Few things touch people’s hearts as much as health. Health care is the key to people’s livelihood.
More new drugs are on the market, "noble drugs" are included in the medical insurance drug list, the "healthy China" action plan is deepened, and the chaos of medical beauty is rectified with heavy blows … … In 2019, these medical and health events related to people’s livelihood attracted special attention. At the end of the year, people hope to further "improve quality" and "reduce prices", and expect relevant departments to prescribe more health "prescriptions" to continuously improve people’s sense of acquisition and happiness.
one
Responding to the challenge of drug resistance, Tu Youyou team clarified the mechanism of artemisinin drugs
Artemisinin is a gift from traditional Chinese medicine to the world, which has contributed to the global malaria control. However, in recent years, the underlying mechanism of artemisinin in the treatment of malaria is still unclear, especially the problem of drug resistance, which is also the biggest challenge facing the global malaria control.
The half-life of artemisinin in human body (the time required for drug concentration to drop by half) is very short, only 1-2 hours. The course of clinical recommended artemisinin combination therapy is 3 days, and the truly efficient insecticidal window of artemisinin is only limited to 4-8 hours. However, the existing drug-resistant insect strains make full use of the short half-life of artemisinin, change their life cycle or temporarily enter a dormant state to avoid the sensitive insecticidal period. At the same time, plasmodium can also produce obvious resistance to the auxiliary drug "antimalarial formula" in artemisinin combination therapy, which makes artemisinin combination therapy "ineffective".
On April 24th, Tu Youyou’s team published an article online in the top international medical journal "New England Journal of Medicine", saying that the recently clarified mechanism of artemisinin drugs shows that they are precursors activated by iron or heme. Iron and heme are by-products of hemoglobin digestion, reaching the highest concentration at the mature stage of plasmodium trophozoite. Once artemisinin drugs are activated, many protein and heme of parasites will be alkylated. Alkylation of heme can also inhibit the detoxification of heme. "It is speculated that the mutation of a single protein target is unlikely to cause drug resistance, which may also explain why artemisinin drugs are still effective after decades of widespread use." Wang Jigang, a member of Tu Youyou’s team and a researcher at Artemisinin Research Center of Chinese Academy of Traditional Chinese Medicine, said.
In this regard, the team proposed a new treatment response plan: First, appropriately extend the medication time; The second is to replace the adjuvant drugs that have developed resistance in artemisinin combination therapy.
2
Can the "white list" of medical beauty be cured?
Non-medical beauty places are engaged in medical beauty treatment, the practice of doctors with informal training, and the use of unqualified medical beauty products … … In recent years, the "three non-"chaos exposed by the media has repeatedly been criticized by the society.
On June 18th, the National Health and Wellness Committee indicated that China Plastic Surgery Association was studying and formulating a credit evaluation management system, and it was planned to conduct credit evaluation of beauty medical institutions in some areas on a pilot basis. "The data of hardware conditions and facilities, annual inspection and doctor qualification of medical beauty institutions will be connected with the existing credit system, and a medical beauty institution &lsquo will be established in the future; White list ’ , objectively present to the people ‘ White list ’ The situation of the organization. " Cao Dequan, deputy secretary-general of China Plastic Surgery Association and director of the evaluation office, said that at that time, the public can search for information on the special website.
Hu Jieren, an associate professor at Tongji University Law School, said that the system itself is highly scientific and operable. It can learn from the existing credit evaluation model, listen to social voices, list the characteristics of dishonesty, and ensure fair and strict punishment. At the same time, in addition to credit evaluation and other mechanisms, the governance of medical beauty chaos requires multi-dimensional efforts and the participation of the whole society. For example, the regulatory authorities should take the initiative and increase penalties.
three
The Healthy China Action Plan is issued. Everyone is the first person responsible for his own health.
In July, the "Healthy China Action Promotion Committee" established in the State Council released "Healthy China Action (2019— 2030), giving authoritative guidance on what to do, how to do it and who will take the lead in healthy China.
