- Email: [email protected]
Ya'an earthquake
Correspondence
1 2
3
The Lancet. Ending violence against doctors in China. Lancet 2012; 379: 1764. Xu J, Wang W, Li Y, et al. Analysis of factors influencing the outpatient workload at Chinese health centres. BMC Health Serv Res 2010; 10: 151. Pan XL, Hassan HD, Wang XH, Zhang H. Service utilization in community health centers in China: a comparison analysis with local hospitals. BMC Health Serv Res 2006; 6: 93.
Internationalisation of Chinese medical schools There are 1193 institutions of higher education in China certified by the Ministry, including those in Hong Kong and Macao: 31 are medical schools teaching traditional Chinese medicine (TCM), and 152 are medical schools teaching western medicine—52 offer an English Bachelor of Medicine, Bachelor of Surgery (MBBS) degree, equivalent to the American Medical Degree. 30·9% of western medicine medical schools and 63·5% of MBBS medical schools enrol international students, 36·2% and 65·4% of western medicine medical schools and MBBS medical schools offer courses on international and global health. 23·0% of western medicine medical schools and 46·2% of MBBS medical schools employ international experts. The geographical distribution of western medicine medical schools in China matches with population and financial resource distribution, with east China having the greatest number of western medicine medical schools. Despite a large wealth gap between regions, east China and south-central China have a similar number of western medicine medical schools (44 vs 41). However, east China has 20 MBBS medical schools, whereas south-central China has 12. The number of TCM medical schools is similar between the two regions. More than a quarter of TCM medical schools enrol international students, and more TCM medical schools have international student exchange 1984
programmes and scholarships than do western medicine medical schools. Many Chinese people rely on TCM for their medical care, and there is a high demand from Chinese students to learn TCM. In the past 20 years, TCM has been largely exported: acupuncture clinics and herbalists have opened in Europe and the USA. Just like a generation of Chinese doctors travelled to learn western medicine, a new generation of international students is going to China to learn TCM. With students and faculty exchanges, global health courses, and interaction with international affiliates, Chinese medical institutions have taken an important first step towards the internationalisation of their education system. Such trends affect the global nature of medical curricula and the medicine discipline itself. Medical training is no longer culturally distinct. Programmes in Chinese medical universities support student and doctor exchanges, but more importantly, they promote idea exchanges between different cultures, leading to a harmonisation between eastern and western perspectives on medicine.
This evaluation system leads to doctors spending a long time writing articles, and spending less time treating their patients, affecting the quality of treatment and the doctorpatient relationship. Because of this pressure to publish articles, doctors have falsified data, and ghostwriter companies are growing rapidly, resulting in untrustworthy articles. This evaluation system relying on SCI articles damages China's scientific research capability and credibility.1, 2 Just like an appeal3 published in The Lancet changed China’s organtransplantation system,4 we hope this Correspondence could end the evaluation system based on SCI articles, and lead to a more reasonable and efficient evaluation system for medical doctors in China. We declare that we have no conflicts of interest.
*Bo Ye, Ae-Huey Jennifer Liu [email protected] Medical College,Shanghai Jiaotong University, Shanghai, 200030, China (BY); and West China Center of Medical Sciences, Sichuan University, Sichuan, China (A-HJL) 1 2
We declare that we have no conflicts of interest.
*Angela Fan, Russell Kosik, Qi Chen
3
[email protected]
The Lancet. Scientific fraud: action needed in China. Lancet 2010; 375: 94. Qiu J. Publish or perish in China. Nature 2010; 463: 142–43. Caplan AL, Danovitch G, Shapiro M, et al. Time for a boycott of Chinese science and medicine pertaining to organ transplantation. Lancet 2011; 378: 1218. Huang J, Millis JM, Mao Y, et al. A pilot programme of organ donation after cardiac death in China. Lancet 2012; 379: 862–65.
National Yang-Ming University School of Medicine,Taipei, Taiwan (AF); Santa Clara Valley Medical Center, San Jose, CA, USA (RK); and Nanjing Medical University, Nanjing, China (QC)
4
Inadequate evaluation of medical doctors in China
Ya’an earthquake
Since the late 1980s, the majority of the large hospitals in China use publishing in the Science Citation Index (SCI) as the main indicator for medical career evaluation, promotion, and also recognition. Most medical doctors in China are under a huge amount of pressure to publish articles each year.
On April 20, at 0802 h local time, just 22 days before Wenchuan earthquake’s fifth anniversary, a magnitude 7 quake struck the province of Sichuan, China. The epicentre was Ya’an in Lushan county. More than 4000 aftershocks were felt in Ya’an in the following days. More than 100 aftershocks were above magnitude 3. 196 people have been killed, 11 470 people were injured, and more than 1 500 000 people www.thelancet.com Vol 381 June 8, 2013
Correspondence
We declare that we have no conflicts of interest.
