Doctor Stranger | Chicken faecal contamination | Plagiarism in medical publications | Generic chemotherapy drugs |

A Korean medical soap opera “Doctor Stranger” has become hugely popular in China, with over 100 million viewers this month. The success is attributed to the star power of the two male leads, Park Hae-jin and Lee Jong-suk.

A major outbreak of hand foot and mouth disease has been reported in Jiangsu, with the Suzhou hospital seeing a three-fold increase this month, and up to 80 children a day with the infection treated at the hospital.

Indian-made generic copies of expensive drugs for conditions such as cancer are becomong popular on the Chinese 'black market'. Chemotherapy agents such as AstraZeneca's Iressa cost 15,000 yuan per pack but can be bought on the generic market for 600 yuan, even though it is unapproved and unregistered in China.

Pregnant women in China have high levels of mercury in their bodies from eating fish, a study from Shenyang has found. The high level pose a risk to their baby's health, say researchers.

China has the dubious distinction of leading the world in the number of medical and scientific academic papers retracted due to plagiarism, according to a new report. A review of retractions from 2008-12 found that China withdrew  24 plagiarised papers (18% of all papers retracted for plagiarism) and 42 duplicate papers (28% of all papers retracted for duplicate publication).

Boys of middle school age are  four times as likely as girls to smoke, a Shanghai survey has found. The Chinese Center for Disease Control and Prevention said 2.2 percent of boys and 0.6 percent of girls said they were regular smokers. A further 11 percent of boys and 6 percent of girls said they “tried” smoking last year.

China's State Council has said it will relax limits on foreign investment in joint-venture hospitals as part of the ongoing healthcare reform process. The move will reduce restrictions on the percentage of foreign ownership in medical joint ventures and increase the number of locations where Hong Kong and Taiwan investors can set up wholly-owned medical centres. Other overseas investors will be allowed to set up wholly-owned hospitals only in areas such as the Shanghai free trade zone.

One of the main barriers to foreign investors setting up new health facilities in China is the high price of  real estate, according to analysts. Investors are instead looking at proposals to take over and run existing hospitals.

James Murdoch, son of the right-wing media owner Rupert Murdoch, was on the board of GSK and gave advice on corporate ethics when the company was  bribing doctors and hospitals in China, according to reports from the UK. He resigned from GSK when he was investigated over the bugging of private citizens by his newspapers.

About a third of chicken meat sold in retail outlets in China is contaminated with faecal campylobacter bacteria due to unclean conditions  the slaughterhouse, a study has found. Another showed that 43% of chicken contained Salmonella.

Dodgy doctors or innocent victims of patient violence?

by Michael Woodhead
In Australia hardly a week goes by without a report in the media of a 'dodgy doctor' - a male medical practitioner who has sexually assaulted a female patient. You don't hear much of this kind of thing from China but coincidentally today there are two reports in which doctors have been accused of inappropriate behavior towards female patients. Are they genuine or are these yet more instances of China's wave of violence against doctors in an overloaded/corrupted system?
In the first case, a doctor in Nanjing was bashed by the drunken husband of a woman who claimed he had acted 'immorally' to lift her clothing to perform a cardiac exam. The doctor had been trying to perform an electrocardiogram test on the women for cardiac function. As anyone who's had an ECG knows, this involves the placing of up to 12 electrodes on the skin of the chest - there's no avoiding contact. The female patient objected to this, called her husband and he hit the male doctor so hard he broke the doctor's nose. The second case is from Gansu, where a woman took exception to a doctor examining her back, despite her seeking help for a suspected fractured coccyx. She accused the doctor of inappropriate manipulation and called her husband - almost identical outcome to the first case - the husband arrived and set about smashing the doctor around the head with a metal stool, leaving him battered and concussed.
 In both cases medical staff say the doctors were behaving appropriately and carrying out the recommended and necessary routine tests on women to investigate their medical problems. If taken at face value, these reports differ from those seen in western countries, where typically a male doctor will perform inappropriate examinations on women in private. It might be that the Chinese medical staff are covering up for their colleague, but personally I doubt it. While I feel sympathy for the women and their sense of being treated inappropriately, it sounds like the system is to blame here rather than lecherous doctors. In western countries like Australia it is now standard operating procedure to have a female chaperone present (or at least available on request) if a male doctor is to perform any kind of sensitive examination of a female patient. Another 'safeguard' with primary care-based systems is that you can see the same personal 'family doctor' or one of a familiar team on each visit, and so trust is built up in the treating doctor. In China's hospital-based system it's often a case of  'wait three hours to see a doctor for three minutes' and the doctors are strangers. The hugely overloaded Chinese healthcare system does not allow women the option of choosing to see a female doctor, and there may not usually be the option of a female chaperone.
As China develops and expectations about healthcare and personal 'human rights' increase, expect more of these kind of complaints and violent reaction to male doctors. And it could become a particular problem in China's western provinces with a high Muslim population. But what of the rights of women who really are being abused by medical staff? With the growing concern about violence against doctors (and the increasing emphasis on punishing those who take matters into their own hands) there is a risk that the bad doctors will get off scot-free.

