New 10-year medical training program will produce rural generalists

The new 10-year medical training will focus on producing 'generalists'

China has initiated a 10-year education program that aims at cultivating more high-calibre doctors and training more general medical practitioners to serve the countryside.
The program emphasizes improving medical students' capacity in clinical practices and will require them to go through training in medical ethics and a formal residency before they become doctors, according to a notice issued by the Ministry of Education on Monday.
A total of 125 Chinese universities have been designated as the first batch of higher-education institutions to lecture medical students under the scheme.
Unlike the United States, where medical graduates have to go through tough examinations and residency programs before they become doctors, the majority of Chinese medical students go straight to work after graduation.
Chinese medical graduates go through residency training as hospital employees. The quality of training is highly dependent on hospitals.
Under the 10-year program, medical students will have to go through two or three years' residency training before they become doctors or assistant to general medical practitioners in rural areas, according to the notice.
Read more: Shanghai Daily

Call for urgent action over soaring HIV rates in gay men in Beijing

One in twenty gay men in Beijing developed HIV during a year

 by Michael Woodhead

Urgent action is needed to tackle skyrocketing rates of HIV infection among gay men in Beijing, Chinese experts say.
Researchers from the Chaoyang Centre for Disease Control and Prevention, assessed the HIV and STD infection incidence among 797 men who have sex with men in Beijing who were initial HIV-negative in 2009.
After about one year, they found that 48 men (6%) had developed HIV infection, equivalent to a rate of  8 cases per 100 person years. For syphilis, 30 of 666 (4%) gay men developed infection, and for herpes 46 of 760 men developed HSV-2 infection during the follow up period.
The risk of HIV infection was highest in younger men (under 25), those who had more than one sexual partner and men with a lower educational level.
The researchers say theirs is the first large study to measure the incidence of HIV among gay men in Beijing and the results "indicate that the HIV incidence rate among MSM has increased dramatically."
They say Beijing has an "extremely high rate" of HIV infection compared with other cities in both China and around the world.
"Explanations for the exceptionally high and steady rise in HIV incidence among Beijing [gay men] are not entirely clear, but one possibility may be that Beijing's relatively vibrant [gay] culture facilitates greater disassortative sexual mixing between gay groups, which in turn can increase HIV background prevalence. The high HIV incidence rate and prevalence among MSM in Beijing indicate that the epidemic in this group is extremely serious and that effective intervention services are urgently needed," says Dr Li Dongliang and co-researchers
They add: "Given the synergistic relationship between STD and HIV infection, interventions for high-risk behaviours and treatment and management for STDs should be combined with HIV control and prevention initiatives among MSM in China. We believe data from this study will help guide future research towards innovative STD/HIV interventions for MSM in China, and mobilise government, public health and non-governmental communities to control the rapid transmission of HIV and STDs among Chinese MSM. Comprehensive actions are urgently needed and the time is now."
Read more: BMJ Open

China's medical schools produce 'underperforming' African graduates

Liberian medical council says poor selection of students to study in China may be to blame for underperforming graduates

Medical authorities in Liberia have called on the government to stop sending medical students to study in China because Chinese medical school graduates are substandard.
The Liberia Medical and Dental Council has called on the Ministry of Health and Social Welfare and the Ministry of Education to place a hold on awarding scholarship to medical students for study in China.
Speaking at a news conference held in Monrovia on November 26, the council through its Chairman, Professor Robert Kpoto, said medical practitioners graduating from Chinese medical schools are performing below expectation.
According to him, this could be that the selection process of these students for the scholarship program was not done properly.
"Medical practitioners graduating from Chinese medical schools are performing below expectation. They are even incomparable with doctors who are here. I mean, they are failure and something must be done about this," Professor Kpoto said.
"I want to think that something might have gone wrong in the selection and vetting processes of these students who have been given scholarship to study medicine in China," said Prof Kpoto. He recommended that the medical council be part of the entire selection and vetting processes so as to get the proper students for such scholarship.
Read more: AllAfrica

China's medical equipment makers face 'prejudice' overseas

Chinese manufacturers such as Mindray must tackle the 'prejudice' against cheap Chinese exports

