China Medical News

On December 27^th, China's first oral antiviral drug, danoprevir (ASC08), for treating hepatitis C virus (HCV) is going through the final approval procedure with the CFDA for general use, said Wu Jinzi, the chief of the development team at Ascletis Pharmaceuticals. The drug requires a 12 week course of treatment, and clinical trials have shown that it can cure 90% of HCV patients.

China has more than 8.5 million people with HCV. HCV can develop into liver fibrosis, cirrhosis and even liver cancer. An HCV drug sold by American drug maker Gilead costs USD 84,000 for a course of therapy, or around USD 1,000 per day, which is far beyond the means of almost all sufferers. Wu said the price of danoprevir has not yet been set, but it will be much cheaper than the American drug. (Source: Xinhua)

To further the medical reform in China, the State Council released a guideline saying that all public hospitals will have to stop marking up the price of the drugs they sell. This is a controversial practice that has been adopted by such hospitals for years, to make up for a government funding deficiency, according to the guideline. Public hospitals generally sell drugs for prices that are up to 15% higher than what they pay for them. Some experts say this gives them incentives to buy more expensive drugs, and causes doctors to prescribe more expensive drugs.

With an expected decline in drug sales, the local government will allow public hospitals to adjust service fees. Checkup and test fees will be reduced, while services that require professional skills, such as diagnosis and surgery, will increase, the guideline said. However, the total cost to individuals will not increase, it added.

In contrast to soaring drug prices, some service fees collected by public hospitals are very low. For example, the price of a diagnosis offered by a doctor with a senior title is no more than 14 yuan ($2.10) in many public hospitals in Beijing, a rate that has not changed for many years.

The local government will make detailed policies to compensate public hospitals for the loss of drug sales revenue, and local governments are encouraged to increase remuneration for medical staff as an incentive, said the chief for medical reform at the National Health and Family Planning Commission.

"A major difficulty in the medical reform is to break up the strong interest groups that have formed in the medical sector over a long period, such as in drug purchases and distribution," said a medical reform researcher at Renmin University of China. (Source: China Daily)

Merck has opened a plant in Nantong, China's eastern Jiangsu Province, to produce pharmaceuticals on the country's Essential Drug List. Merck has invested 170 million euros (188 million USD) in this pharmaceutical plant, which had been under construction since 2013.

"By dedicating the largest manufacturing plant outside Europe to the production of pharmaceuticals to address widespread health care needs in China, Merck is connected to China more than ever," said Mark Horn, managing director of Merck's biopharma business.

The Nantong plant will reach an annual output of up to 10 billion dosages of pharmaceuticals for the treatment of diabetes, cardiovascular disease and thyroid disorders by 2021. The first batch of its pharmaceutical products will enter the market in the second half of 2017. (Source: Xinhua)

The World Obesity Federation has predicted that Chinese youth will top the world in obesity by 2025. The report shows how the obesity rate in China has been growing, and that if the trend continues, obese children and teenagers aged between 5 and 18 in Chinese mainland will reach 48.5 million by 2025, a number that surpasses the total population of Spain. Obese youth is estimated to reach 7.3 million in India, and 16.7 million in the US. In 2013, China ranked 8th in the world's top 20 countries with the fastest growing youth obesity rate. The top three are Vietnam, Azerbaijan and Serbia. The report cautions against the rate of obesity in children in rural China.

Alongside the rising obesity rate among Chinese youth, millions of them are estimated to suffer from diseases such as fatty liver, diabetes, high blood pressure and low glucose tolerance.
The State Council released guidelines in 2011 responding to the increase of obese children in China. The guideline for the development of Chinese youth, set between 2011 and 2020, aimed to prevent more children from becoming obese. The guideline urges local authorities in China to strengthen the training of medical staff around children's health and promote the knowledge of balanced eating and drinking habits among their parents. (Source: South China Morning Post)

During the InterAcademy Partnership for Health 2016 Conference, held during October 4-5^th in Beijing, the deputy head of the National Health and Family Planning Commission said that by 2020, senior citizens aged 60 or above will make up 17% of the population (approx. 240 million).