Jumping the queue at Beijing hospital costs 200-600 yuan

by Michael Woodhead
Faced with the prospect of queuing for hours - or even overnight - for a registration ticket for admission to the Beijing Children's Hospital, parents are prepared to fork out up to 600 yuan to a scalper.
The going rate for a 5 yuan (80 US cents) registration ticket is 200 yuan ($32) for a general appointment and 500-600 yuan ($80-95) for a specialist appointment, according to the Beijing Daily newspaper.
To investigate the scalper situation a reporter from the paper went to the children's hospital foyer and posed as  parent seeking admission of their child for acute illness.  He didn't have to look far - in fact he didn't have to look at all, as he was surrounded by a group of three scalpers all shouting out offers of a variety of 'appointments' and proferring their business cards. They said they could supply registration tickets for appointments on any time and also for any department .
The conversation went like this:

Scalper: What department do you want - general or specialist?
Reporter: How much is a general ticket?
Scalper:  200 yuan. Can arrange any date within the next three months or next week. We have today, tomorrow ... you get the idea. Every day, every department.
Reporter: What about the 'named user ticket system' [similar to train ticketing, in which tickets are only valid for the user ID]?
Scalper:  No problem. We've been doing this for eight years. Just use my ID to get in the clinic, then switch when you get to see the doctor.

On the electronic screen in the hospital foyer there were almost 70 different clinical departments listed, and the screen showed that 90% were 'sold out' - no appointments available. Despite this, long lines stretched back from the registration ticket office window. One father from Shaanxi told the reporter he had been waiting all night without success, and so had turned to the scalpers to get a registration ticket for his sick child. He said he had seen at least ten scalpers operating at the hospital. Several of them were openly touting for business along the line for the registration office. Sometimes they helped each other out and 'swapped' tickets, sometimes they strove to undermine or 'outbid' their competitors. It was a very chaotic situation.
According to a spokesman for the nearby Yuetan Police Station, there were more than a hundred hospital scalpers operating in the area of the hospitals. Although they operated quite openly trying to 'recruit' customers in the queue, arresting them was not easy. This was because they had to be caught 'in the act' exchanging tickets and their illegal sale of tickets had to be confirmed by the person buying them - but most refused and fled. And even when caught, they scalpers faced a maximum of five days in detention and a 50 yuan fine. This was only a fraction of a single 'sale' of a ticket for 200-600 yuan, and thus was no deterrent, the police spokesman said. With no effective law this meant "social order is disturbed", he concluded.

Tropical diseases in China: one down, ten to go

by Michael Woodhead
China has eliminated one tropical disease - lymphatic filiarisis - but has ten others that are still affecting millions of people and some of which are becoming endemic again, according to a new report.
The good news from a review of China's tropical diseases published in The Lancet Infectious Diseases is that the country is on track to eradicate five major diseases (schistosomiasis, leishmaniasis, leprosy, rabies and trachoma) in the next five to ten years.  However, the not-so-good news is that some diseases are still uncontrolled and affect millions of people in poorer provinces of the south and west. The most problematic diseases are dengue fever, food-borne parasitic diseases such as liver flukes and Echinococcosis, according to the article by researchers at the Wuxi branch of the Ministry of Health. Professor Yang Guo Jing and colleagues from the Key Laboratory for Parasitic Diseases say that lymphatic filiarisis was eliminated from China in 2007 after a long campaign to remove it from 16 provinces by using mass drug administration techniques.
Tropical diseases in the 'near-elimination' stage include schistosomiasis, which has been successfully controlled in most parts of the country and numbers reduced from 12 million to 287,000 in 2011. The disease is spread by cattle and water buffalo, and thus changes in farming techniques are needed to help eliminate the disease. Similar improvements in control have been seen for leishmaniasis, the sandfly-spread protozoal infection which used to be common around the Yangtze river basin but now affects only about 2500 people a year. The bacterial infection trachoma that causes blindness is also close to elimination due to implementation of mass campaigns that apply WHO strategies such as facial cleanliness. Rabies has also been controlled, but still causes 2000-3000 cases a year. Immunisation of 70% of dogs at risk should break the cycle of infection, but currently only about 20% are vaccinated. Leprosy was reported to affect about 6000 people in China in 2010, of which about 1300 were new cases. Better surveillance and multi-drug treatment regimens should help eradicate the infection by 2020, the report suggests.
China has has less success with soil-transmitted helminthiasis, and there are about 85 million Chinese affected by roundworm and whipworm. De-worming of schoolchildren seems to have only modest efficacy, and so new strategies such as curbs on the use of human waste as fertiliser are needed, the report says.
The most problematic tropical diseases for China include dengue fever, with outbreaks of the mosquito-borne infection rapidly emerging as a major public health problem. Climate change is worsening the problem, which requires better monitoring and mosquito management strategies as there is no drug or vaccine for the disease.
Another major problem tropical disease for China are the food-borne parasitic zoonoses, such as liver flukes, lung flukes, and other trematodes that may be transmitted by fish, snails and freshwater plants. There are tens of millions of cases in China, which has the dubious honour of having 80% of the 15 million cases globally. New programs are needed to identify high risk disease areas and to address transmission of infection through occupational risk (eg farmers) and also consumption of high risk foods.
Control of these many tropical diseases will require huge  resources to build and design  programs specific for each disease and the high risk locations and populations they affect, the authors conclude.

