China's Diabetes Nightmare

It will come as no surprise to learn that as well as rising levels of obesity, a huge smoking issue and a reliance on fast food, China has overtaken the US when it comes to incidences of Type 2 diabetes.

Lack of public education on the issue means that only 30% of sufferers are aware that they actually have the disease, that quickly becomes life threatening if left untreated increases the risk of stroke, kidney failure and heart attack.  Combined with the high prevalence of smoking in China, the effects on public health could be disastrous.

“Diabetes in China has become a catastrophe,” said Paul Zimmet, honorary president of the International Diabetes Federation and director emeritus of the BakerIDI Heart and Diabetes Institute in Melbourne. “The booming economy in China has brought with it a medical problem which could bankrupt the health system. The big question is the capacity in China to deal with a health problem of such magnitude.” 

Figures released today suggest that almost one in three Chinese, 11.6% of the population, suffers from the disease, compared to only 1% of the population in 1980.  Poor medical guidance for pregnant mothers, and a dearth of nutritional advice from a medical industry mired in corruption hasn't helped the situation, leading nearly half the population having higher than normal blood sugar levels.

The only good news for money-hungry officials is that the epidemic has given rise to a healthy 20% increase year-on-year in profits for drug makers.

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More Korean Women Seek Abortions in China

The train wreck that is China's one child policy has meant that more more South Korean women are getting abortions in the country that ever before.

Abortions have been illegal in the South except in certain cases - rape, incest or severe birth defects.  More women are taking a quick trip to China, were abortion clinics are thriving thanks to China's strict rules on how many children a couple can have. Almost the polar opposite of South Korea's anti-abortion laws, forced abortions and sterilisations are not uncommon,

The legal situation in Korean regarding abortions means that even when the women aren't in the country, they are breaking Korean law.  In an interview with the South Korean daily, Chosun IIbo, an agent who arranges "abortion trips" said "Abortions are legal in China and using aliases removes any records. Chinese doctors are more skilled in abortions, due to their ample experience."  A package deal costs 200m South Korean Won (£116,000).

Seeing the amounts of money that can be made by the illicit trade, a number of South Korean doctors are jumping on the bandwagon along with their Chinese counterparts, often with little regard to the longterm health effects that their operations might have.  "It is very dangerous to make long trips while pregnant or after undergoing an abortion. An abortion in facilities lacking proper sanitary conditions could result in infections or haemorrhage, leading to infertility or even death," Cha Hee-jae of the Association of Pro-life Physicians told Chosun Ilbo.  Also, by travelling abroad, the women have little in the way of legal redress should anything go wrong with the operation.

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Total Recall: How Smearing Foreign Brands Could Backfire for China

Using product recalls to smear foreign companies and brands might not be working in quite the way that the Chinese government hopes for.

China is getting all het up about product recalls in China.  In an effort to show the Chinese people that shoddy goods produced domestically aren’t limited to domestically produced chopsticks, napkins, cooking oil...the air, reports of imported luxury goods being recalled over safety fears are turning in headline news.

After a humiliating scandal when it was discovered that farmers had been adding melamine to batches of milk formula in 2008, eight babies died and some 300,000 were left seriously ill.  Milk tamperers struck again in 2011, and then again 2012 after dangerously high levels of the fungal poison aflotoxin was discovered in the formula.  Last year another company issued a product recall after unacceptable levels of mercury were found in it’s milk powder.

So it’s no surprise that Chinese parents and grandparents, who are often the ones who care for young children in the family, are wary of buy Chinese baby milk.  Chinese consumers switched in their thousands to foreign brands, causing product shortages in Hong Kong and forcing the government to impose strict limits on how much consumers could bring into the country.  With profits of Chinese milk producers in the toilet, some kind of PR offensive was needed, if not to encourage the idea that foreign products aren’t as good (the prices of foreign branded milk powder are rising, despite global supplies increasing) as domestically produced formula, then high profile recalls will serve to remind people that milk powder bought in Hong Kong is just a susceptible to product tampering as that produced in mainland China.

