China’s surgery bottleneck

Access Archive
Jeremy Goldkorn

1. China’s surgery bottleneck, and other medical problems

The fallout from the gene-edited baby scandal continues, with the revelation “that the scientist at the center of the controversy, Hè Jiànkuí 贺建奎, used an AIDS support network to recruit couples experiencing fertility issues for his experiment,” according to Caixin.

The head of that support group expressed “deep regret” for helping recruit parents to participate in the gene-editing experiments, reports Agence France-Presse.  

In the New York Times, Sui-Lee Wee and Elsie Chen write about the ethical issues that come from China’s desire for rapid scientific advancement (porous paywall), with this opening sentence: “First it was a proposal to transplant a head to a new body. Then it was the world’s first cloned primates. Now it is genetically edited babies.”

At the same time that funding and ambition are putting Chinese medical research at the forefront of many innovations, the healthcare system as most Chinese citizens experience it is terribly inefficient, and often inequitable.

Christopher Magoon is a fourth-year medical student who has studied public health in China as a Fulbright scholar, and lived in Yunnan as a Henry Luce scholar. On ChinaFile, he writes about one feature of China’s struggle to keep up with demand for healthcare: “China’s number of surgeons per capita is on par with other upper-middle income countries, but collectively, its surgeons perform 40 percent fewer surgical procedures than their counterparts.” Magoon presents a number of factors for the “low surgical output” of China’s surgeons:

  • Little hands-on training, “such that when Chinese surgeons complete surgical training, many have hardly gotten a chance to cut.”

  • A professional hierarchy that forces junior surgeons to spend many years as assistants or performing only simple procedures. Magoon cites a study that shows less than 5 percent of surgeries in China are completed by doctors under the age of 43.

  • The reluctance to let younger surgeons do any work is also complex: “Surgeons are primarily evaluated — and compensated — based on surgical output.” This means that overworked senior doctors have little interest in teaching.

  • “Senior surgeons may also fear violent backlash from patients” — frustrations with China’s overburdened healthcare system often end in attacks on doctors when patients feel they have been neglected, or abandoned to the junior doctor.

  • To address the problem, “China has begun shifting toward a formalized residency training program, with the Ministry of Health issuing mandatory training standards in 2012,” but Magoon says “progress has been slow and fitful.”

  • The private healthcare sector “is also poised to capitalize on the need to train China’s surgeons of tomorrow.”

For more on private healthcare:

—Jeremy Goldkorn

2. Trade war, day 148: G20 to yield tariff cease-fire, trade ‘architecture’ negotiations?

No one has a very confident prediction about what will happen after Donald Trump and Xi Jinping sit down for dinner tomorrow in Argentina after the G20. Confusing signals have been sent all week, especially from Trump himself: that a tariff cease-fire is “highly unlikely” on Monday, but also that he is “very close to doing something with China” on Thursday, but still does not understand how tariffs work, because he believes they have led to “billions and billions of dollars coming into the United States.”

Overall, the message is that Trump has no idea what he is doing, and whether a deal comes out of the G20 is largely dependent on whether Trump’s gut tells him whether the Chinese offers make him look “strong.”

The Wall Street Journal has the most detailed look (paywall) on what the potential deal forming could look like: a suspension of further U.S. tariffs, in exchange for Chinese concessions such as agreeing “to lift restrictions on China’s purchases of U.S. farm and energy products,” plus continuing negotiations over what officials now call trade “architecture.”

“Architecture” reportedly means “intellectual property protection, coerced technology transfer, subsidies to state-owned enterprises, and even non-trade issues such as cyberespionage.” It is a rebranding of the term “agenda,” in order to sell the potential deal as “strong” to Trump:

The talks first focused on setting an “agenda” for new trade negotiations. But that seemed weak, say people briefed on the discussions, so they shifted to looking at “architecture” — which had a grander connotation. But the idea is largely the same — put together a deal to start negotiations.

If a deal is reached at the G20, the Financial Times reports (paywall), economic adviser Liú Hè 刘鹤 would “lead a delegation of 30 Chinese officials to the US capital on a mission tentatively scheduled for December 12-15.”

Will Xi’s offers to Trump be “strong”? Part of that depends on which parts of trade policy Trump understands or considers important. But an equally large part depends on which voices in China Xi and his advisers listen to:

  • Xi could offer the bare minimum, on the advice of figures such as Péi Chánghóng 裴长洪, former director of the Institute of Economics at the Chinese Academy of Social Sciences. SCMP reports that Pei argues, “We shouldn’t and can’t accept the US imposed terms for a ‘cease-fire.’ The trade war won’t end in two or three years and we should make long-term mental preparations.” Pei adds, “China has its own timetable and road map.”

