Does China overuse IV drips?

[sthubbar]

Is it just me, or do Chinese doctors heavily prescribe IV medication?

I was just at the hospital for my son and it is shocking to see relatively healthy young children with IV drips. These are kids that probably have a sore stomach.

When I see IV drips, I think cancer and chemotherapy, not stomach aches.

If you have been to a Chinese hospital or doctor, is your impression that IV delivered medication is used more, less or about the same as your home country?

[anonymoose]

They seem to be used a lot more here. It seems to be the standard treatment for a common cold.

Also, if you walk past a hospital, it is not uncommon to see people all bandaged up, hobbling along the pavement, carrying a stick with their IV drip bag hanging off the top.

And by the way, the title of this thread is misleading.

[abcdefg]

If you have been to a Chinese hospital or doctor, is your impression that IV delivered medication is used more, less or about the same as your home country?

I share your impression that they are used much more in China than in the U.S.

[Don_Horhe]

This surprised me too. I was under the impression that they were used only in severe cases where the patient can't eat or has to take special medication which can only be administered intravenously. They seem to be used as a sort of panacea in China.

[Matty]

I asked my dentist about this, (she knows everything), and she said it's because it goes straight to the blood system so it has faster results. If you have an aversion to needles, you can usually ask your doctor for tablets instead, but I guess in China they prefer faster results.

It's not so bad really, I had a couple of bottles a day when I had H1N1 in the infectious diseases hospital. As long as you get a good doctor/nurse that is.

[roddy]

Edited title.

I suspect hospitals can charge more for a drip, which requires some degree of supervision*, than pills.

*Although I did once see a football game where at least two players had escaped from the school infirmary and were playing with their drip stands in tow.

[daofeishi]

I have only once had to go to a Chinese hospital for something serious (acute food poisoning and dehydration from not being able to retain fluids), and for sure, they administered as much IV as must have been possible to force into my poor body at the time.

(Oh boy, was being there an experience. I was placed vis-a-vis a poor teenage girl having her stomach pumped after a failed suicide attempt, and her family standing around gazing at the spectacle. My nurse had no problems divulging that information when I asked what all the noise from across the room was. :unsure:)

The IV seemed reasonable at first, but they made sure to keep me at the hospital for a couple of days longer than seemed necessary, and they also didn't take me off the IV until the very last minute of my stay, long after I was able to eat and drink normally. I noticed this, and also noticed that every single other patient that I saw in the hospital was hooked up to the same kind of wooden IV contraption as I was.

I asked my Chinese friends about it later, but to them it seemed completely normal. After getting home and asking around, some of my friends who have had similar experiences claimed that IV is in such common use because it is used on a pay-per-dose basis, and generates more revenue for the hospitals than other ways of administering medicine do. I have not been able to verify the claim with anyone in China, but it seems like a reasonable hypothesis.

[Brian US]

I hear it is an instant cure for a hangover.

[gato]

A little Baidu search shows that the famous fraud fight Fang Zhouzi has actually written an article about this drip business. He was recently physically attacked by one of his targets.

IV drip can be translated as "静脉输液" in its formal use, but is more widely referred as "打点滴", "吊水", or "挂水".

Didn't they say that the Eskimos have 90 different words for snow because they have so much of it. ;)

http://www.fujianfilm.com/bbs/viewthread.php?tid=18611

中国人爱“打点滴”

方舟子

因此，从节省医疗成本和安全的考虑，应该是药物能口服的就不打针，能打针的就不打点滴。这一点国外医院做得比较好。《生命时报》住联合国记者曾经随机走访了纽约市中心的几家医院，竟没有找到一位正在输液的患者。为什么国内医院却反其道而行之呢？

一个明显的原因是为了经济利益。药物注射液的利润要比口服药物高得多。例如常用的抗感染药物甲硝唑，如果是口服的，一个疗程七天的花费只有大约3元钱，但是改用打点滴，一天就要花费大约20元钱。甲硝唑口服能被迅速而完全地吸收，根本没有静脉注射的必要，国内医院之所以乐于用甲硝唑打点滴，显然是利润的考虑。

但是，在医疗改革之前，国内医院打点滴已很流行了，当时医院的费用都由郑辅承担，并无经济压力。所以打点滴在国内的泛滥，应该还有别的因素，比如文化的因素。患者去医院看病，就想着要尽可能接受先进、彻底的治疗，而打点

滴看上去要比吃药先进、彻底得多。许多人觉得打点滴要比吃药病好得快，这在某些情况下是对的，静脉注射药物能被完全吸收，药效也比较快，十几秒钟就能让血液中的药物浓度达到有效范围；但是在其他情况下，就只是一种错觉或心理

作用，感冒打点滴就属于此类。对许多患者来说，上医院看病就要打点滴，成了理所当然的事，而医生为了避免医疗纠纷，也乐于满足患者的要求。如果有中国医生向美国医生学习，对感冒患者不开药或开点镇痛解热药就打发走，自己拿不

了药物回扣且不说，还会被患者认为是不负责任，万一患者因为感冒并发了更严重的疾病，医生的麻烦就大了。

[daofeishi]

...Fang Zhouzi...

