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 There was a problem: The military-run hospital did not have
regulatory approval to offer the immunotherapy course it sold to Wei
at a steep fee. The treatment itself - while promising - is widely
considered by global cancer specialists to be at the experimental
stage.
Wei died at the age of 21, and the outcry his case provoked has
thrown a spotlight on hundreds of hospitals run by branches of
China's armed forces.
Reuters’ interviews with patients, doctors and lawyers show that
military-run medical facilities across the country regularly provide
– and advertise – treatments that are not approved by the Chinese
Health Ministry.
Among a sample of around two dozen of the hundreds of military
hospitals around China, Reuters found roughly four-fifths offered
some kind of immunotherapy on their websites. Some of them said they
had used it to treat thousands of patients.
The ready availability of unapproved treatments at major hospitals
around China underlines serious regulatory blind spots in a
healthcare system treating 1.4 billion people and which is the
world’s second largest drugs market behind the United States.
Military authorities have acknowledged fault at the Second Hospital
of Beijing Armed Police Corps, where Wei was treated. They would not
comment on practices at other facilities. The hospital itself did
not respond to requests for comment.
China's health ministry said that, while immunotherapy had great
potential, there were still question marks around safety and
effectiveness. It has never been approved for commercial clinical
use in China, the ministry said in a statement to Reuters.
Immunotherapy is classed as a category three treatment, meaning it
is “ethically problematic", "high risk" or "still in need of
clinical verification".
However, China's health ministry has little oversight over military
hospitals because its jurisdiction largely concerns the civilian
health system. The military facilities come under the control of the
armed forces.
Lawyers involved in the healthcare sector say the combination of
military oversight and the frequent civilian use create gray areas
about whether national laws apply and how they should be enforced.
The health ministry would not comment on the wider issue of
regulation of military hospitals. The defense ministry referred
Reuters to a statement made at a regular news briefing in May in
which it acknowledged the hospital in the Wei case had acted
illegally. It said oversight of such hospitals would be improved,
but did not say how.
The Reuters review also showed that many of the hospitals surveyed
offered patients stem cell therapy, a treatment which is only
approved in China for clinical trials. The health ministry said in
August last year research into stem cells to treat or prevent
diseases was developing fast, but it was concerned some hospitals
were violating government regulations to offer such treatments to
boost profits.
Shanghai-based Yuan Liming, a partner at law firm Jones Day, said
there is another problem: military hospitals often allow
third-parties to operate clinics within the hospital grounds. The
health ministry told Reuters it was illegal for hospitals to
sub-contract certain therapies to private clinics and that it would
investigate any public hospitals doing so. "It clearly violates
Chinese law, but it's common," said Yuan.
BEST FACILITIES
Some military hospitals are regarded, alongside university
hospitals, as among the country's best medical facilities.
They are overseen by military bodies such as the People's Armed
Police, a paramilitary force that answers to the powerful Central
Military Commission headed by President Xi Jinping.
"Military hospitals, generally speaking, are not subject to
administration and monitoring by the health ministry, but are
subject to supervision by the Central Military Commission," said
Yuan.
There is no indication any of the military hospitals contacted by
Reuters had special exemption to offer immunotherapy treatment. The
Second Hospital of Beijing Armed Police Corps was not approved.
Another hospital, the General Hospital of Shenyang Military, said on
its website it treated more than 1,600 people with a number of
immunotherapy treatments. No one at the hospital was willing to
comment.
Others, including the 302 Military Hospital of China in Beijing, the
101st People's Liberation Army in Wuxi, the Nanjing General Hospital
and People's Liberation Army No. 202 Hospital said on their websites
they had used immunotherapy treatment.
Repeated calls to the Nanjing hospital and the No. 202 hospital went
unanswered. The 302 Military hospital and the 101st PLA hospital
said they had stopped offering the therapy and declined to comment
further.
Gong Xiaoming, a senior Beijing-based gynecologist and former
physician at the prestigious Peking Union Medical College Hospital,
said the main problem was the small private clinics used by military
hospitals. Without tighter regulation the illegal provision of
immunotherapy and other banned treatments would likely continue, he
said.
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Such clinics, though separate businesses, often operate on a
hospital's premises and under its license, putting them in another
regulatory gray area, say lawyers and doctors.
"It's like guerrilla warfare," said Gong. "Every few years they
change location or change name and emerge once more."
COST COMPLAINTS
In Wei's case the hospital had contracted Shanghai-based private
immunotherapy technology company Shanghai Claison.
Claison was not available for comment and a guard who answered the
phone said everyone had "gone on holiday".
Other patients complain of being given pricey and unnecessary
treatments by military hospitals.
A receptionist at a steel trading company, who asked to be
identified only by her family name Xu, went to the People's
Liberation Army (PLA) 411 Hospital in Shanghai in 2014 seeking
treatment for ovarian cysts, a common condition.
The doctor suggested infra-red therapy and she underwent three days
of treatment at 700 yuan ($105) per session, eventually spending a
total of 8,000 yuan.
Concerned with the ongoing treatment, she went to another doctor and
was told she had only needed a small surgical procedure costing 500
yuan. That treatment was successful, she said.
"Everyone trusts doctors," Xu, 25, told Reuters. "With this infrared
therapy, they make you do it every day, and every day they charge
you hundreds of yuan. It's all about making money. "The PLA 411
Hospital said it was not aware of the case and hadn't heard of any
other patient complaints.
SERIOUS PROBLEMS
Before he died, Wei accused the Second Hospital of Beijing Armed
Police Corps, and the search engine Baidu Inc that he had used to
find it, of misleading advertising and disseminating false medical
information.
China's health ministry said an investigation after Wei's death
revealed "serious problems" at the hospital. It was found to have
been illegally working with a private healthcare partner, unlawfully
advertising services and using unauthorized clinical technology, the
ministry said.
The hospital did not respond to repeated calls seeking comment.
China's cyberspace regulator has since imposed limits on healthcare
adverts carried by Baidu, which controls 80 percent of the Chinese
search market, and the company's CEO has called on employees to put
values before profit.
Baidu, which has since cut its revenue forecast, has said it
accepted the regulator's decision and it would implement the
requirements placed on it following the investigation.
As with other forms of immunotherapy the treatment given to Wei,
known as "DC-CIK", uses the patient's own immune system to fight
disease.
Archived articles and posts on the official website of the hospital
that treated Wei, currently blocked, describe the treatment as
well-proven. One, dated Aug. 12, 2013, said the success rate was
more than 80 percent.
In another article, dated Sept. 26, 2015, it wrote that
immunotherapy treatment had saved a late-stage cancer patient who
had been given six months to live. Another patient with kidney
cancer was completely cured.
Doctors questioned by Reuters, however, said the claims made by
Wei's hospital overstated the potential effects.
"Response rates to DC-CIK which are not approved - and in fact to
all current immunotherapy - are modest," said Andrew Furness, an
immunotherapy expert at University College London.
"Patients coming towards the end of their life or having exhausted
all treatment options should not be given false hope," he said.
($1 = 6.6881 Chinese yuan)
(Reporting by Adam Jourdan; Additional reporting by SHANGHAI
newsroom and BEIJING newsroom; Editing by Alex Richardson and Martin
Howell)
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