China Medical News

Chinese doctors said incidence of colorectal cancer has been rising among young white-collar workers due to unhealthy lifestyles and eating habits.

Colorectal cancer usually occurs in people around 60 in developed countries, but in China, the average age to contract the disease is 45, said Professor Kong Dalu from Tianjin Cancer Hospital. "The number of white collars under 30 diagnosed with colon cancer has been rising steadily in recent years, accounting for 10 percent of all inpatients of the disease," he said.

The disturbing rise is in part due to their sedentary lifestyle and an unhealthy diet, said Kong. China has seen a rapid improvement in living standards in recent decades, which results in a diet rich in fat, calories and protein but low in fiber. Oncologists recommend that young adults engage in regular physical activity, and stick to a diet rich of whole grains, vegetables and fruit and low in red and processed meats to prevent the disease. (Source: Xinhua)

China's top health authority is standing by its statement that more than 500 million people had been assigned family doctors as of the end of November, despite a barrage of questions raised by netizens. The National Health and Family Planning Commission said on Wednesday (Dec. 20^th) that the figure was based on data reported by local governments since May. It reiterated that the number of people who accessed family doctor services met the target for the year.

According to a circular from the commission in May last year, more than 30% of China's population was supposed to be covered by family doctors by the end of this year.  On Sunday, the commission said residents in more than 95% of China's cities can now access family doctors, with the total number exceeding 500 million people, more than 35% of the population. However, the announcement was met with disbelief by some netizens, who said the number was too high, Science and Technology Daily reported.

While the commission said on Wednesday that the number of people covered by family doctors had met the target, it added that coverage varies by area, and quality of service in general needs improvement.

A system of family doctors has been promoted nationwide since May and is in its infancy. Many difficulties exist, including a lack of general practitioners and customized grassroots services, the commission said. It said it will focus on improving family doctor services next year, so that residents are more satisfied with the services they receive. Measures include more intense training of healthcare workers at the grassroots.

Currently, family doctors comprise physicians mainly working at grassroots medical institutions, such as community health centers and village health facilities. It is expected that family doctors who serve as health gatekeepers for residents will help solve health challenges such as the increasing number of patients with chronic diseases and soaring medical costs resulting from too many patients going to big hospitals while grassroots medical institutions are ignored, the commission said.

Wang Xin, a family doctor at the Zhongliang Community Health Service Center in Beijing's Shunyi district, said that of all 1,200 residents in the community, about half have signed up with him, the sole family practitioner in the center. "The biggest difficulty in promoting family doctors in Beijing is lack of enough qualified doctors," Wang said. "In some areas a family doctor may not even have a bachelor's degree and cannot provide medical services; they can only provide public health services or prescribe drugs, so local residents lack trust and still prefer to go to big hospitals for treatment."

The number of people covered by family doctor services reached 7.6 million as of May, accounting for 35% of permanent residents in Beijing, according to the city's health commission. Beijing residents can sign up with family doctors in their communities for free because of subsidies from the city government. (Source: China Daily)

China launched a new program Friday to help address poverty caused by illness.　The program, which will last until February, aims to use the slack farming season and the Spring Festival holiday when migrant workers return home, to figure out how many poor people have diseases and keep them updated with new policies, according to Xia Gengsheng from the State Council Leading Group Office of Poverty Alleviation and Development.

Xia said that more than 50% of impoverished residents in 10 Chinese provinces fell into poverty due to illnesses, at the end of 2016.

China aims to lift all people above the poverty line -- per capita annual income of 2,300 yuan (USD 348) -- in rural areas by 2020. Strong efforts have been made in helping the rural poor suffering from illnesses.

More than 4.2 million poor patients with serious or chronic diseases have been treated since last year. The family doctor system has expanded to include around 80% of those living under the poverty line.

Meanwhile, more than 900 top hospitals have dispatched doctors to over 1,000 hospitals in poor counties, and developed a network of distance health care. (Source: Xinhua)

Hospitals will be exempted from responsibility if doctors perform emergency surgery before they are able to secure consent from patients’ relatives.

The ruling, issued by the Supreme People’s Court on Wednesday (13^th), clarifies responsibilities of hospitals when they have to perform medical emergencies but do not have agreements from patients’ families.

Doctors often face this dilemma when they are not able to find patients' families or the relatives do not reach an agreement or refuse to sign before the hospital starts the procedure. But after the surgery, sometimes families disagree and demand the doctors to pay, an official with the national top court’s research office said in a statement.

Now doctors can perform emergency treatment after securing approval from the person in charge of the hospital, the court said. “The courts will support the doctors and the hospitals will not have to compensate under this ruling,” said the official, whose name was not disclosed.

“The move is to encourage doctors to save patients in emergency and consider rescue as the priority.” But if hospitals neglect or are late to take medical actions, they will be held responsible and would have to pay compensation , the ruling added.

The interpretation, which will come into effect on Thursday, can also help regulate hospitals as they handle emergencies, the official added. (Source: China Daily)

China's critical illness insurance (大病医保) now covers more than one billion people, according to the National Health and Family Planning Commission.