Bihan Tang, *Lulu Zhang [email protected] Institute of Military Health Management, Second Military Medical University, Shanghai, 200433, China 1
2
China Daily. Live report: 7.0-magnitude quake hits SW China’s Sichuan. http://www. chinadaily.com.cn/china/2013sichuanqua ke/2013-04/20/content_16426485.htm (accessed April 20, 2013). Xinxhuanet. Ya’an earthquake less disastrous than Wenchuan disaster. http://news. xinhuanet.com/english/ china/2013-04/20/c_132325562.htm (accessed April 20, 2013).
www.thelancet.com Vol 381 June 8, 2013
Psychiatry for the elderly in the UK The introduction of the Equality Act in the UK1 has brought into focus issues of how old-age psychiatry is defined. For some time it has been neither logical nor reasonable to use older than 65 years of age as a criterion for access to (or denial of) a service; now it is probably unlawful to do so. The absence of a robust definition for old-age psychiatry is leading to erosion and fragmentation of services, with some health providers in the UK creating generic all-age (so-called ageless) services. To assess the development of ageless services, we did an online survey of old-age psychiatry consultants in the UK who were members of the Old Age Faculty of the Royal College of Psychiatrists. Of the 81 organisations providing mental health services for older adults in the UK, we received responses from 76. Of the 415 respondents who completed the survey, 196 (47%) reported development of some elements of ageless services in their organisation. Of these, 34 (17%) reported that plans were ongoing to convert to wholly ageless services. In some cases these changes were regarded as positive (eg, access to adult crisis-resolution services), whereas some were regarded as negative (eg, ageless psychology or liaison services). The move to ageless services was regarded as very good or good by 16% (37/230) of respondents, and bad or very bad by 52% (121/230) of respondents. Old-age services are traditionally community based, with teams understanding the social, physical, and psychological consequences that ageing brings into the management of mental illness, which is essential for appropriate management. Oldage psychiatry is needed to provide a service that understands the complexities of managing people
with dementia, severe comorbidity, or psychological effects of ageing and end of life.2 The trend for ageless services will disadvantage further a growing, already disadvantaged part of society.3 We believe that old-age psychiatry services should be preserved and enhanced. We declare that we have no conflicts of interest.
* James Warner, Josie Jenkinson [email protected] Royal College of Psychiatrists, Central North West London NHS Foundation Trust, London W10 6DZ, UK (JW); and Institute of Psychiatry, King’s College London, London, UK (JJ) 1
2
3
Equality Act 2010: guidance. https://www.gov. uk/equality-act-2010-guidance (accessed May 13, 2013). Rajenthran S, Holzer S, Warner J. Redefining Old Age Psychiatry—A pragmatic approach. Int J Geriatr Psychiatry (in press). Anderson D. Age discrimination in mental health services needs to be understood. Psychiatrist 2011; 35: 1–4.
Frailty assessment in elderly people Andrew Clegg and colleagues (March 2, p 752)1 present an excellent overview of frailty. We would like to further highlight the link between frailty and cardiovascular diseases, and a clinical application of frailty assessment. Frailty is a heterogeneous condition, which might account for variations in definitions, phenotypic features, and assessment methods. The concept of disease-specific, or even procedure-specific, frailty is emerging as a clinical paradigm particularly in relation to very specialised treatments including cardiac interventions (angioplasty or bypass surgery). Cardiovascular frailty is an important problem in the elderly. Frailty is an independent risk factor for development or progression of cardiovascular diseases, and cardiovascular diseases (or their invasive management) can lead to frailty.2 Conversely, treating one might improve the other, and the
Ocean/Corbis
were affected.1 Electricity and water supplies were interrupted, roads were blocked. Bad weather, powerful aftershocks, and landslides were secondary disasters for stricken areas. Chengdu Military Region established an earthquake-relief headquarters 18 min after the earthquake, and the Chinese Government established a class 1 natural-disaster response. On April 20, 5000–6000 military and medical rescue workers were sent to the area within a few hours along with the national emergency relief team, according to the China Seismological Bureau. Non-governmental rescue forces were also deployed to the area, bringing strong and important support. Is history repeating itself? Ya’an is located just 100 km south of Wenchuan, in the same seismic zone, (the so-called Longmen Shan zone) part of a very active seismic belt, and both earthquakes happened in the same season. However, there is no evidence so far that Ya’an earthquake is an aftershock of Wenchuan earthquake.2 Importantly, Wenchuan earthquake has given the Chinese Government experience in medical disaster relief and has strengthened the capability of self-rescue among the population.2 Another Wenchuan earthquake is unlikely, but more efforts should be made to reduce losses to a minimum.