The first attempt to demonize foreign companies came in early July with  The National Development and Reform Commission launching an anti-trust probe to investigate the possibility of price fixing.  After the investigation was announced, Nestle and Danone slashed their prices by 20%.  Despite the high prices, sales remained strong simply because Chinese consumers don’t trust the Chinese companies to make products safe for human consumption.  Speaking to the South China Morning Post, Wendy Ma, a new mother in Guangzhou said "It's HK$210, I don't know how much it costs on the mainland. I didn't even bother to check. It's not an option for me to consider. Most mothers who I know have done their research either buy from Hong Kong or go to the trouble of getting shopping agents from overseas to source infant formula.”

In 2008, when the melamine scandal was uncovered, the government, embarrassed by the number of deaths involved decided that "because it is not an infectious disease, so it's not absolutely necessary for us to announce it to the public.".  And while it’s been left to Fonterra to explain why it took a year to report that contamination of it’s milk, kidney stones in infants fed Chinese brands were found up to two years before the whistle was blown, and then only after several months did the story break in the newspapers.

Sanlu itself received complaints from parents of sick children as early as December 2007, but no tests were carried out until much later in June 2008.  Three months later, the Chinese authorities were later alerted by the New Zealand government.  Additionally, the company offered search engine giant Baidu a three million yuan to play down negative coverage of the scandal.  Not something that their PR company Teller International had in mind when they suggested “cooperation” with Internet news outlets.

While the health concerns are genuine, and getting news out to people who may be affected by the taints, the signal to noise ration in coverage of these types of stories in the Chinese soon descends into parody.  Bellicose editorials and selective amnesia seek to give the slightest slip up by a foreign company or government a pro-Chinese spin.  Using the product recall to try to win back consumers to buying Chinese milk powder, despite the terrible track record, a People’s Daily editorial warned consumers not to “blindly trust” foreign products.  Obviously, it’s better to wait and see if infants will be struck down with aflotoxin poisoning or melamine overdoses before consumers distrust a food company.  The transparent attempts to coax consumers back to Chinese products don’t go down well on Weibo:  "Model Brother II" said: "Foreign milk products get contaminated due to negligence, which is equivalent to 'manslaughter'. Domestic producers intentionally add melamine to milk powder, which is 'intentional murder'."  Some went further suggesting that the pre-emptive recall showed Fonterra’s sense of corporate responsibility, especially when compared to the efforts of Sanlu, which produced the melamine laced milk in 2008.

Aggressive PR campaigns against non-Chinese companies that outsell and outperform their Chinese rivals aren’t new inventions.  State television has used it’s “Consumer Rights Day Gala” to single out companies that have done particularly well in the mainland, and have left Chinese companies with shelves full of stock and empty bank account.  Apple and Volkswagen have both run afoul of CCTV “investigations”.  Small problems concerning warranties and dodgy gearboxes were spun out into the old story of foreign companies trying to pass off inferior products to gullible Chinese consumers.

The whole thing fell apart when it became apparent that Weibo users of influential accounts had been bribed by producers of the program.  Although participants claimed that their accounts had been hacked, the fact that the feckless tweeters hadn’t edited out CCTV’s instructions in the messages that they wanted to go out sealed the fate of the microbloggers.  Ironically, the show that promoted itself as protecting consumer trust had irreversibly damaged it’s own reputation with Chinese consumers.  Sales of Apple products don’t appear to have suffered any because of the “expose”, and some suggest that the tech company may have actually benefited from the coverage.

Luxury cars, a favorite of China’s new middle class are also a target for China’s questionable General Administration of Quality Supervision, Inspection and Quarantine.  This month, BMW floated into the governments crosshairs, forced this week to recall 140,000 vehicles because of a faulty seal that could cause water corrosion.  “In terms of financial impact it’s basically zero,” said Robin Zhu, automotive analyst at Bernstein Research. “In terms of brand damage it’s also negligible.”

