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The Thunder of China’s Quiet Second Revolution: How a Few Starving Farmers Brought an Economic Boom by Abandoning Collectivism
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The Thunder of China’s Quiet Second Revolution: How a Few Starving Farmers Brought an Economic Boom by Abandoning Collectivism

Books, Business, China, Industry, Patent law, Photography, Society, Surviving

The Thunder of China’s Quiet Second Revolution: How a Few Starving Farmers Brought an Economic Boom by Abandoning Collectivism

The following essay was originally published as “Desperate Heroism and the Thunder of a Quiet Revolution: The Rise of China’s Economy and IP System” on Nov. 11, 2021 on the intellectual property site, IPWatchdog.com.

On October 16, 2021, as I contemplated lessons from my nine years in China, the Financial Times broke a story that rocked the world—especially the U.S. military: “China tests new space capability with hypersonic missile.” China’s recent launch of a nuclear-capable rocket that circled the globe at high speed “took US intelligence by surprise.” Military experts quickly noticed that Chinese innovation in hypersonic weapons “was far more advanced than US officials realised.” As I’ve seen happen many times in coverage on innovation in China, our mainstream media is now downplaying China’s achievement (“not much of a surprise,” per the New York Times, and nothing but old Russian technology per Foreign Policy). It’s similar to the objections raised for decades about IP and innovation in China: low quality, just copying, nothing to be worried about. Yet in industry after industry, China is taking a leadership position in technology and its international patents that can’t be won by copying. It comes from leading.

Downplaying Chinese innovation may make the West feel more secure, but it is a security based on illusion. Whether one likes China or not, its leadership role in innovation and IP cannot be wisely ignored, as we should learn from their hypersonic missile surprise, and surprises in hundreds of fields ranging from nanotech to paper straws.

My nine years in China taught me that China is serious about innovation and serious about leading in many areas. As I learned in many experiences, the capabilities of Chinese engineers, scientists, programmers, manufacturers, architects, designers, physicians, artists, financiers, and entrepreneurs can far exceed what the West thinks it knows about China. China’s accomplishments happening before our eyes or above our skies can catch us off guard, whether they are in technical fields like biotech, green energy, transportation such as high-speed rail, solar power, mining technology, or nanomaterials, or in the realm of intellectual property (IP) and innovation itself, or in business strategy, political strategy, and numerous other areas. How did this happen? What changed in an impoverished, hungry nation to defy all expectations?

Part of the answer might be found in the heroic defiance of a few desperate farmers in the small village of Xiaogang who helped transform China. Their story teaches us old lessons about property rights and economic liberty that we may need to reconsider for our own future. Xi Jinping visited that village in 2016 and declared, “The daring feat we did at the risk of our lives in those days has become a thunder arousing China’s reform, and a symbol of China’s reform.” I believe you cannot understand China’s journey from poverty to leading the world in IP without knowing this rarely told story.

My Road from Shanghai to Xiaogang

My wife and I began our adventure in China in 2011 when I joined Asia Pulp and Paper as Head of Intellectual Property for what was supposed to be a one-year assignment in Shanghai, followed by a return to be part of North American operations. Fortunately, it became a much longer stay in a beautiful country and the most exciting city I’ve lived in. I wondered how Shanghai and much of China could be so prosperous, free of the economic problems of Cuba, Russia, the former East Germany, North Korea, and other lands that had embraced Marxist-Leninist ideology. Obviously, the economic reforms launched by Deng Xiaoping in the late 1970s and 1980s had succeeded, but there was a backstory that touched me deeply when I learned of it. It would lead my wife and I to make a pilgrimage to an obscure little village in Anhui Province.

My first hint of the Xiaogang (pronounced like “shao gong”) story came while reading Michael Meyer’s In Manchuria: A Village Called Wasteland and the Transformation of Rural China (New York: Bloomsbury Press, 2015). Meyer briefly recounts the story of how China overcame the problem of starvation and transformed to economic success. He first reviews the challenges China faced in the 1950s, when the visions of socialism met the reality of poverty and hunger and over 20 million, perhaps over 40 million, died of starvation during the “Great Famine.” Part of the problem was collectivism (Meyer, pp. 214–5). When farmers have their food confiscated and have to live off small rations, a painful reality sets in: there is no incentive to produce more. In fact, hard work burns more calories and will just make you hungrier. The abuse of the system by those with power over redistributing wealth also led to more discouragement and misallocation of resources. Entrepreneurs and those who were relatively successful would be punished for being “rich,” resulting in the loss of much talent and capital that China needed. The misallocation of resources and the crushing of incentives to make products was not just a theoretical nuisance: it led to the starvation of tens of millions.

Lest defenders of communism think such claims come only from hostile partisans, consider the memoirs of a loyal supporter of Mao, Ji Chaozhu, the man who stood at Mao’s side on many occasions as his translator. His book is The Man on Mao’s Right: From Harvard Yard to Tiananmen Square, My Life Inside China’s Foreign Ministry (New York: Random House, 2008). Though a loyal communist, his tales of the disaster of the Great Leap Forward and the Cultural Revelation incidentally reveal the chaos and starvation that occurred before China’s communism added its essential “Chinese characteristics.” Reading it, I could only mourn for the farmers who were given yellow dirt instead of the fertilizer they needed during the Great Leap Forward, and whose vital iron tools were sometimes sacrificed and turned into worthless scrap metal as villages tried to meet ridiculous quotas for collective steel production.

Meyer’s In Manchuria continues with the story of a secret and illegal scheme that would eventually lead to the overthrow of pure collectivism and bring the economic salvation of China. The scheme was forged in the embers of desperation in the tiny village of Xiaogang in Fengyang County, Anhui Province, not far from the large city of Bengbu. My wife and I with two friends would make a pilgrimage from Shanghai to Xiaogang. Few foreigners have ever heard of the village.

In 1978, China was still reeling from the Cultural Revolution, though that came to an end with the death of Mao in 1976. For the villagers in Xiaogang, it was obvious that something besides collectivism was needed, for the harder one worked, the faster one starved. Twenty-five percent of their county had starved to death during the Great Famine from the Great Leap Forward, and over 67 of the 120 villagers in Xiaogang had starved during that time. Now they were starving again. One man, Yan Hongchang, a 29-year-old father of four and deputy leader of the village work team, decided to make a change that would put his life on the line. Meyer describes the scene:

On the night of November 24, Mr. Yan summoned the heads of the village’s twenty families to a secret meeting. The village accountant was deputized as a secretary, and on paper torn from a child’s school exercise book transcribed a seventy-nine-word pledge to divide the commune’s land into family plots, submit the required quota of corn to the state, and keep the rest for themselves. “In the case of failure,” the document concluded “we are prepared for death or prison, and other commune members vow to raise our children until they are eighteen years old.” The farmers signed the document and affixed their fingerprints.

Thus began China’s rural reform.

Today a large stone monument to the pact greets tourists to the village. But in the spring of 1979, a local official who learned of the clandestine agreement fumed that the group had “dug up the cornerstone of socialism” and threatened severe punishment. Thinking he was bound for a labor camp, Mr. Yan rose before dawn, reminded his wife that their fellow villagers had promised to help raise their children, and walked to the office of the county’s party secretary. But the man privately admitted to Mr. Yan that he knew, since the pact had been signed, the village’s winter harvest had increased sixfold. The official told Mr. Yan he would protect Xiaogang village and the rebellious farmers so long as their experiment didn’t spread. (Meyer, pp. 215-216)

But other villagers saw something unusual was going on and made inquiries. The system quickly spread from village to village, leading to a boom in Anhui Province’s agricultural production, with a 600% increase in production, maybe more. Yan Hongchang’s heroism came at just the right time. Rather than being punished as a criminal, Yan would be ultimately be recognized as a hero who inspired Deng Xiaoping. The voice of a few farmers became a thunder, as Xi Jinping said, that roared across China, catalyzing a transformation from poverty to abundance.

It would take time for the political obstacles to be overcome, but the unmistakable success of this second revolution in China could not be denied. Deng Xiaoping would face criticism, but had the courage to bring about new policies over the next few years formalizing the Household Contract Responsibility System, often called da baogan, which allowed families to farm their own allocation of land. They had to give a portion to the state, but the rest they could eat or sell at unregulated prices. Fifteen-year leases to farm plots were introduced in 1984 and then became 30-year leases in 1993. Agricultural taxes were abolished in 2006. (Meyer, pp. 215-217). For details on the rapid changes that took place, see chapter 5, “Disbanding Collective Agriculture,” in Jonathan Unger’s book, The Transformation of Rural China (New York: Routledge, 2002). Also, see the recent interview with Yan Hongchang recorded by Ni Dandan in “The Farmer Who Changed China Forever“ (SixthTone.com, Aug 21, 2018).

The signing of the Xiaogang da baogan contract is captured in a painting displayed at the spacious Da BaoGan Memorial Hall in Xiaogang, a short walk from the easily-overlooked home of Yan Hongchang, which is the key place to visit if you go there. The original of this painting is in a museum in Beijing.

Soon the principle of “household management” would become enshrined in the Chinese Constitution, Article 8:

Working people who belong to rural collective economic organizations shall have the right, within the scope?prescribed by law, to farm cropland and hillsides allotted to them for their private use, engage in household sideline production, and raise privately owned livestock. [emphasis added]

This recognition of a form of property rights for farmers was a vital step in China’s economic resurgence. What is today proudly called “socialism with Chinese characteristics” has traits that seem to resonate with principles of economic freedom and property rights. That economic revolution not only replaced famine with abundance, but has lifted China in many ways, opening doors for intellectual property rights, which also got a foothold in 1984.

The home of Yan Hongchang, where the Xiaogang contract was signed on Nov. 24, 1978.

The windowless room where the Xiaogang contract was signed. We must never forget the courage and desperation of that tiny group of farmers huddled together in a small room with no windows – an important detail, for it meant that local government informants could not walk by and listen to the meeting. The contract they signed specified that if any of them were caught, the others would raise their children. But they would rather risk death by execution than stand by and watch their families continue to starve. I’m so grateful for what they did.