A few fibs about healthcare in China's human rights report

by Michael Woodhead
Don't be too cynical about China's rather self-congratulatory human rights review for 2013. 
 It contains some genuine advances as well as the the usual stuff how much more freedom of speech Chinese citizens enjoy. (The fact that I would not be able to read nor write my blog post or tweet about this report in China because blogspot and Twitter are banned sums it up really). Yes, China has improved human rights if you count lifting citizens out of poverty and providing them with an education and not treating the women like horses. I'll give you that.
But when it comes to the human rights aspects of China's healthcare system, the report is notable for what it leaves out. The report says China has developed a social security system "suitable to China' s current social conditions'. More specifically for health it says that China has established a basic national medical insurance system, that covers than 1.3 billion people, or over 90% of the population. Government subsidies for basic medical insurance for have risen from 40 yuan per person in 2007 to 280 yuan in 2013. It also claims that the reimbursement rate for hospitalisation expenses covered by relevant policies has been raised to around 70%. There are many more figures like this that make it sound as if China now has a functioning health insurance system that covers most of the population. As you will know if you have read many of my previous posts, this simply isn't the case.  The reality is that China's medical insurance scheme coverage of expenses is minimal and fragmented. It's a user pays system and most Chinese people still face high out of pocket expenses for even the most basic hospital treatment. Look at this new report from Guangzhou on the impact of health insurance on the burden of medical fees for Chinese patients. Its conclusion:
"social health insurance participation has a weak negative or even no significant association with the out-of-pocket payments of hospitalized patients. This seems to contradict the principles of social health insurance, which aims to reduce people's out-of-pocket payments and enhance their wellbeing."
Or this study released this week entitled: "The impact of expanded health system reform on governmental contributions and individual co-payments in the new Chinese rural cooperative medical system." It concludes that while co-payments in most rural provinces have been reduced, "a greater financial burden for healthcare persists among persons in the poorest rural regions." The WHO recently reported about the devastating effect that a major illness can have on household impoverishment in China - in other words, low income families are being financially ruined by their medical expenses - they simply can't afford to be sick, and become destitute. And it's not just the low income Chinese who are feeling the healthcare crisis: blogger Zhang Lijia tells of the common experience of middle class urban Chinese:
"The doctor took one cursory look and sent me for an allergy test on an imported machine and then prescribed numerous creams and pills. The total bill was US$800 - more than the average monthly salary in Beijing."
These then are just a few examples of the reality of China's healthcare 'human rights record'. China looks foolish when it publishes reports like this which are so obviously misleading. They have many aspects of their healthcare system of which they can be proud - the good public health services that ensure high vaccination levels and control of infectious diseases such as malaria, for example.
However, if you count universal basic healthcare as a human right China has failed to protect the human rights of its citizens. In this it is in good company - the USA is in much the same boat, as healthcare remains unaffordable for those who cannot get insurance.
Xi Jingping often talks about the 'Chinese Dream' - and that's what this human rights report is when it comes to healthcare - more dream than reality.

A dozen medical news stories to start the week ...

1. The Chinese name for dementia should be changed because the characters meaning “insane” and “idiotic” are demeaning and inappropriate, according to a professor of clinical psychiatry who wrote an editorial in the International Psychogeriatrics journal.

2. Professor Ye Shuang from the Renji Hospital in Shanghai has told an international rheumatology conference that the cheap diabetes drug metformin is a simple steroid-sparing agent in lupus, and thus could enhance efficacy and reduce side effects of therapy, according to Rheumatology Update.

3. A clinic in Shandong Province is said to have charged a pregnant women double for an ultrasound scan because she had twins. The hospital defended its charging, saying it it charged 'per organ'.

4. China's New Rural Cooperative Medical System (NCMS) is not working well for the poorest counties, according to health economists. In a new study they say that hospital out-of-pocket payments are higher for the poorest counties of China under the scheme.

5. A hospital in Shanxi has apologised to a man with a rash who was given vaginal pessaries as oral medicine. The man complained when he read the label but the doctor insisted they were the right medication. He later admitted his error and blamed it on the noisy and chaotic working conditions at his clinic.

6. Officials from the National Institutes for Food and Drug Control in Beijing have defended the quality of vaccines manufactured in China after a critical article in Nature raised doubts about the standards of production.