1985
1 2
3
The Lancet. Ending violence against doctors in China. Lancet 2012; 379: 1764. Xu J, Wang W, Li Y, et al. Analysis of factors influencing the outpatient workload at Chinese health centres. BMC Health Serv Res 2010; 10: 151. Pan XL, Hassan HD, Wang XH, Zhang H. Service utilization in community health centers in China: a comparison analysis with local hospitals. BMC Health Serv Res 2006; 6: 93.
Internationalisation of Chinese medical schools There are 1193 institutions of higher education in China certified by the Ministry, including those in Hong Kong and Macao: 31 are medical schools teaching traditional Chinese medicine (TCM), and 152 are medical schools teaching western medicine—52 offer an English Bachelor of Medicine, Bachelor of Surgery (MBBS) degree, equivalent to the American Medical Degree. 30·9% of western medicine medical schools and 63·5% of MBBS medical schools enrol international students, 36·2% and 65·4% of western medicine medical schools and MBBS medical schools offer courses on international and global health. 23·0% of western medicine medical schools and 46·2% of MBBS medical schools employ international experts. The geographical distribution of western medicine medical schools in China matches with population and financial resource distribution, with east China having the greatest number of western medicine medical schools. Despite a large wealth gap between regions, east China and south-central China have a similar number of western medicine medical schools (44 vs 41). However, east China has 20 MBBS medical schools, whereas south-central China has 12. The number of TCM medical schools is similar between the two regions. More than a quarter of TCM medical schools enrol international students, and more TCM medical schools have international student exchange 1984
programmes and scholarships than do western medicine medical schools. Many Chinese people rely on TCM for their medical care, and there is a high demand from Chinese students to learn TCM. In the past 20 years, TCM has been largely exported: acupuncture clinics and herbalists have opened in Europe and the USA. Just like a generation of Chinese doctors travelled to learn western medicine, a new generation of international students is going to China to learn TCM. With students and faculty exchanges, global health courses, and interaction with international affiliates, Chinese medical institutions have taken an important first step towards the internationalisation of their education system. Such trends affect the global nature of medical curricula and the medicine discipline itself. Medical training is no longer culturally distinct. Programmes in Chinese medical universities support student and doctor exchanges, but more importantly, they promote idea exchanges between different cultures, leading to a harmonisation between eastern and western perspectives on medicine.
This evaluation system leads to doctors spending a long time writing articles, and spending less time treating their patients, affecting the quality of treatment and the doctorpatient relationship. Because of this pressure to publish articles, doctors have falsified data, and ghostwriter companies are growing rapidly, resulting in untrustworthy articles. This evaluation system relying on SCI articles damages China's scientific research capability and credibility.1, 2 Just like an appeal3 published in The Lancet changed China’s organtransplantation system,4 we hope this Correspondence could end the evaluation system based on SCI articles, and lead to a more reasonable and efficient evaluation system for medical doctors in China. We declare that we have no conflicts of interest.
*Bo Ye, Ae-Huey Jennifer Liu [email protected] Medical College,Shanghai Jiaotong University, Shanghai, 200030, China (BY); and West China Center of Medical Sciences, Sichuan University, Sichuan, China (A-HJL) 1 2
We declare that we have no conflicts of interest.
*Angela Fan, Russell Kosik, Qi Chen
3
[email protected]
The Lancet. Scientific fraud: action needed in China. Lancet 2010; 375: 94. Qiu J. Publish or perish in China. Nature 2010; 463: 142–43. Caplan AL, Danovitch G, Shapiro M, et al. Time for a boycott of Chinese science and medicine pertaining to organ transplantation. Lancet 2011; 378: 1218. Huang J, Millis JM, Mao Y, et al. A pilot programme of organ donation after cardiac death in China. Lancet 2012; 379: 862–65.
National Yang-Ming University School of Medicine,Taipei, Taiwan (AF); Santa Clara Valley Medical Center, San Jose, CA, USA (RK); and Nanjing Medical University, Nanjing, China (QC)
4
Inadequate evaluation of medical doctors in China
Ya’an earthquake
Since the late 1980s, the majority of the large hospitals in China use publishing in the Science Citation Index (SCI) as the main indicator for medical career evaluation, promotion, and also recognition. Most medical doctors in China are under a huge amount of pressure to publish articles each year.
On April 20, at 0802 h local time, just 22 days before Wenchuan earthquake’s fifth anniversary, a magnitude 7 quake struck the province of Sichuan, China. The epicentre was Ya’an in Lushan county. More than 4000 aftershocks were felt in Ya’an in the following days. More than 100 aftershocks were above magnitude 3. 196 people have been killed, 11 470 people were injured, and more than 1 500 000 people www.thelancet.com Vol 381 June 8, 2013
Correspondence
We declare that we have no conflicts of interest.
