Shanghai Street View: Delevering Drug Use
This week we’ll take a break from the taxi wars and bike promotions shaking up the streets of Shanghai and turn instead to our city’s health care system, where a quieter revolution is taking place in our hospitals. This particular campaign has seen Shanghai’s scores of hospitals and clinics aggressively cut back on their use of antibiotics, in response to growing global concerns that over-prescription of such drugs could lead to the rise of a new generation of superbugs.
This particular campaign is long overdue, and reflects a broader Asian fascination that gives drugs an almost god-like status with the ability to cure anything from minor sniffles to far more serious ailments like chronic pain. That view contrasts sharply with the US, where drugs are revered for their ability to cure many ailments but are also seen as limited in their ability to combat more ordinary conditions like common colds and body aches.
Nearly any westerner who has spent time in China will say that one of his strongest impressions of local hospitals is their presence of their large rooms filled with patients in armchairs getting medicine via intravenous (IV) drips. Such rooms are non-existent in US hospitals, and instead IV drips for westerners usually conjure up pictures of a critically ill patient getting treated in a hospital’s intensive care unit.
I personally have refused to get IV drugs on my few visits to Chinese hospitals where doctors recommended such treatment, and usually either accept oral medicine or don’t accept any medication at all for simple things like sore throats. But my Chinese friends are far more willing to take a seat in the IV room if the doctor recommends it, and don’t mind siting patiently for hours as the medicine drips slowly through a needle into their arm.
It seems that antibiotics are one of the more popular medicines offered through such drips, which has led to their massive overuse in Chinese hospitals and clinics, raising global concerns about the potential for creating new drug-resistant diseases. In a nod to that reality, Shanghai launched a campaign in 2007 to reduce antibiotic overuse and has announced some promising results in the 8 years since then.
According to the city’s assessment, antibiotic prescriptions have fallen sharply over the life of the campaign to just 10 percent of all prescriptions at present, down from around half when the program began. The program has seen hospitals monitor their doctors more closely, forcing them to think twice before prescribing antibiotics for many patients who probably don’t need them. As a result, antibiotics have also fallen out of the list of most prescribed drugs by Shanghai, a major change from 2007 when they occupied half of the top 10.
In Doctors We Trust
The blind trust by patients in their doctors that facilitates such drug overuse isn’t exclusive to China, and is also exploited in Hong Kong and Taiwan. When I lived in Taiwan, doctors routinely prescribed numerous drugs for me every time I visited one of their small private clinics, often for small problems like a sore throat or skin rash. I would usually check the drug names on the Internet after my visits, and nearly always discovered the medicines had no relationship to my condition and were often meant for things like heartburn or simple headaches.
I later discovered that such abuse occurs in Taiwan and also Hong Kong because doctors can make extra money from drug sales, thus encouraging them to prescribe unneeded medication. The case is similar in China, where hospitals also make money from drug sales. The practice differs sharply in the US, where most people go to independent pharmacies for their medicine, eliminating the profit incentive for doctors to overprescribe drugs.
At the end of the day, changing doctors’ prescription habits is really only half of the solution to China’s drug overuse. The other element lies with patients, who need to stop blindingly believing everything their doctors tell them and take a more active role in their medical care by understanding their illnesses and the drugs they’re taking. Doctors could play a big role in that regard by trying to explain treatment options to patients, though that would mean an end to the more authoritarian nature of the current doctor-patient relationship.
In my view, a major sign that the system is really changing would be the disappearance of the IV drip rooms, which is one of the most obvious places where the drug overuse is taking place. Such a move would not only improve the health of both patients and our city’s medical system, but would save patients the inconvenience of wasting hours of time in the hospital to receive drugs they don’t need.