Leveraging minor faults in the final product and BMW’s “environmental standards” (the joke of being that the government is accusing a foreign car brand of contributing to the infamous air quality in China), an application by BMW and it’s Chinese partner Brilliance to double production at their plant in Shenyang was denied.  Again, the reaction on the Chinese Internet boards has been mostly praise, since the company is seen as being responsible in it’s efforts to provide safe products.  “At least a large corporation like this is willing to put customer’s safety first. I’ve never heard of a recall initiated by a local auto manufacturer, let alone a large-scale recall like this,” wrote one blogger.  The ghosts of Sanlu have yet to be laid to rest.

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Beijing, MD

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Rumour has it that BBC journalists are offered a single piece of advice when they arrive to cover a story in India – eat everything because you’ll get sick anyway.  The same advice can be applied to those traveling through China.

My health has taken a few knocks in China. From the usual travelers stomach to kidney stones to God knows what I’ve had mixed in my drinks in Sanlitun. For the last few months, my insistence that I cook at home following the poisoned chopsticks, poisoned napkins and oil swill horror stories that surfaced over the summer has meant that I’ve had a pretty good 8 months so far.

Then I met a child and went down with that most feared of afflictions - a summer cold. My policy on kids has always been that they’re messy, stinky, horrible little creations that only their mothers could love - there's far too many of them, we could do with a lot less, and I'm always in the minority  when it comes to discussing this precise point.  . My experience with Chinese kids has been to steer clear of them. Few of them have heard the word “no” in their short lifetimes, and almost all of them have little or no idea of what constitutes basic hygiene. In a country where I’ve had to tell a fully grown 24 year old man to please stop picking his nose in my class, this shouldn’t be too much of a shocker.

I admit that I am somewhat biased in the negative when it comes to the Chinese attitude towards what good parenting means. I’m one of those old fashioned types who thinks that a child should not be left with grandparents or the aiyi for 16 hours a day while the mother goes off to study English. Come to think of it, I’m rather biased towards anything medically traditional in China. I think it comes from the time when I was suffering from what could only be described as “epic diarrhea” after eating chuanr of dubious origin and was subsequently given TCM that I was told would take three or four days to take effect.

Deciding that in three or four days I would be lucky to have any bones left, I went to a better pharmacy and bought some proper medicine – I asked for loperamide at the pharmacy, the chemist muttered that she didn’t know if they had it, checked and returned with handfuls of loperamide based medications – only in China can you find a pharmacist who doesn’t know what medicines they have in stock.

Those of us who have lived here for a while know the appalling state of public health.  Despite being illegal, spitting (of the FA Premier League variety) borders on becoming a Chinese custom.  Public toilets have little in the way of soap, and the hospital toilet that I went to today in order to provide a sample for the erstwhile medical professional in charge of the gastroenterology department at the Sino-Japanese Friendship Hospital (which isn’t that friendly) had little in the way of running water.  On more than one occasion, I’ve seen people who in restaurants and coffeeshops enter a cubicle in a public convenience, and exit a few minutes later without washing their hands.  Grown men pick their noses, waitresses pick their feet in street restaurants and there is, what has been termed by the group of expats that I hang out with, a certain “brown smell” that lingers in the hutongs over the summer months.

It’s safe to say that public hygene is not a top priority for the Chinese.  People get sick with little regard as to why they get sick.  Public awareness of modern medicine is low, and people would rather spend money on cheaper traditional cures and folk remedies than go see a doctor.  That’s because most people don’t actually trust their doctors.  No one knows the difference between a viral and bacterial infection, and few people actually argue with their doctor when and if they think that their doctor is wrong.