From Agricultural Reform to the Rise of Intellectual Property

Allowing people to control and purchase property, even if still formally owned by the government, and to prosper from their work and their investment of capital, created an environment of relative economic liberty. As collective communes were finally discarded in favor of letting farmers control their own allocations of land and profit from their work, the recognition of property rights also began spreading to the realm of intellectual property. An overview of the early rise of China’s patent law is told by Bonan Lin, Jon Wood, and Soonhee Jang in “Overview of Chinese Patent Law,” 35th International Congress of the PIPA, Toyama, Japan, Oct 19–22, 2004.

China passed its first patent law in 1984 and then created its Patent Office in 1987 under the leadership of a man I deeply admire, Dr. Lulin Gao. Drawing upon his familiarity with the German IP system, he paved the way for the creation of the Patent Office and became its Commissioner, serving from 1987 to 1998. Then he led the way in establishing the State Intellectual Property Office (SIPO) and served as its first commissioner. While the patent system in its infancy had weaknesses, China has steadily strengthened its IP laws, IP awareness, and IP training. What I saw year after year in China was an urgent effort to strengthen IP laws and IP enforcement, including the establishment of specialized IP courts and programs across the country aimed at helping companies and officials strengthen IP. Patent quality is steadily improving, as is innovation.

China’s IP activity and achievements have come at a nearly hypersonic pace, catching the West off guard. China now leads the world in Patent Cooperation Treaty (PCT) patent applications. These expensive international applications are usually presumed to be a sign of quality innovation. When China’s domestic patents began to climb rapidly and surpass the filings of many nations, Western voices often suggested that China’s relatively low number of PCT filings revealed that innovation in China was nothing to take very seriously. That argument now lacks any merit. But it still seems to be “common knowledge” in many corporate and government circles that innovation in China is weak and that China relies on copying. A little patent searching will show that China’s patent filings in so many areas, from graphene to paper straws, exceed those in the United States and other nations by such great margins and with such interesting advances that copying utterly fails as an explanation. Yes, copying has occurred, but it’s the value-added innovation on top of learning from others that makes China such a powerhouse. This can no longer be ignored or be downplayed, and hopefully China’s recent hypersonic shot-over-the-bow will help strategists reconsider the power of China to lead, not just copy, in numerous critical areas—including the IP system itself.

By Jeffrey Lindsay|2023-01-31T10:33:28-07:00April 27th, 2022|Categories: Books, Business, China, Industry, Patent law, Photography, Society, Surviving|Comments Off

Illustration of SARS-CoV-2 virion from the CDC.

Millions of people around the world are worried for China and hope there is soon a full recovery from the dreadful disease, COVID-19. Few things sounds more dreadful than being trapped in a locked-down city where thousands are infected and almost everything is shut down. Pray for the success of Wuhan in conquering this pandemic.

While I expressed my concerns about the severity of these rapidly spreading disease and the impact it is having on so many people, one acquaintance who wishes only to be known as C.T. shared with me some of her tentative findings about the impact of several factors on the death rate of pneumonia found across the world.

Her investigation examinedÂ factors that may affect how severe pneumonia becomes in once healthy patients. I find her proposal interesting and potentially valuable enough that I’d like to invite feedback from experts to see if there is any merit to her thinking. If her work could help alleviate some of the suffering that COVID-19 is causing, and specifically decrease the mortality rate, that would be fantastic. Perhaps there’s nothing there. Intelligent feedback is what I am looking for.

Please note that I am not making any medical claims or suggesting that nutrition or nutritional supplements can directly reduce the risk of coming down with or dying from COVID-19 or pneumonia in general. I am not seeking to spread rumors about the disease (spreading rumors is strictly illegal in China, especially rumors or incorrect information about sensitive issues such as COVID-19 and its management, and I strive to abide by the regulations), but am inviting experts to review a tentative possibility that could be helpful to China and other nations.

C.T.’s hypothesis deals with the possible role of glucosamine and other aspects of nutrition in reducing the risk of pneumonia. Glucosamine is a natural material found in cartilage and in the shells of shrimp, crabs, etc. and the skeletons of marine animals. It is also present in China’s abundant and delicious mushrooms and other fungi (see “Dietary Sources” below). It is an antioxidant that our body can produce, though it is also commonly sold as a dietary supplement said to help treat osteoarthritis and reduce pain in joints (see an overview of reports on glucosamine at ScienceDirect). In what follows, I’ll add some comments to C.T.’s points andÂ mix a few finds from my searching with some of the things she has found.

The relationship between glucosamine and cartilage health has a reasonable basis (though for relieving pain, as the BBC reports, it’s not clear that glucosamine supplements actually do more than a good, full-strength placebo), and cartilage is present in several vital parts of the lungs, from the trachea through the bronchi. C.T.’s hypothesis is that viral disease may infect chondrocytes, cells that product cartilage, and that our own immune system in response may then attack those cells and lead to tissue damage that allows naturally present bacteria to cause severe infection. But could there be a relationship between glucosamine and pneumonia mortality? C.T. proposes a mechanism involving the SOX-9 protein and its role in driving a “cytokine storm” where dangerous cycles can lead to severe illness. She argues that dietary influences that inhibit or enhance the effect of SOX-9 (i.e., down regulate or up regulate) may help explain significant differences in pneumonia mortality among nations, with tea and perhaps pomegranate juice being likely to up regulate SOX-9 while diets high in shrimp and cartilage may provide the glucosamine that can may regulate SOX-9.Â You can see her recent comments on the Coronavirus and the crisis in Wuhan in her post of Jan. 31, 2020, “My two bits about the novel coronavirus from Wuhan,” which points to her earlier post with the key information she wishes to share.

Whether or not C.T.’s proposed mechanisms and dietary considerations are correct, there are peer-reviewed studies suggesting that glucosamine can in fact reduce mortality from respiratory illness.

The scientific literature on glucosamine tends to focus on its role in cartilage formation and in alleviating problems with joints and bones. But there are some surprising finds related to other effects. Here are a few to consider (the first and fourth were pointed out by C.T. in her original work):

1. Griffith A. Bell et al., “Use of glucosamine and chondroitin in relation to mortality,” European Journal of Epidemiology, 27/8 (2012): 593-603; https://www.jstor.org/stable/23272500.

Abstract: Glucosamine and chondroitin are products commonly used by older adults in the US and Europe. There is limited evidence that they have anti-inflammatory properties, which could provide risk reduction of several diseases. However, data on their long-term health effects is lacking. To evaluate whether use of glucosamine and chondroitin are associated with cause-specific and total mortality. Participants (n = 77,510) were members of a cohort study of Washington State (US) residents aged 50-76 years who entered the cohort in 2000-2002 by completing a baseline questionnaire that included questions on glucosamine and chondroitin use. Participants were followed for mortality through 2008 (n = 5,362 deaths). Hazard ratios (HR) for death adjusted for multiple covariates were estimated using Cox models. Current (baseline) glucosamine and chondroitin use were associated with a decreased risk of total mortality compared to never use. The adjusted HR associated with current use of glucosamine (with or without chondroitin) was 0.82 (95 % CI 0.75-0.90) and 0.86 (95 % CI 0.78-0.96) for chondroitin (included in two-thirds of glucosamine supplements). Current use of glucosamine was associated with a significant decreased risk of death from cancer (HR 0.87 95 % CI 0.76-0.98) and with a large risk reduction for death from respiratory diseases (HR 0.59 95 % CI 0.41-0.83). Use of glucosamine with or without chondroitin was associated with reduced total mortality and with reductions of several broad causes of death. Although bias cannot be ruled out, these results suggest that glucosamine may provide some mortality benefit. [For links to references cited by Bell et al., see the Springer page for this article.]

2. Kun-Han Chuang et al., “Attenuation of LPS-induced Lung Inflammation by Glucosamine in Rats,” American Journal of Respiratory Cellular Molelcular Biology, 49/6 (Dec. 2013): 1110-9.

Abstract: Acute inflammation is often observed during acute lung injury (ALI) and acute respiratory distress syndrome. Glucosamine is known to act as an anti-inflammatory molecule. The effects of glucosamine on acute lung inflammation and its associated mechanisms remain unclear. The present study sought to address how glucosamine plays an anti-inflammatory role in acute lung inflammation in vivo and in vitro. Using the LPS intratracheal instillation-elicited rat lung inflammation model, we found that glucosamine attenuated pulmonary edema and polymorphonuclear leukocyte infiltration, as well as the production of TNF-Î±, IL-1Î², cytokine-induced neutrophil chemoattractant (CINC)-1, macrophage inflammatory protein (MIP)-2, and nitric oxide (NO) in the bronchoalveolar lavage fluid (BALF) and in the cultured medium of BALF cells. The expression of TNF-Î±, IL-1Î², IFN-Î³, CINC-1, MIP-2, monocyte chemotactic protein-1, and inducible NO synthase (iNOS) in LPS-inflamed lung tissue was also suppressed by glucosamine. Using the rat alveolar epithelial cell line L2, we noted that the cytokine mixture (cytomix)-regulated production and mRNA expression of CINC-1 and MIP-2, NO production, the protein and mRNA expression of iNOS, iNOS mRNA stability, and iNOS promoter activity were all inhibited by glucosamine. Furthermore, glucosamine reduced LPS-mediated NF-ÎºB signaling by decreasing IÎºB phosphorylation, p65 nuclear translocation, and NF-ÎºB reporter activity. Overexpression of the p65 subunit restored the inhibitory action of glucosamine on cytomix-regulated NO production and iNOS expression. In conclusion, glucosamine appears to act as an anti-inflammatory molecule in LPS-induced lung inflammation, at least in part by targeting the NF-ÎºB signaling pathway.

3. Yuh-Lin Wu et al., “Glucosamine Attenuates Cigarette Smoke-Induced Lung Inflammation by Inhibiting ROS-sensitive Inflammatory Signaling,” Free Radical Biology and Medicine, 69 (April 2014): 208-18; DOI: 10.1016/j.freeradbiomed.2014.01.026.