7. A national campaign to prevent neural tube defects has helped increase the rate of periconceptional folic acid supplementation from 15 % to 85 %. However, more than half of the women began taking the supplements too late, only after learning they were pregnant.

8. The inflammatory disease of blood vessels, Kawasaki Disease has been traced to wind-born toxins from cropfields of north-eastern China, according to researchers.

9. Cases of 'breakthrough' chickenpox in children who have been immunised under the one-dose schedule of varicella vaccination are milder than cases of chickenpox in unvaccinated children, a study from the Fengtai Center for Disease Control and Prevention; Beijing, shows.

10. The province of Hebei surrounding Beijing is full of 'ghost hospitals' as patients opt to seek healthcare at major hospitals in the capital, according to a new report. Some Hebei hospitals are 70% empty, and the preference for Beijing is putting strain on the city's already overloaded hospitals.

11. A 3-year old girl with a stomach disorder is being fed mouth-to-mouth by her father who chews up her food for her as she cannot digest it. The father says he needs tens of thousand of yuan to pay for the operation to cure his daughter and has already received several thousand yuan in donations.

12. The Chinese craze for IV infusions has claimed another victim, after an 11-year-old boy with a fever died shortly after being put on a drip at a hospital in Foshan, Guangdong. The hospital says it is investigating the case to ascertain the cause of death.

Sichuan polio cases show need for better vaccine coverage

by Michael Woodhead
A small outbreak of polio that occurred in Sichuan was derived from a vaccine-related strain, according to researchers from the WHO Regional Polio Reference Laboratory in Beijing.
In a new report they describe the strains of polio virus isolated from three cases of flaccid paralysis that occurred in an isolated region of Aba, Sichuan in 2011 and 2012.  They say the virus strain was similar to that used in the trivalent (Sabin) oral polio vaccine, but with minor changes that affected its attenuation and temperature sensitivity. The virus was found in the three cases of polio, all of which occurred in unimmunised infants below the age of one. The virus was also found in one close contact. The new strain of polio virus appears to have been circulating in the remote community for about seven months, they said."
"Our findings reinforce the point that circulating vaccine-derived poliovirus can emerge and spread in isolated communities with immunity gaps, and highlight the emergence risks of type 2 circulating vaccine-derived poliovirus accompanying the trivalent OPV used, they said.
"To solve this issue, it is recommended that type 2 OPV should be removed from the trivalent OPV or use of inactivated polio vaccine (IPV) instead.
The findings are reported in Clinical and Vaccine Immunology.

China: medical procedures are now dictated by fortune tellers

by Michael Woodhead 
In the west, patients often do their ‘homework’ by consulting medical books and websites before seeing a doctor – but in China patients are doing their homework with fortune tellers. A new report shows that patients are relying on fortune tellers to decide what date they will have an operation, when to have a caesarean section and even to guide cosmetic surgery for a more ‘fortunate’ face.
At a Liaoning Hospital, head of nursing Ren Yumei says about 80% of women choose to have a caesarean section birth, and many of them are done so they can select the ‘auspicious’ date and time selected for their child’s birth from fortune tellers consulting the books of the “Great Immortals’.
“Many women and their families demand not just the day but the hour of birth according to horoscopes, they won’t accept any deviation,” she says.
In Anshan, head surgeon Wang Yongshen says the same thing is now happening with patients requiring elective surgery. Patients demand a specific time for the operation – sometimes even in the early hours of the morning.
“Even when they know that surgery in the middle of the night is likely to be less safe and effective they opt for it because of the influence of the fortune tellers,” he says. And when hospitals refuse these unscientific requests, patients turn to smaller private clinics that are happy to cash in on the new fad for ‘auspiciously timed medical procedures’, even though their medical standards are often suspect.
Obstetric nurse Ren Yumei says she is concerned to see mothers and families putting their baby’s health at risk by forcing an early delivery just to have a ‘lucky’ birth timing. She says the health risks of premature birth are well known, including respiratory and developmental problems as well as blood and cardiovascular risks.
A surgeon at a cosmetic clinic in Shenyang says he even sees patients who wish to change their appearance based on advice from fortune tellers. He had one young man who insisted on having surgery to give him a bigger chin because this would make him appear more bold and daring, in accordance with his horoscope, according to an adviser. He went ahead with the operation despite medical advice that it would restrict his jaw movement.
Professor Zhang Bao of the Tianjin Institute for Social Sciences says the new trend is anti-scientific and a remnant of ‘old thinking’ superstitious ignorance. He said the two schools of thought could not co-exist and there would be a collision between the two.
He said many ‘fortune tellers’ were in business for personal gain and they made extravagant claims that had no regard for the welfare of the patient. He said such practices should be strictly supervised and exposed for what they are. If they continued to provide harmful advice fortune tellers should be prosecuted and punished, he said.
The original report is published by Xinhua.

