DISEASES IN CHINA: HEPATITIS, DIABETES AND TUBERCULOSIS

DIABETES IN CHINA

Diabetes is increasingly becoming a serious problem in China. The disease is growing there in sheer numbers faster than anywhere else in the world. The number of people suffering from diabetes has reached 92 million in China, almost 10 per cent of its population of 1.3 billion, according to a March 2010 study in the New England Journal of Medicine.

Diabetes is becoming common with younger and younger people in China. One out of every 20 diabetes sufferers in Beijing is 13 or younger. Many blame the trend on increased obesity occurring at younger and younger ages and a more fat- and sugar-laden Westernized diet and fast food. Most new cases are Type II diabetes which associated with obesity and lack of exercise. Some Asian ethnic groups are particularly susceptible to Type II diabetes.

Only one third of those who have diabetes have been diagnosed and of those only about half are being treated. Many Chinese have traditionally used herbal medicines to treat their condition and do not even know what insulin treatments is. The Chinese government is starting to aggressively seek help from the large international drug companies on treating and containing the disease.

Diabetes Increasing at an Alarming Rate in China

There are now about 92 million diabetics in China but that is expected to rise to 130 million by 2030. "We were very surprised and couldn't believe how fast it grew," Peking Union Medical College Hospital specialist Xiang Hongding told Reuters after a typical morning spent seeing 22 patients in four hours. The rapid growth means diabetes often goes unrecognized until secondary symptoms appear, making treatment much harder. [Source: Lucy Hornby, Reuters, March 26, 2012]

“Adding to the burden, Asians in their prime earning years of 30-50 are more likely to develop diabetes than Caucasians, according to the Saw Swee Hock white paper on diabetes. "When I found out, my heart was very heavy. I worried I wouldn't be able to support my family. I was afraid I couldn't function in this economy," said patient Wang Yuanqing, father of an 8-year-old, whose diabetes weighs heavily on him even though he has kept it under control since his diagnosis a year ago. [Ibid]

Diabetes Starting to Overwhelm China’s Healthcare System

Lucy Hornby of Reuters wrote: “In 30 years, the Chinese people have gone from having barely enough to eat to worrying about spreading waistlines, leaving the healthcare system struggling to keep up with an exponential rise in "nobleman diseases" like diabetes. "In the last 20 years, diabetes has developed a lot, but it's only now showing up in the medical system," said Dr Tong Xiaolin, vice director of the Guanganmen Hospital in Beijing, who sees dozens of patients during Monday office hours. "People are now just flooding into the system in real numbers. The next 10 years will be a real drain on the system." [Source: Lucy Hornby, Reuters, March 26, 2012]

“Spending on diabetes reached $17 billion in China in 2011, a tiny amount compared with the $465 billion spent worldwide, according to a white paper from Singapore's Saw Swee Hock School of Public Health and the Harvard School of Public Health. That represents about 5 percent of total healthcare spending in China, with some estimates rising to 13 percent. In the United States, where costs have ballooned, diabetes accounts for about $1 in every $10 spent on healthcare, according to the American Diabetes Association. Spending on diabetes at U.S. levels of $201 billion a year would swamp China's system, leaving it unable to tackle other priorities. [Ibid]

Diagnosing and Treating Diabetes in China

Lucy Hornby of Reuters wrote: “Liu Yuxiang travels five hours to Beijing every month to see Dr Tong, and reckons she has spent 30,000 yuan ($4,700) on Chinese medicines to treat painful and swollen legs. Western drugs to control blood sugar cost her another 12,000 yuan a year, 80 percent of which is covered by insurance. [Source: Lucy Hornby, Reuters, March 26, 2012]

“If we didn't have a doctor in the family I would never have known. No one around us had any knowledge of it," said the cheerful 64-year-old, who suffered from years of thirst, fainting fits and hospitalization before her daughter-in-law suggested she might have diabetes. [Ibid]