Abstract

Cigarette smoking causes persistent lung inflammation that is mainly regulated by redox-sensitive pathways. We have reported that cigarette smoke (CS) activates a NADPH oxidase-dependent reactive oxygen species (ROS)-sensitive AMP-activated protein kinase (AMPK) signaling pathway leading to induction of lung inflammation. Glucosamine, a dietary supplement used to treat osteoarthritis, has antioxidant and anti-inflammatory properties. However, whether glucosamine has similar beneficial effects against CS-induced lung inflammation remains unclear. Using a murine model we show that chronic CS exposure for 4 weeks increased lung levels of 4-hydroxynonenal (an oxidative stress biomarker), phospho-AMPK, and macrophage inflammatory protein 2 and induced lung inflammation; all of these CS-induced events were suppressed by chronic treatment with glucosamine. Using human bronchial epithelial cells, we demonstrate that cigarette smoke extract (CSE) sequentially activated NADPH oxidase; increased intracellular levels of ROS; activated AMPK, mitogen-activated protein kinases (MAPKs), nuclear factor-ÎºB (NF-ÎºB), and signal transducer and activator of transcription proteins 3 (STAT3); and induced interleukin-8 (IL-8). Additionally, using a ROS scavenger, a siRNA that targets AMPK, and various pharmacological inhibitors, we identified the signaling cascade that leads to induction of IL-8 by CSE. All these CSE-induced events were inhibited by glucosamine pretreatment. Our findings suggest a novel role for glucosamine in alleviating the oxidative stress and lung inflammation induced by chronic CS exposure in vivo and in suppressing the CSE-induced IL-8 in vitro by inhibiting both the ROS-sensitive NADPH oxidase/AMPK/MAPK signaling pathway and the downstream transcriptional factors NF-ÎºB and STAT3.

4. Jean-NoÃ«l Gouze et al., “Exogenous glucosamine globally protects chondrocytes from the arthritogenic effects of IL-1Î²,” Arthritis Research and Therapy,Â 8 (2006), article #R173; https://doi.org/10.1186/ar2082. (PDF also available.)

Abstract

The effects of exogenous glucosamine on the biology of articular chondrocytes were determined by examining global transcription patterns under normal culture conditions and following challenge with IL-1Î². Chondrocytes isolated from the cartilage of rats were cultured in several flasks either alone or in the presence of 20 mM glucosamine. Six hours later, one-half of the cultures of each group were challenged with 10 ng/ml IL-1Î². Fourteen hours after this challenge, RNA was extracted from each culture individually and used to probe microarray chips corresponding to the entire rat genome. Glucosamine alone had no observable stimulatory effect on the transcription of primary cartilage matrix genes, such as aggrecan, collagen type II, or genes involved in glycosaminoglycan synthesis; however, glucosamine proved to be a potent, broad-spectrum inhibitor of IL-1Î². Of the 2,813 genes whose transcription was altered by IL-1Î² stimulation (P < 0.0001), glucosamine significantly blocked the response in 2,055 (~73%). Glucosamine fully protected the chondrocytes from IL-1-induced expression of inflammatory cytokines, chemokines, and growth factors as well as proteins involved in prostaglandin E2 and nitric oxide synthesis. It also blocked the IL-1-induced expression of matrix-specific proteases such as MMP-3, MMP-9, MMP-10, MMP-12, and ADAMTS-1. The concentrations of IL-1 and glucosamine used in these assays were supraphysiological and were not representative of the arthritic joint following oral consumption of glucosamine. They suggest, however, that the potential benefit of glucosamine in osteoarthritis is not related to cartilage matrix biosynthesis, but is more probably related to its ability to globally inhibit the deleterious effects of IL-1Î² signaling. These results suggest that glucosamine, if administered effectively, may indeed have anti-arthritic properties, but primarily as an anti-inflammatory agent.

In light of these studies, there seems to be reason to believe that glucosamine may be helpful in reducing the mortality of pneumonia. If so, being prepared to have a diet with some glucosamine sources or to have some glucosamine on hand might be reasonable should COVID-19 become a serious threat in your community, or if you are traveling under conditions where you may be exposed to the SARS-CoV-2 virus. Your intelligent feedback on this is welcome — but anonymous trolling comments that I too often tolerate will be deleted here in order to increase the chance of readers finding intelligent comments that help us better understand the issues raised here.

C.T.’s Proposals on Mechanism and Diet

C.T. wrote the following a few days ago:

Hi, Jeff, I know it sounds presumptuous, but I think I figured out which environmental triggers are involved in making it so people exposed to this virus do/do not become symptomatic and how severe the symptoms are.

1) Damage to the hyaline cartilage (by the immune system targeting infected cartilage cells) is much less likely to happen where the diet contains glucosamine (in shrimp paste and cartilage), where there is no exposure to dry and cold air, and where there is not bleach being sprayed in the air (seriously, have Hubei’s bureaucrats never heard of chemical pneumonia?).

2) The cartilage cells, if damaged, think they have to rebuild the hyaline cartilage matrix and so secrete chondroitin sulphate and other cartilage matrix molecules; the gene SOX9 is very instrumental in doing this, but if it is overly active it can cause there to be too many such molecules building up in the lungs. Voila! Viral pneumonia. What gets SOX9 going? EGCG appears to “stimulate exuberant cartilage matrix secretion” (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247298/), and EGCG is THE special molecule in tea leaves. What did the poor people of Wuhan ingest in their apartment quarantines: rice, veggies, legumes, and tea–no meat or shrimp. What else affects SOX9? Turmeric (curcumin decreases SOX9 activity–lucky Thailand), Fluoride (also helps decrease SOX9 activity–lucky India), Pomegranate (increases SOX9–unlucky Iran, where they drink pomegranate juice when sick). This hypothesis holds up even in Italy, where they drink wine and coffee all the time except when they’re trying to lose weight or fight a cold–then they drink green tea. And it utterly refutes all the stupid internet trolls who were going on and on about how “Chinese people have horrible hygiene.”

C.T.’s original post on the relationship between glucosamine and mortality in pneumonia and the possible mechanisms involved is “Glucosamine to protect cartilage during influenza infection,” Petticoat Government, Feb. 5, 2018. Here is an excerpt with the key arguments she makes:

1) The flu infects chondrocytes, the cells in cartilage. They are the only cells in hyaline cartilage, which type of cartilage is coincidentally found in places–joints, rib ends, nose, larynx, trachea, bronchi–that are among the hardest hit by influenza. (https://www.britannica.com/science/cartilage)

2) Influenza-infected chondrocytes don’t seem to actually experience obvious damage until the body’s immune system goes on the attack. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC422866/; http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2567.2003.01621.x/full) [Edited 2/17/2018: Someone pointed out to me that chondrocytes are within an extracellular matrix that has no blood vessels, so other cells, including attacking immune cells, can’t reach them. I looked more into that issue and found a 2015 cartilage transplant study which found that cartilage isn’t as immune-privileged as it used to be believed it was (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522233/). I suspect that chondroblasts–the immature chondrocytes next to the blood-vessel-containing perichondrium–are the first chondrocytes which the immune system cells attack, and then due to their destruction the cartilage matrix becomes compromised; if that compromised state becomes severe enough, immune cells can then gain access to the mature chondrocytes within, as well.]

3) Cytokines are part of the immune system’s attack arsenal. The cytokine IL-1beta is a critical component of lung inflammation during infection with influenza type A H1N1. (http://onlinelibrary.wiley.com/doi/10.1002/jmv.24138/abstract;Â https://www.ncbi.nlm.nih.gov/pubmed/27714503)

4) Glucosamine–a natural compound found in cartilage–happens to protect chondrocytes by being a potent inhibitor of IL-1beta. (https://link.springer.com/article/10.1186/ar2082)

5) Damaged cartilage in the trachea/bronchi could allow for more penetrating infection by viruses/bacteria that normally would not be able to do much harm and in that way make flu sufferers much more susceptible to pneumonia. Most of the people who died from the 1918 flu died because “bacteria that normally inhabit the nose and throat invaded the lungs along a pathway created when the virus destroyed the cells that line the bronchial tubes and lungs.” (https://www.nih.gov/news-events/news-releases/bacterial-pneumonia-caused-most-deaths-1918-influenza-pandemic)

6) People who take glucosamine (it’s a common supplement for arthritis) are much less likely to die of respiratory illnesses than their peers. (https://link.springer.com/article/10.1007/s10654-012-9714-6)

So if you’re worried about influenza, it might be worth it to buy some glucosamine and take it when you’re exposed to influenza so you can protect your hyaline cartilage and thus make yourself less likely to develop pneumonia….

Eat well cooked, or non-manufactured source- glucosamine rich foods (like shrimp) to help the cartilage stay strong, and stay away from tea plant and pomegranate for a second. (Pomegranates are healthy, but are rich in natural SOX9 stimulants… Which is good… But on a viral, over-production level ((what happens with this virus)) you get to much in the lungs too fast, and therefore pneumonia.)

By the way, I have worked with nearly pure EGCG as part of my consumer products research work in the past and was often surprised by how reactive it is. Dissolve a little white EGCG in water and combine with baking soda or other alkaline material and find out what strange, ugly stains you can create on materials such as tissue paper or fabrics after allowing it to sit for a few hours. It has many effects in the body, some clearly positive, but I can imagine that there are situations where this reactive material isn’t helpful. Can it play the role that C.T. suggests? I don’t know, but would like to learn more. Is it possible that giving tea to the ill might not be a good idea? I don’t know, but it may not be helping in Wuhan, though so much of what’s happening there remains opaque. If you have additional useful information, please let me know.