Improving the system of critical illness insurance has been a major task for the health sector during the 13th Five Year Plan period (2016-2020). While expanding the coverage of the insurance to all urban and rural residents, health authorities also lowered the threshold for payment by insurers, raised the ratio of payment by insurers and expanded the scope of services covered by insurance.

Wang Hesheng, vice head of the commission, said that insurance for critical illnesses now covers more than 50% of patients' medical costs, and in some rural areas a basic medical insurance system for the impoverished covers 80 to 90% of medical fees. The commission said it would work to ensure families with low incomes, senior citizens, juveniles and those with severe disabilities or severe diseases will receive proper medical treatment. (Source: Xinhua)

China opened its first emergency mobile center for cases of poisoning in Guiyang, capital of southwestern China’s Guizhou province on Dec 6. The center is stationed at the Guizhou People's Hospital and is expected to increase the local capacity of dealing with emergent cases of poisoning.

The center in Guizhou will offer professional treatment, including on-the-spot surveys, tests, individual protection and medical security. Cases of poisoning emergencies in recent years from around the world will be analyzed to improve the training and exercise of health emergency staff.

During the 13th Five-Year Plan (2016-20), China will open 11 emergency mobile centers all around the country. (Source: National Health and Family Planning Commission)

Fan Lei, 32, cannot wait to get her first human papilloma virus (HPV) vaccine, after a fretful three-month wait. "I asked for leave immediately after the call from the community health service center," she said. The HPV vaccine Fan received in the city of Yinchuan in northwest China's Ningxia Hui Autonomous Region, was developed by U.S.- based Merck & Co, and approved by the China Food and Drug Administration to enter the market in May. The first batch reached Chinese consumers a month ago.

The introduction of the new vaccine came after a good response from Chinese women to GlaxoSmithKline's Cervarix, the first HPV vaccine licensed for use in China, earlier in the year. But Cervarix has an age cap of 25, while the Merck product is available for anyone from 20 to 45. "In fact, I intended to get the Cervarix vaccination, but was told I was too old," Fan told Xinhua.

The younger generation in China, especially middle-class women of Fan's age or younger, now have a much greater health consciousness. In just a month, the center Fan visited received more than 910 reservations for the new HPV vaccination, but only 280 vaccines were available, according to Gao Xiaoyan of the center.

The popularity of HPV vaccines in Yinchuan mirrors the strong demand nationwide. According to the report "Cancer Statistics in China 2015" published by CA: A Cancer Journal for Clinicians, more than 30,000 patients died of cervical cancers, and over 98,900 new cervical cancer cases were reported in China in 2015. In other words, three Chinese women were killed by cervical cancer every hour.

But cervical cancer, by far the most common HPV-related disease, can largely be prevented. According to the WHO, nearly all cases of cervical cancer, the fourth most frequent cancer in women, can be attributed to HPV. It can take 15 to 20 years for cervical cancer to develop in women with normal immune systems, and the symptoms tend to appear only after the cancer has reached an advanced stage, making it important to take precautions in advance.

The two HPV vaccines currently available on the market can protect against both HPV 16 and 18, which cause at least 70 percent of cervical cancers, according to the WHO. The vaccines may also offer cross-protection against other less common HPV types that cause cervical cancer. But for some time, HPV vaccines were not greenlit on the Chinese mainland due to safety concerns, and many had to travel to Hong Kong to get a shot.

A complete HPV vaccination requires three shots in six months, which meant patients had to travel to Hong Kong three times during this period, at high cost. "Some of my friends went to Hong Kong to get the vaccination, but it's too troublesome to go from Yinchuan. Now we have it at home, it's much easier," Fan said. Though one shot of the vaccine costs over 800 yuan (121 U.S. dollars), Fan and her friends believe it is worth the money. "It is pricey. But compared with the economic and mental burden of the disease, it is nothing," she said.

China is also developing its own HPV vaccine. Clinical testing of a second-generation HPV vaccine, led by the National Institute of Diagnostics and Vaccine Development in Infectious Diseases, was approved by the China Food and Drug Administration in late November. It is expected to enter the market in 2022.

"HPV vaccination can prevent most types of cervical cancer, but a regular health check is still necessary," said Zhou Liwei, vice chairman of the Center for Disease Prevention and Control in Ningxia. "Cervical cancer patients are getting younger. We should care more about our health through regular health checkups and proper vaccinations," Fan said. (Source: Xinhua)

On Dec. 8^th, several Chinese hospitals started a clinical test for a ventricular assist device (VAD), which is believed to be the first such test conducted on the Chinese mainland. A VAD is an electromechanical device for assisting cardiac circulation, which is used either to partially or completely replace the function of a failing heart. It is expected to benefit hundreds of thousands of Chinese patients with severe heart failure.

The VAD was developed by Chongqing Yongrenxin Medical Devices Co. Ltd., a Sino-Japanese joint venture. The device entered a period of clinical testing in Japan in 2005. In November, the Chongqing-based company officially obtained approval for the clinical test from the China Food and Drug Administration.

According to Hu Shengshou, president of Fuwai Hospital, heart failure caused more than 40% deaths due to diseases in China annually. Hu said that China has at least 600,000 patients with severe heart failure. However, due to a severe donor shortage, the country only conducts around 300 heart transplant surgeries each year.