"Everyone is the first responsible person for his own health." Wang Xiaoning, director of the Institute of Geriatrics of the General Hospital of the People’s Liberation Army and secretary-general of the China Association for Science and Technology’s life science association, particularly agreed with this point in the document. He explained that WHO has already concluded that in the promotion and maintenance of national health, the contribution of medical care is less than 10%, which mainly depends on people’s lifestyle and living environment. Wang Xiaoning said: "It turned out that ‘ Grip ’ The focus is on the 10% part, and now it is necessary to put ‘ Grip ’ Put it in 90%, that is, people’s lifestyle and living environment. "
Experts say that it is not enough for doctors and health departments to embrace health. Cardiovascular and cerebrovascular diseases are the first cause of death among Chinese residents, "Healthy China Action (2019— In 2030), it is mentioned that the goal of healthy China will reduce the premature mortality rate of major chronic diseases from 18.5% in 2015 to no more than 15.9% in 2022. Yang Jingang, an associate professor at Fuwai Hospital of China Academy of Medical Sciences, believes that the goal can only be achieved by mobilizing social forces, and the organizational model of "Patriotic Health Campaign" can be used for reference. Only by linking disease prevention and control indicators with the performance and responsibility of district leaders can we coordinate all resources and really play a role.
four
Major projects support the initial establishment of a drug innovation technology system in China.
In view of the difficulties and expensive medical treatment for ordinary people, and the heavy dependence on imports of high-end medical equipment and drugs, as early as 2008, China deployed and implemented the major scientific and technological project of "major new drug creation" (hereinafter referred to as the new drug creation project).
"With the special support of new drug creation, a total of 14 Class 1 new drugs were approved after February 2017, showing a blowout growth." At the end of July, at the conference of "Creation of Major New Drugs", Chen Kaixian, deputy chief engineer of special technology and academician of Chinese Academy of Sciences, introduced that in the past two years, new progress has been made in the research and development of special varieties, and six Class I new drugs have been approved for the treatment of malignant tumors. In addition, the achievements of the special project of new drug creation include the first domestic and the second long-acting anti-AIDS drug, the new anti-infective drug, Clindamycin, which is independently developed, and the world’s first aromatic hydrocarbon receptor modulator and non-hormonal small molecule chemical drug, Benvimod & HELIP, which has therapeutic effect on psoriasis. …
The national drug innovation technology system has been initially established in the special project of new drug creation, and a series of technical platforms have been laid out; Initially, a grid-based innovation system with scientific research institutes and universities as the main source innovation, enterprises as the main technology innovation, the close integration of the upper, middle and lower reaches and the deep integration of politics and Industry-University-Research has been established, and the ability of independent innovation has been significantly improved.
five
The paper has sparked a heated discussion on whether "Aristolochic acid-induced liver cancer" is a real hammer or a misunderstanding.
In August, aristolochic acid once again became the focus. Han Zeguang, a professor at systems biomedicine Research Institute of Shanghai Jiaotong University, published a paper in the international journal Hepatology in the field of liver diseases, which was emphasized by many media as "aristolochic acid has caused liver cancer to have a real hammer". This study revealed that aristolochic acid alone can cause liver cancer in mice in a dose-dependent manner, that is, the greater the dose of aristolochic acid, the shorter the time to cause liver cancer and the larger the tumor. When aristolochic acid is combined with carbon tetrachloride, it can induce liver cancer in mice in a dose-dependent manner, including hepatocellular carcinoma and hepatocellular carcinoma and intrahepatic cholangiocarcinoma.
However, Luan Yang, a researcher at Shanghai Jiaotong University School of Medicine, and others believe that the data obtained by Han Zeguang’s team under certain experimental conditions are not enough to draw the conclusion that aristolochic acid causes liver cancer, and it cannot be called a "real hammer". "Specific experimental conditions" means that the experimental object is young mice and carbon tetrachloride liver injury model.
Some experts also said that some media interpreted the latest experiment of Han Zeguang’s team as "solid hammer" evidence that aristolochic acid is the main cause of liver cancer in China, but it should be noted that the original literature is in young mice (equivalent to 1-mdash; 2-year-old baby) and carbon tetrachloride liver injury model, which is different from the clinical occurrence of liver cancer, and many independent studies have been published in the world for many years, but no results of liver cancer caused by aristolochic acid have been made in adult mice, so it is too early to think that aristolochic acid is the main cause of liver cancer in China.
six
The original research drug went to sea for the first time, and the national research anticancer drug was approved for listing in the United States.
A movie, Dying to Survive, made anticancer drugs attract public attention. Subsequently, zero tariffs on imported anticancer drugs and negotiations on anticancer drugs have also become hot spots of public concern.