 Chinese healthcare equipment maker Mindray continues to gain recognition overseas despite some ongoing prejudice, reports Cecily Liu in London
David Yin, managing director of Europe at the Shenzhen-based Mindray Medical International Ltd, says that Mindray is now a large player in the medical devices industry, exporting products to 190 countries and regions.
In 2011, it had $881 million in net revenue, more than half of which was generated overseas.
"We are committed to international expansion, especially in Europe and the United States," Yin said. "These two markets are like two fortresses we have to conquer to become a truly global leader.
Mindray was established in Shenzhen, Guangdong province, in 1991, originally as a trade company that sold medical equipment produced by foreign companies in China.
But the founders of the company, Xu Huang and Li Xiting - who had both worked in the 1980s as engineers at a State-owned maker of medical instruments - had ambitions to have Mindray produce its own medical equipment.
Under that impetus, the company began to invest heavily in research and development and developed its first patient-monitoring device in 1992.
Mindray began to prepare itself for international expansion later that same decade after recognizing that the market for medical equipment was smaller in China than in advanced economies such as Europe and the US, where healthcare is a priority of the public sector. One important step it took toward that end was making sure its products met regulatory standards abroad.
Most of the company's devices and equipment bear the European Economic Area's CE marking, meaning they can be sold in the countries that make up European Union, plus in Iceland, Liechenstein and Norway. Some of its products have also won approval from the US Food and Drug Administration.
However, one obstacle Mindray still must overcome is the prevailing prejudice against Chinese products, Yin said.
"This is particularly a challenge when it comes to customers of developed markets like Europe and the US," Yin said.
"We had to continuously explain to them that Chinese products are not just cheap exports, but because China has many high-tech companies, it has many highly skilled employees. And it has many companies that understand clients' needs and are keen to solve clients' problems."
Read more: China Daily

Illegal blood sales in Hebei lead to 40% hepatitis C infection rate

Many rural Hebei blood donors have chronic hepatitis C and urgently need care

 by Michael Woodhead

More than 40% of Hebei villagers who took part in illegal blood donation sales have contracted hepatitis C, Beijing researchers have found.
A study of 520 villagers in rural Hebei found that 45% had taken part in illegal commercial plasma and blood donation activities in the late 1980s and early 1990s.
 Of the 236 people who had sold their blood or plasma, evidence of hepatitis C infection was found in 101 (42.8%). Overall, hepatitis C seropositivity was confirmed in 148 of the 520 (28.5%) villagers interviewed.
Dr Huang Changhong and co-researchers from the Institute for Viral Disease Control and Prevention at the Chinese Centre for Disease Control and Prevention in Beijing said that selling plasma was the strongest independent predictor of hepatitis C virus seropositivity, while past history of an operation was also independently associated with hepatitis C virus infection.
"Unsafe practices during illegal plasma donation led to a high risk of hepatitis C virus seropositivity for donors during the late 1980s and early 1990s. Many infected people suffered chronic hepatitis from that time onwards and urgently need treatment and care," they conclude.
Read more: International Journal of Infectious Diseases

Epilepsy stigma persists in China

Measures are needed to alleviate the stigma of epilepsy

by Michael Woodhead

Epilepsy can bring severe stigma for patients in China and strong measures are needed to alleviate the stigma and change attitudes, say Beijing researchers. 
Clinicians at the Beijing Tiantan Hospital Affiliated to Capital Medical University, did a survey of 106 patients with epilepsy as well as their caregivers, family members and clinical staff.
They found that there was still a strong stigma around epilepsy seen in peoples' understanding of epilepsy and the patients' own perception of epilepsy. There was also a noticeable stigma evident in attitudes of other people t epilepsy, in the social and cultural environment, and in the social support available to patients with epilepsy and in government regulations and policies.
"We found that the stigma of epilepsy is a very negative self-feeling from the patients' perspective, said Dr Guo Wencui and colleagues.
"Hence, we suggest that effective measures to alleviate stigma should be based on ways of eliminating factors that cause institutional stigma. Additionally, a personalized approach to eliminate factors that cause internalized and interpersonal stigma needs to be adopted. Only by addressing impacting factors at each of these three levels can the stigma of epilepsy in China be alleviated or even eliminated."
Read more: Epilepsy and Behaviour

Big pharma goes to China to look for TCM-based blockbusters

Drug companies like GSK are investing in research to evaluate traditional Chinese remedies