VAD is known globally as one of the most effective measures to treat patients with severe heart failure. Domestically-made devices are not yet ready to be put into commercial use, while foreign-made devices are often unaffordable. The device will be put into use in 2018 after the clinical test concludes. (Source: Xinhua)

China’s elderly population is estimated to hit 480 million by 2050, accounting for two-fifths of the total figure in Asia, said Zhu Yaoyin, vice-president of China National Committee on Aging on Dec 6.

China is currently the only country in the world with an elderly population of over 200 million, and that percentage is expected to increase by 24% from 2000 to 2050, twice that of the estimated world average, Zhu said.

In addition, Zhu noted, China has turned into an aging society as a developing economy, which constitutes a serious issue. As a result, the country is faced with a huge task, especially with ongoing urbanization and a low-birth rate trend.

Zhu promised that the country will further enhance the social security system and basic public services for senior citizens, and find solutions to tackle major difficulties. Meanwhile, the country will take measures based on comprehensive evaluations to improve the elderly care system, such as community-based and smart care services. (Source: People’s Daily Online)

A new study provides data on the “know-do” and “policy-practice” gaps found in tuberculosis diagnosis and care across three levels of China’s health system.

Tuberculosis Diagnosis in China

In China, tuberculosis remains a high health burden and the rate of accurate tuberculosis diagnosis is low. There may be several factors influencing the low rate of diagnosis, particularly in rural areas. So far, health care research has focused on those already diagnosed, but research into those who are undiagnosed in rural areas remains scarce. Healthcare providers and policymakers need to understand the reasons for the low rate of diagnosis in urban areas in order to implement effective policies to eliminate TB.

In a recent study published in PLOS Medicine, researchers from the University of North Carolina trained and sent standardized “test” patients to present with classical TB symptoms for 274 healthcare providers at village clinics, township health centers, and county hospitals in China.

The results showed that the county hospitals managed the patients’ visits correctly 90% of the time, compared to only 38% in township health centers and 28% in village clinics.  While antibiotics were prescribed in 61% of the consultations, incorrect antibiotic use was high at all levels of care.  Only 28% of village doctors and 18% of township providers correctly referred the case onward.

The “Know-Do” Gap

Although patients presenting with symptoms typical of TB were generally not properly managed, the deficits were not due to a lack of provider knowledge.  These same doctors managed according to TB recommendations 81% of the time when these same symptoms were described in clinical vignettes.  In other words, the providers seemed to know the medical guidelines for TB management but, in practice, do not follow them.  This “know-do” gap can be seen in hospitals worldwide.

The “Policy-Practice” Gap

Although sputum testing is recommended for tuberculosis diagnosis, this study found that when the healthcare providers ordered tests, they were most likely to order chest X-rays. Despite the availability of sputum testing, their focus was to establish what might be wrong with these individuals who were unwell rather than on diagnosing TB.

Despite incorrect testing practices, their actions may not be indicative of poor medical care.  Primary healthcare providers may see several patients each week whose symptoms could be associated with TB, but could also be caused by a chest infection.  They may not want to worry patients unnecessarily or add to patient and/or clinic costs.  In understaffed centers, healthcare providers may practice under the assumption that individuals with persistent conditions such as TB will return to be seen again.

This study highlights that the elimination of tuberculosis should not rely upon the development of better tests or pills.  The disconnect between medical guidelines and medical practice, particularly in poorly resourced and rural areas, will require interventions targeting integrated healthcare training in real-world situations so that they feel empowered to properly diagnose and refer tuberculosis patients. (Written by Debra A. Kellen, PhD; Source: Medical News Bulletin)

China's leading drug maker and distributor, Shanghai Pharmaceuticals Holding Co. Ltd., said Wednesday it will take over Cardinal Health Inc's China business. Shanghai Pharma's subsidiary Century Global and Cardinal Health's subsidiary Cardinal Health Cayman Islands Ltd. signed a contract Wednesday to buy the Cardinal Health Co., Ltd. for 557 million U.S.-dollar acquisition. Century Global thus holds Cardinal Health China business through the acquisition.

U.S. pharmaceutical distribution giant Cardinal Health Inc's China business is the eighth largest drug distributor in the country, with a network covering 322 Chinese cities. The acquisition will enable Shanghai Pharma to enter the market in Tianjin and Chongqing municipalities and Guizhou Province, expanding its distribution network to 24 provincial-level areas, and the company will become one of the biggest imported drugs agents in China, said Liu Dawei, board secretary of Shanghai Pharma. (Source: Xinhua)

The traditional Chinese medicine (TCM) industry in China grew by 20% in the past year, according to the State Administration of Traditional Chinese Medicine (SATCM). The sector earned more than 860 billion yuan (about US$130 billion) last year, one third of the country's total medical industrial output, said Wang Guoqiang, head of the SATCM.

The Law on Traditional Chinese Medicine went into effect on July 1,to regulate and support the development of the industry. With a history of more than 2,000 years, TCM has unique theories and practices in herbal medicine, acupuncture, massage and dietetics. There are 482,000 TCM practitioners in China now. (Source: Xinhua)

Li Bin, minister of the National Health and Family Planning Commission held a news conference on the sidelines of the 19th National Congress of the Communist Party of China on October 22nd, and said that the availability of medical resources in China has increased in the past five years, with people at grassroots having better access to healthcare facilities.

