acted in good faith, accepting the referral and the information from the fake was real. The fake doctors have since disappeared and the clinic they worked at was fined 3000 yuan and given 18 demerit points. The family of the girl complained that this was too lenient.

Hubei group protest forced psychiatric treatment of people without mental illness

People who complain against the government are being forced into mental institutions and given forced treatment with antipsychotics and electroconvulsive therapy, a human rights group in Hubei has told Radio Free Asia.. Liu Feiyue, a spokesman for the Civil Rights and Livelihood Watch says the psychiatric hospital system is being abused and there have been 40-50 cases of forced treatment of healthy people during 2013, in contravention of China's new Mental Health Law, which came into effect in 2013 but is not being implemented on the ground.

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

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

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

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

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

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

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

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

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

News in brief: clinical studies from China

Measles is now rare in Guangzhou thanks to vaccination, but complete eradication will require vaccination of transient populations who now account for more than half of cases.

People who have a heart attack in China delay going to hospital for more than two hours, often because they don’t recognise the symptoms or their importance.

Chinese people consume dangerously high amounts of salt, with a Yantai study showing that 97% of men and 87% of women had intakes of over 6 g salt per day (mostly from added salt and soy sauce). Salt intake was related to high systolic blood pressure.

More than one in four new mothers in Guangzhou experience post-partum depression.

Compulsory routine infant vaccination with pneumococcal conjugate heptavalent vaccine would reduce pneumococcal disease in China by at least 32%, would prevent 2,682 deaths in the first five years of life and would save $1,190 million.

In rural China epilepsy goes untreated or undertreated in two out of three people with the condition, a Sichuan study has found. One third of people with epilepsy did not know about the disease and had not sought medical help.

The cultural pressure for gay men in China to marry means that their wives face a high risk of HIV and syphilis, researchers from Ningbo say. They found that only one in four gay men always used condoms with their wives, which explained HIV rates of more than 8% in women married to gay men.

Low vitamin A levels are linked to eye cysts (chalazia) in south west China

Weather has an important influence on measles transmission in China, with infection more likely after cold spells and during dry weather.

Shanghai hospitals' database hacked and records sold to drug companies

translated by Michael Woodhead
A 'mole' hacked into the databases of three major Shanghai hospitals using wireless laptops and extracted drug usage data that was sold to pharmaceutical company representatives, Eastday reports.
The Huangpu court has found two people guilty of fraud after they downloaded drug data from the three hospitals and sold it for 12,000 RMB to drug company contacts. One of the hackers worked in the technical department of one hospital, the other was a pharmacist. The hacker used a laptop computer while sat in a car in the carpark of the hospitals to hack into the wireless network. They were caught in July 2013 when IT staff noticed unauthorised users extracting data, and traced them to the nearby car park, where they were arrested by police. They were fined 5000 RMB and sentenced to one year in jail.
In the past, pharma companies would sometimes pay hospitals for the drug usage data, but this practice has been outlawed. The hackers made contact with drug company representatives and told them they could sell the information each month for 46 different drugs for 250 RMB per item. They emailed the data to the drug company employee, who will be tried separately for corruption.

China needs to act on overuse of intravenous infusions - BMJ

[Pic: www.news.cn]

Action is needed to reduce China’s massive overuse of intravenous infusions for inappropriate indications, according to an article in the BMJ this week.
The timid steps taken so far by the Chinese government have done little to dent the widespread misuse of IV infusions, with as many as ten billion courses – or eight per person per year – being given, says Yuan Sanying of the West China Hospital, Sichuan University, Chengdu.
She says the government has recognised the problem and has acted to reduce financial incentives for prescribing infusions. However, there is still enormous pressure on doctors to set up IV infusions and the practice continues in most hospitals. Many hospitals even have dedicated infusion rooms, she notes.
Ms Yuan, who works as a nurse in the Department of Liver Surgery, says hospitals look like ‘infusion forests’ during cold weather spells as patients are treated with infusions for common respiratory ailments. And yet doctors acknowledge that most patients don’t need IV medication and could be better treated with oral remedies and rest.
The use of infusions is a major burden on hospital staff, with nurses reporting being overworked and diverted from other tasks as they spend half their working day setting up IV infusions. The Ministry of health has responded by monitoring the number of infusions and by banning some hospitals and doctors from earning commissions from the use of infusions. However, inappropriate is still driven by pressure from patients who believe that they will recover faster if they have an infusion. Doctors and nurses who refuse to provide infusions face getting into disputes with patients and their families, she says. Yuan Sanying says financial restrictions should be extended to all hospitals. She also recommends a public education campaign, similar to the ones that have discouraged the public from using antibiotics for viral illnesses.