Bihan Tang, *Lulu Zhang [email protected] Institute of Military Health Management, Second Military Medical University, Shanghai, 200433, China 1
2
China Daily. Live report: 7.0-magnitude quake hits SW China’s Sichuan. http://www. chinadaily.com.cn/china/2013sichuanqua ke/2013-04/20/content_16426485.htm (accessed April 20, 2013). Xinxhuanet. Ya’an earthquake less disastrous than Wenchuan disaster. http://news. xinhuanet.com/english/ china/2013-04/20/c_132325562.htm (accessed April 20, 2013).
www.thelancet.com Vol 381 June 8, 2013
Psychiatry for the elderly in the UK The introduction of the Equality Act in the UK1 has brought into focus issues of how old-age psychiatry is defined. For some time it has been neither logical nor reasonable to use older than 65 years of age as a criterion for access to (or denial of) a service; now it is probably unlawful to do so. The absence of a robust definition for old-age psychiatry is leading to erosion and fragmentation of services, with some health providers in the UK creating generic all-age (so-called ageless) services. To assess the development of ageless services, we did an online survey of old-age psychiatry consultants in the UK who were members of the Old Age Faculty of the Royal College of Psychiatrists. Of the 81 organisations providing mental health services for older adults in the UK, we received responses from 76. Of the 415 respondents who completed the survey, 196 (47%) reported development of some elements of ageless services in their organisation. Of these, 34 (17%) reported that plans were ongoing to convert to wholly ageless services. In some cases these changes were regarded as positive (eg, access to adult crisis-resolution services), whereas some were regarded as negative (eg, ageless psychology or liaison services). The move to ageless services was regarded as very good or good by 16% (37/230) of respondents, and bad or very bad by 52% (121/230) of respondents. Old-age services are traditionally community based, with teams understanding the social, physical, and psychological consequences that ageing brings into the management of mental illness, which is essential for appropriate management. Oldage psychiatry is needed to provide a service that understands the complexities of managing people
with dementia, severe comorbidity, or psychological effects of ageing and end of life.2 The trend for ageless services will disadvantage further a growing, already disadvantaged part of society.3 We believe that old-age psychiatry services should be preserved and enhanced. We declare that we have no conflicts of interest.
* James Warner, Josie Jenkinson [email protected] Royal College of Psychiatrists, Central North West London NHS Foundation Trust, London W10 6DZ, UK (JW); and Institute of Psychiatry, King’s College London, London, UK (JJ) 1
2
3
Equality Act 2010: guidance. https://www.gov. uk/equality-act-2010-guidance (accessed May 13, 2013). Rajenthran S, Holzer S, Warner J. Redefining Old Age Psychiatry—A pragmatic approach. Int J Geriatr Psychiatry (in press). Anderson D. Age discrimination in mental health services needs to be understood. Psychiatrist 2011; 35: 1–4.
Frailty assessment in elderly people Andrew Clegg and colleagues (March 2, p 752)1 present an excellent overview of frailty. We would like to further highlight the link between frailty and cardiovascular diseases, and a clinical application of frailty assessment. Frailty is a heterogeneous condition, which might account for variations in definitions, phenotypic features, and assessment methods. The concept of disease-specific, or even procedure-specific, frailty is emerging as a clinical paradigm particularly in relation to very specialised treatments including cardiac interventions (angioplasty or bypass surgery). Cardiovascular frailty is an important problem in the elderly. Frailty is an independent risk factor for development or progression of cardiovascular diseases, and cardiovascular diseases (or their invasive management) can lead to frailty.2 Conversely, treating one might improve the other, and the
Ocean/Corbis
were affected.1 Electricity and water supplies were interrupted, roads were blocked. Bad weather, powerful aftershocks, and landslides were secondary disasters for stricken areas. Chengdu Military Region established an earthquake-relief headquarters 18 min after the earthquake, and the Chinese Government established a class 1 natural-disaster response. On April 20, 5000–6000 military and medical rescue workers were sent to the area within a few hours along with the national emergency relief team, according to the China Seismological Bureau. Non-governmental rescue forces were also deployed to the area, bringing strong and important support. Is history repeating itself? Ya’an is located just 100 km south of Wenchuan, in the same seismic zone, (the so-called Longmen Shan zone) part of a very active seismic belt, and both earthquakes happened in the same season. However, there is no evidence so far that Ya’an earthquake is an aftershock of Wenchuan earthquake.2 Importantly, Wenchuan earthquake has given the Chinese Government experience in medical disaster relief and has strengthened the capability of self-rescue among the population.2 Another Wenchuan earthquake is unlikely, but more efforts should be made to reduce losses to a minimum.
1985