Li mentioned that by the end of last year, the number of medical institutions in China reached 980,000, and the number of health workers exceeded 11 million. She added that the number of registered physicians per 1,000 people in China reached 2.3 last year, compared with 1.8 five years ago, the number of registered nurses per 1,000 people in China reached 2.5 last year, compared with 1.5 five years ago, and the number of hospital beds for every 1,000 people reached 5.4 last year, compared with 3.6 five years ago.

Of all 7.9 billion diagnostic and treatment services provided by hospitals and clinics in China last year, more than 55% were provided by institutions at grassroots. And to help medical institutions at grassroots improve abilities, more than 6,800 public hospitals have established partnership with such institutions through internet to provide guidance and training, Li said.

To control medical expenditure, all public hospitals, the primary provider of healthcare services in China, banned price markup for the drugs they sold to patients at the end of September, a practice carried out for decades by many public hospitals as a major source of income, Li said. Besides drugs, fees for medical services and checkups and tests, such as CT scanning, were also reduced as part of the ongoing healthcare reform. For example, in Beijing, which abolished drug price markup in all the city's public hospitals in April, patients saved 4.4 billion yuan ($665 million) in medical expenditure between April and September, Li said. (Source: China Daily)

Scientists in China have identified DNA markers specific to liver cancer, which is expected to greatly improve accuracy in diagnosis of one of the most common cancers in China.

Using the new technology, doctors can provide a diagnosis and prognosis to patients with liver cancer through simple blood tests. That could decrease the chances of a misdiagnosis by more than half, according to Xu Ruihua, director of the Sun Yat-sen University Cancer Center in Guangzhou, Guangdong province, who has led the research.

After five years of research, involving over 100 researchers from different institutes, the scientists identified methylation in DNA circulating in the blood that is related to liver cancer. Methylation, like genetic mutation, is an abnormal genetic change that can cause cancer, Xu said.

Using samples of circulatory system DNA from a large group of 1,098 liver cancer patients and 835 healthy people for comparison, they constructed a diagnostic prediction model that showed high diagnostic specificity and sensitivity, Xu said in the study, which was published in Nature Materials, a science journal, on Oct 9.

Liver cancer is one of the most common cancers in China. The number of new cases reached 466,000 in 2015, and the cancer caused 422,000 deaths that year, according to the center, accounting for more than half of the world’s liver cancer cases and deaths. (Source: China Daily)

Health authorities have been emphasizing the control of bacterial drug resistance and the rational use of antibiotics, and efforts made in the past 10 years have yielded noticeable results, said Xiao Yonghong, a member of the National Health and Family Planning Commission’s expert committee for rational use of drugs and a professor at Zhejiang University’s First Affiliated Hospital.

Last year, antibiotics dispensed at medical institutions across China accounted for 11.2% of the total value of all drugs sold at those institutions, compared with 19.7% in 2010, he said. According to Xiao, in 2010, more than 67% of inpatients in China used antibiotics, and nearly 20% of outpatients used antibiotics. By the end of last year, the percentages decreased to 37.5% and 8.7%, respectively. The quantity and frequency of antibiotics used on patients also saw a decrease of about 41% from 2010 to 2016.

With the reduced use of antibiotics, the proportion of cases of major multidrug-resistant bacteria at medical institutions in China have been controlled, according to Xiao. “Gaps still remain between China and countries that have taken the lead in the control of bacterial drug resistance, but China is close to the US and major countries in Europe in certain aspects,” Xiao said. For example, the proportion of cases of methicillin-resistant Staphylococcus aureus, a type of multidrug resistant bacteria prevalent in many countries, was lowered from about 52% in 2011 in China to about 30% last year. In comparison, the proportion of cases in the United States is 44% and in India, 48%, Xiao said. (Source: China Daily)

China Circulation Magazine published the "China Cardiovascular disease Report 2016", which showed that the mortality rate of cardiovascular disease was the highest amongst total deaths in China, even higher than cancer. The mortality rates of cardiovascular disease are 45.0% in rural areas and 42.6% in urban areas. Overall, the prevalence rate and mortality of cardiovascular disease in China are still in the rising stage, and with the obvious prevalence of CV risk factors in China, CV disease is expected to continue growing rapidly in the next 10 years.

According to the report, the number of cardiovascular disease patients was estimated to be 290 million, including 13 million with stroke, 11 million with coronary heart disease, 4.5 million with heart failure, 5 million with pulmonary heart disease, 2.5 million with rheumatic heart disease, 2 million with congenital heart disease and 270 million with hypertension.

The report said that in 2015, the mortality rate of cardiovascular disease was 298.42 /100,000 in rural areas (144.79 / 100,000 for heart disease and 153.63 / 100,000 for cerebrovascular disease) and 264.84 /100,000 in urban areas (136.61/ 100,000 for heart disease and 128.23 / 100,000 for cerebrovascular disease).

Cerebrovascular disease:

The mortality rate of cerebrovascular disease exceeds that of heart disease, and according to the national census data, there were 853,600 urban residents and 1,034,900 rural residents who died from cerebrovascular disease in 2015.