It’s only when you get sick in China that the Twilight Zone sensation that you’ve learned to live with and sort of accept gets cranked up a notch. I was told during a particularly traumatic episode of diarrhea that I shouldn’t drink any water, I’m repeatedly told that drinking cold water during the summer (regularly pushing the mercury up to 35 degrees) is bad for my health – indeed, it’s even worse if you’re a woman for some unknown reason. Pregnant women shouldn’t drink icy drinks after giving birth (actually they shouldn’t shower, leave the bed or do anything that would raise their pulse about 60 beats a minute).  There's no Casualty, or ER or even anything like The Flying Doctors on Chinese TV, and for expats the difference is palpable - no one knows anything.  If you don't believe me, I'll leave you with one final story -  to cure a bad hangover, I went into a pharmacy and asked for aspirin - I was  sold the morning after pill.

Unravelling the Melamine Milk Scam

In 2007, the FDA discovered that high levels of melamine were found in pet food, and many dogs and cats across America had become ill after eating the contaminated feed. At first, the CCP had denied that the food had been exported at all from China saying, going as far to say that no wheat gluten products had been exported from China to the US.

The Las Vegas company, ChemNutra that imported and subsequently resold the pet food from from the Chinese company Xuzhou said that the Chinese company had presented itself as the sole manufacturer, but investigation by the Chinese authorities revealed that the company may have had as many as 25 different suppliers. Xuzhou had failed to declare that it was exported food or animal feed to the Chinese export regulators and therefore circumvented the checks that are usually carried out on products intended for animal or human consumption.

Months before the pet poisoning case came to light, Xuzhou had posted on Internet bulletin board soliciting melamine scrap. Why exactly a food company was asking for large amounts of melamine scrap was not investigated by the Chinese, even though a ban currently exists on using melamine in vegetable protein. Despite being illegal, chemical producers admit they have supplied food companies with melamine - "Melamine is mainly used in the chemical industry, but it can also be used in making cakes", said Li Xiuping, a manager at Henan Xinxiang Huaxing Chemical in Henan Province.

The US immediately banned imported wheat gluten products from China, mainly because the idea that the chemical had been deliberately introduced into animal food, and that the same might be true for products intended for human consumption.

If poisoning pets wasn't bad enough, in December 2007, a baby milk manufacturer started to receive complaints from parents that their baby formula was making their babies sick.

The Sanlu Baby Milk poisoning crisis hit shortly after the Olympics closed, but what most people don't know is that accusations that the company had been supplying tainted, possibly life threatening baby formula as early as December 2007, and the company wrote to local CCP officers in June 2008 to assist them in covering up the scandal to avoid "whipping up the issue and creating a negative influence in society." Even as late as August 6th, two days before the start of the Olympic Games, the company had pulled it's products from manufacturers, but had not issued a public recall. A public statement was not issued until September 9th, by which time dozens of babies had developed life threatening kidney stones, and at least one baby had died. A recall of 700 tons of baby formula followed on September 11th. Ten days later, fifty-three thousand babies were reported as being sick, and just under thirteen thousand Chinese babies had been hospitalized, with over 100 listed as being in serious condition.

Because of the apparent safety inspections that Sanlu were supposed to have performed on their own products, they were granted an exemption from the State General Administration of Quality Supervision, who also awarded Sanlu a State Science and Technology Award, which is the highest accolade that can be awarded to a Chinese company. When the company first revealed that contaminants were being found in their baby milk, the Olympic Games was incentive enough for the government to "increase control and coordination of the media, to create a good environment for the recall of the company's problem products," this was essentially a concerted effort from local and central government cadres to hush-up the fact that poisonous melamine had been added routinely to milk to artificially increase the protein content.

Mass confusion followed, as babies were rushed to hospital with critical kidney complaints, and testing of imported Chinese food products revealed that melamine had been added to many more products than previously thought. Even though four babies died, and some fifty thousand children were hospitalized as a direct result of ingesting the plastic resin, the government felt that the Olympic Games were more important to China that Chinese babies were.