Dietary Sources

C.T. points to shrimp as an important dietary source of glucosamine. I should add that it appears that the glucosamine of shrimp comes from the shell, not the flesh. In Asia, many people eat the shells, or so it seems to me, especially small shrimp where the shell is quite thin and, in fried shrimp, can be tasty and easy to eat. She also mentions gristle, which is commonly consumed, especially chicken gristle. Another source may be soups in which the bones of animals have been stewed for a long period of time. Bone-rich soup, at least in China, especially when stewed long enough to create a white broth, is widely held to be very nutritious and ideal for those who are ill, and probably supplies some glucosamine. I find it delicious, too.

There are also options for vegetarians. Mushrooms contain chitin, the widespread natural polymer found in the shells of shrimp, crabs, insects, etc., and glucosamine is one of the building blocks of chitin and I believe it can be released when digested. See Tao Wu et al., “Chitin and Chitosan–Value-Added Products From Mushroom Waste,” Journal of Agricultural Food Chemistry, 52 /26 (Dec. 29, 2004): 7905-10;Â DOI: 10.1021/jf0492565. Also see Pin Zhang et al., “Kinetic Models for Glucosamine Production by Acid Hydrolysis of Chitin in Five Mushrooms,” International Journal of Chemical Engineering, 2020, article ID 5084036 (2020); https://doi.org/10.1155/2020/5084036.

Unfortunately, for those in Wuhan, there are reports that the diet is now necessarily simple and thus there may be less meat (bone and cartilage included) and less shrimp than usual, so the protective effects of glucosamine, if real, may be less available than normal. C.T. worries that the combination of cold, stress, and confinement, coupled with a low-glucosamine and high-tea diet and even the occasional exposure to bleach or other harsh chemicals in the effort to kill the virus in many places might make a perfect storm for elevated pneumonia risk for those infected with the virus. If C.T.’s proposal is correct, then bringing glucosamine or glucosamine-rich foods to Wuhan and other affected areas may be a helpful step to help reduce loss of life.

One of China’s great blessings when it comes to food is the richness of its fungi, with numerous wild and domesticated mushrooms and other fungi that are so delicious. Some are far too expensive for me, but there are many varieties that are relatively inexpensive but very nutritious, especially the black wood ear fungus called mu er (literally wood ear). It’s more expensive than rice or common vegetables like carrots, onions, or cabbage, but it’s still quite cheap and has also been touted for its immune strengthening benefits. I order some much of the time when I’m in Chinese restaurants in China. Perhaps adding this to the diet of the people in Wuhan and other afflicted cities could help?

Is Glucosamine Safe for Those Allergic to Shrimp?

Finally, one important issue is whether those with seafood allergies, including shellfish allergies, should take glucosamine since it is often made from the shells of shrimp. Please consult with your physician and don’t take crazy risks based on random bloggers. However, something to consider as you discuss such matters with competent medical authorities is that several studies suggest that commercially available high-quality glucosamine may not contain the allergens that are harmful to some people. Here are a couple studies to consider:

J. Villacis et al.,Â “Do Shrimp-Allergic Individuals Tolerate Shrimp-Derived Glucosamine?,”Â Clinical and Experimental Allergy, 36/11 (Nov. 2006): 1457-61;Â DOI: 10.1111/j.1365-2222.2006.02590.x.

Abstract

Background: There is concern that shrimp-allergic individuals may react to glucosamine-containing products as shrimp shells are a major source of glucosamine used for human consumption.

Objective: The purpose of this study was to determine whether shrimp-allergic individuals can tolerate therapeutic doses of glucosamine.

Methods: Subjects with a history of shrimp allergy were recruited and tested for both shrimp reactivity via a prick skin test and shrimp-specific IgE by an ImmunoCAP assay. Fifteen subjects with positive skin tests to shrimp and an ImmunoCAP class level of two or greater were selected for a double-blind placebo-controlled food challenge (DBPCFC) using glucosamine-chondroitin tablets containing 1,500 mg of synthetically produced (control) or shrimp-derived glucosamine. Immediate reactions, including changes in peak flow and blood pressure, and delayed reactions (up to 24 h post-challenge) via questionnaire were noted and assessed.

Results: All subjects tolerated 1,500 mg of both shrimp-derived or synthetic glucosamine without incident of an immediate hypersensitivity response. Peak flows and blood pressures remained constant, and no subject had symptoms of a delayed reaction 24 h later.

Conclusion: This study demonstrates that glucosamine supplements from specific manufacturers do not contain clinically relevant levels of shrimp allergen and therefore appear to pose no threat to shrimp-allergic individuals.

Heather C. Gray, et al., “Is glucosamine safe in patients with seafood allergy?,” Jounral of Allergy and Clinical Immunology,Â 114/2 (August 2004) 459â€“460; DOI: https://doi.org/10.1016/j.jaci.2004.05.050 (PDF also available).

Excerpt:

Six subjects participated in the study. All 6 had a history consistent with a systemic reaction to shellfish. All 6 had positive skin prick test responses to shrimp, crab, lobster, or a combination of these. All 6 had negative skin test responses to the glucosamine extract (Table I) and uneventful oral challenges with glucosamine, with no change in skin, vital signs, or spirometry….

Approximately 600 patients must be recruited to ensure that the chance of rejecting an allergy rate of at least 0.5% is less than 0.05. This pilot study, which indicates that glucosamine is probably safe for patients with shellfish allergy, emphasizes the need for further investigation, with larger studies looking at different shellfish allergens and the consistency of glucosamine formulations.

Further research is needed on this issue and others raised above. If you have other information on the food safety issue or other issues raised here, please share. Thanks!

I welcome your civil, thoughtful feedback.

Other Related Resources:

Theodore M. Brasky, “Use of Glucosamine and Chondroitin and Lung Cancer Risk in the VITamins And Lifestyle (VITAL) Cohort,” Cancer Causes and Control, 22/9 (Sept. 2011): 1333-42.

Jody Braverman, “Nutritional Value of Bone Gristle,” LiveStrong.com, September 30, 2019.

Update, 2/28/2020: There’s one study C.T. mentioned suggesting that chondroitin, which is often combined with glucosamine in supplements, can cause pneumonia rather than prevent it, based on a single patient. See Takeshi Satomura et al., “A Case of Drug-induced Pulmonary Disease Considered to be Caused by a Supplement Containing Chondroitin,” The Journal of the Japan Society for Respiratory Endoscopy,Â 37/2 (2015): 214-18; DOI https://doi.org/10.18907/jjsre.37.2_214.

AbstractÂ

Drug-induced pulmonary disease can be caused by a variety of drugs including supplements. We examined a case of drug-induced organizing pneumonia induced by a supplement containing chondroitin. Case. An 80-year-old man had been taking supplements for knee pain since early July 2013 and subsequently developed a cough and fever. A chest radiograph demonstrated infiltrative shadows, and he was admitted to our hospital. His condition did not improved with antibiotic treatment and bronchoscopy was performed for diagnostic purposes. A transbronchial lung biopsy specimen showed organizing pneumonia, and the patient’s condition was ameliorated with steroid therapy. We established a diagnosis of drug-induced pulmonary disease based on the results of a lymphocyte stimulation test for a supplement containing chondroitin. Conclusions. We conclude that the use of supplements containing chondroitin may result in drug-induced pulmonary disease.

That single case may not be meaningful, but if you’re concerned and want more glucosamine after consulting with medical personnel, you can just use glucosamine alone or a diet with glucosamine. Chondroitin tends to me relatively more expensive anyway. Consult your physician and don’t rely on bloggers.

By Jeffrey Lindsay|2020-02-28T13:45:51-07:00February 28th, 2020|Categories: China, Food, Health, Safety, Shanghai, Society, Surviving, Travel tips|Tags: Corona virus, COVID-2019, SARS, SARS-CoV-2, virus|Comments Off

Corona Virus Asia Travel Tip for Flights: For a Better Trip, Skip Trip.com

One of the many things we’ve learned while being caught up in the difficulties of travel in Asia due to the Corona virus is just how unreliable and unhelpful some travel agencies are. One example is Trip.com (formerly CTrip). I’ve used them for years and have usually liked their service, but the total failure of their customer service now (unlike that of, say Delta Airlines) has made me resolve to avoid them for flights. They can seem to save money on many flights, but if you need help when an emergency arises like all the travel chaos from the Corona virus pandemic, Trip.com has been absolutely unreliable (speaking only of our experience, of course). They seem to have hired many new customer service reps to handle the high demand, but to me they seem to be not fully trained and even tell us that they are not authorized to make changes. All they do is take your request, forward some garbled version of your request to some mysterious “flight specialist” and tell you an email will come later. If something goes wrong, they won’t call and help you out. You will just get an email saying that your request was denied. Now you can start over!

They say that the request will come within one day, but it can be three or four days (as one agent explained to us and as we experienced), and then you may find, as we did, that they completely misunderstood your request or bungled it completely. Then you have to call again and start over, and by then it may be too late to get the flights you need. There is no sense of urgency in helping customers with urgent needs.

We have found that the information they give you is incorrect,Â or that they charge high fees for flight changes that most airlines aren’t charging (I don’t know why they do this and will assume that it’s just a mistake or a glitch of third-party systems, but it to some it might create the impression of exploiting the crisis, which I don’t think is intentional).

In our latest case of several exasperating incidents with Trip.com, when we had to make flight changes due to cancelled flights, we bought a new ticket on Trip.com for my wife to get her back to China to teach when her international school opens its doors again in Shanghai in March. When we learned that the school had again delayed its opening date and also realized that the we needed to delay that flight due to escalating virus concerns, we called and found the agent was very unhelpful and could only pass on a request. They promised an email within 24 hours. It didn’t come.

We called twice more, and one agent said she was not authorized to make any changes. We called again and another agent seemed more helpful, but told us we would have to wait for an email. We explained we had already waited and it never came. Then he said he would “escalate” the request. We did get an email the next day, but it said that since we were changing the airport of departure (not true! everything was the same except the date), there was a large fee of about US$300. Completely wrong — it was the exact same itinerary, just a different date. Maybe the fee is correct and just the reason given was bungled? We’re not sure because all we have is just a confusing email.