Shenzhen takes to family doctors

by Michael Woodhead
On International Family Doctor Day a Shenzhen joint venture clinic with Hong Kong University is claiming that general practitioners are proving popular with patients. 
The HK University Shenzhen Hospital clinic offers a GP service in which patients with chronic diseases can book face to face appointment with their family doctor. The clinic has an 80% return rate and the main diseases treated are cardiovascular disease, diabetes, arthritis and mental health problems, according to GP Dr Liu Ruihong. He said other hospital clinics are not open to external referrals, and only accept internal referrals. However, the GP clinic works on international model in that a GP can refer to the hospital clinic and vice versa. He says that according to WHO criteria, patients with chronic diseases are best treated by a generalist doctor with continuity of care and an emphasis on preventive care. With good GP care, patients with chronic diseases can stay healthy and avoid the need for hospital treatment for decades, he says.
After six months of a pilot program, the clinic is proving popular with patients and an increasing numbering are registering with the clinic and returning to see their personal doctor, he added.

Six of the top medical news stories from China

1. China has a huge shortage of midwives, and would need a further 800,000 to meet the WHO standard of one for every thousand women of child-bearing age, according to a new report. Health officials say the problem will worsen as China adopts a two child policy.

2. Efforts to control pneumococcal disease and Haemophilus influenzae type b (Hib) in children by vaccination are failing due to low immunisation rates and delayed immunisation, a study from Shanghai shows. A review of vaccination records for 28,000 children up to the age of seven found that 51% had one dose of Hib vaccine and 11.4% had one dose of pneumococcal vaccine. Only 8.2% of children had Hib vaccine at the right time and only 0.5% had timely pneumococcal vaccine. Rates were particularly poor for migrant children, the study found.

3. Rates of hypertension have increased in China and yet treatment and control of the condition remain poor, according to researchers from Shandong. In a study of more than 4000 people they found that the incidence of hypertension increased from 2.9 per 100,000 people in 1991–1997 to 5.3 in 2004–2009 Antihypertensive treatment and control rates for hypertension were 5.7% and 1.7% in 1991–1997 and 19.9% and 7.6% in 2004–2009, respectively.

4. The rate of disabilities from road crashes in China has skyrocketed as the number of cars on the road has increased over the last two decades. The incidence rate for road traffic disabilities increased over time from 1.50 per 100,000 people in 1980 to 11.2 per 100 000 persons in 2005, according to Professor Zheng Xiaoying of the Institute of Population Research, Peking University.

5. Malaria is still a major problem in central China especially during floods and rainy periods of the summer. A study from Mengcheng County, Anhui found that there were 3683 malaria were notified during the study period of May to October 2007 Most of the cases occurred a week to a month after flooding and waterlogging. Public health action should be taken to control the potential risk of malaria epidemics after wet weather, the researchers from Shandong University said.

6. The recent outbreaks of H7N9 avian influenza also resulted in many mild and asymptomatic infections as well as severe life threatening cases, researchers from Guangdong have reported. Their surveillance program noted 21 cases of infection in Guangzhou, China in 2013 and 2014, of which several were mild or asymptomatic infection. Family clusters occurred, suggesting limited person-to-person transmission of the H7N9 virus, they said.

Wuhan medical staff on trial for organ trafficking

by Michael Woodhead
A gang of 12 organ traffickers including surgeons, anaesthetists and nurses on on trial in Wuhan accused of selling organs for up to 360,000 yuan ($58,000).
In a case know as the "undergound kidney trafficking network" the 12 are accused of buying and selling kidneys in a million-yuan scheme scheme in which donors were paid 30,000 yuan ($5000). According to the Anhui News, the gang performed six commercial organ transplant operations between 2012 and 2013, for which they charged between 170,000 and 360,000 yuan ($27,000-58,000), which was divided up between the participants. The gang included a surgeon called Dr Chen, an anaesthetist Dr Peng, an assistant surgeon Dr Yao, two surgical nurses, and two follow-up nurses. There was also a group of 'fixers and 'agents who bought medical equipment and drugs and who set up the deals and arranged premises in the Jiangxia district in which to perform the illegal operations.  Other gang members arranged transport and liaised between medical staff and buyers and sellers. Eleven members of the gang have already pleaded guilty to the offences. The ringleaders of the gang were an agent called Deng and Dr Chen. Deng set up the deals through the internet, making contact with people looking for an organ and also contacting people who were willing to sell one of their kidneys. Deng said he received 34,000 yuan ($5500) for each deal. One donor in the court said he could now put his heart at rest. he said he greatly regretted his disastrous decision to sell one of his kidneys when he was deeply in debt. now he said he was easily tired and had lost all his strength after the operation.
Xinhua report does not say at which hospital the doctors worked or who the buyers of the organs were, nor what the outcomes of illegal organ transplant surgery were.