According to the Statistics Yearbook of National Health and Family Planning Commission (NHFPC), the mortality rate of cerebral hemorrhage was higher than that of cerebral infarction in 2015, with 52.09/100,000 vs. 41.82/100,000 in urban area and 72.26/100,000 vs. 46.99/100,000 in rural areas.

Coronary heart disease:

According to NHFPC's Statistics Yearbook, the mortality rate of coronary heart disease was around 110/100,000 in 2015, with slightly higher rates in rural areas. This mortality rate was slightly higher than the rates in 2014 (110.5/100,000 in urban and 105.37/100,000 in rural).

According to this commission's PCI network data, there were total of 56,753 interventional therapies conducted for the treatment of coronary heart disease in 2015. This calculates to around 427/1,000,000 people in China who were treated with PCI. The average number of stents remained at around 1.5/person.

The annual volume of coronary artery bypass grafting (CABG) is around 40,000 cases, and is increasing at a rate of around 10% each year. Around 60% of China's pure CABG is carried out without cardiopulmonary bypass, whereas in Western countries, this is around 20%.

Arrhythmia

According to the NHFPC's online registration system, there were approximately 65,697 cases of pacemaker implantation in 2015, which increased by 9.98% since 2014. And there was no significant change in pacemaker indications compared with 2014: Sick Sinus syndrome accounted for 51.1% and atrioventricular block accounted for 39.8%. Dual chamber pacemaker accounted for nearly 69%.

Implantable cardioverter defibrillator (ICD) also showed an increasing trend with an 18.3% increase from 2014, and there were 2,759 cases of ICD implantations in 2015. Single chamber ICD accounted for 67.1% with the rest being dual chamber. 58% of ICD implantations were for secondary prevention.

Cardiac resynchronization therapy (CRT) also showed an increasing trend with an 8.4% increase from 2014, with 2,986 implants in 2015. CRT-D accounted for 57% and CRT-P accounted for 45%.

There were also 1111,000 cases of catheter ablation in 2015, with an annual growth rate of around 13.5%~17.5% since 2010. (Sources: Xinhua and Medlive.cn)

The Ministry of Human Resources and Social Security in a statement on Wednesday July 19th said it had agreed to add 36 drugs to the National Reimbursable Drugs List (NRDL) in return for an average 44% price cut against last year's retail prices.

The ministry updated the NRDL after an eight year hiatus in February, when it said it was still negotiating around 45 expensive medicines with high clinical value. On Wednesday, it said the agreed price cuts were as much as 70% - reflecting drug-makers' desire to get their products onto state insurance schemes, which helps boost sales volumes.

"After the negotiations, the majority of the imported medicines will be cheaper than in surrounding international markets, greatly reducing the financial burden on Chinese patients from healthcare costs," the ministry said.

The additions to the list include a number of major cancer drugs such as Roche Holding AG's Herceptin, Avastin and MabThera, Celgene Corp's Revlimid, Johnson & Johnson's Zytiga and Novartis AG's Afinitor. Also included are AstraZeneca PLC's heart treatment Brilinta and Novo Nordisk A/S' diabetes injection Victoza.

The ministry said of the 36 drugs added, 31 were "Western" treatments - including 15 for cancer - and five were traditional Chinese medicines (TCM). (Source: Reuters)

The National Bureau of Statistics revealed in the latest statistics on July 25 that the life expectancy of Chinese people has increased to 76.34 years old in 2015, an extra 18 months longer than in 2010. This makes the average Chinese person's life 4.74 years longer than the world average.

Chinese women's life expectancy reached 79.43 years old, 2.06 years older than in 2010, while men die earlier at 73.64 years old. This is a 1.26-year improvement from 2010, showing women's life expectancy is growing faster than men's, in line with the global trend.

The National Bureau of Statistics said Chinese life expectancy exceeded that of upper middle-income countries, reflecting China's remarkable gains in medical care and living standards.

The figures also show that the ratio of Chinese men to women has narrowed from 117.7 in 2012 to 113.5 in 2015. The bureau said the ratio was normalizing, which will promote a long-term balanced population development.

According to the white paper　released by the Beijing municipal government and Beijing Municipal Commission of Health and Family Planning, which reported on public health and Beijing residents' health conditions in 2016, the life expectancy of residents with household registration in Beijing reached 82.03 years last year. (Source: China Daily)

A guideline to improve the supply to prevent shortages was issued on Wednesday (June 28th) by nine government agencies, including the National Health and Family Planning Commission, the National Development and Reform Commission, and the Ministry of Human Resources and Social Security.

China has about 3,000 drugs approved for common clinical use, with 130 of them occasionally in short supply, according to Zeng Yixin, deputy head of the National Health and Family Planning Commission. "That's mainly due to the market gap between supply and demand," Zeng said.

Under the new guideline, an online drug consumption monitoring network will be set up to determine which drugs might run out and issue timely warnings about emerging needs so that the authorities can intervene. The guideline calls for the creation of a cross-province coordinating system to alleviate regional shortages of certain drugs.

