Liver disease in China: A long way to go
Authors: Tian Yang, Han Zhang, Wan Yee Lau, Feng Shen, Meng‐Chao Wu
Journal: Hepatology (2015)

We read with great interest the recent special article by Wang et al.1 in Hepatology, which summarized the prominent achievements of Chinese clinicians and scientists in the research in the prevention and management of liver disease in the last two decades. As Chinese liver clinicians, we appreciate their demonstration of the vital role of China in the field of liver disease. Herein, we would like to add a few points. Admittedly, to distance itself from its reputation as the "great country of liver cancer," China has invested far greater amounts of research funding in the field of liver disease than for other diseases.2 This has promoted an exponential increase of publications on liver disease by Chinese scholars, even in the best-known professional journals such as Hepatology. However, beyond these seemingly glamorous publications, is there as much creative output or real value compared with the great investments? Are there considerable references or changes to the clinical practice guidelines for liver disease? Are there enough realistic benefits to Chinese society? Are there significant translational research achievements from bench to bedside? Table 2 in the article shows the increased number of inpatients with liver disease at one hospital in Beijing.1 In our opinion, the data in this table may not have been representative of the national epidemiological trend of liver disease in China as a whole, in consideration of patient selection bias, the variation in different departments, and the adjustment of specialties in only one hospital. Obviously, data from a national or large regionally based census or national liver disease database would be more convincing here. However, unfortunately, there is no such census or database available in China. Therefore, we suggest that, rather than training hepatologists and promoting global collaborations, as the authors suggested in their article,1 providing funding to construct a national liver disease database should be prioritized. Wang et al. also pointed out that the recently increased incidence rates of liver cirrhosis and hepatocellular carcinoma in China are attributable to low awareness of the perniciousness of liver disease and low treatment rates for patients, especially in the broad rural areas.1 Except for the fact that the majority of Chinese people are obliged to pay a large part or even all of their medical costs, another important reason is that hepatitis B virus carriers still encounter discrimination in various aspects of their lives in China, as we mentioned in an article in The Lancet.3 Therefore, on the one hand, China should be involved in the large-scale dissemination of scientific knowledge about hepatitis B and other liver diseases so as to eliminate the ingrained fear that leads to discrimination; on the other hand, it should plug more money into the health care budget, increase health financing available for the Chinese people, and ensure that more citizens obtain real benefits. Thus, more patients with liver disease can afford regular specialized examinations as well as preventive treatments. In conclusion, China still has a long way to go in the prevention and treatment of liver disease, and it has to deal with many realistic challenges, including increasing disease burden, lack of a national liver disease database, insufficient translational research achievements, inadequate public health education, and a limited governmental health care budget. We hope for success in the future. Tian Yang, M.D.1 Han Zhang, M.D.1 Wan Yee Lau, M.D.1,2 Feng Shen, M.D.1 Meng-Chao Wu, M.D.1 1Clinical Epidemiology and Research Center Eastern Hepatobiliary Surgery Hospital Second Military Medical University Shanghai, China 2Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR, China