As Cancer Rates Rise in China, Trust Remains Low

April 17, 2013

As Cancer Rates Rise in China, Trust Remains Low

By DIDI KIRSTEN TATLOW

BEIJING — Living in China these days, we’re bombarded with scary accounts of rising cancer rates that are partly linked to some of the world’s worst pollution. The slogan this year for National Cancer Prevention and Care Week, which began Tuesday, spells it out: “Protect the Environment, Keep Cancer Away.” That even the Chinese state is highlighting a link between the poor environment and cancer reflects an atmosphere of deep concern, verging on panic, over public health, as more and more people ask: Is China killing itself in the pursuit of spectacularly fast, very dirty, economic growth? Of course, there are other, important reasons for rising rates, like an aging population and changing diet and lifestyles, as the Shanghai cancer specialists Guo Xiaomao and Long Jiang recently wrote in The Xinmin Evening News. And China’s cancer rate is still below that of the United States. About 3.5 million people are diagnosed with cancer yearly, the Zhejiang Science and Technology News Net reported Tuesday, citing a 2012 report by the National Cancer Registry. (Other news accounts put the figure at 3.12 million. Statistics in China often vary.) In the United States, with a population less than a quarter of China’s 1.35 billion, more than 1.6 million people are expected to receive a diagnosis of cancer in 2013, according to the American Cancer Society.

But cancer rates in the United States are falling, whereas in China they are rising, doctors and officials say. And China’s death rate from cancer is far higher — about 2.5 million people yearly, compared with the 580,350 expected to die in the United States this year. Complicating things further, some doctors are wondering: Is China facing a double health whammy as rising disease rates challenge a troubled medical system?

At the top of the list of reasons China may be facing a cancer crisis is the crucial issue of mistrust between patient and doctor. A new article in the Journal of Oncology Practice, published by the American Society of Clinical Oncology, illustrates this problem. The lack of trust, reflected in regular accounts in the Chinese news media of patients and their families venting anger or even physically attacking physicians, is rooted in a perception that doctors are out for personal gain and may be incompetent or corrupt. But according to the article — written by two oncologists, Dr. David H. Garfield of the United States and Dr. Harold Brenner of Israel, and a Chinese oncology nurse, Lucy Lu (who in 2011 were in a group that set up the first of several planned outpatient cancer centers in China, the article said) — doctors are afraid of being blamed by hospital administrators for “bad outcomes,” or deaths, and may act in ways that may protect themselves but may not be in the patient’s best interests.In “Practicing Western Oncology in Shanghai, China: One Group’s Experience,” Ms. Lu wrote: “We are attempting to serve a huge population with limited resources, and the system to protect Chinese physicians remains a big issue. If there are bad results, the physicians are guilty unless they can prove themselves to be right.”

Curiously, for a one-party state obsessed with control, in medical treatment “There is no culture of ‘the captain of the ship,”’ they wrote. “Thus, we cannot control what other treatments patients are simultaneously receiving.”

Ms. Lu says in the article: “Our Western physicians take difficult cases as challenges, whereas Chinese physicians first assess risk to themselves and hesitate in helping patients.”

All too often, the human touch is lacking. “Hospitals are reluctant to have patients die on their premises. Lack of hospices for dying patients” is a problem, the authors wrote.

The article is spreading fast among Chinese oncologists, some of whom are dedicated practitioners. They say its criticisms are broadly accurate. Their recognition of the problem is attended by mixed feelings of regret, “for the patients, for the physicians, for the government,” as one doctor said. (The doctors asked not to be identified because they work in the military medical system, which forbids interviews with the news media.)

The article’s conclusion is being especially hotly discussed — and acknowledged — by Chinese doctors. Ms. Lu’s summary says: “The speed of advancement of the whole country is so fast that we may have missed something that is important, and we need to think about it. We need to learn more from the West than just importing these fabulous machines.”

The Western doctors called their time in Shanghai “a challenging experience,” explaining that “Respect for and knowledge of Chinese culture and an attempt, as difficult at that may be, not to be judgmental are required.”

There’s that. Then there’s this: As news accounts, often backed by official reports, multiply of cancer villages, of rivers and wells running milky — or orange, or red, or black — with pollution, of rising cancer rates among young people as well as old, the Chinese doctors’ reactions are the most telling: They care deeply about their patients and they love their country, they say. Yet they know there are serious questions as to whether the system allows best practice. And they don’t see easy solutions.