Beijing’s 3-point reform plan for maternity services

by Michael Woodhead
Maternity services are to shift from hospitals to community health centres and women will not be allowed to have routine Caesareans unless there is a valid medical indication, Beijing health officials have announced.
New reforms are needed in maternity policies to cope with the expected increase in births as China moves to a two child policy, according to the city health department.
Under new measures, three new basic policies will be introduced. These are for women to register first with a community health centre rather than a maternity hospital. Following tests at six week of pregnancy, women will be enrolled on the maternity database, and women will then be graded into one of four levels according to risk of pregnancy. Only high-risk pregnancies (such as in older women) will be managed in tertiary level hospitals. Low risk births will be managed in local hospitals and clinics, the new policy states. In addition, women will no longer be offered caesarean section unless there is a good medical indication. The head of Beijing maternity services department says caesareans must be discouraged because China already has a 45% rate, which is much higher than the WHO benchmark of 14%. In addition, caesarean birth mean women spend longer in maternity hospitals, taking up scare resources, she said.
Health officials said the maternity system was already at breaking point with something like 94% occupancy of obstetric beds and thus no additional capacity to cope with a two child policy. Maternity services will be expanded but they also must be used more rationally, the officials said. By managing low risk pregnancies outside the hospital system, this will free up beds to deal with high risk pregnancies, they said.

Smoking deprivation | Suicidal ideation in school students | Obesity surgery | Oestrogen in the environment

About 7% of Chinese people smoke so much their spending on cigarettes deprives the household of essential items like food, a study from Beijing has found. Low-income smokers were more likely to have smoking-induced deprivation.

Suicidal ideation occurs in one in three Chinese high school girls and 20% of boys, a study of 5249 students in Anhui Province of China has found.

Laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy are safe and effective for the treatment of morbid obesity, resulting in 63% and 76% loss of excess weight, a study from Nankai Hospital of Tianjin Medical University has shown.

The waist circumference cut off for high risk of central obesity and metabolic syndrome is 85 cm for women and 90 cm for men, researchers from Shandong have shown.

In Shanghai, almost one-in-five boys are obese and 8% of girls are obese. The prevalence of combined overweight and obesity is 49% for boys and 31% for girls aged 8-15-years, according to a study that found rates of obesity started to increase from age 10 years.

Oestrogen hormones are widely used in animal rearing in China and this leads to high levels of the hormones in excreted manure which is then used on crops, perpetuating the environmental contamination and human exposure, researchers from the State Key Laboratory of Water Environment Simulation, Beijing have shown.

The highly pathogenic strain of H7N9 avian influenza is quite different from other H7N9 strains seen in China and appears to have come about by re-assortment with the H9N2 strain, according to researchers from the Guangdong Provincial Center for Disease Control and Prevention.

Infliximab is safe and effective in Chinese patients with ulcerative colitis, resulting in 85% response rates and 62% remission rates after 30 weeks of treatment. However, relapse rates are high, say researchers from the Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou.

Freaky Friday: nurses now dress as air hostesses at Jiangsu Hospital

by Michael Woodhead
Just when you thought you'd seen it all, here's a Chinese hospital that has come up with a gimmick to promote its service-oriented approach.
The Lianshui Huaian Hospital of Chinese Medicine has sent 12  nurses on an Eastern Airlines-style airline cabin crew training course and now requires them to wear air hostess uniforms on the wards. The aim is to emphasise the personal service aspect of the hospital's care, says hospital manager Bo Haijuan.  He came up with the idea a year ago and has been doing market research about the plan, which was implemented this month. The nurses were recruited from other departments and hospitals based on age, height and appearance, and their etiquette skills were nurtured in a one-month training course.
Bo Haijun says he wanted the 'hostess nurses' to stand out from ordinary nurses, who he said gave patients a 'cold face', lacked manners and had little personal caring spirit. The hostess nurses always have a warm smile and patience, he said. However, they still carry out all the normal patient care and technical functions of regular nurses. A reporter from Yangzi Evening News noted that in the hospital the nurses administered treatment such as moxibustion, but they also dealt with small service matters such as offering coffee and comfortable chairs for waiting patients. Their uniforms resemble those of airline cabin crew although the skirts are slightly longer for modesty reasons.
The new nurses who spoke to the reporter said they felt more pride in their job but now had to be more careful about their lifestyle and appearance. One said she no longer dare stay up past midnight on social media because she feared having dark rings under her eyes and looking tired - now she went to bed at 10pm. Another said she had to avoid fatty food because she must keep her figure. The hospital said the hostess nurses got higher pay, but that was because they did harder work in providing service to patients.

HPV vaccine delay | Baidu medical fraud | Malaria system success | Gassers in short supply | GSK case won't stop bribery

1. China may be delaying approval of HPV vaccines made by foreign companies until the country has a homegrown competitor, according to Global Times. The HPV vaccines Gardasil and Cervarix are still not available in China despite 30,000 women dying in China every year of HPV-related cervical cancer. Some Chinese doctors and officials claim there are ethnic differences in vaccine responses between Chinese and Europeans, and clinical trials that in Chinese people are needed to ensure of the vaccines' safety and efficiency on Chinese.