Illegal Beijing bird markets the source of exported H5N1 influenza virus

A backstreet illegal poultry market stall in Beijing was the likely source of the highly pathogenic avian influenza A(H5N1) virus infection that killed a Canadian visitor, infectious disease specialists have suggested.
In January a 28-year old woman developed H5N1 infection on her return to Alberta after visiting Beijing. She died after developing neurological complications. It was assumed that she had picked up the infection in Beijing but it was reported that she had not had close contact with poultry while in the city.
However, the woman probably picked up the virus from one of many illegal poultry market stalls that exist in Beijing, according to Dr Yang Peng of the Beijing Center for Disease Prevention and Control. In a letter to the Journal of Infection this week, Dr Yang says the Canadian case was only the second such case of H5N1 to be linked to the city. He describes a similar case in which a 19-year old woman developed H5N1 infection and died in 2009. Analysis showed that the H5N1 virus was avian in origin and belonged to clade 2.3.4. The woman had bought a live healthy duck from a street market and she had prepared it for cooking. Dr Yang said poultry breeding and live markets were prohibited in Beijing, but illegal markets had sprung up in the suburbs, and these sold poultry reared in nearby Hubei and Tianjin districts.The stall area where the women bought the duck tested positive for H5N1, according to Dr Yang. He therefore suggested that the recent Canadian case of H5N1 may have occurred after the visitor passed through a street market or stall.
The findings "indicate that illegal and uninspected selling and transportation of live poultry from regions outside of Beijing may have posed a high risk on human infection with avian influenza in the general population of Beijing currently. The enhanced inspection of illegal selling of live poultry, the strict regulation of transporting live poultry from regions outside of Beijing, as well as health education on changing dietetic culture is greatly warranted in Beijing, in order to reduce the risk of infection with avian influenza viruses in the general population of Beijing including visiting foreigners," the letter concluded.
And in another development this week, the full genomic analysis of the Beijing-derived H5N1 case has been published in the Emerging Infectious Diseases. The analysis "provides valuable insight into the presence of mutations that may reflect adaptive changes, altered virulence, and/or transmission phenotype," the researchers said.

Woman needs six stitches after argument with doctor

[Editor's note: there are three shocking things about this story, not just the alleged violence against the woman].

A woman in the Sichuan town of Yibin has needed six stitches for a wound sustained after a fight with a doctor over a dirty cushion. The woman named Chen says she got into an argument with a doctor in the X-ray department after she asked him to swap the cushion on the bench because it had  a bloodstain on it. The woman said that she took her 20-month old son to the hospital for a checkup when he had a cough and cold. When she took him into the X-ray room for a scan, she noticed the bloodstain on the cushion and asked the doctor to change it. However, the doctor refused and said "get on with it". When the woman took out some paper towels and started to clean the cushion, she says the doctor disappeared into  side room. She admitted she swore at him in frustration and then the doctor came back and swore back at her. The argument erupted and she said the doctor struck her on the head, cutting it open and causing bleeding, for which she needed six stitches. The woman said she was eventually faced with a bill for 3000 yuan in medical costs and she is demanding compensation from the hospital.
When the Dr Li was contacted at the Huaxi city Renmin Hospital he gave a different story. he said there were some bloodstains from a traffic accident on the cushion  that he had been trying to clean off, but the clinic was extremely busy and he was under a lot of pressure to examine a waiting room full of patients.  He said the woman called Li had been in an argumentative and volatile mood and had shouted and swore at him before chasing him into the side room. He said he had not hit the woman but had pushed her away after she started brawling with him, and she had fallen and hit her head.
 A hospital spokesman said he could not comment on the matter until a police investigation was completed.

Three things shock me about this story:

1. A dispute over a dirty cushion could result in a violent argument between a female and a male doctor.

2.  A woman would  take her infant with a minor illness like a cough and cold to a hospital and have the child exposed to high doses of radiation with needless chest X-rays.

3. The medical bill for a cough and cold (and stitches) could be as high as 3000 Yuan.

What health stories are Chinese people seeing in their media today?

Here are a few samples of the medical and health stories appearing in the Chinese press today (links are to Chinese language sources):

Beijing has introduced screening for H7N9 in high risk groups such as those working in poultry markets.

Cities have been told to strengthen reform of hospital system, and second-line regional hospitals to introduce reform pilot projects.

Overeating and drinking during the Chinese New year has resulted in a 4-fold rise in hospital treatment for gastric problems.

False rumour spread about Beijing women whose stomach 'exploded' after overeating.