  • Or, Xi could offer much of what the Trump administration wants, on the advice of liberal economists like Shèng Hóng 盛洪 of the recently shuttered Unirule Institute of Economics and Zhāng Wéiyíng 张维迎 of Peking University, who argue, NPR reports, that “what Trump is asking for — further opening China’s markets to the private sector and eliminating unfair competition from China’s state-run companies — will not only be good for U.S. companies, but also for the Chinese people, because China’s private sector employs three times more people than its state-run sector.” SCMP reported yesterday that there are “about a dozen” of these intellectuals lobbying for reform, including “several figures close to the country’s chief trade negotiator Liu He.”

  • A couple positive signals that China is searching for compromise, rather than a further standoff: Authorities have “loosened restrictions on budgets and how long researchers can stay in the United States for some government-backed think tanks and specialists familiar with US-China relations,” the SCMP reports. And on Monday this week, Beijing made another effort to show it is opening up its restricted markets by granting Germany’s Allianz Group permission to establish China’s first wholly foreign-owned insurance holding company.

Other stories likely on leaders’ minds heading into the weekend:

—Lucas Niewenhuis

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Our whole team really appreciates your support as Access members. Please chat with us on our Slack channel or contact me anytime at jeremy@thechinaproject.com.

—Jeremy Goldkorn, Editor-in-Chief

Here are the stories that caught our eye this week (other than trade war news, highlighted above):

  • Chinese scientist Hè Jiànkuí 贺建奎, who shocked the world this week by asserting that he had altered the genes of twin baby girls to make them resistant to HIV, defended his work publicly on Wednesday while facing growing criticism from other researchers in the scientific world. China has suspended the research activities of the scientists, citing a violation of the law.

  • Northwest China’s Ningxia Hui Autonomous Region, home to nearly 10 million Hui Muslims, has reportedly signed a cooperation anti-terrorism agreement with the Xinjiang  government. The news has sparked concerns that China’s harsh policies in Xinjiang, especially the mass detentions of Muslims, could be expanded to other parts of the country. Meanwhile, Bitter Winter obtained footage of the inside of a recently-built “vocational training center” in Xinjiang, showing that it looks exactly like a prison, and very little like a school.

  • An all-star group of China scholars, including Anne-Marie Brady, Orville Schell, Bonnie Glaser, John Pomfret, and Ezra Vogel, has written a report published by the Hoover Institute titled “Chinese Influence and American Interests: Promoting Constructive Vigilance” (summary, full report). The report is highly critical of the Chinese government, and makes a case that the U.S. needs to do much more to stop Communist Party influence and espionage operations.

  • China defended keeping two American citizens hostage, as bait in order to attract their father, Liú Chāngmíng 刘昌明, one of China’s most wanted fugitives.

  • A new report released by the Chinese Center for Disease Control and Prevention shows an alarming rise in HIV diagnoses over the past year. While experts explained that the surge in the number of HIV-infected people is mostly because of a sample expansion, the center warned that it could be a harbinger of worse times ahead, since about 30 percent of people infected with the virus in China are still spreading it without acknowledging their HIV status.

  • Jack Ma is a Communist Party member, it was revealed, though the news about the Alibaba co-founder should really not be surprising.

  • Peter Humphrey, who along with his wife Yú Yīngzéng 虞英曾 spent two years in a Chinese prison for illegally acquiring personal information of Chinese citizens while working for pharma giant GlaxoSmithKline, is fighting back after the highly politicized case. Humphrey filed a complaint with Ofcom, the British communications regulator, against China Central Television and its international division, China Global Television, for violating British broadcasting rules.

BUSINESS AND TECHNOLOGY:

  • Luxury advertising on WeChat
    Chinese titan Tencent plays an aggressive new game: luxury / Jing Daily
    “Luxury brands account for a significant portion of this advertising growth. Though no specific revenue figures were released, nearly 90 percent of companies placing ads on WeChat over the past year marked their business as ‘luxury,’ Tencent told Jing Daily.”

  • Smartphone founder blacklisted for gambling debt
    Founder of smartphone brand Gionee on social credit blacklist / TechNode
    “Liú Lìróng 刘立荣, founder and chairman of Gionee, one of China’s earliest phone manufacturers, has been added to the country’s black list of social credit  as of October 26. According to a court in Shenzhen, Liu must pay more than 200 million yuan ($28.8 million) in debt before he can be removed from the list.”

  • Where does global plastic waste go now?
    China’s plastic waste import ban forcing US and Japan to rethink options / SCMP
    “China’s ban on imports of plastic waste is forcing nations like Japan and the United States to scramble as they look for new ways to deal with their trash, including exporting recyclable waste to Southeast Asia. But instead of finding solutions, it appears the problem of disposing of recyclables has only become exacerbated, especially with the exploitation of developing countries such as Malaysia and Vietnam, which lack the regulatory infrastructure to prevent illegal dumping.”

  • Ecommerce border taxes
    China lifts tax-free ceiling for personal online purchases from abroad / TechNode
    “China’s Ministry of Finance announced Friday that it will lift the tax-free ceiling for personal cross-border ecommerce retail purchases to 5,000 yuan (around $720) from 2,000 yuan, for certain goods.”