The senior health official noted that the situation with chronic disease is severe, with more than 260 million chronically ill patients in the country, and that these illnesses are to blame for over 86% of deaths in China. The official also said that the per capita annual spending on health was estimated at around 472 U.S. dollars in 2015. (Source: Xinhua)

China's top broadcast watchdog announced on August 26^th that it will tighten regulation over health and medical related TV programs and advertising. The State Administration of Press, Publication, Radio, Film and Television (SARFT) recently issued a circular stating that such programs could only be produced by TV station personnel. Such programs will also be required to be reviewed and recorded. Programs made by private companies will not be allowed on air, the circular said. SARFT also banned advertisements during such programs. Experts on medical or health programs must have relevant qualifications issued by health authorities. The circular also imposed limits on the length and form of medical advertisements. Each advertisement should not exceed one minute, with advertisements disguised as TV programs strictly prohibited, it said.

Also, China will intensify efforts to regulate online commercials following public ire over deceptive online advertising. According to the vice head of the State Administration for Industry and Commerce (SAIC), a temporary regulation will take effect on Sept. 1, requiring publishers to clearly mark all online commercials as advertisements to warn netizens.
A college student died in April after he followed allegedly deceptive information promoted by search engine Baidu and signed up for medical treatment at a Beijing hospital. The upcoming regulation makes it clear that paid promotion of information on search engines is classed as advertising.
According to the SAIC, a department tasked with monitoring online commercials will also be established. From September 2015 to August 2016, the SAIC and other market regulators discovered around 3,200 cases of unlawful online advertising. (Source: Xinhua)

Beijing will launch a crackdown on scalpers that camp out at the city's hospitals to book and resell appointments, authorities said Tuesday (August 16^th). In a meeting on hospital offences and crimes, Beijing Police ordered hospitals to increase security and install surveillance cameras. The police will respond to any complaints made by these medical institutions and handle any emergencies related to scalpers, said the deputy head of Beijing's Public Security Bureau.
Scalpers in hospitals snap up registration numbers, making booking appointments very difficult for the public. In late January, a video shot at a Beijing hospital went viral in China. In the video, a woman raged about the fact that appointments for specialists had been booked by scalpers, who were selling them for 4,500 yuan (688 U.S. dollars), 15 times higher than the original fee. In Chinese hospitals, patients often pay a fee to schedule medical appointments and are issued a number ticket upon booking.
Triggered by the video, hospitals in Beijing have taken measures, including a real-name system for appointments, but a number of scalpers have continued regardless. (Source: Xinhua)

According to the official report released by the China Internet Network Information Center (CNNIC) on August 3rd, China has 710 million Internet users as of June, accounting for 51.7% of its total population, exceeding the global average by 3.1%.
China gained about 21.3 million new web users in the first half of 2016, an increase of 1.3 percent compared with figures from the end of 2015, the report said. The report noted that 191 million people, almost 27% total Internet users were from rural areas, marking a huge gap of 35.6% in the Internet penetration rate between urban and rural areas. (Source: Xinhua)

Beijing's smoking ban, which came into effect on June 1 last year and made it illegal to smoke indoors in public places, has curbed smoking in the capital and won widespread public support, according to a survey published on May 27 by the Chinese Association of Tobacco Control.
The Beijing ban, the strictest in the country's history, prohibits smoking indoors at public places and at outdoor venues, such as schools and children's hospitals.

The survey at 450 public places in the Chinese capital found that the situation has improved markedly since the ban came into force. The biggest improvements were seen in bars and restaurants, while hospitals were recognized as the best enforcers of the ban, the survey said. Smoking was reported in only 14% of the bars visited, compared with 90% before the ban came into effect. A researcher at the Chinese Association of Tobacco Control, said the benefits have been recognized by the public, including many smokers.