Liaoning woman, 18, arrested and forced to make public confession adn apology for spreading false rumours on Weibo about the death of a person from H7N9 influenza.

Rural children have rates of underweight and growth retardation four times greater than those of urban Chinese children, according to NHFPC.

Violence against doctors in disputes with pateints has become so common it is 'normal' says Harbin emergency physician.

Will the expanded cover for major illness bankrupt the rural health insurance scheme?

China's media lauds the "4 cent prescription doctor"

The Chinese-language version of the China Daily is lauding a Henan doctor who prescribed a treatment for a child's rash (an antihistamine) that cost only 4 cents. The cheap cure is seen as big news at a time when many Chinese are complaining about the high costs of medical treatment. The story is based on the overwhelming web response to the Weibo posting of a mother of a two-year-old child, who posted that she couldn't believe how cheap it had been for her child's treatment.
The Weibo post described how she took her child to see a doctor at the Zhengzhou People's Hospital No 3 paediatrics department. The female doctor there told her the rash was due to an allergy and she would prescribe an antihistamine called chlorpheniramine. Based on her previous experience with hospitals, the mother expected to pay several hundred yuan for a long course of medicines - and so she was very surprised when she only had to pay 4 fen for 4 tablets of the antihistamine. She was so impressed that she took a photo of her hospital bill. She was also doubtful that such a cheap treatment could work, and so was again surprised when her child made a quick recovery from the rash.
When she posted this on Weibo, her story and photo was immediately re-posted thousands of times, with netizens starting an online discussion about the high cost of treatment and the difficulties of getting to see a doctor. Many praised the doctor at the children's hospital and said such doctors were hard to find these days.
When a China Daily reporter tracked down Dr Qin Ruijuan, she said her 4 cent prescription was nothing special and that she had only been doing her duty. "Any other doctor in my position would have done the same thing," she said. Dr Qin said the antihistamine was the most appropriate drug for the condition and only a short course was needed.
Dr Qin said some patients believed that doctors made a lot of money in commissions when prescribing drugs and treatments, but this was not the case. She said there was no link between doctors' incomes and treatments ate her hospital, nor were there any targets or quotas.
The China Daily reporter wrote that this was supposed to be the case at all hospitals and a new directive from the National Health and Family Planing Commission issued in December had re-iterated this rule. This included a new series of prohibited practices in healthcare, known as the 'Nine Forbiddens' included taking commissions or kickbacks from prescribing and having quotas  or targets for treatments and prescriptions.
However, the reporter noted that there was a trend for hospitals to stock newer and more expensive medications at the expense of cheaper medicines . This led to a situation where it was impossible for doctor to prescribe affordable medicines because they were not stocked by the pharmacy. And because the profits were so tiny with cheap drugs "manufacturers don't want to make them, pharmacies don't want to sell them and doctors don't want to use them".

Violence in healthcare take a strange turn: nurse beaten by intern for questioning his advice

Healthcare staff in China have become inured to the threat of violence from disgruntled patients and their relatives, but this week a nurse has been subject to a violent beating from an unexpected quarter - an intern in her own department.
The nurse called Li Mei (pseudonym) says she still can't make sense of what happened, but she believes it was because she expressed doubt about the medical advice provided by a new intern in her department called Dr Du Mou.
A Shaanxi newspaper reports that the nurse was working in the internal medicine department of the Railway Hospital at Lueyang, Shaanxi alongside a male intern.
The nurse gave an interview to a journalist while she was lying in bed with an obvious red welt across her swollen face. She said the young male doctor had punched her repeatedly in the face, chest and stomach and also kicked her. She said it was because she had reminded him that his medical advice for one seriously ill patient was incorrect.
"As soon as I finished speaking he hit and kicked me. I was just stunned and dizzy and left with ringing in my ears," she said.
The nurse said she was now so sick she was unable to breastfeed her one year old child.
The local police station said they had sent officers to attend the incident, but when they arrived and ascertained what had happened, they were told by hospital management that this was an internal hospital disciplinary matter and they need not get involved. The head of the department confirmed to the reporter that an incident did take place but he refused permission for media to speak to the intern involved, who was still on duty.
The hospital director said the hospital managers said they were taking the incident very seriously and treating the injured nurse as best they could. An investigation would look closely into the events and would handle the matter gravely. The intern who hit the nurse was a recent graduate from medical school who had not yet passed his one year probation period. The intern said the nurse had sworn at him and cursed his family and he had impulsively struck out and hit her just once. The manager said interns did not have prescribing rights or the authority to give medical advice without supervision form a qualified doctor. He understood the two parties gave very different versions of the incident and the hospital was now investigating.