“Many doctors, especially in the countryside, have no inkling that diabetes could be the underlying cause for a number of symptoms -- including blindness, numb or tingling legs, digestive disorders and circulatory problems. "Diabetes is very easy to diagnose, but even so, most doctors don't know how to do that," said Xiang, 68, who got his early medical training during China's tumultuous Cultural Revolution and now teaches rural doctors in diabetes diagnosis. "The patients don't know, and when they get to us they say the doctors didn't know.” [Ibid]

“Basic medicine to keep diabetes under control is relatively cheap in China, at about 2,000 yuan ($320) a year. But treatment for a patient who has developed advanced symptoms could easily reach 18,000 yuan a year, roughly equal to the average yearly income of urban Chinese. Common drugs for diabetes are covered by insurance, but equipment for at-home testing and monitoring of blood sugar levels -- which can reach 400 yuan a month -- is not. [Ibid]

Diabetes Drugs and China

Lucy Hornby of Reuters wrote: “Catching diabetes early could help drug makers like Novo Nordisk, the top seller of insulin in China, or Bayer, which markets a drug that helps reduce glucose absorption after meals. Both help educate on diabetes in China.Traditional Chinese medicine developers could also benefit. Guanganmen Hospital's Tong Xiaolin has received more than 9 million yuan in government grants to study how Chinese medicine can offer lower-cost, effective treatment of diabetes complications. [Source: Lucy Hornby, Reuters, March 26, 2012]

“Traditional Chinese medicine has a real role to play in treating complications," he said, as patients trooped through his office. He consulted records handwritten in blue notebooks, while nurses prepared the next patient in line. "Chinese medicine is very helpful in controlling nausea, or depression due to pain. Some patients are in such pain they can't sleep and consider suicide," Tong said. [Ibid]

“Better education of doctors and patients, and standardizing Chinese medicine dosages, could also reduce reliance on the "quack" medicine that proliferates in the teeming communities that ring China's mega-cities. [Ibid]

Respiratory Diseases in China

Respiratory diseases cause nearly a quarter of all deaths in China, compared with 2 or 3 percent in the United States. Rates are particularly high in the countryside, where respiratory disease is the number one killer. Many respiratory diseases are air pollution related. Even though women smoke less than men they suffer equally from diseases like lung cancer and bronchitis.

The Harvard School of Public Health has estimated that 65 million people will die from chronic obstructive pulmonary disease and 18 million will die from lung cancer between 2003 and 2033 from smoking and burning fuel indoors with chronic obstructive pulmonary disease accounting for around 19 percent of all deaths and hung cancer, 5 percent.

Tuberculosis rates are rising. There are 29.7 cases of the disease per 100,000 people, compared to 56.7 per 100,000 in Russia; 34.3 in Japan; 15.0 in Germany; 10.6 in Britain, and 8.7 in the United States. Drug-resistant tuberculosis is widespread in several provinces of China.

One in Ten Cases of Tuberculosis in China Are Drug-Resistant

In June 2012, AP reported: “One in 10 cases of tuberculosis in China cannot be treated by the most commonly-used drugs. Researchers say the findings from the 2007 survey on drug-resistant TB, published in the New England Journal of Medicine, show that the government must invest more in public health services to better diagnose drug-resistant strains of the killer lung disease. Hospitals must also be prevented from routinely misusing drugs that worsen the problem, they say. [Source: AP, June 7, 2012]

"For the first time, we have a representative, national survey of this problem in China. It shows that this is pretty serious," said Dr. Daniel Chin, a TB expert at the Bill & Melinda Gates Foundation in Beijing who is one of the study's authors. "One in 10, by any standard globally, would be pretty high." The proportion of drug-resistant TB found in the survey was in line with previous estimates that were based on provincial studies, the researchers said. While the survey was done in 2007, the researchers said it took time to culture and test samples from each patient. [Ibid]