For drugs in short supply nationally, emergency imports will be arranged, and if that doesn't work, "the authorities will assign selected drug companies to produce more", Zeng said. (Source: China Daily)

At the beginning of this year, China’s National Health and Family Planning Commission, along with seven other ministries, issued a new policy designed to streamline pharmaceutical distribution channels.

Previous distribution chains were typically comprised of manufacturers who sold to multiple distributors, which then goes through multiple tiers of distributors before reaching the hospitals, thus the price becoming high with margins at each tier.

This new policy, originally introduced in December 2016, is called ‘two invoice system’ where, during the distribution process from drug manufacturer to the hospital, only two invoices can be issued. The manufacturer issues a first invoice to the distributor, while the distributor issues a second invoice to the hospital or medical service provider. This aims to reduce the cost of pharmaceuticals (by eliminating the margin of multiple tiers of distributors) and to prevent possible corruption.

The system is currently being piloted in a number of provinces, and is expected to be fully implemented nationwide by the end of 2018. (Source: China Briefing / China Business Review)

As part of the general healthcare reform, measures were introduced in April 8 aimed at ending the markup on drugs prescribed at public hospitals and modifying the prices for registration, consultation and treatments.

After one month of implementing these measures, Fang Laiying, head of the Beijing Health and Family Planning Commission, said the latest measures worked well to provide better and more rational treatment at more affordable prices. He said that the average drug cost for each outpatient visit during the past month has decreased by 9.6% in tier 3 hospitals and by 14.8% in tier 2 hospitals. For inpatient care, the average drug cost has decreased by 17.7% in tier 3 hospitals and by 24.0% in tier 2 hospitals, with the entire hospitalization fee decreasing by 4.1% and 14.1% respectively (note: drug cost has reduced but the consultation fee has increased).

Under a hierarchical medical system, he said, patients with minor diseases visit community clinics. Only the seriously ill go to large hospitals for specialist care. But with no price difference, patients tend to swarm into already crowded large hospitals, even those suffering from a common cold, experts said. Meanwhile, community clinics are underused, resulting in a waste of medical resources.

After modifying the prices for registration, consultation and treatment in the latest reform, more residents, particularly those suffering chronic diseases, began to visit community clinics, Fang said.

Total outpatient visits in community clinics increased by 3.4% during the past month over March, according to official data, while outpatient visits dropped by 15.1% in tier 3 hospitals and 7.2% in tier 2 hospitals.

Under the new reform, all 3,600 medical institutions in the city are required to purchase drugs directly from pharmaceutical manufacturers through an open public bidding platform to further reduce prices, he added. That has helped the capital save 420 million yuan ($60.8 million) in the past month, according to the latest figures available. (Source: China Daily and MENET)

China's FDA is offering to grant conditional OKs for orphan meds already approved abroad, even without in-China trial data. The new orphan drug move is one in a series of new proposals posted online May 11. China’s FDA is once again planning major changes to its clinical trial and drug approval policies, further aligning them with its Western counterparts. A key feature is the new “conditional marketing authorization” for orphan meds.

The CFDA is offering to grant conditional approval for meds that treat life-threatening conditions where significant unmet medical needs exist, if early- or mid-stage data can predict the drugs’ clinical benefits. This policy resembles the EMA's “conditional marketing authorization” and the U.S. FDA’s “breakthrough therapy” program.

The CFDA first listed the policy as part of its expedited review program rolled out last February, but the agency goes further this time by expanding it to cover orphan meds already approved in foreign countries, even those without any trial data from China. As in the U.S. and Europe, drug-makers would be required to conduct confirmatory trials or follow-up studies as agreed with regulators.

This is not entirely new territory for the CFDA. The agency conditionally approved Actelion’s Zavesca (miglustat) for Niemann-Pick disease type C in 2013, based entirely on trial data obtained in Western countries. The Zavesca data had been generated for a European approval application, and the Chinese review included post-marketing data as well. The CFDA asked for a follow-up trial on at least 15 patients in China to confirm its efficacy and safety. After that, the med gained official approval last year.

But this is the first time CFDA has put the rare disease policy in writing. If implemented, it stands to increase new drug applications from orphan drug-makers intent on gaining increased access to a pharma market that, despite economic woes, remains one of the world's fastest-growing.

Other proposed policy shifts include allowing foreign study data for Chinese NDAs, changing the clinical trial regulatory management system from certification to registration, and converting clinical trial approval to a 60-working-day response window. (Source: FiercePharma)

According to the deputy chief for disease control and prevention at the National Health and Family Planning Commission National Health and Family Planning Commission, the number of registered patients with serious mental disorders in China reached 5.4 million last year, with three-quarters suffering schizophrenia. Previous figures released by the commission showed the number of such registered patients was 4.3 million by the end of 2014.

