Saturday, November 3, 2007

Markets in Everything

In China, Brain Surgery Is Pushed on the Mentally Ill;
Mi Zhantao, a poor 25-year-old living with his parents outside this provincial capital in eastern China, was battling depression and had trouble socializing. Doctors said he had schizophrenia. They recommended brain surgery.

Mr. Mi's family spent about $4,800 -- the equivalent of four years' income, and more than their life savings -- on the operation, at No. 454 Hospital of the People's Liberation Army in Nanjing. The highly controversial procedure involved drilling tiny holes in the young man's skull, inserting a 7½-inch-long needle and burning small areas of brain tissue thought to be causing his problems.

The surgeon, who operated on Mr. Mi the day he met him, says he has performed nearly 1,000 such procedures, mostly for schizophrenia, but also for illnesses ranging from depression to epilepsy, since the hospital started offering the operation in 2004.

Mr. Mi's parents say the surgery did nothing but leave their son with a partially limp right arm and slurred speech. He continues to be depressed and withdrawn, his mother says. Wang Yifang, the surgeon, says he checked the medical records and, as far as he knows, the patient left the hospital uninjured....

Doctors at Massachusetts General perform between six to 12 ablative procedures a year for mental illness, but only after rigorous screening, says Dr. Eskandar, the director of stereotactic and functional neurosurgery. The operations are intended to ease symptoms of intractable depression or obsessive-compulsive disorder. Patients must be competent to give informed consent, and the procedure, which normally takes at least a year to be approved, must be cleared by a committee including psychiatrists, neurologists, ethicists, surgeons and a layperson.

China's system is vulnerable to abuse because doctors make as much as 90% of their income through bonuses tied to business they generate, according to Henk Bekedam, who until recently was the World Health Organization's chief representative in China.

"In China, nowadays, in some military hospitals, their brain center is a profit center," says Sun Bomin, director of functional neurosurgery at Shanghai Jiao Tong University's Ruijin Hospital. Most of China's hospitals are run by the health ministry, but some are overseen by the 80-year-old People's Liberation Army, a legacy of the days when the military ran its own services. Those hospitals now are open to the public.

No comments: