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Analysis Medical Research in China

Clinical practice guidelines in China

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.j5158 (Published 05 February 2018) Cite this as: BMJ 2018;360:j5158

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Re: Clinical practice guidelines in China - not enough adaptation

Many countries, including China and Russia, try to do their best in developing the health care system by developing national clinical practice guidelines (CPG) through adapting the best Western CPG. This article is a commendable effort.

One of the problems, not mentioned in the article, is that specialists are not eager to adapt the International/European CPGs but just to translate them. They want to say proudly that they are working using the best CPGs. And this behavior is in conflict with the resources of the system.

Another problem, visible here, is that the worries of the Western world are superimposed onto the national health/care system despite available evidence. Eg. in this article the CPG for obesity is described as modified by lowering the threshold for intervention. The reason: the surrogate outcome demonstrates that the "the risks of hypertension, type 2 diabetes, and dyslipidaemia increase dramatically with a BMI >24". But mortality - the important outcome - is not increased so much in Asian populations (DOI: 10.1056/NEJMoa1010679), at least below BMI 27. The obesity CPG of Western origin may be modified for China in the opposite direction.

This is an example also of a missed opportunity to reduce the burden of medical interventions in an underfunded system.

Competing interests: No competing interests

07 February 2018
Vasiliy Vlassov
Physician
National Research University Higher School of Economics
pob 13 Moscow 109451 Russia