顶

I have tremendous respect for that guy. He is like China's James Randi, sans the beard but double the courage.

[JenniferW]

This is the lead story on the Danwei website today.

[abcdefg]

This is the lead story on the Danwei website today.

If you are referring to this article, it's a different though related issue.

http://www.danwei.org/

Massive over-use of antibiotics in the media

Posted by Jeremy Goldkorn on Tuesday, November 9, 2010 at 9:17 AM

The overuse of antibiotics is extremely worrisome and is more fully reported here:

http://www.chinadaily.com.cn/usa/2010-11/09/content_11521847.htm

Addicted to antibiotics

By Li Li (China Daily)

Updated: 2010-11-09 07:46

[Brontie]

I'm an RN in an American hospital. In western medicine, patients are routinely started on an IV when admitted to the hospital to allow quick access to their circulatory system in case of an emergency. This doesn't mean they are receiving medication. The IV will usually be saline or sugar water. If it is suspected they have an infection, they will be cultured and then an antibiotic will be added to the IV. If they go into respiratory arrest for whatever reason, emergency medications such as adrenaline can be administered quickly and save their life. If they are dehydrated, as happens in many illnesses, they can be quickly rehydrated without having to hold down a lot of water. Almost all patients in American hospitals will walk around with an IV whether they are receiving any drugs or not.

[kongli]

Yea, if your not gonna take Chinese medicine you are either getting a shot or an I.V.

[sincyrity]

This is a very serious issue in China. I'm an American doc at an expat clinic in Beijing, and it's well known that the rate of use of antibiotics is far higher than other countries. As others noted, this issue is getting new attention in Chinese papers for the last couple weeks, so hopefully finally this pattern will change.

The main reason, by far, is that Chinese hospitals profit off of their medicines, so a big % of profit is from antibiotics. Yes, most of the time the IV antibiotics are not needed, they are used for almost all virus infections in China and it's completely not indicated. This issue will not really resolve until hospitals separate their pharmacies from the hospital, or not allow a profit off of their meds. The government is actively working on these needed reforms but it will take a long time...

[sthubbar]

Yike, the mentioning of the overuse of antibiotics has me a little concerned. Yes, of course they did prescribe antibiotics to my son, even though they said he has a fungal infection.

It is no use, me trying to explain this idea of overuse of antibiotics to my wife, whatever the doctor says to do, we have to do, and I just keep my fingers crossed.

Brontie, welcome to Chinese-forums. You mention "when admitted to the hospital", though what we are talking about here is patients that's aren't admitted, they are just visiting the doctor and the preferred method of administering medication is IVs. It would be great for you to come over and visit some Chinese hospitals and share your expertise about the difference between the two systems.

[xiaocai]

Some how the discussion has shifted from overuse of IV to antibiotic abuse?

But if the same antibiotic is used then the risks of giving rise to resistant strains would be about the same. Many common antibiotics come in both oral and injectable forms, and many of them like penicillins do work better if given IM/IV. The problem is, unlike taking tablets or capsules, IV needs to be done by trained people with sterile devices and great care. Even the procedures have long been standardised, it still carries much higher risk of causing secondary infection and other complications when compared to oral and IM. That's why many guidelines will normally recommend oral first then IM and then IV if necessary. If you are hospitalised then yes, most of the time you will get IV especially in the first few days, the reason being what Brontie mentioned previously. But if you are put on IV in a community hospital for a simple skin infection, I would think that they just try to make more money from giving you more expensive IV dosage from as well as charging you service fee. These have all been mentioned by 方舟子 as quoted by gato.

Antibiotic overuse is a different issue. The report by China Daily has given a full account in English.

To sthubbar:

Some fungal infections need antibiotics too, or antifungals to be more exact. If there is secondary bacterial infection, antibacterials may be used too. But I hope your son is not getting IV for his fungal infection? Unlike antibacterials, IV antifungal treatment IS only reserved for very severe cases.

[sthubbar]

Xiaocai,

Thanks for your concern. My son didn't get an IV drip, so no IV anti-fungal med, just topical.

[sincyrity]

Hi Xiaocai; in China, talking about IV is essentially the same as talking about antibiotics. It's almost routine in all Chinese hospitals for people diagnosed with the common cold to be recommended to get antibiotics -- and not the pill form, but 7 days of once-a-day IV antibiotics. This of course is a huge moneymaking machine. Chinese patients, when they come to my expat clinic with the cold, absolutely expect me to give them IV antibiotics, and it takes a lot of explaining to change their minds.

The good thing is that the WHO and all agencies are very aware of this issue, but of course it will take years to change such mindsets...

[xiaocai]

Yes what you have mentioned is true and in many cases both are involved. I just want to clarify that they, IV and antibiotic overuse, carry their respective risks and should be regarded as different problems. Even if they do not give IV but just oral antibiotics to people who are actually not having a bacterial infection, then the chance of giving rise to resistant strains is about the same. However, if any medicine is indicated, be it antibiotic or something else, IV should only be considered when oral and IM or any other route which is safer than IV are not suitable.