A note on China's 'guided news' in healthcare

Editor's note: In the three months that I have been translating Chinese-language medical and healthcare stories into English I've noticed that a clear pattern emerging. Every week or so a story theme emerges for stories across China, in which a certain issue is covered in slightly different ways by local media outlets. One clear example of this has been the  shortage of doctors in certain specialities such as emergency medicine and paediatrics. Over a period of 10-20 days I would notice a crop of stories about paediatrician shortages emerging from right across the nation.  Interestingly, each region would have its own angle on the issue: in Heilongjiang the local media might interview a hospital manager and get feedback about difficulties in recruiting new doctors. In Nanning, however, the local media might do a 'day in the life' type feature on the problems of being a paediatrician in a busy and understaffed children's ward. The overall message would be the same. I don't think I'm being too paranoid in thinking that this suggests a certain degree of 'guided news coverage' is being co-ordinated at a national level. In other words, a central media department is instructing regional media outlets that a certain issue must be highlighted in local news coverage. In the last few weeks I've noticed that there have been more stories about the costs of drugs and how hospitals and doctors are tackling the problems of overservicing and high drug prices (eg with the' corridor doctor' story). All these stories seem to be aimed at supporting the Chinese government's latest policy of curbing high drug prices and reining in hospital costs.
Here are a few examples of  'news themes' from the last few weeks:

• Doctor shortages in emergency medicine and paediatrics.
• Overservicing by hospitals
• Drug prices too high - and corruption/kickbacks
• Violence against doctors - and the contributory factors of workforce supply and demand
• Medical insurance coverage to be extended
• Primary care clinic expansion
• Medical education reforms - internships
• Private investment in healthcare

Antibody vaccine for H7N9 is more effective than Tamiflu, say Shanghai researchers

translated by Michael Woodhead
Shanghai researchers say traditional inactivated vaccines cannot be developed against H7N9 but they have developed a gene vaccine which is more efficacious than Tamiflu against the virus.
According to an article in the Workers Daily, an antibody therapeutic vaccine that is effective against the current strain of H7N9 has been developed by Shanghai researchers and is now about to start  clinical trials. Researchers at the Shanghai Public Health Clinical Centre Infectious Disease Research Institute said they had developed antibodies that were effective against H7N9 in vitro and they are now starting tests in humans.
Professor Xu Jianqing of the Infectious Disease Research Institute said that work on the vaccine began in April last year after the first major H7N9 influenza virus outbreaks.  He said the team had made a breakthrough with a gene vaccine in December when they injected the vaccine into 30 mice infected with H7N9. After 30 days none of the mice had died and none had signs of H7N9 infection, which represented the first real proof of efficacy.
Professor Xu said many other research groups in China were doing H7N9 vaccine research but using  traditional inactivated vaccines. However, he said experiments had shown time and again that compared to other influenza viruses, the H7 influenza virus was not amenable to being incorporated into an inactivated vaccine, as it was deformed by the chemicals used, rendering the immune response inadequate. Similar efforts by Dutch researchers to develop a vaccine against the H7N3 virus strain in 2003 were also a failure for a the same reason. This showed that inactivated vaccine technology was not going to catch on for the H7 virus, he said.
The Shanghai researchers had therefore taken the bold step of taking the most important genetic material from the H7N9 virus and implanting it into a mature vaccine carrier. This was the equivalent of putting it into a safe and inserting this into a cell, said Professor Xu. And because the virus structure was not destroyed by putting it into an egg albumen, it elicited a good immune response, he added.
Professor Xu said the new vaccine would be suitable for people at high risk of H7N9 such as those working in live poultry markets and household members.
Within Shanghai's R&D community the new H7N9 vaccine was seen as a breakthrough after an audacious attack. Xu Jianqing said the immune system of H7N9-infected people produced antibodies, and the sooner the body produced antibodies the better the prognosis. He added that Tamiflu was effective if given within the first few days of viral infection, as this was the 'empty' window before the body had started producing its own antibody.  But after more prolonged infection Tamiflu quickly became ineffective,  and drug resistance appeared quickly. Researchers were inspired to try using exogenous antibodies during this initial 'empty window' period when there was no natural H7N9 antibody being produced. The observed effects of the gene vaccine were clearly better than Tamiflu during this period, said Xu Jianqing. In fact, in 2003 during the SARS outbreak, there had also been small scale treatment models of experimental antibody treatment that were successful in curing a patient.
It is reported that at present the H7N9 antibody treatment has already successfully completed two phases of in-vitro testing and it is estimated that Phase 3 testing will be complete within one month. From among the 100+ types of antibody currently in testing the best will be selected for clinical use.