 by Ted Alcorn and Ouyang Yadang
Over the past five years, the world's largest pharmaceutical companies have invested billions of US dollars in research capacity in China, drawn there by the country's low research costs, enormous talent pool, and rapidly expanding market for health care. 
But the research facilities they have built in China are now leveraging their location to tap into the country's wealth of traditional Chinese medicine (TCM), with the hope that the ancient practices can point the way to new treatments.
Almost all general hospitals in China have TCM departments and one in ten physicians is trained exclusively in TCM, with most western-medicine doctors also receiving some training. McKinsey report estimates that in China in 2011 there were $13 billion in sales of herbal medicines formulated according to TCM principles. The Chinese Government has fostered the sector in various ways, such as providing high rates of reimbursement for TCM through its national insurance programmes and ensuring the availability of common traditional treatments. More than a third of the drugs on the country's essential drug list are TCMs.
But China is also eager to see the drugs popularised abroad, says Ted Kaptchuk (Harvard Medical School, Boston, MA, USA), an expert on east Asian medicine. “China wants to globalise, and part of its mission is [to demonstrate] its contribution to cosmopolitan, universal culture. And one of the places it is seeing potential is around its traditional medicine, which of course it has a lot of national pride in.”
GlaxoSmithKline (GSK) is one of several pharmaceutical giants that have taken an active interest. GSK built a major research centre in Shanghai in 2007, and at the beginning of 2012 it announced the formation of a new unit there devoted to the study of TCM. Zang Jingwu, who heads the research centre, says the unit is building a library of compounds derived from Chinese herbs that it will use to screen against known molecular targets, in the hope of identifying novel chemical scaffolds for engineering new drugs. GSK's network of local researchers has been crucial in amassing the library, which Zang describes as “quite sizeable”. The unit is also deconstructing existing TCM treatments with the goal of developing its own evidence-based prescription TCMs for treating disorders ranging from Alzheimer's disease to inflammatory diseases to cancer.
At Beijing's Guang'anmen Hospital, where one of the country's earliest TCM oncology departments was established, most of the inpatients have already received western treatment for their cancer or are receiving treatment that integrates chemotherapy and TCM. Those receiving exclusively TCM are predominantly late-stage patients with poor prognoses who still find the traditional treatment improves their quality of life. Lin Hongsheng, who directs the department, says she was sceptical about TCM when she arrived there in 1976 but has since become convinced of its value, particularly for ameliorating the side-effects of chemotherapy. In studies of late-stage cancer patients she has undertaken there with her colleagues, integrated TCM and western treatment has given better results than exclusively western treatment.
Read more: Lancet Oncology

Rankings of China's top 100 hospitals released

Peking Union Medical College Hospital tops the hospital rankings for China

 by Michael Woodhead

Peking Union Medical College Hospital has come top in the rankings of China's hospitals just released by Fudan Universty School of Hospital Management.
The other hospitals in the Top Five nationally are the West China Hospital of Sichuan, the General Hospital of the Chinese People's Liberation Army, Ruijin Hospital of Shanghai Jiaotong University and the Xijing Hospital, Fourth Military Medical University. The list of the top 100 hospitals is based on rankings submitted by 1300 medical specialists. The experts were asked to rate hospitals according to factors such as quality of medical care, level of scientific research, construction, and clinical technology. The peer review experts were drawn from from 28 professional disciplines of the Chinese Medical Association, and medical associations from provinces, autonomous regions and municipalities. The Fudan University rankings were first drawn up in 2009 and this year's rankings show no major changes but some subtle differences. The compilers of the rankings say they also want to engage in a ranking of the Schools of Medicine, but this would be very different to hospital ranking list. They say their ranking system is independent and allows the patient to understand the characteristics of Chinese hospital specialist reputation, but alsoan understanding of the hospitals' "disciplinary construction" and management level.
See the full list of 100 hospitals at: China Medical Tribune

Zhejiang hospital adopts 'Toyota management' service techniques

Hospital says Toyota's 'continual improvement' techniques improve patient service

by Michael Woodhead

In China there is still reluctance by public hospitals to focus on awareness of services for patients and there is still a long way to go for hospitals in making care more patients centred.
 However, one hospital in Zhejiang province has been leading the way in reforming management practices. Over the last three years Dongyang City People's Hospital has been implementing 'Toyota Production System' management tools and guidance to staff to carry out continuous improvement in services.
Despite being quite a small hospital, Dongyang City People's Hospital in the central region of Zhejiang is well-known in throughout China because it is the first public hospital in the country to implement reforms of the corporate governance structure.
The hospital is the first to introduce a 'presidential responsibility system' under the leadership of the board of directors. The corporate governance structure reforms and refinement of management are distinctive features of Dongyang City People's Hospital, that have attracted many peers come to learn.
Recently, the construction of a new hospital building of 90,000 square meters in one fell swoop doubled the size of the hospital. This gave fresh impetus to the development of the hospital. However, rather than just improving the 'hardware', Dongyang City People's Hospital's effort is also invested in 'software' and the emphasis can not be underestimated. To enhance service awareness, Dongyang City People's Hospital  has in recent years used the Toyota Production System (also known as lean management) to imbue staff with service awareness.
Training consultant Zhai Sheng Biao is manager of the QS-FIRST Service Management Consulting Centre. He oversaw the dissemination of Toyota Production System to improve knowledge and enhance the quality of hospital services. He worked out personalised service improvement programs for each hospital, as well as the selection and training of several hospital services "internal trainers". These internal trainers aim to achieve universal service improvement through intense organisation.
For most Chinese public hospitals, the Toyota Production System is a fairly new and unfamiliar system.  Di Shengbiao's "Toyota philosophy" and methods attempt to bring practical lesson from industry to the practice of the Chinese hospital management and thus help the head of the hospital to create a  "Toyota hospital".
Dongyang City People's Hospital vice president Yong-Ming Zhao says the Toyota Production System has been popular and produced significant new changes.
The hospital's head of nursing says enthusiasm in participation has been high and the program has achieved wide uptake in the hospital. There have also been physician-led improvement projects focusing on topics closer to clinical practice; other projects have focused on the improvement of the healthcare safety and quality of medical care.
The new service quality program has been adopted by all levels of staff at Dongyang City People's Hospital, with even the cleaners having an 'aunty' leader whose initiative was to guide cleaners to becoming dedicated to hygienic toilets. Representatives from other hospitals  have been impressed by these developments, saying that in their hospitals cleaners would not take the initiative. "A sense of service is now deeply rooted in the general staff of the People's Hospital of Dongyang," one said.
Read more: China Healthcare