On September 23rd, the National Health and Wellness Commission and other 10 departments jointly issued the Healthy China Action — — Cancer prevention and treatment implementation plan (2019— In 2022) (hereinafter referred to as the "Program"), the "Program" pointed out that a set of "combination boxing" will be made by unblocking the temporary import channels of anticancer drugs that are urgently needed in clinic, promoting the substitution of generic drugs, and incorporating them into medical insurance, so as to improve the accessibility of anticancer drugs and enable ordinary people to buy, afford and use anticancer drugs in China.
The "Proposal" clearly stipulates that the zero tariff on imported drugs should be promoted, and various links such as R&D, production, procurement, import and use should be fundamentally straightened out, and the price of anticancer drugs will continue to decline, further promoting the simultaneous listing of new overseas drugs in China and avoiding the "foreign moon and domestic circle" caused by the difficulty in obtaining anticancer drugs.
Nowadays, the situation of "only getting in but not getting out" of original anticancer drugs has been broken. On November 14th, zanubrutinib, a BTK inhibitor developed by Baekje Shenzhou Company, was approved by the US Food and Drug Administration (FDA) for the treatment of adult patients with mantle cell lymphoma who had received at least one therapy before. At this point, "the drug became the first new anti-cancer drug independently developed by local enterprises in China and approved for listing by the FDA, realizing the new drug originally developed by China ‘ Zero breakthrough ’ 。” Dr Wu Xiaobin, general manager and president of Baekje Shenzhou China, said.
seven
Supervision is imminent. E-cigarettes are as harmful as traditional cigarettes.
Some businesses advocate that e-cigarettes are less harmful to human body and can help smokers quit smoking. Self-adjusting taste, cleanliness and environmental protection, and convenient use have all become eye-catching labels of e-cigarettes.
"Generally speaking, e-cigarettes will highlight the characteristics of high technology content and trendy fashion in product performance and ingredients. However, the ingredients of e-cigarettes are nothing more than nicotine, water, spices, propylene glycol and glycerol. As for the principle, it is even simpler, just an electronic evaporation, and there is no technology content at all." Zhang Zhigang, a senior engineer of China Environmental Behavior Law Society, said.
More seriously, consumers don’t know that under normal use conditions, the concentrations of some metals (including lead, chromium and nickel) and formaldehyde in some e-cigarette aerosols are equal to or higher than those in traditional cigarettes, and these harmful substances are even higher than the content of second-hand smoke produced by traditional cigarettes. In addition, e-cigarettes will also produce some toxic substances that are not found in traditional cigarette smoke, such as glyoxal, which is flammable, toxic and irritating, and its vapor or fog will stimulate eyes, mucous membranes and upper respiratory tract.
With the United States, Japan, India and other countries banning e-cigarettes to varying degrees, the voice that China should legislate and supervise e-cigarettes as soon as possible is getting louder and louder. Hu Qingyuan, director of the National Tobacco Quality Supervision and Inspection Center, said: "Fortunately, we have already started to act." On November 1, the State Tobacco Monopoly Bureau and the State Administration of Market Supervision jointly issued the Notice on Further Protecting Minors from E-cigarettes, urging enterprises or individuals that produce and sell e-cigarettes to withdraw their e-cigarette advertisements published through the Internet, and the supervision of e-cigarettes is becoming increasingly strict.
eight
Can cerebral palsy be cured? "Needle-sealing therapy" triggered a normative discussion on new therapy.
Cerebral palsy is recognized by the medical community as incurable. However, the media reported that the Third Affiliated Hospital of Zhengzhou University (hereinafter referred to as the Third Affiliated Hospital of Zhengzhou University) adopted "needle sealing therapy" for children with cerebral palsy (the full name is "point plus acupoint drug injection therapy"), and the hospital claimed to evaluate 381 children. The results showed that 190 cases, that is, nearly half, were normalized.
On October 21st, an article questioned the "needle sealing therapy" invented by Wan Guolan, the founder and honorary director of the Children’s Rehabilitation Department of the Third Affiliated Hospital of Zhengda, and the "needle sealing therapy" was pushed to the forefront. Sun Yong ‘an, chief physician of the Department of Neurology, Peking University First Hospital, said that "needle sealing therapy" is more of a gimmick, and even if it is effective, its effect is limited. Nerve injury is generally caused by congenital development or acquired injury. If it is cerebral palsy caused by poor nerve development in the embryo, even if there is some growth compensation, it is still difficult to completely cure it.
