華陀再世
一個中國醫學生(CMG)在美國的生活。。。
The New Major Player in Cancer Research: China（By Charles M. Balch, MD）
九七年以來的中國癌症研究: The Chinese have made huge investments, at both the government and private-sector levels, in support of biomedical research in China. The level of research and the quality of cancer care at many of the major centers are at the same level as that in the United States or Western Europe. The support of specialized cancer programs, especially at major cancer centers and academic centers, and in the infrastructure for conducting clinical trials and database management, has established China as a major player on the world stage in oncology research. As cancer care and research become organized more and more across China -- a country of 1 billion people -- Chinese researchers have the advantage of a gigantic population of cancer patients who are eligible for clinical research programs, and the potential data from these trials can influence the whole field of cancer research.
High-quality clinical research and translational research in China has shown very significant advances in the last 10-15 years. Take CSCO (Chinese Society of Clinical Oncology 中國臨床腫瘤協會), for example, which started as a meeting small enough to include all the attendees in 1 photograph, and this year the attendance will exceed 15,000.
I believe it is a combination of government support, the private sector involving biomedical research, and the leadership of many physicians at both local and national levels.
We are becoming a global society, and with the advance of the Internet, people all over the world are hungry for knowledge about how to better treat their cancer patients. In China, I have observed over the years that oncologists are better organized than they were in the past for educational meetings such as this one, which aims to keep up to date with advances both in China and globally.
中國臨床腫瘤協會會議和相關的國際會議: The CSCO meeting has really matured as a major medical meeting, partly because of the alliance with ASCO and other organizational partners. Dr Sandra Swain, the President of ASCO (American Society of Clinical Oncology 美國臨床腫瘤協會), traveled here to represent ASCO and to give scientific presentations. The key is education. ASCO and CSCO are collaborating in the training of doctors here in China on the proper conduct of clinical trials, and that collaboration is mutually beneficial. If the clinical investigators in China conduct clinical trials following the same scientific practices as those in other countries, then oncologists in other countries can more readily accept the results reported in China and adopt them in their practice. Of course, one of the requirements for Chinese investigators is to report some of their results in good scientific English, so that their colleagues in other countries can understand and better evaluate their results and conclusions.
Expansion is also occurring on a regional level in Asia. An organizational effort is being made to have periodic joint meetings between CSCO, the Japanese Society of Clinical Oncology, and the Korean Society of Clinical Oncology -- an all-Asian meeting with formal collaboration of those 3 oncology organizations.
We are experiencing a globalization of healthcare and biomedical research. With the accessibility of information on the Internet and the ability to travel more easily, we are beginning to share our knowledge at a global level and utilize information that benefits all of us worldwide. For example, the Chinese have one of the largest concentrations of patients with acral lentiginous melanoma, which we see infrequently in the United States. We can learn from their experience with this disease and apply data from their well-conducted trials about those patients that may be relevant to our practice in the United States and in other countries.
關於中國癌症臨床會議的宗旨和成就: The major mission of CSCO is educating doctors who practice throughout China about the details of contemporary cancer management. At this meeting, there are 60 international speakers who bring perspectives of cancer management and research advances that are going on outside of China. Chinese attendees can hear directly from these experts about advances in other countries, as well as from Chinese investigators. Although the number of invited international guests is limited, each person is part of a global networking experience. For example, in the hallway coming to this meeting, a physician invited me to come to his meeting in Shanghai next year. In turn, I will have him as our guest at the University of Texas Southwestern Medical Center in Dallas.
關於中國學者的英文水準: One challenge for Chinese investigators is to master English as a scientific language. Those who understand it, who are fluent in both written and spoken English, are the ones who can best interface between China and the rest of the world. Their impact is going to be greater and greater, especially as young Chinese investigators who are fluent in English are able to communicate in and write for English-language journals. For example, in the journal of which I am the editor, the Annals of Surgical Oncology, the largest percentage of our manuscripts comes from Asia.
The acceptance rate for Japanese manuscripts is pretty close to that of the United States and Europe. The acceptance rate of manuscripts from China is not as great, but one reason is not so much the quality of their science but rather the quality of their scientific English. I believe this is a temporary limitation. The Chinese are very resourceful, and they will increasingly use editorial services to report their results in fluent English so that their science will compete in peer reviews with the science that is conducted elsewhere in the world.
關於醫療發展不平的問題: In the major cities in China, the level of sophistication of care delivery systems is excellent, but I have no direct knowledge about the quality of care in small- to medium-sized Chinese cities.
As I have traveled in China, I have observed a significant investment in the building of new hospitals, but not the same degree of investment in the delivery of ambulatory or "day hospital" services, which is such an important component of reducing healthcare costs in the United States and in parts of Europe. Our hospitals have evolved into large-scale units for seriously ill patients who need more intensive monitoring and skilled nursing care. We have found ways for the majority of cancer patients under treatment to stay in surrounding hotels or come back and forth to "day hospitals," even for major surgery or infusion chemotherapy. I believe this strategy must be the next evolution in the care delivery system in China, because keeping patients in hospitals when they don't need active nursing care is very expensive.
關於癌症預防: I have heard reports that one third of the smokers in the world are Chinese men. If that is true, then the Chinese are going to pay dearly in the future with an epidemic of lung and head and neck cancers caused by smoking and chewing tobacco that will cause the premature death of many millions of Chinese men. It will also pose a very large expense burden on the Chinese government to take care of these patients, because they will not die in 3-6 months the way they used to. There are a lot of very potent but very expensive drugs that can be used to treat lung cancer and extend life for many weeks or months. But this is a trade-off, because these smoking-induced cancers are preventable and should not be such a heavy health burden for patients and a major expense to the government, which pays for expensive cancer treatments at the end of life. More emphasis should be placed instead on preventing tobacco-induced cancers in the first place. Unless there are policies and better public education about the risk of dying from smoking cigarettes and chewing tobacco, the government and the public at large are going to pay dearly for staggering healthcare costs sometime in the next 10-20 years.
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