Lancet profile of Dr Lixin Jiang: at the heart of China's evidence base

Dr Jiang Lixing

by David Holmes
There's a quiet revolution going on in China, and Lixin Jiang is at the very heart of it. 
Since the turn of the millennium, Jiang has been in the vanguard of a growing movement within the Chinese medical profession to make evidence-based medicine the foundation of their practice, and to build the evidence base from within China itself. And with the support of Shengshou Hu, the influential head of Fuwai Hospital in Beijing, where Jiang is based at the affiliated National Centre for Cardiovascular Disease, she has been a “whirlwind force for evidence” says Richard Peto, Co-Director of Oxford University's Clinical Trial Service Unit (CTSU).
Since 1999, Jiang has worked closely with Peto and his fellow CTSU Co-Director Rory Collins on a succession of large, international trials, and she credits the pair with opening an “entirely new window, through which I not only learned how to manage large-scale clinical trials in China, but more importantly, learned how to look at the world with critical eyes”. This though, according to Peto, is Jiang being too modest. “She was really excited by the idea of clinical trials and we just introduced her to the concept. She picked up the ideas and ran with actually making them work, and trying to actually get them accepted within the Chinese medical profession.”
Jiang's first large-scale trial, COMMIT, was a baptism of fire, with over 45 000 patients with acute myocardial infarction enrolled from 1250 hospitals. With guidance from CTSU, Jiang began to oversee the routine running of the trial in China in 1999, and during the next few years she took her team to monitor more than 400 hospitals throughout China, including many smaller, secondary hospitals in remote rural areas. As well as providing a crash course in the vagaries of clinical trial management, the study affected Jiang on a personal level. “I was born in the city and I didn't have a real picture of rural life; before that study I lived in a very limited, narrow world”, she says. “But when I visited these hospitals I was so touched by the real situation; so much poverty, it was so difficult for doctors and patients in rural areas at that time. And through visiting these kinds of hospitals all around China, it touched me so deeply, and I learned about China, I learned more about hospitals, and I learned about clinical trials.”
COMMIT was a watershed moment not just for Jiang, but for clinical research as a whole in China. “The Chinese doctors were really excited to have good evidence, Chinese evidence, about the treatment of Chinese patients in Chinese hospitals”, says Peto. After visiting a number of trial sites, the US Food and Drug Administration approved a new indication for clopidogrel in acute myocardial infarction: the first time such a decision had been based on data solely from China. The “research got taken worldwide and influenced worldwide treatment patterns”, says Peto. “Without her it wouldn't have succeeded”. An auspicious precedent thus set, Jiang has gone on to coordinate a succession of large, long-term, international clinical trials and case-control studies in China, including HPS2-THRIVE, TRACER, and HPS3/TIMI55:REVEAL, INTER-HEART, and SHARP.
The success of these studies owes a huge debt to Jiang and her team's meticulous planning and tireless capacity building, according to Runlin Gao, Chief Cardiologist of Fuwai Hospital and the immediate Past President of the Chinese Society of Cardiology. “She established a committed research team and a stable collaborative network, including nearly 200 large hospitals in China, and she and her team also developed some practical modules for running trials in China, such as the pre-registration of potential participants, a process of identifying capable and committed local sites, and central monitoring”, Gao explains.
But for all the progress that has been made, Jiang is a realist. “Sometimes I say that maybe our limitations are much bigger than our strengths”, she comments, pointing to the complexity of the regulatory system in China. The process to get a trial approved “generally takes about 10 months to 1 year”, explains Jiang; “that is longer than most other western countries, and the process is not very easy”. The unfamiliarity of patients with large-scale clinical research in China can also present problems. “Patients do not fully understand this type of study, they very often have doubts about our motivation, and we don't have a very harmonious relationship between doctors and patients here, and that is a very big problem”, says Jiang.
“Overall”, Jiang says, “the government has greatly improved the conditions for clinical research, but we still have a long march to go. We in China really need evidence not only for clinicians but also for policy making, so China should accelerate the pace of improvement.” As Principal Investigator of China-PEACE, a major cardiovascular outcomes study funded by the Chinese Government that involves more than 200 hospitals across China, Jiang will play a pivotal part in generating this knowledge “for China from within China”, says Gao. And as Honorary Editor of The Lancet Chinese Edition, Jiang says she hopes to “accelerate the dissemination of knowledge, and the concept of evidence-based medicine” in China. According to Peto, she will succeed. “She's making things happen that I don't think anyone else would be able to make happen”, he says. “She's really the trialist to watch.”
Read more: The Lancet