“The ancient and treatable lung disease is caused by germs that spread when a person with active TB coughs, sneezes or speaks. It has in recent years evolved into stronger forms: drug-resistant TB, which does not respond to two top drugs, and extensively drug-resistant TB, which is virtually untreatable. A handful of what's been unofficially dubbed 'totally drug-resistant' cases have also been identified, most recently in India. [Ibid]

“TB is usually cured in six to nine months with a mixture of four antibiotics, but if that treatment is interrupted or the dose reduced, the bacteria mutate into a tougher strain that can no longer be killed by standard drugs. The drug-resistant form takes up to two years and thousands of dollars to treat. [Ibid]

“The survey conducted by the Chinese Center for Disease Control and Prevention, or China CDC, also showed that 8 percent of patients with drug-resistant TB were actually extensively drug-resistant cases. The survey's researchers tested 4,000 TB patients recruited through local TB clinics over nine months. [Ibid]

“In 2007, an estimated 110,000 cases of drug-resistant TB and 8,200 extensively drug-resistant cases developed, making it the largest annual number of new drug-resistant cases in the world, the study said. "This is a very grave situation because we don't have any new drugs to treat the patients with," said Dr. Wang Yu, director of the China CDC and another author of the study. "It is a problem that the whole world is facing... and over time, it will only increase.” [Ibid]

Chinese More Likely to Get Drug-Resistant Tuberculosis in Hospital

AP also reported: “In the past decade, China made marked progress in fighting tuberculosis, which until recent years was the most fatal infectious disease. But many state-run TB facilities still don't have the resources to test patients for drug-resistant strains in order to give them the right drugs, and many are also unable to track every patient to ensure that drug regimens are closely followed. [Source: AP, June 7, 2012]

“The survey also showed that patients who were last treated in a tuberculosis hospital were 13 times as likely to have drug-resistant TB as those who had been treated elsewhere. They likely became infected in the hospitals or were given the wrong drugs. The overuse and misuse of antibiotics is very common in China because it is a way for underfunded hospitals to boost revenue through drug sales. [Ibid]

“The hospital is clearly a major culprit in this, even what we call tuberculosis hospitals which are supposed to be specialized in the treatment of drug-resistant TB, they are actually perhaps, as this study has implicated, contributing to drug-resistant TB," said Chin, who is also deputy director of programs at the Gates Foundation in China. [Ibid] China's rate of drug-resistant TB cases is lower than in some Eastern European countries, but the absolute number of cases, given the country's large population, is high - similar to that of India, said Dr. Fabio Scano, World Health Organization's Stop TB officer in Beijing, who was not involved in the study. [Ibid]

Hepatitis B in China

Hepatitis is a big problem in China. It accounts for a large proportion of deaths. Around 700 million Chinese, more than half the population, have had hepatitis B. Of these 120 million, 10 percent of the population, are believed to be long term carriers, who can transmit the disease for years even though they show no outward symptoms. About 25 percent of these will ultimately suffer from some kind of complication related to the disease. .

About 90 percent of those who have had hepatitis were infected at birth. The 10 percent that caught it later on are mainly the ones who become carriers. Many were infected with needles that were reused during vaccination campaigns for tuberculosis and tetanus and encephalitis in the 1970s, 80s ad 90s.

Many people get Hepatitis B from their mothers and many show no symptoms. Even so they are denied jobs and placement in schools because blood tests pick up the disease. Some people who know they have the disease don’t date, refuse to get married or don’t tell their spouses.

Hepatitis B kills 808 people a day in China, compared to eight a day in the United States. The Chinese government did little to contain the disease until 2005, when it started a program of free vaccine for infants, by that time it had already become an epidemic. In 2006, Beijing announced that fighting the disease was a top priority and celebrities with it came forward and said the were hepatitis B carriers.

Hepatitis B Transmission and Symptoms

Hepatitis B is contacted by direct contact with an infected person’s blood or contact with the infected person’s bodily fluids, such as through sharing needles or having sex. Transmission is mainly through blood contact, such as a blood transfusion, or to a lesser extent from infected unsterilized needles, acupuncture and tattooing. Transmission through sex is rare. It can not be contacted through casual contact such as shaking hands.