The reason why the so many dairy products have been tainted with melamine is quite simple: China is still a nation of farmers, and cows are expensive, they can buy cheaper cows, but they invariably produce milk which has a lower protein yield. If melamine is added to the milk, then the protein yield, when tested, will be much higher and the milk won't be refused by a bottling factory, the return on the farmer's investment is higher too – when added to cottonseed meal, the falsified protein yields can mean an extra one thousand Yuan per ton of meal. The farmers don't know what melamine is, they just know that if they add it to their milk, or to their animal feed, they'll get more money for it. Since melamine was added to what the cows eat, and then that milk was polluted even further by milk dealers and at milk collecting stations, the amount of melamine that was found in some milk products was thirty-six-times higher than US FDA regulations permit. Even if a farmer, or a feedmill owner wanted to test the what they were feeding to their animals, the testing kits cost $145 each (about 1,000RMB), it's too expensive, so no one performs any tests.

The whole sorry tale has come out into the open, but it's not just that fact that Sanlu and many others were adding poisonous chemicals to their products, it's the idea the companies tried to cover-up what happened, and that various government departments were complicit in making the situation much worse that it should've been.

Sanlu initially denied the allegations that it's products were linked with the rise in admissions of infants with kidney problems. They tried to buy off critics and gave free milk to the parents who were kicking up the most fuss. Wang Yuanping wrote an Internet post about the problems that his child was having, Sanlu dutifully offered him $400 worth of free milk to take the Internet post down, he complied and gave the milk to his friends. On the advice of a Beijing based PR firm, Teller International, Sanlu turned their attention to Internet search engines.

Teller and International advised Sanlu to co-operate with companies like Baidu, one of the largest Chinese Internet search websites. Sanlu's interpretation of the "co-operation" was to offer Baidu a $440,000 (three million RMB) "budget" to screen all the negative press from the search engine indices. To date, 32 countries have withdrawn dairy-based products from their supermarket shelves, and the stock price of Sanlu has plummeted by 40%. The World Health Organization was particularly harsh in it's criticism of the crisis, saying, that this was "clearly not an isolated accident, [but] a large-scale intentional activity to deceive consumers for simple, basic, short-term profits."

Anger has grown in the Chinese populous too, with many people wondering why the government is so unmoved by the death of Chinese babies. Wen Jaibao apologized, eventually, but his requests for forgiveness sound awfully similar to the way he asked for the people's pardon for the deaths of coal miners, contaminated drinking water, and the slow reaction to the 2007 snow storms that plagued southern China:

"This incident made me feel sad, though many Chinese have been understanding. It disclosed many problems for government and company supervision of the milk sources, quality and marketing administration... The government will put more efforts into food security, taking the incident as a warning.

What we are trying to do is to ensure no such event happens in future by punishing those leaders as well as enterprises responsible. None of those companies without professional ethics or social morals will be let off."

-Wen Jiabao, China's Premier (21 September 2008)


The apologies were well intentioned, but the Chinese went a little too far at a meeting at the WHO when they claimed that the melamine had been, in fact, added accidentally, directly contradicting the WHO's own observations that the contamination had been deliberate. The CCP also began denying that certain things or people even existed.

When Zhu Yonglan, the Director of the State Council Central Government Offices Special Food Supply Center, revealed in a speech in August 2008, that her firm had worked to supply party members, retired cadres and their families with dairy food that was organically produced and of the highest quality, as she said herself,

"We all know that average production facilities use large quantities of chemical fertilisers and pesticides. Antibiotics and hormones are commonly used in raising livestock and poultry. Farmed aquatic products are contaminated by various kinds of water pollution. It goes without saying that these are harmful when consumed by humans,"

In a Xinhua press release on September 26th, the CCP denied the existence, not only of the food supply centre, but also the fact that Zhu Yonglan had been awarded the contract, and that Zhu Yonglan didn't actually exist at all.

Luckily, to draw attention from the fact that the Chinese government was aware of the damaging effects of melamine and that it was in the national food chain, and that they had set up a special company in order to insulate Party leaders from the poisons, the launch of the Shenzhou VII rocket was a nice little distraction for Xinhua to play up, while it played down anther disastrous health scare in China.