Encouraging results from China's antiretroviral program for HIV children

With antiretroviral  therapy, HIV survival rates were higher than 94%

 by Michael Woodhead

China's paediatric antiretroviral program for children with HIV is highly effective, latest figures show. 
A review of medical data from more than 1800 children under 15 who were treated with antiretrovirals found that more than 94% were still alive and in improved health after three years of treatment There were 93 deaths among 4,022 child-years of treatment and the overall mortality rate was 2.31 per 100, according to Dr Zhang Fujie and co-researchers from the National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing Ditan Hospital. As expected, the factors associated with higher death rates included weight-for-age and markers of stage of disease such as haemoglobin levels and CD4 cell levels. "Our finding that 94% of children engaged in this program are still alive and of improved health after three years of treatment demonstrates that China's national paediatric ART program is effective," they conclude.
Read more: Clinical Infectious Diseases

Beijing scientists first to discover hepatitis B receptor

[translated] by Michael Woodhead

Researchers at the Beijing Institute of Life Sciences have finally revealed the true nature of the cell surface receptor molecule for the Hepatitis B virus ( HBV ) .
The discovery of the receptor, to which the hepatitis B and hepatitis D viruses must bind for host cell infection, will help researchers understand the mechanism of hepatitis B infection.
The work was completed by a  team led by Dr Li Wenhui at the Beijing Institute of Life Sciences, and the research published online in the eLife magazine for 11 January 13,2011 , entitled "Taurocholic acid sodium ion transporter polypeptide hepatitis B and hepatitis D virus functional receptors". The magazine is the leading magazine of the international field of life sciences.
The search for the receptor has been on for decades and Li Wenhui team's discovery has caused a sensation among international peers. Dr. Steven Fung, a professor at the University of Heidelberg, Germany, said "the outstanding results of the HBV research areas can not be underestimated, and will be changing the the HBV field of research, and will also will likely lead to the development of new hepatitis B treatments and drugs for the benefit of hepatitis B patients."
Read more: China GP

Pharma awards highlight foreign drug companies' R&D in China

Pharma companies such as Xian Janssen are investing in R&D in China

Eleven top Chinese pharmaceutical, medical and healthcare professionals were honored in Beijing last month with the 13th Wu Jieping-Paul Janssen Medical & Pharmaceutical Award for their leadership and innovation.
The award supports exemplary efforts by practitioners who work to improve the quality of patient healthcare through innovation and is consistent with China's ambition of establishing a national innovation system by 2020 in which talent development is a critical aspect of the overall plan.
"The Wu-Jan Award honors professionals whose innovative work improves the health and quality of life of the Chinese people. Xian Janssen is delighted to support this award. We are committed to caring for patients and constantly striving to improve China's public health," said Thad Huston, president of sponsor Xian Janssen.
In addition to its own expansion in research and development in Shanghai and Beijing, Xian Janssen has also worked with Tsinghua University's School of Medicine for the prevention and treatment of infectious disease.
The company also supports talent programs for the university. The best way to cultivate innovation at top academic institutions in China is to cultivate talent, said Professor Shi Yigong, who is also the dean of the School of Life Sciences at Tsinghua University.
Xian Janssen has invested $4 million over five years in the school to recruit top talent from home and abroad.
Other multinational pharma companies are also investing in cooperation with Chinese universities and medical institutions to conduct R&D work, especially on early-stage research, given the specialties of the local partners' research teams and laboratory facilities.
Bayer HealthCare Co has been cooperating with Tsinghua University over innovative drug discovery since 2009. The joint projects focus on different research aspects starting from early research programs to gain deeper understanding of disease mechanisms, identification of new drug targets and spanning further to joint structural biology research and medicinal chemistry programs.
"A new focus of our collaboration will be the area of structural biology, where scientists from Tsinghua University will work in close collaboration with Bayer scientists to solve the 3D protein structure of biological molecular targets as a basis for new drug discovery projects," said a spokesman.
At the end of 2011, Merck Sharp & Dohme  revealed its plan to invest $1.5 billion in R&D in China over five years. In addition to building its Asia R&D headquarters in Beijing, some of the money is earmarked for collaboration with local universities and medical institutions, .
"The decision to locate the facility in the capital city was made to bring the company closer to national-level and first-class research bodies and universities - such as Peking University, Tsinghua University and Beijing Institute of Life Science (a division of the Chinese Academy of Sciences)," Kim said, adding that the company also hopes to attract high-quality young talent to the universities via the partnership.
Read more: China Daily