After getting the email showing that Trip had completely bungled our request and wanted us to pay $300 to make a change in dates on a $500 ticket, we called back and got the same story. The agent could not make changes but could make a request and then we could have the great pleasure of waiting (what, 3 to 4 days?) to see if we could make a change on a flight that is currently scheduled to depart in 3 days. Brilliant. And worthless. I can almost imagine getting an “escalated” email in 3 days saying that since our flight has just departed, there can be no change. Tough luck.

Our departing flight is with Delta Airlines. They have been wonderful to work with during this crisis, in spite of some mistakes, and have not charged fees for changes in our dates and departure locations. But Trip wants to charge us $300 for a change. Ouch. Sadly, because we booked with a 3rd party, calling Delta for help on this doesn’t work because they have to send us back to Trip. In the future, skip Trip for a better trip.

Your experience may be much better than ours, and all of this may be due to the pressures of the virus pandemic, but other companies are maintaining decent customer service, not this maddening cycle of delays and impotent agents.

By Jeffrey Lindsay|2020-02-12T20:50:48-07:00February 10th, 2020|Categories: China, Consumers, Surviving, Travel tips|Tags: Ctrip, Trip.com, virus|Comments Off

Views on the Corona Virus Pandemic in China

As I write, I have been out of China for over 3 weeks and am past the incubation period for the dreaded Corona virus that has been sweeping China. We were away in Vietnam on aÂ trip just before the Chinese New Year when the pandemic started looking serious, and were able to adapt our plans to stay out of China for a while. It has become a difficult place to be, even for those fortunate enough to avoid the virus.

We hope that the unprecedented efforts to contain the Corona virus in China will bring rapid containment, but the impact of the virus will also bring hardship to millions. The complete lockdown of many large cities like Wuhan can make life very difficult.Â Even inÂ beautiful, modern metropolises like Shanghai and Hangzhou, where relatively few cases of the virus have occurred, life can be difficult. People coming home from travel, like two American friends of mine who just returned to Shanghai from Australia, or a European friend who just got back to Hangzhou from a visit in Shanghai, are finding that strict regulations make them prisoners in their own apartment as the government requires quarantine for travelers. That’s if you are lucky enough to get home at all — my friend in Hangzhou said that she got home just one day before a ban on travelers entering the city went into effect. I don’t know how accurate that is, so I’m just reporting what she understands.

In Shanghai, people returning on Sunday and hoping to start work on Monday are in for disappointment and frustration. It may be one or two weeks before they can go back to work, depending on local rules. After that quarantine period, apartment complexes will only allow you to leave once every other day. Martial law comes with much uncertainty and some hardship, but perhaps this is needed. But hats off to those with the wisdom to have stored basics like food and other supplies to be ready for a time of trouble. People aren’t going hungry as far as I know, but it’s probably much harder to get what you might be used to now.

One man in Shanghai desperately needed to get his new passport that was sent by DHL to Shanghai, but had not been delivered to him for a number of days because DHL was largely shut down due to virus fears. It was only by going to DHL offices and “crying” for hours in front of the building that he finally got the attention of workers there who dugÂ into a pile of undelivered packages and found his passport, giving him time to get to the airport barely in time. Without that, he would have been in violation of Chinese law with an expired visa. You don’t want to violate visa rules!

Such accounts, though, may pale in comparison to the woes of those who are trapped in places they don’t belong, without resources and friends. Or even local Wuhan residents struggling with the challenges of living life under a lockdown with so much uncertainty, in spite of valiant efforts now to provide support and services. An American trapped in Wuhan did manage to get a seat on a plane out organized by the US government, but the problem was getting to the airport, some 30 miles away from his home. A few weeks ago that would have been easy: just take a taxi. But taxis in Wuhan have been shut down except for a handful dedicated to taking patients to the hospitals, but this requires a complex process of getting approval from the local government committees for each region of town and there’s no chance of getting a ride to the airport. With no feasible way to get to the airport, the man missed the flight and his seat was given to someone else. Fortunately, he had a second passport with Germany, and was able to get on the evacuation flight for Germany, a nation that kindly sent a bus to give German citizens rides to the airport. (Congratulation to those of you who recognize the many virtues of having a second passport. When things go crazy in your home country, it’s nice to have another option.)

In spite of China now going all out to contain the virus, there seems to be international anger toward China and the Chinese people. There are accusations that China did not act quickly enough or is not doing enough. Individual Chinese people are also experiencing blame and anger. Hotels, shops, and restaurants in some areas are turning away Chinese people. Rudeness and xenophobic hysteria abound. As I left Asia a few days ago, after a two-week virus-free exile in Vietnam before I began a business trip to the US for a research project in Minneapolis (I just love the University of Minnesota, by the way!), I read a front-page article in the New York Times on my flight from Hanoi to Seoul and was pained to see further evidence of the worldwide anger toward China. Motoko Rich’s Feb. 1-2, 2020 article, “Global Xenophobia Follows Virus.” See also MarketWatch’s “â€˜No Chinese allowedâ€™: Racism and fear are now spreading along with the coronavirus” from Feb. 3.Â This is a tough time to be Chinese. The video below from a Chinese man in Florence, Italy reminds us of the humanity of those facing prejudice because a virus originated in their country.

Some say there’s a deja vu sense to this virus, which is causing so much hysteria around the globe. But there’s reason for the hysteria: the virus has left China, and now has killed people elsewhere in the world, including (as of Feb. 4) Hong Kong (1 death) and Philippines (1 death), etc., etc., etc., for a total of, well, three deaths so far outside of China. But in China, nearly 500 people have died, so the death toll is on its way to reaching that of the worldwide 2009 influenza pandemic with the H1N1 virus. Well, on its way to some degree, I suppose. The H1N1 virus that started in the Americas spread worldwide and ended up killing over 200,000 people (maybe as many as 500,000). Not 200, not 500, but over 200,000.

Do you recall the the draconian measures taken by the US government to contain that virus in 2009 and 2010? And do you remember the worldwide hostility toward North Americans for that North American virus? The shunning of all things American, the refusal to allow Americans to stay in hotels or enter restaurants, the locking down of New York, Miami, and LA? The martial law, the quarantines, the months of delayed school and the crushing of the US economy? The inability to fly, travel, or even leave your apartment? My memory must be fading, because I don’t remember any of that. I remember encouragement to get flu shots then and warnings about the virus, but not the massive, painful disruption of travel, work, school, and normal life, nor escalation in anti-American sentiment.

China is responding to the crisis by locking down many cities, stranding over 60 million people, with martial-law measures in many other cities with tough regulations forcing many to be quarantined and hindering travel, work, and normal life. There is also the cessation of much public transportation or blockades on roads in and out of many cities, the shutting down of thousands of tourist attractions, delayed operations for millions of employees, delayed school for millions, and so forth. Such extreme measures to contain this virus, and yet there is still international hysteria and blame. Outside of China, two have died, a few hundred are affected. It may get much worse, but right now, it’s noting compared to seasonal bouts of influenza and nothing close to our own H1N1 pandemic that generated hardly any hysteria and resulted in a government response that was not exactly aggressive (I’m not saying it should have been — I really don’t know what should have been done). My point is, do we really need to shun China and be angry at the Chinese people for this one?

Yet the virus has unusually dangerous characteristics and may merit the extreme measures to control it. I’m not sure. But I hope we’ll keep this in perspective relative to the thousands of deaths the US experiences every flu season from related though perhaps less severe viruses. And I pray that we’ll remember China and recognize the great burdens the Chinese people are bearing, and not add to their burdens unnecessarily. Keep China and the Chinese people in your prayers, and thanks to those who are taking steps to help rather than to blame.

By Jeffrey Lindsay|2020-02-10T12:55:17-07:00February 10th, 2020|Categories: China, Health, Safety, Shanghai, Society, Surviving, Travel tips|Tags: disease, virus|Comments Off

How to Schedule a Visit with the US Embassy/Consulate in China

If you are a US citizen living in China and need to meet with the US Embassy or Consulate to renew a passport or for other issues, you need to schedule an appointment online. Here’s the link: https://china.usembassy-china.org.cn/u-s-citizen-services/acs-appointment-system/.

There are five cities to choose from: the embassy in Beijing, and consulates in Shanghai, Chengdu, Guanzhou, and Shenyang.

Services offered include:
(1) applying for or renewing passports, as well as replacing lost or stolen passports;
(2) applying for a Consular Report of Birth Abroad (CRBA);
(3) notarial services; and
(4) marriageability affidavits.

In Shanghai, you will typically go to the Consulate office at Westgate Mall at 1038 West Nanjing Road, near the West Nanjing subway stop on Line 2. You’ll need to take an elevator up to the 8th floor above the mall. Be prepared for long lines, but if you have an appointment it will be OK.

For notary services, be sure to bring your passport and a wad of money. Each document you want notarized will cost your something like $50. Bet you thought your taxpayer dollars ought to cover that, right?

As the website indicates, no appointment is needed for some services:

Apply for Consular Report of Death Abroad (CRODA)
Report a passport lost/stolen when you are in urgent need to travel outside of China. Â Bring proof of pending travel to ACS office
Pick upÂ passport and/or Consular Report of Birth Abroad (CRBA) upon notification they are ready
Pick up Social Security checks or ask questions about Social Security benefits
Submit additional documents requested for a pending passportÂ application
Register to vote

The offices are busy but the service strikes me as very professional and well organized. Good luck!

By Jeffrey Lindsay|2019-11-24T01:12:20-07:00November 24th, 2019|Categories: China, Shanghai, Surviving, Travel tips|Tags: passports, US|Comments Off

Air conditioning repair in Shanghai

Be grateful for some of the overlooked workers in China who put their lives on the line everyday for our benefit. The people who carry out some seemingly basic services like window washing, air conditioning repair or installation, welding, and construction are often overlooked and looked down upon because these are jobs that don’t require advanced education and may not have high salaries. Many of the people doing these jobs come to China’s big cities as migrant workers from outside provinces, and may not fit in with local society. But they deserve a great deal of respect and gratitude.Â Something as seemingly mundane as an air conditioning repair may involve breathtaking skills and dangers most Westerners might not expect.