The results of the survey will provide vital information for lawmakers, as the country mulls extending the ban to implement China's first-ever nationwide anti-smoking legislation. The proposed law was drafted by the National Health and Family Planning Commission, which solicited opinions from several government departments, said a spokesman for the commission.

However, insiders said the draft offers too much leeway because it would allow smoking areas to be established in public places, such as restaurants, bars and coffee or tea shops. A deputy director of the Beijing Tobacco Control Association, said: "That's like setting aside a peeing area in a swimming pool."

A spokesman for the National Health and Family Planning Commission said smoking areas in public places cannot protect people from the effects of second-hand smoke, and also added that "they make enforcement of the anti-smoking regulations even harder and more complicated." Nationwide, many obstacles remain to the full implementation of smoking bans, the spokesman said, citing poor public awareness of the health risks posed by both active and passive smoking, and a lack of respect for rules.
Moreover, China's tobacco industry is a State monopoly and the government relies heavily on the revenues generated, which means vested interests may attempt to block or delay measures to control tobacco use, he added. (Source: National Health and Family Planning Commission)

High prices of imported and patent drugs are a great burden for Chinese patients and the country as a whole. The National Health and Family Planning Commission said that some pharmaceutical manufacturers have agreed to lower some drugs' prices on condition of bulk purchase. GlaxoSmithKline (GSK) will reduce the price of tenofovir disoproxil, a treatment for hepatitis B, from 1500 yuan (229 USD) to 490 yuan per month. Icotinib, an anti-cancer drug made by China's Betta Pharmaceuticals, will be dropped from 12,000 yuan to 5,500 yuan for a month's supply. AstraZeneca will lower the monthly cost for the anti-cancer gefitinib from 15,000 yuan to 7,000 yuan. (Source: Xinhua)

A recent global review by the UK's Lord Jim O'Neill on anti-microbial resistance, estimates that by 2050 antibiotic resistance could result in 1 million premature deaths annually in China. "China could suffer an enormous loss of GDP because of that," said O'Neill, who headed the expert review team. According to the report, China uses around half the world's antibiotics, of which 48 percent are consumed by people and the rest are used in the agricultural sector. Weak regulation on the use of antibiotics in agriculture also further encourages overuse, it said.

A director of the Institute for Disease Prevention and Control of the People's Liberation Army, said excessive antibiotic residue might be passed on to humans through meat consumption, increasing the possibility of antibiotic resistance in people. He added that this could "contaminate" other parts of the world due to increasing international travel and exchange. O'Neill said: "It's a serious global challenge and thus needs a global solution."

According to a member of the Rational Drug Use Committee of the National Health and Family Planning Commission, "The Chinese government recognized the challenges and implemented measures starting in 2012 to tackle that". The measures include stricter control over public access to antibiotics, overhauling their overuse by hospitals, and monitoring of antibiotic resistance. "Antibiotic use dropped by 40% by the end of last year," he said, citing the national surveillance network of drug use linking large hospitals nationwide. (Source: National Health and Family Planning Commission)

This is the first Mother's Day following the relaxation of the four-decade family planning policy in January to allow all couples to have a second child. According to a report released by Chinese job recruitment site, Zhaopin.com, which questioned 14,290 career women on their work and life choices, nearly 60% of working mothers in China don't want to have a second child. The study also found that 20% of women who have not given birth do not want a child.

For their reasons of not wanting a child, more than 56% mentioned "cost", with the second most common reason being the amount of time, energy and attention involved. Other reasons included career risks, the pain of childbirth and little faith in their marriages. A senior consultant at Zhaopin, said "most career women think it is impossible to live solely on their husbands' paychecks" and also "they fear that if they stop working, they will become isolated from a dynamic society and lose their career prospects".