2.  Baidu earns its fortune by promoting fraudulent medical information at the cost of health and even lives, critics say. The search engine site is the main avenue used by illegal drug manufacturers and illegal hospitals to advertise in China, they claim. Many drugs that are explicitly banned by the China Food and Drug Administration (CFDA) are still on promotion on Baidu, an article in Daily Kos says.

3. A '1-3-7' system of dealing with malaria cases that is very successful and could be a model for other countries, researchers from the Jiangsu Institute of Parasitic Diseases claim. The system is based on case reporting within one day, case investigation within three days. and focus investigation and action within seven days.Since the system was implemented in 2012 the proportion of cases investigated in 3 days has reached 100%, and seven-day action rates are 50% and rising.

4. China has a shortage of 200,000 anesthesiologists as doctors avoid the speciality due to low salaries, heavy workloads and lack of a strong training system, experts say. A conference was told that China has only 100,000 anesthesiologists but needs 300,000. Eight anesthesiologists died of overwork last year, according to Yu Weifeng, head of the anaesthesiologist branch of the Chinese Medical Doctors Association.

5. A cure for the endemic corruption in China's healthcare system is still far away despite the scare campaign against executives of British pharma company GSK, the online magazine Caixin says. While the crackdown makes the authorities look like they are being tough on bribery for prescribing, the reality is that doctors still accept commissions and there is no fix for the 'demand side' of the bribery equation, the magazine says. The health ministry cannot afford to alienate doctors, who are central to the problem, it concludes.

Six of the best medical stories from China: Wed 14th May

1. Obesity is on the increase in China with new figures showing that men have a 2.8 kg/m2 higher BMI in 2009 compared to their counterparts in 1993, while women have a 1.5 kg/m2 higher BMI . Waistlines have also increased by 9 cm for men and 5cm for women, according to researchers from the National Institute of Nutrition and Food Safety, Beijing.

2. A man with arthritis died while undergoing treatment at an Anhui clinic and was secretly buried by the doctor on nearby waste ground, the Shanghai Daily reports. The 53-year old man went to the Hefei clinic for treatment of shoulder arthritis, but appears to have had an adverse reaction to an injection and started foaming at the mouth. Instead of trying to treat the man, the doctor who owned the clinic locked him in the room until he died and then took the body outside and dug a big hole to bury it in. Dr Li was found out when police examined video surveillance camera footage and was detained on suspicion of severe medical malpractice.

3. The 'Tiger Mom' style of parenting in China is contributing to mental health problems in later life, according to a study from the Department of Clinical Psychology, Beijing Anding Hospital and the Beijing Key Laboratory of Mental Disorders. The study found that parental punishment, rejection and control were key factors in borderline personality disorder (BPD). Paternal punishment, low maternal emotional warmth predicted BPD diagnosis, especially in women. Maternal emotional warmth may be a protective factor against BPD.

4. Noxious gases from sewage treatment plants pose a threat to human health, a study from Tianjin has found. Researchers found that sewage treatment plants emitted toxic levels of hydrogen sulphide and also many classes of organic carcinogens from waste water.

5. China now has 2.78 million nurses, or one for every 500 people, according to new figures. However, many nurses are working in non-traditional roles such as non-communicable disease management, rehab and hospice care.

6. Fudan University in Shanghai has teamed up with local health services to set up an experimental health care unit to explore healthcare reforms and flexible models of care such as patient transfers, medical insurance payments and doctors working at more than one medical facility.

Four-fold rise in chickenpox shows China's one-dose varicella vaccination policy is not enough to prevent outbreaks

by Michael Woodhead
China needs to move from a one-dose to a two-dose varicella vaccination schedule because he current system is not preventing outbreaks of chickenpox, a study from Beijing has shown.
There have been more than 62 outbreaks of chickenpox (varicella) among children in the Fengtai district of Beijing since 2008 despite vaccination rates of over 80%, researchers have reported this month. They found that the number of varicella cases has increased fourfold in the district from
from 167 in 2008 to 622 in 2012. More than 60% of the cases were breakthrough infections in children who had been vaccinated, according to Dr Zhang Xue and colleagues at the Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University.
"These results indicated that in the Beijing Fengtai District, one-dose vaccination could not effectively protect the vaccination recipient from varicella infection or cut off the varicella transmission during the outbreak," they wrote.
Their study suggested that the efficacy of the varicella vaccine wanes after a few years, and in children with varicella, the average time since vaccination was six years, (76% of cases occurred more than five years after vaccination).
Varicella was also more common among children of migrant worker families, presumably because of lower vaccination rates and due to overcrowded living conditions.
The researchers said their findings showed that the single dose vaccine program introduced in 1997 was not sufficient to contain varicella in China.
"In summary, our study provides justification for implementing a two-dose varicella vaccination program in cities in China, such as Beijing, despite the presence of already-high vaccination coverage."