In the photo above, a daring worker has climbed out onto the ledge of our apartment building to repair a problematic air conditioner. He has a rope connected to a railing if he should fall, but I’m not sure the rope looks all that safe and wonder if the railing would hold. On a second occasion, the man came alone and I was the one holding his security line for a while. His life was in my hands for a few moments. I was humbled to realize that this good, hard-working man takes on deadly risks every day to help people have a service that he may not enjoy in his own dwelling place.

By Jeffrey Lindsay|2019-11-09T17:45:10-07:00November 9th, 2019|Categories: China, Safety, Shanghai, Society|Tags: jobs, labor, repairs|Comments Off

Surviving China Tip: The Glass in Your Bathroom May Not Be Safety Glass
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Surviving China Tip: The Glass in Your Bathroom May Not Be Safety Glass

China, Consumers, Housing, Products, Shanghai, Surviving, Travel tips

Surviving China Tip: The Glass in Your Bathroom May Not Be Safety Glass

From an earlier disaster: the remnants of a shattered shower that cut my wife’s foot when it failed as she simply tried to exit the shower.

As I write, I’m looking at three new cuts on my right foot that happened when my elbow gently bumped a glass shelf in the corner ofÂ my walk-in shower. The glass was unsecured and it only took a gentle bump to send it to the floor. When it shattered, fragments of glass went flying, 3 with enough force to cut my foot that was about 30 centimeters from the impact. One gash was about an inch long, while the other two were small puncture wounds. But none were welcome on a busy day like today.

In China, don’t assume that safety glass has been used in places where you would expect it. If there is something like a glass shelf in your shower, remove it if you can because when it breaks, you might be injured.

My wife had a more serious problem in a different apartment. One of the two sliding glass doors of the shower wouldn’t slide at all because the roller bearings supporting it were so old that one of the little rubber rollers it required was missing about half of the rubber. The landlord refused to repair the glass door and said it was still possible to move the other door, though it, too, was becoming rough for similar reasons. But she refused to spend any money to repair it. A few weeks layer, as my wife was trying to exit the shower, the door wouldn’t move normally. She grabbed the metal bar on the shower door and tried to slide the door open, at which point the entire door shattered. It crumbled as if it were made from some kind of safety glass, but there were still hundreds of sharp edges and her foot was badly cut. (As I said, be careful with anything glass in your bathroom or anywhere else. There could be danger a foot. Or both feet.)

When we reported this to the landlord, complete with photos of the shattered glass and her bleeding foot, we did not even get a “sorry!” in response. Her reply was that this was our fault and we would have to buy her a new glass door. We met later and after some firm negotiation, we got that down to just paying for half of the cost of the door. Plus she chewed us out for having thrown away the metal pieces from the shattered door, which added to the cost of the repair. We were out about $150. We could have gone to arbitration and easily wasted much more than $150 worth of wasted time and anxiety, perhaps with a victory, or more likely the kind of ruling that is favored in China: “Why don’t you two just split the difference? You guys pays pay $150.” We wanted to stay on friendly terms with this woman and chose not to fight — it’s often futile, anyway.

Incidentally, we spent a good deal of our own money to fix up the apartment belonging to that particular prior landlord. We paid to have an ugly living room painted in fresh white, bought new furniture, decorated it, etc. She was impressed with how much better it looked. Delighted, in fact. So delighted that she realized that her attractive refreshed apartment could be rented at a higher price than the good deal we had obtained when we moved in, so she announced that she was raising our rent by 30%. Ouch. We refused and moved out. Glad to go, though we loved the place and the complex it was in.

Our current landlord, though, is just wonderful. Very kind to us and very attentive, often brings us good food, and is a friend. But we are sad that her place is getting old and will require some serious repairs in the future for some of the things that we are just living with because we like her — things like corroded original water pipes under the floor that were replaced recently with a wild system of visible PVC tubes running between rooms. Probably not up to code, but we’ve been able to cope. Just wish the glass shelf had been made with safety glass!

This tip applies to apartments, hotels, and anywhere else there is glass that could break. Be careful here or in any part of the world. My bad for not removing the glass shelf before the accident!

By Jeffrey Lindsay|2019-09-03T22:06:39-07:00September 3rd, 2019|Categories: China, Consumers, Housing, Products, Shanghai, Surviving, Travel tips|Tags: bathrooms, glass, safety, showers|Comments Off

Accepting a Job in China? Some Questions to Ask (and an Exercise for English Teachers)
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Accepting a Job in China? Some Questions to Ask (and an Exercise for English Teachers)

Business, Career, China, Education, Housing, Safety, Society, Surviving, Travel tips

Accepting a Job in China? Some Questions to Ask (and an Exercise for English Teachers)

After nearly 8 years in China, I’ve met a lot of foreigners and heard many surprising stories of some of the challenges they face in their jobs, especially when working for Asian companies. In most cases, the employee made assumptions about their job and their employer based on their experience with Western companies. Others didn’t fully understand what was expected of them and what they would have to do. This can lead to pain, frustration, embarrassment, and financial loss. Please don’t make lots of assumptions and assume that everything will be like it is back home.

You need to ask a lot of questions! If you find yourself saying, “I’m sure it will be OK” or “I trust it will be fine,” you may have a problem. In a very foreign culture with different laws and different levels of compliance with those laws, it’s much better to be asking, “What could go wrong?” Some of the questions you might want to ask may seem a bit bizarre, such as “Do I need to bring my own mop?” It’s a fair question, though tongue-in-cheek in most cases, as explained below.

Here are some suggested questions to ask:

Can I see the contract(s) you want me to sign before I resign my current job and show up for work in China? Sometimes the “standard” contract your company will give you when you show up for work will be a shocker. You may find the salary you agreed upon is not what is in your contract, that the benefits that were promised are not in the contract, and that troubling provisions are in the contract, such as a rejection of many of the normal employee rights provided by China’s generous labor laws, and even a requirement that portion of your income will be withheld for some period of time and perhaps only given to you if certain goals are achieved that you may not be able to control and achieve on your own. When you ask about the benefits or other terms you have negotiated, the response may be, “Of course! But that’s just verbal. Trust us.” Realize that the HR person saying that may be totally sincere, but several years or weeks later he or she may be gone (HR turnover is intense in China) and the new person will not believe you when you bring up the verbal agreement that supposedly was made. Contracts may not always mean a lot in China, but verbal agreements with people who are no longer around mean even less.
Can you put that in writing? Don’t assume that any of the benefits and other terms you have negotiated will be put into writing in your contract. Be prepared for that, which is usually something that we gullible foreigners have not even imagined as a possible risk. I suggest that you insist that everything is in writing. At a minimum, have emails confirming the terms before you accept an offer and keep copies, copy other witnesses, etc., to create a paper trail, and have dated and signed printouts of those terms witnessed and notarized as a defense (get them notarized in China also, if you can, or at least signed by Chinese witnesses), but also realize that the paper trail may not do all that much for you if you don’t get those terms in the contract.
Will there be more than one contract to sign with potentially inconsistent, conflicting, or generally problematic terms? This is likely if you end up with a split income, as described below, or if you are a high-end employee subject to a non-compete agreement or other special terms in addition to a standard employee contract. The additional contract(s) may have terms that undermine or exacerbate portions of your basic contract, or that create serious problems in other ways. Be ready for careful analysis and outside legal guidance and recognize that you can propose alterations. The worse thing to do is say, “Well, I trust that it will be OK.” Remember, the key question is, “What could possibly go wrong?”
Will I have a legitimate work permit and a work visa? Sadly, many companies bring people here on a tourist visa and have them work illegally. This can get you detained, fined, and deported. If the company is not actively working to get documents needed for a visa long before you come to China, they may be planning to rely on your tourist visa, even if they promise they will get you a visa once here. Sadly, I know too many English teachers who get into awkward situations when some of the companies that bring them here don’t properly provide work visas for them. Sometimes the company tries their best but the Chinese side (a company or school) takes short cuts and put the teachers at risk. Ask lots of questions. If there is uncertainty, be sure to try out the bonus exercise I give at the end!
How will the taxes due to China be paid? Ex-pats are typically told that the company will handle all Chinese taxes. Make sure this is in writing. Also make sure the company will pay taxes on your full income, which leads to the next question:
Are you going to split my income to evade taxes? Sadly, some companies use a practice of splitting a foreign employee’s pay, with part of the salary being paid to a Chinese bank account, and another part being paid to a bank in the employee’s home country, typically using some foreign (non-Chinese) agency to wire money to the home country. That system is convenient for getting money to your home bank account, but the problem is that the employer typically doesn’t report the foreign income to China and only withholds Chinese taxes for the China income. Ex-pats generally don’t understand that taxes aren’t being paid on the foreign income when this happens, and it can be a devastating shocker to eventually learn what might have been going on and how much risk and gargantuan penalties you potentially face. There are cases where an employee in China may do genuine work for oversees entities that may justify offshore income, but you should check carefully into this matter and get legal advice before accepting split income arrangements. Do not risk getting into trouble in China, and do all you can to respect Chinese law. If you find your company is not respecting Chinese tax laws, it’s time to resign. For some good guidance, see these articles by Dan Harris at the China Law Blog: “China Expat Pay: Splitting with Hong Kong is 100% Illegal and 200% Dangerous (Part 1)” and Part 2.
Will you respect Chinese Labor Law or will my work contract say I have essentially no rights (e.g., no severance pay, etc.)? Some contracts say that there will be no benefits or rights except for what is mandatory under China’s labor laws. That means no severance pay, for example, and other potential disappointments.
When I leave, how much notice do you require? If you are asking me to give, say, three months of notice, will you respond to my resignation notice by exercising your right to terminate me with 30 days’ notice with no severance pay? Yes, this absolutely can and does happen, even for employees who have seemingly been loyal and valuable workers for many years. It’s an ugly way to treat an employee, but there are often incentives for some people in the company to lay off a certain number of people, so they might jump at the chance to turn a voluntary resignation into a lay-off that gets them credit for their own KPIs, so I’ve been told by a China expert. The employer will always retain the right to fire you with 30 days notice (some will give less and dare you to sue), so if you are asked to give more notice than that, point out that this is unfair and either change the contract to require 30 days or consider a provision that gives you compensation if they refuse to respect your advance notice and respond by giving you 30 days notice in return.
How much cash will I need to bring to get started with housing and everything else in China? Many people don’t understand that the company is not going to help you with housing at all or that at most they will provide some monthly stipend toward housing, but only after you have found your apartment and paid the huge fees and deposits required to get started, and then present your company with an official receipt for your first month’s rent. If you are renting, say, a 15,000 RMB/month apartment, you may have out-of-pocket expenses from paying your first month’s rent plus a deposit of two-months’ rent, plus a rental agent fee of 35% of a month’s rent, adding up to a little over 50,000 RMB, or nearly $7,400 in cash before you receive your first paycheck and long before you’ll get your first housing stipend for some portion of your monthly rent. It’s expensive to start working in China. Are you ready?
Will housing benefits and other benefits begin as soon as I start, or is there some minimum term of service required before they begin? Which ones actually begin on day one? And can you put that into writing? One friend relied on the promised housing stipend in selecting a nice apartment, more expensive than he might want if paying for it on his own, but only later found out that the significant housing benefit would only begin after several years of service. Ouch.
To begin my job in China, will you bring me through China customs in the normal legal way, or will I be smuggled in by, say, crossing a mountain along the Vietnam border? If your employer turns you over to a smuggling team and requires you to march through the jungle or scramble over a mountainous border to sneak into China, or even if you come through a legal port but are just whisked into China through a “special lane” without your documents being checked and entered into China’s system, you are entering illegally and will have a world of trouble to face, especially if your employer takes away your passport, making you almost like a slave. This usually doesn’t apply to people coming here to work for higher-end jobs that require college degrees, but often applies to those coming to be maids or “ayis,” as is the case for many women from the Philippines. They are often taken advantage of in many ways due to their lack of legal status and their fear of seeking legal protection when they are cheated or abused. Don’t enter China illegally!
Will my health insurance actually help if I need surgery? And will it help my family or just me? Health care is fairly inexpensive in China, unless you want care provided by Western-style clinics or hospitals. Even if you rely on less expensive local hospitals (I love Shanghai East and it’s inexpensive VIP clinic, for example), you may be disappointed with how little your corporate health insurance covers. And insurance packages usually just apply to the employee, but may offer an option to purchase a plan for your spouse or children. Learn early what you are getting, if anything.
Will I be required to work on Saturday and Sundays? Can you put it into writing that I will have my weekends free? Sometimes corporate leaders launch campaigns to increase productivity, or the appearance of productivity, by requiring employees to start coming in on Saturdays or weekends. That’s really hard on ex-pats who come here hoping to experience China. Hard to experience it when you are trapped in an office all week long. Those coming here to teach also often find that there are school shows and performances held on weekends that they are required to be at. Unexpected duties tend to crop up with little notice, after people have purchased plane or train tickets, or even during holidays. Keep your weekends free and try to get something in writing to that effect. Even then, you will see that big national holidays often involve turning a Saturday or Sunday into work days to add more vacation days to a holiday. This can be frustrating.
Will critical corporate announcements all be in Chinese? Will there be any translation help for me? Even large multinational companies will tend to have at least some important email and documents sent to employees in Chinese only, and many won’t take any pains to provide translation. If you are not a Chinese speaker, this can make life difficult. Learn Chinese, make friends with Chinese speakers who can help you, and find ways to cope.
What documents do I need to bring to get my work permit? The rules have evolved on this critical issue, but have long been surprising. For example, when I came in 2011, I learned that I needed to bring my ORIGINAL diploma from BYU. In the US, people often don’t care about the diploma. It’s just a pretty document that we don’t really care about, but it’s a big deal here. You may need to contact your school to get a notarized physical copy of your diploma to work in China. And there may be a number of other original documents you need: your wedding license, your birth certificate, a letter from your former employer, etc. One friend of mine is unable to get the promotion he has long deserved because the small college that issued his diploma long ago has failed and is no longer, making it impossible to get a physical diploma now. A disaster for him, I’m afraid.
Reporting for duty!