Cerebral palsy is difficult to treat, and there is no standard single treatment. Some experts said that we should not arbitrarily think that all self-created therapies are ineffective. Because medicine is a practical subject, it is advancing through constant exploration and trial, and some new therapies really need to break through the routine. However, the technology applied in clinic should be universally recognized and supported by evidence-based medicine. To carry out a clinical trial, first of all, the institutions involved and the researchers involved in the trial must have the qualifications to carry out clinical research; Second, it is necessary to carry out strict registration and filing, and strictly design the test plan, demonstration and modification; Third, it should be recognized by clinical trial management institutions and ethics committees; Fourth, the subjects should have the full right to know, the experimenter should ensure the safety of the subjects, and the subjects have the right to withdraw at any time during the treatment. As for the efficacy of the new therapy, it also needs a large sample of randomized double-blind controlled studies to verify it.
nine
At the dawn of treatment, "small molecular glue" can devour the pathogenic protein of Huntington’s disease
Involuntary dance-like movements, cognitive impairment and mental abnormality … … Huntington’s disease is one of the four major neurodegenerative diseases. Because the biochemical activity of the mutant Huntington’s protein (mHTT) causing the disease is unknown, it can’t be targeted. The traditional method of blocking the activity of the pathogenic protein by blocking agents is not suitable for the treatment of the disease.
At the end of October, researchers from Fudan University published their achievements in Nature, and found a "small molecular glue" that "devours" Huntington’s disease-causing protein through screening based on compound chips and cutting-edge optical methods, which is expected to bring new dawn to the clinical treatment of Huntington’s disease.
In the study, the team focused on controlling autophagy, an intracellular protein degradation pathway, to effectively reduce the level of mutant Huntington protein. In order to solve the problem of "self-injury", the team imagined to invent a kind of "small molecule glue", which can aim directly at the bull’s-eye, firmly stick LC3 and pathogenic protein (or other pathogenic substances) together, and then wrap the pathogenic protein into autophagy bodies for degradation. After screening, purification and a series of cell experiments, the research team obtained four kinds of "small molecular glues" that can bind LC3 and mutant Huntington protein.
According to team member Lu Bojun, at least two of these four compounds can cross the blood-brain barrier and directly reduce the level of mutant Huntington protein in the cerebral cortex and striatum of Huntington’s disease mice through low-dose intraperitoneal administration, without affecting the level of wild-type Huntington protein in brain tissue, and also improve the disease-related phenotype, which provides a breakthrough point for the development of oral or injection drugs for Huntington’s disease, and is expected to be applied to motor coordination disorders, facial twitching and muscle spasms.
10
"Aristocratic Drugs" Self-devalued Medical Insurance Drug List Negotiation to Reduce Patients’ Burden
Only when good drugs enter medical insurance can people finally get benefits.
In December, the National Health Insurance Bureau released the National Drug List of Basic Medical Insurance, Work Injury Insurance and Maternity Insurance in 2019 (hereinafter referred to as the Drug List). The results showed that 97 of the 150 negotiated drugs were successfully negotiated, and the average price dropped by 60.7%. This is also the largest since the establishment of the medical insurance system in China, with remarkable results.
During the negotiation, the National Medical Insurance Bureau spared no effort in bargaining. Take the shortlisted hepatitis C drugs as an example, four companies directly measure the quotation on the spot, and the quotation of each drug should be accurate to two decimal places. There are two quotations in total. If both of them fail to reach the psychological price of the medical insurance bureau, or exceed 15% of the medical insurance payment standard, they will be directly out. In the end, Ledipaviso fosbuvir tablets from Gilead Scientific Company, fosbuvir patavir and Elba Wegera Rive tablets from Merck were selected with an average decrease of 85%.
Xiong Xianjun, director of the Department of Medicine Management of the National Health Insurance Bureau, said that the significant reduction in drug costs is one of the results of this negotiation. By giving play to the role of the medical insurance department as a "strategic buyer", the drug costs will be greatly reduced by changing the price. A number of world-renowned "noble drugs" have been marked with "civilian prices", and imported drugs have basically given the lowest price in the world. It is conservatively estimated that through negotiation of price reduction and medical insurance reimbursement, the personal burden level of patients will be reduced to less than 20%, and individual drugs will be reduced to less than 5%.