Symptoms for hepatitis B include, jaundice, fatigue, abdominal and joint pain, loss of appetite, nausea and vomiting. Sometimes people never get symptoms. Unlike hepatitis A, hepatitis B can cause cirrhosis of the liver (a disease which kills liver cells and impairs the ability of the liver to perform vital functions), liver cancer and permanent liver damage.

Hepatitis B can be a wasting disease that causes victims to slowly waste away or unpredictable disease which lies dormant for years and suddenly and painfully strike with vomiting, yellowing of the skin and eyes, fatigue and join pain. One victim told Bloomberg News, “When it first flared up, I felt like I would rather die than live with this disease.”

After about seven years with the disease victims they become very weak and the cost of medicines eat up a significant portion of their income. Victims often die of cirrhosis, liver cancer or some other liver disease. Hepatitis B is spread primarily from mother to infant and from reused needles, which are often used in clinics to save money. In China abut 40 percent of sufferers hey the disease form their others.

Hepatitis B Treatment

Hepatitis B is incurable but it can be prevented with a vaccine. For those that get it, full recovery is likely but 10 percent of hepatitis B sufferers become chronic carriers and are at greater risk for cirrhosis and liver cancer. The drug interferon reduces the chance of a return of the disease. It is effective in about 30 to 40 percent of patients.

Hepatitis B is difficult to bring under control because many carriers are symptomless yet the can still transmit the disease. One of the main reasons you should avoid blood transfusions is the risk of getting hepatitis B. One of the main reasons you should get a hepatitis B inoculation is in the event that you have an accident while traveling abroad and are given blood infected with hepatitis B in a transfusion.

The vaccine for hepatitis B that is widely available. First offered in the United States in 1991, it consists of a series of three shots (an initial dose, a second dose one or two months later and a third dose 4 to 12 months after the first). After the second dose you can consider yourself inoculated for the short term. The third shot is a booster. The Hepatitis B vaccine provide protection for at least 15 years.

Many Chinese with the disease fail to get medicine or treatment because of the stigma attached to it. For that seek help, the best Western-made drugs such as Baraclude by Bristol-Meyers-Squibb can be prohibitively expensive, costing $60 to $150 a month. Western drug companies are aggressively moving into China, seeing opportunities for profits and growth. Some are working with non-profit groups to bring the cost of treatment down. Thus far the government has not stepped into help with treatment in a significant way.

Hepatitis Discrimination and Prevention in China

People who are known to have hepatitis are widely discriminated against. They are denied certain jobs and even fired from existing jobs. In many cases employees are discovered to have the disease during annual company physicals. They are let go on the spot with three months salary as severance pay. Students with the disease have been forced to move into segregated dormitories.

A ban against employing civil servants with hepatitis B was only lifted in 2005. Carriers of the disease are still not allowed to work in the food industry, public restrooms, hotels and beauty parlors. Some who were denied jobs have sued for discrimination. One man even killed the official who denied him a job.

Hepatitis B is so widespread that the government has embarked on a national hepatitis B immunization program for young children. So far the immunization campaign has been extensive in the rich coastal areas (around 70 percent) but less widespread in the Western province (less than 50 percent) and Tibet (5 percent). Some Chinese doctors say the idea for screening parents for hepatitis is a good one.

To make sure the immunization campaign reaches total coverage, the government has earmarked $78 million for the program. A group sponsored by Bill Gates has also pitched in and donated special syringes that automatically become unusable after one use. The three-dose vaccine cost only $3 in China. In some places it costs only $1.50.

Image Sources:

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, National Geographic, The New Yorker, Time, Newsweek, Reuters, AP, Lonely Planet Guides, Compton’s Encyclopedia and various books and other publications.

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© 2008 Jeffrey Hays

Last updated July 2012

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