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Correspondence

Young Chinese doctors and the pressure of publication


In recent medical job fairs, most large hospitals in China have considered articles listed in the Science Citation Index (SCI) as a must or priority for candidates. SCI articles are also the key to a large bonus or rapid promotion. It seems that SCI articles are controlling the fate of young doctors in China, whose goal is to be a research superpower by 2020. As young doctors, we feel under great pressure to publish. However, basic scientic research is dicult, being almost outside the scope of our profession, and clinical research requires long-term follow-up or large case numbers, which are not easy to achieve for a young doctor. In our graduate careers, many of our classmates spent a large amount of time in the laboratory doing unfamiliar experiments, just so that they could publish SCI articles. Even in the hospital, SCI articles are still an important indicator of success for a department or doctor. Is this really more important than clinical competence? Such a requirement is unreasonable and completely unnecessary. Not only does the pressure to publish take up too much energy and time, with little professional help, it can also lead to an inappropriate medical atmosphere. Young doctors should be paying more attention to the accumulation of medical experience and improving their communication skills with patients. Academic articles are welcome, but they should be mainly for the purposes of communication, and should be non-mandatory and derived from clinical practice. Moreover, articles should not be distinguished simply by whether or not they are cited by SCI. Young Chinese doctors are encountering more and more challenges. Chinas health-system reforms
www.thelancet.com Vol 381 February 2, 2013

should remove the SCI article burden, and build up a healthy assessment mechanism for these doctors.
We declare that we have no conicts of interest.

Should cancer treatment be a matter of a countrys creditworthiness? As Plato said, a good decision is based on knowledge and not on numbers.
I declare that I have no conicts of interest.

Heng-Feng Yuan, *Wei-Dong Xu, Hai-Yan Hu


xuwdshanghai@gmail.com
Department of Orthopedics (H-FY, W-DX) and Department of Kidney (H-YH), Changhai Hospital, Second Military Medical University, Shanghai 200433, China

Ioanna G Tsiligianni
i.tsiligianni@hotmail.gr
Asites Rural Practice, Agia Barbara Health Care Center, Heraklion, Crete, Greece 1 Cancer and volunteer organisations open letter. http://www.bestrong.org.gr/el/news/ cancer_and_society/?nid=3973 (accessed Dec 12, 2012). Siebelt F, Bryan V. Germanys Merck halts supply of cancer drug to Greek hospitals. Reuters Nov 3, 2012. http://www.reuters.com/ article/2012/11/03/us-greece-drugsidUSBRE8A205Z20121103 (accessed Jan 16, 2013). Greek Statistics Oce. Household research on income and living conditions, 2011. http:// www.statistics.gr/portal/page/portal/ESYE/ BUCKET/A0802/PressReleases/A0802_SFA10_ DT_AN_00_2011_01_F_GR.pdf (accessed Jan 16, 2012). Government Gazette. Law 4093, FEK A 222/12-11-2012. http://www.et.gr (accessed Jan 16, 2012).

Politics and cancer management: lessons from Greece


Health should be managed according to evidence-based medicine and the principles of health equity and sustainability. Human rights should be respected, especially those of vulnerable cancer patients. However, political initiatives can easily undermine the role of the doctor when there are limited resources. On June 11, 23 organisations representing cancer patients and volunteers in Greece sent an open letter1 to the government and leaders of the political parties in a last eort to convey the emergency situation created and the threats that patients with cancer face not only to their dignity and the course of the disease, but also to their lives. Why the anguished cry? Simple: pharmacists and pharmaceutical companies are not being paid, so some have stopped supplying drugs.2 This has resulted in serious shortages. Further escalating these problems is the fact that consumables such as catheters, drainage bags, and tracheal tubes are usually paid for by patients, with the money being refunded several months later. However, the proportion of the population at risk of poverty has already reached 214% according to the Greek statistics oce,3 and the situation is set to worsen after the government agreed to more budget cuts on Nov 7, 2012.4

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