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In China's health care system, a major crisis of faith

A woman enters an office of GlaxoSmithKline in Beijing, China, on Thursday, July 11, 2013. China’s police ministry accused executives of pharmaceutical supplier GlaxoSmithKline  on Thursday of conducting a large and long-running bribery campaign to persuade doctors to prescribe drugs. AP Photo/Alexander F. Yuan

Vasily Zaytsev was a Soviet sniper who killed some 300 Nazis during World War II. Before dying a national hero in 1991, he was honoured with several awards including the Hero of the Soviet Union and the Order of Lenin.

But these days, his name is making headlines again, for reasons Zaytsev himself could have never imagined. According to allegations reported by the Wall Street Journal, Chinese sales personnel with GlaxoSmithKline chose the sharpshooter's name -- Vasily -- as a code name for their secretive marketing strategy aimed at bribing doctors into prescribing Botox.

(This is not the first time such accusations have been made. In January, an anonymous tipster -- the same one who brought the recent allegations to light -- claimed that Glaxo's Chinese sales staff have been rewarding doctors with money, dinners and free trips for prescribing the company's drugs. The company told the Wall Street Journal that a probe of the earlier allegations failed to turn up any evidence of corruption).

Today, a Lancet editorial emphasized that the allegations remain unproven but are troubling nonetheless. This is because they are part of -- and feed into -- a larger crisis in China: the public's growing mistrust of doctors and other medical workers.

Doctors are widely respected, even revered, in many parts of the world but this is no longer the case in China, where medical personnel are increasingly coming under attack. In March 2012, an 18-year-old patient attacked medical workers at his tuberculosis clinic, killing an intern and injuring three others with a fruit knife. In 2011, a cancer patient stabbed his surgeon 17 times because she had failed to remove his tumour; a riot also broke out in a hospital in Nanchang after a patient died in surgery, forcing more than 100 medical staffers to pick up sticks and mace to defend themselves.

These incidents are not happening in isolation. In 2010, there were 17,000 acts of violence against doctors in more than 70 per cent of hospitals in China, according to state-owned newspaper China Daily. In June 2009 alone, roughly 20 doctors were killed or severely injured by relatives of patients.

There are many factors driving this alarming trend. The expansion of China's healthcare system has failed to keep pace with the country's explosive economic and population growth and in 2011,  the country only had 1.8 physicians per 1,000 people, according to the World Bank. By comparison, France had 3.4, Spain had 4.0, and the United Kingdom had 2.8.

The same China Daily article above also writes that many attacks are linked to malpractice disputes -- Chinese patients have few options when they feel they have been wronged and so "patients resort to violence when they feel there is no proper mechanism to resolve malpractice disputes."

Not only are many Chinese citizens unable to afford quality healthcare, doctors are also being poorly compensated. According to Time Magazine, the Chinese Medical Doctor Association has reported that 96 per cent of physicians are dissatisfied with their salaries, which on average is just 19 per cent higher than what a typical Chinese worker would earn. According to the Economist, some urban Chinese doctors make as little as $780 per month; a survey of doctors has also found that one in four are depressed, reports the New York Times.

As a result, physicians are increasingly seeking extra money, not only to see patients but also to perform surgeries and medical tests. There are also widespread reports of doctors prescribing unnecessary drugs; according to the Lancet editorial, healthcare observers say it has become an "open secret" that doctors are being bribed to shill for specific drug companies and "this alleged practice has compromised the public's trust in doctors."

As the Lancet editorial points out, doctors are not the only ones who suffer from this ongoing breakdown of the physician-patient relationship; patients stand to lose too. The toxic atmosphere is undermining the entire healthcare system in China, driving doctors out of the industry and discouraging young people from entering the medical profession altogether.

In the end, every doctor attacked translates to several lives harmed -- not only the doctor's own, but also the patients he or she is prevented from treating in the future.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar



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According to the OPHRDC, Ontario's population in 2011 as reported by each LHIN, was 13,372,997, yet that same year indicates Ontario had only 11,902 family practitioners (the one doctor you need to see to be seen by any specialist). My calculations put Ontario's number of family physicians at 0.89 per 1000. Shouldn't our numbers have factored into this article?

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