The World Health Organization estimates that more than 54 million people in China suffer from depression. A professor of psychiatry at Beijing University Sixth Hospital said that "This means only a small portion of people with mental diseases are actually diagnosed and treated". He added "In many other countries, patients with mental disorders first seek treatment at community health centers or their family doctors, but in China, most patients go to big comprehensive hospitals first, as other institutes may lack qualified psychiatrists" and suggested the lack of facilities and talent at community-level medical institutions are major obstacles to prevention and treatment of mental illnesses in China. (Source: China Daily)

According to a new study, nearly 67% of people with diabetes in China have difficulty keeping their blood glucose within safe levels because of widespread "clinical inertia" - a reluctance to prescribe combination drug therapies that have proved effective in other countries. Backed by pharmaceutical giant MSD, the study tracked more than 5,000 patients and 237 clinical research centers for almost a year. It is thought to be the largest study ever conducted in China on the treatment of Type 2 diabetes. The findings were published in the first issue of Science China Life Sciences, an academic journal of the Chinese Academy of Sciences and the National Natural Science Foundation of China.

Research and clinical practice overseas has shown that a combination of the drugs metformin and sitagliptin is effective and safe. Other drugs may also be added for a triple effect. But clinical inertia in China has undermined effective treatment, according to Wang Jianping, a director of diabetes care research at the Third Affiliated Hospital of Sun Yat-Sen University in Guangzhou, who led the study.

Many Chinese physicians do not prescribe combination therapies in a timely manner, which leads to patients having excessively high blood glucose levels over a long period, he said. Poor control over time can lead to health problems such as heart disease, as well as damage to the eyes, kidneys or nerves.

Doctors "are reluctant to prescribe combination therapies, largely due to a lack of clinical evidence and treatment consensus" in China, Wang said.

Mu Yiming, a senior diabetes specialist who was part of the study team, said the findings could help bridge the knowledge gap and help develop clinical evidence in China supporting combination drug treatments. In addition, he said, "We're working closely to integrate the findings into the latest version of the national treatment guideline, which is due very soon".

Xing Xiaoyan, head of endocrinology at China-Japan Friendship Hospital, also stressed the importance of patient education. "It's hard to change behavior, and some patients tend to reject combination drug therapy, citing potential adverse reactions," Xing said. She said the cost of drugs was a concern for many patients, but the government is helping. "We've seen the government cover more diabetes treatments under public health insurance," she said.

According to the National Health and Family Planning Commission, China has about 113 million adults with Type 2 diabetes, roughly 25% of the global total. Experts estimate that more than 493 million Chinese are pre-diabetic, which means their blood glucose levels are too high but not high enough for a diabetes diagnosis. (Source: China Daily)

According to the National Health and Family Planning Commission, although there is a downward trend of tuberculosis (TB) cases in recent years, China reports roughly 900,000 new cases annually, keeping it among the 30 countries with the highest incidence of the infectious disease. Latest statistics from the commission's disease prevention and control bureau showed that by the end of 2016, the TB incidence rate stood at 61 per 100,000 people in China, down 14% since 2011.

The commission said that bacterial infection was not evenly distributed across the country, and rural areas in the western regions recorded the highest TB prevalence. The Xinjiang Uygur autonomous region reported the highest TB prevalence, at 184.5 people out of 100,000 in 2015, and the Tibet autonomous region and Guizhou province followed.

The commission has taken number of steps in the past several years to alleviate the TB burden in these areas, including increasing investment for health projects, improving training for local medical staff and encouraging local governments to issue favorable policies for TB patients, such as increasing medical insurance reimbursement for the disease. The commission said that health authorities will continue to support areas with higher reported cases of TB, and it also plans to intensify research in the prevention and control of TB in the next few years, with a focus on vaccines and new therapies for TB including chemotherapies and immunotherapies.

According to a national plan on the control and prevention of TB released by the State Council in February, the Incidence of tuberculosis in China is expected to be reduced to below 58 for every 100,000 people by 2020. According to the document, services for preventing and treating tuberculosis should be further improved by 2020 and those who have the disease should be diagnosed early and given access to regular treatment.

Former president of the Chinese Anti-tuberculosis Association said that there are few new drugs for TB, and those commonly used have lost their effect in many patients due to drug resistance. The WHO estimated that in 2015, China had 57,000 cases of multidrug resistant TB. (Source: China Daily)

Beijing Municipal Commission of Health and Family Planning announced on March 22nd that all medical institutions involved in the reform will abolish price markups, usually at a rate of 15%, on the drugs they sell to patients. The reform covers more than 3,600 medical institutions in Beijing, including all public hospitals, as well as some private medical institutions. In addition, all medical institutions will purchase drugs from pharmaceutical manufacturers through open and competitive public bidding, so drug prices will be further reduced. With these measures, the price of drugs sold at these hospitals is expected to be reduced by about 20%.

Abolishing drug price markups, which has been a key source of income for public hospitals, has been a major, but thorny, task of China's ongoing healthcare reform that is aimed at a universal coverage of basic healthcare services. The practice has been adopted by most public hospitals in China since the 1950s to make up for a deficiency in healthcare funding from the government, authorities said. They've mentioned that drug price markups result in serious problems such as "encouraging medical institutions to use more drugs and more expensive drugs, which results in a rapid rise of medical costs and increased burdens for both the government's medical insurance fund and patients".

Beijing started to pilot abolishing drug price markups in five public hospitals in 2012, and the income from drug sales accounted for about 33% of the total income for those hospitals last year, compared with 43% in 2012, according to the commission. To make up for revenue losses in drug sales, hospitals involved in the reform will increase the prices of some of the services they provide, such as surgery and nursing as well as traditional Chinese techniques such as acupuncture. Meanwhile, fees for checkups that involve the use of expensive machinery will be reduced.