  • Apple cleans up App Store
    Apple kicks hundreds more apps out of China’s App store / Cult of Mac
    “Apple continues to remove third-party applications from the Chinese version of the App Store for violating its terms of service. It reportedly removed 718 apps this week.”

POLITICS AND CURRENT AFFAIRS:

SOCIETY AND CULTURE:

VIDEO ON SUPCHINA

Viral on Weibo: Watch brave gas station workers put out a fire in 90 seconds

On November 29, a group of gas station workers managed to quickly put out a fire underneath a car, in Rizhao, Shandong Province. Luckily, nobody was hurt.

We also published the following videos this week:

FEATURED ON SUPCHINA

From ‘Wolf Warrior’ to an actual wolf: The work of Haiyang, a Chinese mouth acrobat

Mouth acrobatics — kouji 口技 — involves the vocal mastering of hundreds of sounds, from cicadas to missiles. It’s a 2,000-year-old Chinese art form, and Haiyang is one of its best modern practitioners. He voiced many of the tank blasts and missile explosions in Wolf Warrior 2 (the highest-grossing Chinese film ever released), and recently was a main act in the Chinese Embassy’s Lunar New Year party, finding himself in a picture with the main guest of honor, Ivanka Trump.

Zhang Shichuan and Zheng Zhengqiu: The unlikely duo who pioneered Chinese cinema

History now remembers Zhang Shichuan, a businessman, and Zheng Zhengqiu, an intellectual, as two of the key founding fathers of Chinese cinema. Their story could well be a film in itself.

The China Project Quiz: Science!

Quiz time! This month we present: Scientists, breakthroughs, inventions, and Tu Youyou — 12 questions to test how much you know about science in China. Let us know how you do — tweet your score to @supchinanews.

Five jaw-dropping street foods China keeps for itself

Chinese street food and small eats are hot in the West and picking up steam where burgers and the cronut left off. But, Howie Southworth writes for The China Project, the real foodie romance that you deserve still lives comfortably across the Pacific. These unsung heroes of street cooking have yet to displace potstickers or spring rolls on the Western stage, but once they do, nothing you know about Chinese cuisine will be the same.

Mingbai: Ancient Chinese games that test wits and break up families

Board games are great, whether you’re trying to hone your strategic skills, show your know-it-all cousin what you’re made of, or simply want to pass the time. And while international classics like Monopoly and chess are played all over the world, China has some iconic games of its own that are known and loved across the country. This month, Mingbai zooms in on some of China’s classic social games.

Chinese Corner: Dolce & Gabbana’s cultural appropriation and ‘China’s Elon Musk’

In this installment of Jiayun Feng’s weekly review of interesting nonfiction on the Chinese internet, she looks at Dolce & Gabbana’s long-standing racism toward China, Yu Minhong’s sexist remarks, single-child families in China, and He Jiankui, the man behind gene-editing babies.

Taiwan’s political landscape changes overnight

On Saturday, the people of Taiwan headed to the polls to cast ballots for nearly 11,000 officials, in local elections — think mid-terms — and essentially repainted the map of Taiwan blue from green, or from ruling party Democratic Progressive Party (民進黨 mínjìndǎng) broadly pro-independence to the more China-friendly Nationalist, or Kuomindang (國民黨 guómíndǎng). The results were also a huge letdown for LGBT activists in Taiwan.

Kuora: Explaining mainland China’s case against Taiwan independence

This week’s column looks at the mainland Chinese argument for Taiwan being a part of China as opposed to an independent country. The PRC holds that Taiwan was part of China since at least as far back as the 17th century, when it was extensively settled by people from Fujian province across the strait during the Ming Dynasty.

SINICA PODCAST NETWORK

Sinica Podcast: ‘Shaken Authority’: Party-speak, propaganda, and the Sichuan earthquake of 2008

This week on Sinica, Kaiser and Jeremy speak with Christian Sorace, assistant professor of political science at Colorado College. The three discuss his book, Shaken Authority: China’s Communist Party and the 2008 Wenchuan Earthquake, which analyzes the ways the Communist Party uses rhetoric to serve its interests, the consequences of this endeavor for the region and survivors of the quake, and the urbanization of China’s rural areas.

NüVoices Podcast: Long-Form Magazine Writing With The New Yorker’s Jiayang Fan

In this episode of the NüVoices Podcast, Alice Xin Liu and Joanna Chiu are live from New York! Following a heady and successful launch of NüVoices’ first North American chapter, they reunite at the The China Project offices in Brooklyn and interview one of their idols: Jiayang Fan, staff writer and de facto China correspondent at The New Yorker magazine.

PHOTO OF THE DAY

Strolling on the beach

A dog on a beach in Rizhao, Shandong Province. Photo by Daniel Hinks.

Jeremy Goldkorn worked in China for 20 years as an editor and entrepreneur. He is editor-in-chief of The China Project, and co-founder of the Sinica Podcast. Read more

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