Health minister performs liver transplant - but some question his qualifications

Professor Huang Jiefu is a transplant surgeon as well as China's deputy health minister

by Michael Woodhead

China's deputy health minister Professor Huang Jiefu was wearing his surgeon's hat when performed a liver transplant in Guangzhou this week - but some cynics have questioned his qualification to do so.
The health minister, who is a transplant surgeon by training, performed a liver transplant from a 50-year old woman at Lingnan Hospital, Sun Yat-sen University Third Affiliated Hospital, to highlight China's new organ donations pilot
The 66-year old deputy minister like to keep his hand in as a transplant tsurgein and is never far away from the operating table, performing an average of two operations a week at the Beijing Union Medical College Hospital .
Professor Huang paid tribute to the deceased woman and her family for donating the organs saying: "this death saved three lives and in addition also allows two people to see with corneal transplants, which is a great thing."
Professor Huang has the vision that China can build a sustainable ethical and national organ donation transplant system. He lead the way in setting up the Chinese Human Organ Transplant Ordinance promulgated in May 2007, and has been open in admitting to the international community to the fact that China had been using organs from executed prisoners as a major source of transplants - but now wants to change that.
"Since the donor organ pilot, organ transplant regulations have achieved significant progress in Guangdong and voluntary organ donations next year may exceed the number of death row inmates organ. Of course, we do not opposed to the death row inmates voluntary contributions. "
However, after the publicity over the latest transplant procedures by the minister some Chinese citizens took to microblogging sites such as Weibo to question whether he was fully licensed and qualified to do so, and questioning how he could be both a senior government minister and "moonlighting" as a practicing clinician.
Professor Huang responded with good humour to allegations that he was an "illegal doctor".
"I have been licensed as a doctor since I graduated from medical school, I wrote China's national textbook on liver transplants, I do liver transplant teaching videos, and I am also been recognised by medical organisations in Australia and in the United States. Being a practising surgeon is the most important thing in the world to me - how could I not have a medical license in this country? " 　　In response to the accusations of  "moonlighting" argument, Professor Huang responded that although he is a Ministry of Health official, his most fundamental role is still as a doctor, "The media calls me Minister Huang, but I actually prefer the title of Professor Huang. The priority in my life and career has always been to help and treat the patient, and I have always had career satisfaction and pride through the surgery I do with my hands, seeing patients to restore health."
Read more: Jiankan Bao

Doctors warn about rise in cosmetic surgery among Chinese girls

Girls under 18 are not psychologically mature enough for cosmetic surgery

by Michael Woodhead

More and more Chinese minors who are "ruled by beauty" are seeking cosmetic surgery for  non-medical reasons and doctors are warning about the trend.
Doctors say that cosmetic surgery requires psychological maturity and minors should be wary of cosmetic surgery as they may become end up physically and mentally "disfigured".
In one example this month, a middle aged couple in Shenyang, Liaoning, a middle-aged couple turned up at the Liaoning Provincial People's Hospital, to ask doctors in the Plastic and Reconstructive Surgery department why thy had performed cosmetic surgery on their 17-year old daughter without their permission
Medical staff were confused - and when they checked the patient's medical records they found the girl's ID card copy showed her as 22-year-old - and therefore an adult.
However, a hospital review found the girl was actually a high school student, who get that her face was chubby and therefore got the idea of having cosmetic surgery. For this reason, she deliberately made herself a fake ID on which she changed her age, and ultimately was successful in obtaining cosmetic of surgery.
In response to this, the Liaoning Provincial People's Hospital, director of the Plastic and Reconstructive Surgery Dr  Long Yuanji said there were no circumstances in which minors could be allowed to have non-medical cosmetic plastic surgery, and therefore  the hospital requires that any young people who seek surgery must be accompanied by parents and signed agree to surgery.
Chinese media reporters have  found that the  demand for cosmetic surgery gradually increased towards the end of the year the, most of it for girls. There were three main groups of High School, Middle School, and Art School candidates who sought surgery as preparation for college entrance admission. The main categories of surgery favoured by minors were  double-fold eyelids, nose jobs,  bone lengthening and liposuction f.
Dr Long said cosmetic surgery was increasingly sought by minors but it requires not only physical maturity, but also there needs to be psychologically maturity as patients need to be fully prepared to face a series of unknown surgical risks. Many minors are psychology not fully mature but blindly follow the trend. However, their ability to tolerate it is limited and if surgery 'fails',  it inflicts a huge  psychological blow.
Often after cosmetic surgery there is a gap between expectation and results, he says. He cites rhinoplasty surgery as an example, as it is, sometimes difficult to achieve satisfactory results with the nose. Dr Long urges parents and minors not to let plastic surgery lead them into being disfigured.
Read more: China Medical Tribune