A senior expert on human resources at Chinese job-finding platform 51job.com, said, "Taking the economic situation into consideration, it is not realistic to require companies to provide absolute equality when choosing their employees. Chinese women shoulder more family responsibility. It is not just about maternity leave — a female employee might only get back to work three to five years after having her first child. If a job requires frequent business trips, extra work and more attention to work instead of to the family, a capable male candidate would be more suitable," and added "it is not about gender choice — I would say this is a market choice." (Source: China Daily)

Premier Li Keqiang signed a decree on April 23 which has banned drug wholesalers from selling vaccines following a scandal in which millions of dollars' worth of improperly stored or expired vaccines has been sold to patients nationwide. With this decision, a vaccine tracking system will be set up in which virtually all vaccine circulation will occur under official arrangements, and enterprises and users will need to record information about the circulation and use of vaccines so that even the smallest vaccine package can be pinpointed anywhere in its entire life cycle.
Also, this decision will improve management of cold-chain storage and transportation, prohibiting vaccines from leaving the cold-chain system and requiring regular temperature monitoring. In addition, institutions and hospitals must request storage temperature records upon receiving vaccines, and needs to keep clear records of their purchases and received inventory.
The decision also heightened accountability. Fines for serious violators, such as those improperly storing and transporting vaccines, will be increased. Government officials will be required to resign from their jobs if they fail to perform their supervision duties well. (Source: Xinhua)

According to the National Health and Family Planning Commission, there were more than 6.4 million cases of infectious diseases reported on the Chinese mainland in 2015, with a total of 16,744 deaths as a result of an infectious disease.
About half of the infectious diseases were categorized as Class B infections by China's Law on the Prevention and Treatment of Infectious Diseases, and HIV/AIDS, tuberculosis, rabies, hepatitis, and human infection of H7N9 avian influenza, accounted for 98.55% of deaths in this category (16,584 deaths). Class C infection occupied most of the remaining half of the infections, with foot and mouth disease, infectious diarrhea, and influenza accounting for 97.5% of deaths in this category (160 deaths).
Cholera was the only Class A infection, with 13 cases and no deaths were reported. (Source: Xinhua)

According to China's public health statistical yearbook in 2015, the number of pediatricians in China dropped from 105,000 to around 100,000 within five years. On average, there are only 43 doctors per 100,000 children. This situation is worse in some smaller cities, such as Weinan, located about 70km away from Xi'an, which is a capital city of Northwest China's Shaanxi province, in which they only have 17 doctors per 100,000 children.

The shortage of pediatricians has made it difficult for parents. In one of the best hospitals in Xi'an, the waiting area for the pediatric department and surrounding corridor was swarming with hundreds of parents and sick children, with cries ringing out continuously. This department receives more than 500 patients daily, and one doctor said "In the mornings I receive more than 100 outpatients," which means that the doctor can only spend only a few minutes with each patient.

A director of the pediatric department at Xi'an Central Hospital believes that low salary, high pressure and high risk are the main causes behind people's reluctance to become pediatricians. A doctor at this hospital mentions "My working time a day is, on average, more than 10 hours", a nurse mentions that "We always find ourselves facing anxious parents yelling at us", and another nurses mentioning "Pediatricians earn 30% less than other departments, because the department earns less income". In China, medicines and examinations are the primary source of income for medical departments and children are prescribed less medicine than adults. The dosage for 10 to 15 children equals that of roughly one adult.

A decrease of pediatric graduates has also fueled the shortage, because in 1998, the Ministry of Education abolished pediatric departments in universities. A political adviser mentioned that, in Southwest China's Guangxi Zhuang autonomous region, there were only five universities with pediatric departments, as most stopped accepting pediatric majors. He added "Without timely measures, the situation will become worse". (Source: Xinhua)

At the 2016 national TCM meeting held in January, the director of the State Administration of TCM mentioned that the number of TCM hospitals in China has increased by 500 in the past five years, which is an increase of 15.5%. In addition, the numbers of TCM outpatient departments and clinics increased by 531 and 5,890, respectively. This director said that in 2014, there were 530 million visits to TCM hospitals, accounting for 17.9% of total hospital visits across the country, and that the TCM industry became a 730 billion RMB (110.8 million USD) industry in 2014, representing one third of the total industrial output of China's medical industry. (Source: Xinhua)