Drug addicts

Dose me up, doc

Anne Sheafe Miller made history in 1942, when she became the first person on record to be curedwith penicillin (surviving a high fever brought about by septicemia). The discovery of modern antibiotics a few years earlier not only saved Miller’s life – it also revolutionised public health.

But it was a breakthrough that came with severe risks, doctors warned. Misuse of antibiotic treatments could allow more virulent diseases to evolve, by creating bacteria much more of a challenge to eradicate.

The warning is one that many Chinese medical practioners do not appear to be heeding. State Food and Drug Administration vice director Wu Zhen recently admitted that the country’s antibiotics use was more than 10 times the global average (at 138 grams per person) That’s an extraordinary statistic – China’s population size normally brings down per capita averages to well below its international peers.

“About 90% of Chinese inpatients are prescribed antibiotics, while the figure is only 30% in Western hospitals,” Du Wenmin, vice director of Shanghai Clinical Centre for Drug Adverse Reaction Monitoring, told the Shanghai Daily.

The misuse extends to the most potent form of the drugs: intravenous antibiotics (those injected directly into the bloodstream). China used a “staggering” 8 bottles of IV treatments (including antibiotics) per person in 2009, reports Xinhua. “The figure is much higher than the 2.5 to 3.3 bags per person set down by international standards,” said Zhu Zhixin, vice director of the NDRC. Zhao Deyu, director of emergency medicine at Nanjing Children’s Hospital, also told Xinhua that many lower-grade antibiotics widely used in other countries have been abandoned in Chinese treatments, as they are no longer effective.

How about the potential for more drug-resistant super bugs to develop? As the data builds up on higher levels of antibiotic resistance among Chinese patients, some experts fear a return to a pre-antibiotic era of medicine, in which existing treatments begin to prove less effective on a global basis.

The impact of overuse in China itself is already apparent. Complications from overdoses and allergic reactions to antibiotic treatments already kill an estimated 80,000 people nationally each year. More than a million children have also been made deaf by misuse of the antibiotic streptomycin, according to the People’s Daily.

Why are antibiotics so often over- prescribed? In part, because patients are eager for strong medicines. But experts say the main reason is the financial incentives built into China’s healthcare system.

Some doctors tend to prescribe the most advanced antibiotics to achieve the quickest results, says Huang Liuyu, director of the Institute for Disease Prevention and Control of the People’s Liberation Army. But he also told China Daily that many others do so to cash in on kickbacks from drug companies.

Those fees often provide essential income to hospitals and their staff. “[In some hospitals] drug-generated revenue accounts for 70%-80% of the total hospital revenues,” explains Xinhua, “and the use of high-grade IV antibiotics is the fastest and most secure money-making method.”

A scandal last December in the southern city Zhuhai, just across the border from Macau and Hong Kong, highlighted the problem once again, when local authorities reportedly uncovered illegal fees paid by pharmaceutical firms for drug contracts.

“All nine hospitals in Zhuhai were implicated,” according to Caixin magazine. “The system of corruption and bribes has remained unchanged. It is still widely known that kickbacks and bribes are the primary source of income for public hospitals in Zhuhai.”

One solution that’s been suggested is the introduction of Western-style clinical pharmacists to monitor the prescriptions that doctors hand out. But what’s to stop them being tempted by the incentives on offer too? A recently established centralised drug list may bring down costs and reduce the shortfall in hospital budgets – alleviating the pressure to generate income via over-prescribing antibiotics. Beijing’s vaunted healthcare reforms are intended to achieve this; but will they work?

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