According to the Beijing Municipal Commission of Development and Reform, overall, it is estimated that the cost of treatment per outpatient will be reduced by about 5%, while there will be an increase in price of 2.5% for inpatient treatment.

All public hospitals in China will abolish price markups by the end of this year, the National Health and Family Planning Commission, China's top health authority, said earlier this month. (Source: China Daily)

There is a huge market potential for drugs and more foreign pharmaceutical companies should tap the sector, Bi Jingquan, chief of China Food and Drug Administration (CFDA), said on March 5^th

Bi said there are several reasons behind the shortage of new drugs in China, including the availability of the medicines in other countries. Some of the other causes are: Strict drug inspection and approval policies, shortage in drug inspection and approval personnel at the CFDA, and concerns from some foreign pharmaceutical companies over intellectual property protection in China, which make them reluctant to sell new drugs in the country, he said.

The authorities will take measures such as streamlining approval procedures for drugs, intensify protection of intellectual property rights, and increase the staff for drug approval so that more new medicines are available in the market, he added.

The total number of staff for drug approval in China rose to 600 by the end of last year, while the number for the United States was 5,000, Bi said. The number of drugs that await approval fell to 8,000 by the end of last year, due to measures taken to accelerate approval, he said. (Source: China Daily)

China has updated its list of medicines covered by national medical insurance, adding some new drugs with a focus on pediatrics and major illnesses such as cancer, hepatitis, and renal and cardiovascular diseases.

China has a national medical insurance program, and the National Reimbursement Drug List (NRDL) names all the drugs covered by the insurance program, some in full (type A drugs) and others partially (type B). Patients must pay the full price out of pocket for those drugs outside the list, which means a huge financial burden, especially when new but more effective drugs are not covered.

The update, the first since late 2009, saw the list grow by 15% to 2,535, among which 1,297 are Western-style meds, an 11% increase. The additions include some blockbuster meds like tenofovir, an antiviral drug to treat hepatitis B and HIV, and marketed by GSK as Viread, cancer drug gefitinib, sold under the brand name Iressa by AstraZeneca, and China’s own non-small cell lung cancer med icotinib (Conmana).

The drug prices of these three products were largely reduced last year as part of a negotiation with the ministry, and for example, GSK cut Viread’s price in China by two-thirds last year, a move that obviously helped it earn a place in the updated drug list. In an interview by Reuters, a GSK spokesman said. "We have already seen a major increase in the uptake of our Hep B medicine (Viread) since reducing its price by 67% last year and inclusion in the NDRL will drive further access around the country."

Provincial-level governments are now requested to make their own lists by the end of July of this year. They can tweak a bit of the national list’s type B drugs based on local medical needs, meaning they can add or delete a few and detail their own coverage rates for each drug. (Source: FiercePharma and Reuters)

A new generic gefitinib drug (Chinese commercial name Yiruike) produced by China's Qilu Pharmaceutical will hit the market on February 19^th. Its release ends an almost decade-long monopoly by Iressa, developed by AstraZeneca and introduced to China in 2005.

Yiruike was approved for marketing by China's State Food and Drug Administration after Iressa's patent protection expired in April 2016, and is indicated as a first-line therapy for patients with non-small cell lung cancer (NSCLC) who have the EGFR-TK mutation.

Qilu's general manager Li Yan said "Yiruike, at less than 2,000 Yuan a pack, is a fraction of the price of the previously available drug, meaning more people in need can be helped". Although the Chinese health authorities cut Iressa's monthly cost from 15,000 Yuan to 7,000 Yuan in 2016, the cost of Yiruike will be more affordable. (Source: Xinhua)

China registered over 3.6 million new cases of malignant tumors and 2.2 million deaths from cancer in 2013, said the vice director of the national tumor register center, on February 18^th, quoting the findings of a report released by the national cancer center. The report noted that 270.59 in every 100,000 people develop cancer in China. The report also revealed that there are around 733,000 new cases of lung cancer in China each year, with about 591,000 people dying from it annually making it the deadliest cancer in China. (Source: Xinhua)

According to the National Health and Family Planning Commission (NHFPC), the number of births in China was 17.86 million last year, which is an increase of 7.9% (or 1.31 million) compared to 2015, and the highest annual number since 2000. The portion of the births to couples who already had at least one child rose to at least 45% last year, and a director of the NHFPC said "Some regions, mostly large cities in eastern areas, began recording second children as comprising more than half of local newborns". Expert estimations suggest the number of new births each year will stand between 17 to 20 million in China by 2020.
A professor of population studies at Nankai University said "The long-term effect of the universal second-child policy is very helpful to China's sustainable development," and that "By 2050, the policy is expected to bring about an extra 30 million working-age people and reduce the nation's aging rate by 2%". (Source: China Daily)

Separate data by China's National Bureau of Statistics (NBS) counted a slightly higher figure of 18.46 million births in 2016. The discrepancy was blamed on different statistical methods - the NBS numbers were based on a sampling survey, while the NHFPC's were based on hospital birth certificate data - but officials said both confirmed a significant upwards trend. (Source: BBC)