Vitamin B deficiency linked to depression in Chinese people

Thiamine deficiency linked to three-fold higher risk of depression

by Michael Woodhead 

People with low levels of the vitamin B component thiamine have a three-fold higher risk of depression, Shanghai researchers have shown.
According to researchers from the Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences at the Shanghai Institutes for Biological Sciences, thiamine has been hypothesized to play an important role in mental health; however, few studies have investigated the association between thiamine nutritional status and depression in the Chinese population.
Therefore they conducted a trial to examine levels of thiamine and its phosphate esters [thiamine monophosphate (TMP) and thiamine diphosphate (TDP)] in erythrocytes of 1587 Chinese men and women.
They found that just over 11% of people had depressive symptoms, and that lower concentrations of all three thiamine biomarkers were associated with a higher prevalence of depressive symptoms.  People with the lowest thiamine levels had a 3-3.5 time higher risk of depressive symptoms compared to people with higher levels of thiamine.
"In conclusion, poorer thiamine nutritional status and higher odds of depressive symptoms were associated among older Chinese adults. This finding should be further investigated in prospective or interventional studies," the researchers say.
Read more: Journal of Nutrition

China is 'missing' 200,000 paediatricians

China has limited numbers of paediatricians and childrens' hospitals

by Michael Woodhead
China has at least 200,000 'missing' pediatricians, because the growing need for pediatric medical services has not been matched by increases the number of paediatricians, lsays Professor Zhu Zonghan,  vice president of the Chinese Medical Association and president of the CMA's pediatrician branch.
Speaking at a meeting of the CMA paediatrics bench in Changsha this week, Professor Zhu said there was severe asymmetry in paediatric needs and services and "the establishment of the Paediatric system with Chinese characteristics is necessary." 　　
He said that of China's total population of over 1.3 billion, about one-fifth of the proportion of children. However, the country only has 68 children's hospitals, accounting for 0.42% of the national medical institutions. There are only 258,000 paediatric beds representing 6.4% of total hospital beds in the country.
There is also a serious shortage of the pediatrician human resources, and a lack of any long term training program.
Over the past 15 years, thenumber of paediatricians has increased by only 5,000 nationally, says Professor Zhu.
It is proposed that the creation of a  Chinese College of Paediatics and Child Health will help to alleviate the lack of pediatricians. Institutions such as the Hunan Provincial Children's Hospital of Nanhua University, are leading the way in developing graduate and undergraduate training programs in pediatric medical services.
Read more: Health News/JiankanBao

Code of Conduct for health practitioners released by Ministry of Health

Code of practice covers practitioners such as doctors, nurses and pharmacists

by Michael Woodhead
A new national "code of conduct" for medical standards and ethics for medical institutions and health practitioners has been issued and must be "strictly followed", the Ministry of Health has announced.
The code of conduct covers doctors nurses, pharmacists and other health practitioners as well as medical institutions and organisations under the Ministry of Health, the State Food and Drug Administration and the State Administration of Traditional Chinese Medicine.
The ten part code of conduct sets out basic standards such as emphasising adherence to medical ethics and national laws. It defines the role of health practitioners as having a people-oriented practice, adhering to a philosophy of healing the sick, and preventing and curing diseases. Practitioners are also required to be humanitarian, rational, sincere and and act in the spirit of medicine to provide patient-centred health services for the people.
The code also requires practitioners and health organisations to respect the patient's right to informed consent and privacy, safeguard the legitimate rights and interests of the patients and to respect the rights of patients where they may face discrimination because of race, religion, disability or socioeconomic status.
The code of conduct also stipulates the practitioners and health organisations must not seek to take advantage of patients through bribes, soliciting donations or rewards, nor should they engage in profiteering, fraud  or abuse of medical insurance. Practitioners and institutions must also avoid conflicts of interests when providing medical services and products and should advertise and promote their services and products in an ethical way.
It is also required that health practitioners be regularly evaluated to ensure they are maintaining good standards. Practitioners who violate the norms of medical institutions, may be criticised and educated, suspended or dismissed, depending on the seriousness of the infringement. Serious cases of negligence or malpractice may need to be investigated and death with in accordance with the disciplinary rules and case investigation and handling procedures.
The code has been disseminated to all provinces and organisations and will come into effect immediately.
Read more: Ministry of Health

