The Oxford Uehiro Centre for Practical Ethics
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Contents (New)
Health Reform in China Is Basically Unsuccessful
Market-oriented health care reform has been a controversial issue at its beginning since 1985. 20 years has elapsed. Recently, the Research Center for Development as a thinking tank for central government, State Council published a report titled ¡°Evaluation of the Reform of Health Care System in China and Recommendations¡± in which the authors claimed that the health care reform in China is basically unsuccessful. After 20 years reform in which health care as public goods became private or personal goods, the health care coverage only reached 50% in urban population and 10% in rural population, however, the medical expenditure amounted to 5.42% of GDP. The equity in medical services and the macro-efficiency of health input both decreased, so China was ranked 188 in equity of health financing and distribution and 144 in total performances of health care among 191 countries in 2000. These not only affected people¡¯s health but also drove them into poverty. The reason of the unsuccessfulness is that the reform was market oriented, but market cannot or is not willing to provide the health care to those who need, and those who need cannot afford. (According to statistics near 50% of patients did not go to hospitals, 30% of those who should be admitted into hospital did not apply for the admittance because they could not afford the costs.) The resources were allocated by the market to high-tech services and to the regions with high purchasing power, not to prevention, primary care, common diseases, so the accessibility of health care was decreased. The great majority of Chinese now complained that ¡°it is difficult for illness to be treated¡±, and ¡°it is too expensive for illness to be treated¡±. The report also pointed out the mistakes in the ideas of health reform, such as hospitals taken as an enterprise, relying on financial input from local governments, the separation between medical services and public health services, ¡°keep big hospitals and sell small hospitals¡°, setting up personal health care account, medical insurance relying on payments, and problems in new collective health care in rural areas. The remedy the authors suggested is to set up a unified health care system in which all citizens enjoy free public health care and basic medical care services regardless of the difference between urban and rural areas and the difference between public ownership, collective ownership and private ownership, and non-basic medical care can be given to the market.
Ethical Issues in International Collaborative Research
In no. 7 2004 Newsletter of Research Center for Bioethics PUMC was published an article with the title:
Ethical Issues in International Collaborative Research
China is one of developing countries with poor resources. It is possible for some people from developed countries to use their advantage of rich resources and exploit our vulnerable status to do some misconduct in collaborative project, and some institutes and scientists are eager to get the grant so as to neglect to protect the patients/subjects¡¯ rights and welfare.
The objective of collaborative project should be the urgent need for our country, not the urgent need for sponsor country but not for ours, or not for meeting the interest of scientists from sponsor country only.
Some collaborative project took Chinese side only as a sample provider, but not committed to capacity building of scientific research in our community or country.
Some project took Chinese partners as only coolies. The budget was not transparent, Chinese partners did not know how much is the grant. There was no lecture fee for Chinese lecturers, no credit or acknowledgement for their contribution to published articles.
In some collaborative project was only mentioned the respect for the laws of sponsor countries, not respect for the laws of host countries. Mutual respect and benefit sharing are very important.
Bypassing SFDA (State Food and Drug Administration) a US drug company worked with Center for HIV/AIDS to do clinical trials of a HIV drug which has not been approved by US FDA nor it was approved to do clinical trial in China under the excuse of giving it to China as a gift without any payment.
In the informed consent form drafted by Western pharmaceutical companies there is always omitted of the compensation and free medical care when injury happens during the trial.
In Phase I of some collaborative project the trial of large dosage was conducted in China, but the trial of small dosage in USA.
9. It is a long-term goal of our efforts to establish an equal, equitable and just relationship between developing and develop countries in the international collaborative research.
Strange Events in International Bioethics Activities
In no. 7 2004 Newsletter of Research Center for Bioethics PUMC was published an editorial with the title ¡°Strange events in International Bioethics Activities¡±. In the editorial the author pointed out that the majority of Chinese scientists, physicians, medical ethicists or bioethicists, and officials responsible for administrating biomedical research and clinical trials, are making efforts to comply the research with national regulations and international ethical guidelines. The shortcomings and problems emerging in the biomedical research and clinical trials should be treated seriously and practically on the basis of evidences and according to laws, regulations and guidelines, and in dealing with these the monitoring of patients/subjects, the public and media are also welcomed.
But we regretfully noticed that at the meetings on bioethics which were held in Berlin (2003) and Paris (2004) the organizers invited one party of a controversial case to raise groundless allegations and attacks to the other party who was not invited despite of the opposition from Chinese side, it is unfair and violated the principle of due procedure in a democratic society, and it also did great harm to the future international communications.
The existing shortcomings and problems in biomedical research and clinical trials should be dealt with only through seriously summing up of experiences and lessons, rational discussion, and suggesting improvement recommendations. Any practice which is unfair, violates due procedure, and appeals to sensational reports does not work and unhelpful, especially the practice like that during Cultural Revolution in which the right of other party to expression was to be deprived of, and the allegations against it were fabricated. It is really strange that somebody in these countries tried to use this event to attack another country, it reminds us of the history during which imperialist Japan and imperialist Russia engaged in a war but in Chinese territory.
The facts are: independent scientists team, independent journalists team and independent lawyer team organized respectively by Chinese and US sides did fact investigations during these three years and their findings are consistent that the allegations made at the meetings above are groundless and they are nothing to do with bioethics.
However, it should be recommended that the government, institutes and scientists have to make necessary efforts to seriously sum up the experiences and lessons in biomedical research and clinical trials, improve their governance, enhance the communication between scientists and the public/media, and make them to understand the significance and importance of biomedical research and clinical trials, and enhance the capacity building of bioethics/research ethics.