Do I need to bring my own mop or broom? OK, joking, of course, but there’s a point here: sometimes wonderful sounding jobs with lofty titles turn out to be painful and rather menial. You might think you are in charge of something major, and find out that in reality you are just mopping up after someone else. The best way to prepare is to talk to people in the company or who once worked for the company to understand what the job is really likely to involve. I talked with several former and current employees before making my decision, and that was really helpful, though I still had some surprises. But many pleasant surprises as well. I’ve had a wonderful 8 years here without too much mopping, and a lot of excitement that has swept me away at times.

No matter how much you try to pin things down, understand that things tend to change rapidly in China, so be prepared to be flexible. (Also be prepared to walk away if things turn out to be really shady.) In my case, for example, I was supposed to work here for one year, and then I would be brought back to the US to be part of a US expansion team. That sounded perfect. About one year later, as I wondered why I wasn’t hearing anything about the US expansion team, I asked around and learned through the grapevine that the U.S. expansion team had been fired and no longer existed, and all plans for my return to the US had been dropped. It was a surprise, but a very fortunate one in my case because one year would not have been long enough. Whew! I’m so grateful for that unexpected change. But in Asian companies, as many ex-pats have found, you may have to ask and inquire persistently to learn of these big changes or upcoming problems because communication to employees might not be a strong point of your particular company, nor will it be one of the KPIs for HR.

“What Foreigner?” An Exercise Useful for Some English Teachers

Now, for those coming here as English teachers, one of the jobs with a relatively high risk of trouble, here’s a physical exercise that may prepare you for your day-to-day work, especially if your company is not going to arrange for a legal work visa for you before you arrive. (If they tell you that all you need is a “student visa” and that you will be a student just doing “volunteer work” as a teachers, you might need this exercise, especially if you are being paid anything and especially if you are in a more developed city like Shanghai.) It’s a fun exercise, even a game, called “What Foreigner?” It’s something you should play a lot to be prepared so when you play it here for real, you’ll be ready. It takes 3 people to play, but you can get by with only two players if one does double duty.

You are the foreigner, and you need to begin by standing in a room in your home, school, church, or other facility with multiple rooms. We’ll call that facility “the school.” That room will be “the classroom.” You will hold a textbook or other objects that help you feel like you are in the middle of teaching a class. Act like you are teaching.

Have Friend #1 and Friend #2 go to the front door of the building. Friend #1 will step outside the door and pretend to be the police while Friend #2 will stay inside and pretend to be a school administrator. Have them wait a few minutes. When Friend #1 feels ready, he or she knocks on the door. Friend #2 looks through a window, peephole, or crack to see who it is, then turns and shouts toward you, “Police!” Friend #1 comes in and then begins walking to the classroom. As soon as you hear the shout, your job is to drop everything and escape out a back door or side door before you are spotted, and then to run as fast as you can until you are far from “the school.” Meanwhile, when Friend #1 arrives in the “classroom,” he or she asks, “Where is the foreigner?” Friend #2 then tries very hard not to laugh and says, with a sense of indignation, “What foreigner?”

Did you get out in time? Whew! Congratulations! Now do it again. Best to practice now so you’ll be ready. And yes, for those who don’t get US-style humor, I am making a joke here. I do not support violation of law in China, and recommend that you do not accept illegal work in China! Those who end up teaching in questionable English programs, working illegally as teachers, end up in lots of difficult situations where they have to run or pretend to be students. If you are teaching a class for pay, you are working and need a work visa. China is increasingly rooting out these illegal operations. I suggest you don’t take risks and strive to diligently adhere to Chinese law.

Even if you do all you can to be legal and everything looks good, you may find that your company or agency has done something illegal that may affect you. For example, a couple of teachers we knew thought they were completely legal, teaching for pay with a legal work permit in Shanghai, but it turns out that a local agency had falsified their application for a work permit in order to meet Shanghai’s strict requirements and claimed that they had advanced degrees and more years of experience than they really had, which is a serious crime that can get you deported. When the US company that brought them here as teachers learned of this, they realized that the couple was in grave danger and had to rush them out of the country without even a chance to say good-bye to their students. If you can, look at the documents being submitted for your work permit and visa and make sure that nothing has been falsified.

If you are coming to China, congratulations! It’s the most exciting and wonderful place I’ve ever been. Working here has been the most exciting (though occasionally the most painful and frustrating) part of my career so far. But ask lots of questions and do all you can to be legal and to respect China’s laws.

By Jeffrey Lindsay|2019-11-09T17:46:48-07:00April 13th, 2019|Categories: Business, Career, China, Education, Housing, Safety, Society, Surviving, Travel tips|Tags: contracts, employment, jobs, law, passports, taxes, visas, work permits|Comments Off

Offered a Good Job in China? Congrats! Now, Can You Afford It? (Bring a Wad of Cash!)

So you’ve got a great job offer in China? Way to go! But can you afford it? More specifically, can you afford the large up-front expenses that many foreigners face when they are required to arrange their own housing. That usually doesn’t apply to school teachers living on campus or to many big executives living in palaces (expensive villas), but for many of us, the company or institution we work for requires us to find our own housing (though they may provide a hotel for a couple of weeks to give you time to find a place to rent). Renting an apartment involves enormous expenses. Are you ready?

Rent in China’s large cities is quite high. A small place may still cost you $1,000 a month (6800 RMB) but it can easily be $3,000 a month if it’s in a nice location with, say, three bedrooms. Even if your company reimburses you for rent or for part of your rent, the process of renting involves large up-front costs that you need to pay. Rental agreements usually require a deposit of two months of rent, plus paying up front for your first three months of rent, and then paying 35% of one month as a fee to the real estate agent. You can be broke before you ever move in if you aren’t prepared. Get details and make sure you know what your company will cover and what they won’t.