Beijing mums and babies have severe vitamin D deficiency

More than 50% of pregnant women had vitamin D deficiency

by Michael Woodhead
Pregnant women living in Beijing are at high risk of vitamin D deficiency, and many babies are born underweight because their mothers lack of the vitamin, Chinese researchers have shown
Clinicians from the Department of Pathology and Experimental Medicine at the 306 Hospital of PLA, Beijing measured vitamin D levels [25-hydroxyvitamin D (25(OH)D] in seventy pregnant woman and also analysed the health of their babies
They found severe vitamin D deficiency  (levels below 25 nmol/l) in 55 % of mothers and 47 % of newborns. Neither mothers nor newborns had vitamin D concentrations that reached the normal level (over 75 nmol/l). In addition the levels of vitamin D in mothers was positively correlated with that in the unborn (i.e. in placental cord blood). The research show that newborns of mothers with severe vitamin D deficiency had lower birth length and birth weight. The baby's head circumference and birth weight were lower in vitamin D-deficient newborns.
"[Our] study indicates that pregnant women and neonates residing in Beijing are at high risk of vitamin D deficiency.  [Vitamin D] concentrations are dependently related to maternal 25(OH)D levels. Maternal and neonatal vitamin D status influences newborn size," the researchers conclude.
Read more: Public Health Nutrition

China's haphazard hospital domain names cause confusion

by Michael Woodhead
Before seeing a doctor, many Chinese people will look at a hospital 's official website, but China's hospital official domain names are very confusing and the messy system invites deception and fraud, critics say
Investigations by reporters show that the official websites of some China's top hospitals have different suffixes and 56 different kinds of domain names have fifty-six kinds. Some have .cn suffixes such as the Beijing Union Medical College Hospital (www.pumch.cn), some are dot-coms, such as the Huaxi Hospital (www.cd120.com); others are .com.cn,  .org and even .net, such as the Henan Provincial People's Hospital (www.hnsrmyy.net).
These extensions have different meanings, and  the Director of the Centre of Telecommunications Research Institute at the Ministry of Industry and the Internet, Dr He Baohong, says that according to international norms, .com is the business enterprise domain, .net is the domain for network service providers, .org is the domain name for a non-profit organization, and .cn is China's national top-level domain. So it seems the use of the .com domain suffix by top hospitals does not reflect their public service or non-profit organisation role.
China's hospital domain naming system is also not user friendly. Domain names for major hospitals come in a wide variety, some are based on the hospital initials  such as the Sino-Japanese Friendship Hospital website (www.zryhyy.com.cn); some are named based on pinyin, such as Huashan Hospital website (www. huashan.org.cn), some use the hospital name and "hospital" for the the domain name, such as the Fuwai Hospital website (www.fuwaihospital.org). The domain names of some hospitals are just indecipherable, such as the Guangdong Provincial People's Hospital (www.e5413.com), which looks like a "shanzai" (fake).
The  PR department of the Guangdong Provincial People's Hospital, said "e5413" really is the official website of the hospital, because "5413" is a homonym that sounds like "I am a doctor," aand the hospital wanted to take the name as a meaningful and easy to remember.
It is actually too simple for  hospitals to register the domain name, all  they  need to do is find a domain registrar and there are no strict requirements. Currently there are more than 80 domain name registrars, and registration can be made for .com, .org, .net, and .cn sites. All that is needed is a valid ID and often less than a hundred dollars you can register a domain name.
The hospital website name should standardised. Compared with hospitals, other public organisations that have contact with the daily life of ordinary people are named more systematically and according to regulations. The official websites of government departments are unified as .gov.cn,  the name mainly in English or with an abbreviation. For example, the Ministry of Health (www.moh.gov.cn) and the General Administration of Sport (www.sport.gov.cn). In the field of education, whether public or private the universities have edu.cn endings, such as Peking University (www.pku.edu.cn), and Henan Vocational and Technical College, (www.hnzj.edu.cn). Internationally, the official websites of major hospitals are  almost all based on .org endings, such as Massachusetts General Hospital (www.massgeneral.org) and Mayo Clinic (www.mayoclinic.org). Hospitals outside the Chinese mainland, use a local suffix and generally .org subdomains, such as Taiwan's Chang Gung Medical Group (www.cgmh.org.tw), while Hong Kong hospitals are with the Hospital Authority (www.ha.org.hk) .
Dr He Baohong says there are no obstacles to unified domain name specifications for hospitals in China. Public hospitals may be assigned to the non-profit organisation from the point of view of the meaning of the domain name, and the standardised suffix of choice would be .org, or org.cn. For-profit hospitals have available domain suffixes such as .com or com. cn end, to give patients an idea at a glance. In addition, there is also the opportunity within the website domain name registrar to have unified domain names under hospital.cn. This could be achieved as long as the health sector and public and private hospitals co-operate with each other.
Read more: China Healthcare