Husband wins 300,000 yuan compensation from Beijing hospital over wife's death from pneumonia

A Beijing man has won Y300,000  in compensation from the Harmony Hospital in Beijing after a four year legal battle over the death of his wife from complications of pneumonia. The man claimed that his wife had died following  a lung biopsy to investigate the cause of her breathing difficulties. He claimed 900,000 yuan in compensation for living expenses and funeral costs, and was initially 25,000 yuan settlement by the hospital, which denied responsibility for the death. However, the man appealed to a higher court and was awarded 300,000 yuan when the court found that hospital in providing follow up care to the 57-year old woman. The court heard that the woman had a chronic lung disease resembling asthma. and was admitted to the hospital for tests in May 2011. However, the tests were carried out by a junior doctor who ordered a biopsy which the husband claimed was not necessary to diagnose pneumonia. The court also accepted his claim that the follow-up care after the biopsy was lacking as the woman received little supervision and developed pneumothorax and died. The court found that the hospital did not make basic precautions such as doing a risk assessment on the patient for the procedure, or managing thoracic drainage competently. It also heard that the hospital had altered medical records to try cover up its malpractice, but the court did not accept the evidence for this.

Doctor taken hostage after patient dies of lung cancer

by Michael Woodhead
An oncologist was taken hostage by a knife-wielding man at a Dongguan hospital after the man's father died from lung cancer, Guangdong media have reported.
The doctor, surnamed Chang, was able to escape from his captor during negotiations with police, but two police were injured while trying to apprehend the hijacker. Doctors say the man was the son of a patient who died after an operation for lung cancer on 9th May. Doctors said the patient had been unco-operative throughout his treatment and had refused to follow doctor's advice, even refusing to stay in bed when he was sick. When the man got out of bed and started moving round, he had breathing difficulties and his condition deteriorated and he collapsed. After the man died, his son left and returned with a knife, which he used to threaten staff, and he took Dr Chang hostage and locked the door. He called for Dr Wen to come over, believing him to be the one responsible for his father's death and said he would kill him and then himself. Dr Chang told the man that he was the one who operated on his father and only he was responsible. When he tried calling for Dr Wen three times without success, the man got more agitated.
A police hostage squad with shields came to the hospital and started negotiations with the attacker, who had Dr Chen held with a knife at his neck. When the hostage negotiator asked the man to approach to talk, Dr Chen was able to suddenly break away and escape from the room. The attacker chased after the doctor but was stopped by police who used their shields to press him to the wall. When the attacker was trapped he lashed out at police with the knife, stabbing two of them around the ear and the hand, injuring them.
The 28-year old man was then arrested by police. Dr Chang said it was the first time in his career that he had ever come across such an extreme situation.

Xian parents say government has suppressed findings of side effect damage from kindergarten antivirals

by Michael Woodhead
One of the top Xinhua stories this week is a report from Xian claiming that the local government in the city has suppressed or manipulated the results of health checks on children dosed with antivirals by kindergartens.
The report is a follow up on the shock discovery that two local kindergartens had been routinely dosing children with antiviral medication. The so-called "Yao Er Yuan" [药儿园] scandal (a pun on the Chinese name for kindergarten - You Er Yuan 幼儿园 - replacing one character with that for drug) was supposedly about schools dosing kids with antivirals to prevent them getting colds and to improve their attendance (and performance) at the schools. The practice was strongly condemned by health authorities, with the National Health and Family Planning Commission (NHFPC) issuing a warning that this kind of practice was strictly prohibited, and calling on all local authorities to conduct checks on kindergartens. 
The children attending the kindergartens involved were referred to local hospitals to undergo checks to ensure that there had been no untoward effects from having being exposed to the antivirals. However, some parents are now saying that the checks have been a sham and the results of health checks have either been fabricated or suppressed. One parent quoted by Xinhua is a Mr Zhu, who says that his five year old daughter had suffered from renal impairment and haematuria from the antivirals, but this had not been picked up by the official hospital checks. He took his daughter to another hospital for a check up and they found significant kidney damage, but this was not reported by the official hospital. Further investigation by Xinhua reporters found that there were several hundred children whose tests showed that had experienced adverse health effects from the antivirals, but the official government figure was just 65. Further investigation revealed other anomalies. Many of the tests results were identical, suggesting they were not genuine but just copies. Discrepancies were also seen in ultrasound scans of children, which experts again said were not genuine. One parent reported that when he took his child for a scan he was given the 'result report' even before she had undergone a scan.
A Xinhua reporter put these claims to the local government in Xian, which responded by saying that the investigation into adverse effects had not been concluded and any figures released were premature. They said the concerns raised by parents and the media would be referred to higher authorities, which would take the feedback as part of its ongoing investigation into the antiviral dosing of kindergarten children.
[Editor's note: it might seem odd that a Chinese government newspaper is highlighting apparent government malpractice ... there may be more than this than meets the eye, or perhaps it is genuine attempt to expose wrongdoing as part of Xi Jingping's campaign against 'formalism' and 'poor working styles'].