You may be able to negotiate a reduced deposit of just one month, but even if you do, you need to have a wad of cash of enough funds in your Chinese bank to pay 43,500 RMB for a 10,000/month apartment. That’s over $6,000. Your credit cards won’t be accepted.

Know what you’re up against before you come!

By Jeffrey Lindsay|2019-01-11T06:42:51-07:00January 11th, 2019|Categories: China, Consumers, Finances, Housing, Shanghai, Surviving|Comments Off

When Cabbies Dump You

Though most of my cab rides in Shanghai turn out well, occasionally something goes sour. In the heat of the moment, it’s easy to make some serious mistakes, just like I did today.

My cab ride had just begun when I pulled a beloved Chinese epic sci-fi novel from my bag to begin some precious reading time. Suddenly the cabbie saw something come in on his cell phone and turned around and told me that he was sorry, but I had to get out so he could go get another customer. Had I been better prepared, I would have said no, I’m your customer, and please take me to my destination. This might not work and sometimes could lead to a big argument or even physical fight, but I should have resisted or at least have him take me a little closer to my destination or to the nearest subway or something better than what I did, which was 1) give up easy and 2) make a dangerous and actually illegal exit in the middle of an intersection.

“Rats,” I thought, when he told me to get out. I resigned myself to his rejection, but was actually too cooperative. He was in the left lane at an intersection at a red light. There were just seconds before it would be green, so I needed to hustle. It wasn’t a busy intersection, but still, it was wrong to let him force me out there. As I hastily prepared to open the right door, I was focused on traffic coming along the right side of the car, not wanting to be hit by a motorcycle or other vehicle. This was stupid and dangerous, for I at least should have insisted that he first drive me to a safe spot.

I got out safely and he drove off. Only later would I realize that he had my beloved book, with many markings and notes, sitting unloved in the back of his car. I was only 75 pages into it, but it was a painful loss, and I had no way to reach him because he didn’t charge me for the brief ride, meaning I didn’t get a receipt.

Rule #1 of cab rides is NEVER GET OUT WITHOUT A RECEIPT. The main reason for this is in case you leave something behind, you can use the receipt to call the company and identify the driver and get your goods back in most cases. (It also is essential if you get double billed if you got the cab through WeChat, paid by cash, but then also got an automated WeChat bill.) But a corollary to that rule is if you are being booted out without a receipt, get a photo of the driver’s ID posted in the front of the cab and a photo of his license plate number in case you need that info later, either to recover lost goods or, as in this case, to also report illegal dumping. And you might as well ask for an old spare receipt (fapiao) as partial compensation for your lost time–they usually have several.

Of course, if you have your wits about you enough to get the ID and license plate, you will also be thinking about not losing goods and looking carefully before you step out of the car. But this requires being smart enough to step out of the car in a safe spot where you can take the time to slowly gather your things, check the seat carefully, and gracefully exit instead of just making a made dash to get out of an intersection while someone drives off with your book (or cell phone, wallet, passport, etc.).

Recapping, when a driver wants to dump you for another customer:

Know that this is illegal and try to insist on your rights. If he won’t respect your request, take your time. Ask for an explanation. Repeat your request. Don’t feel obligated to jump out right away. No need to reward his bad behavior. But stay friendly and don’t provoke a fight.
Take a photo of his ID (this will alert him that you have the power to report him, and that may change his tune on the spot). Ask for a spare fapiao as well. Make sure you have the phone number of his company. When you get out, also get a photo of the license plate and maybe of him as well (leaving a door open for a while can buy you time for this so he doesn’t speed off immediately).
Take your time to gather your stuff. Don’t leave things behind! Always ask yourself: is there anything in the trunk? On the floor? Anything that could have slipped from my pockets?
Never get out at an unsafe and inconvenient location. If he won’t take you to your destination, insist that he drive you forward to the next subway station or at least to an area where it might be easier to catch a cab, and make sure he takes you to a safe spot to exit.

By knowing your rights and being assertive/annoying in a calm, friendly way, you may help him realize that cabbie crime doesn’t pay, maybe making things easier for the next customer. But don’t provoke him into extreme anger. Some cabbies have assaulted passengers, so be careful. You can just roll over like I did — but don’t do it in a rush, for you are more likely to lose things and have an accident. Take your time and insist on safety.

For me, the loss is mostly recoverable, for I just ordered a new copy of the book on Amazon.cn, and will have it back in my hands tomorrow. Taxi losses can be much more painful than that, so be careful and keep your wits about you.

By Jeffrey Lindsay|2018-11-05T04:45:26-07:00November 5th, 2018|Categories: China, Safety, Shanghai, Surviving, Travel tips|Tags: cabbies, scams, taxis|Comments Off

Routine Physical Exams in China

If you work for a large company in China, you may be given a routine physical checkup every year through a local Chinese clinic. I’ve been through several versions of this in my years in China. The process can be a bit overwhelming, but it’s certainly efficient.

In these exams, you and many dozens of other people will be herded from one station to another where a “specialist” will perform there duty. Blood test, urine sample reception, eye exam, ear exam, ultrasound inspection of your heart and neck, cardiograph, magic “qi” measurement with electrodes, blood pressure check, etc. It can go pretty quickly and seems very efficient. However, it’s not exactly perfect.

In my last exam at Ciming Clinic on Hongqiao Road near Yili Road, the ear specialist looked into both ears and said all was well. On to the next station. But in reality I had severe ear wax in both ears that was already causing some hearing loss and soon would be causing ringing in one ear. When I had a real ear doctor look at it, he was amazed at how much wax there was. It took two treatments by a good ear doctor at Shanghai East Hospital to get most of it out, and a third treatment by an excellent German specialist at the Gleneagle Clinic at the Tomorrow Center at People’s Square to finish the extraction. How on earth did the Ciming ear specialist not notice and inform me of the problem? I don’t think he even looked when he stuck the ear probe in my ear.

Others have made similar complaints. Basic things are missed. The process is useful for basic indicators, but don’t assume that all is well if the results are positive, or that some of the problems they point to are real. Some of the tests may be unnecessary or even weird, sometimes apparently trying to justify a strange piece of equipment someone acquired. So see a real doctor afterwards to discuss your results and talk about your health. In the mass production operations, generally nobody will ask you basic questions that should be the beginning of a health exam. Good luck!

By Jeffrey Lindsay|2018-09-26T16:43:30-07:00September 26th, 2018|Categories: China, Consumers, Health, Shanghai, Surviving|Comments Off

A Grieving Mom in Shanghai Learns Her Son May Not Have Pancreatic Cancer After All: Misuse of the CA-19-9 Antigen Test
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A Grieving Mom in Shanghai Learns Her Son May Not Have Pancreatic Cancer After All: Misuse of the CA-19-9 Antigen Test

China, Consumers, Education, Health, Safety, Surviving

A Grieving Mom in Shanghai Learns Her Son May Not Have Pancreatic Cancer After All: Misuse of the CA-19-9 Antigen Test

A few days ago a grieving mom in Shanghai, a good friend of ours, shared some tragic news with me: her teenage son had pancreatic cancer, one of the worst cancers. Her son was likely to die soon, if the doctor was correct. Only about 20% of pancreatic cancer patients live past 5 years. She was almost overcome with grief and had been crying for a couple of days. But even though she had gone to an expensive hospital that caters to foreign clients, she wasn’t sure she should trust the doctor. The mother called me to see if I knew where she could turn for help. She didn’t know that one of my sons happens to be a doctor treating cancer at a leading US clinic.

I received a photo of the lab report for the boy and sent it to my son. The physical results reported that a scan of internal organs showed no unusual problems indicative of cancer. There were no other symptoms, just a slightly elevated CA-19-9 antigen level, 45 instead of a desired maximum of 37.

My son was greatly disappointed that the doctor would create such needless panic by telling the mom that her son probably had pancreatic cancer. My son explained that the CA-19-9 test is not supposed to be used for diagnosing cancer on its own. Absent other symptoms of cancer, its predictive power for cancer is less than 1%, he said, and when he learned that the son was just a teenager, he said it’s even less likely to be pancreatic cancer because that disease is almost unheard of in young people. The mother’s grief was turned to relief.

I later found scientific publications confirming what my son had said. For example, seeÂ K. Umashankar et al., “The clinical utility of serum CA 19-9 in the diagnosis, prognosis and management of pancreatic adenocarcinoma: An evidence based appraisal,” Journal of Gastrointestinal Oncology, 2012 Jun; 3(2): 105â€“119; doi: 10.3978/j.issn.2078-6891.2011.021:

CA 19-9 serum levels have a sensitivity and specificity of 79-81% and 82-90% respectively for the diagnosis of pancreatic cancer in symptomatic patients; but are not useful as a screening marker because of low positive predictive value (0.5-0.9%).

Other articles indicate that diabetics, such as this young man, can have inflated CA-19-9 values (this applies at least for Type 2 diabetes–I’m not sure if CA-19-9 artifacts from Type 1 diabetes has been investigated), one of many possible alternative causes of elevated CA-19-9 values. Alternative causes for the elevated test result do not appear to have beenÂ considered by the doctor who terrified a mom by declaring that it was probably pancreatic cancer. Again, the test can be useful in tracking the progress of treatment of a known cancer, but should not be used to diagnose cancer in the absence of other evidence, as in this case.

Keep this in mind when you have your physical in China. Don’t panic if a doctor reports that you might have pancreatic cancer based on a blood test result alone. Get a second opinion and understand why that value may be high, but don’t panic. Physical testing here can often include too many unnecessary tests in search of phantom problems that may be listed in your report by people who aren’t necessarily qualified to make such proclamations.

The family still needs to be cautious and follow up on the possible causes of the inflated test result, but it was only slightly elevated unlike the much higher scores that I’ve seen reported in patients who actually do have pancreatic cancer.

I am so grateful that my son was able to help bring peace to a mother who had been crying for a couple of days over the “fake news” she received from a generally good hospital. I suggest that here or anywhere else you should be open to the possibility that some doctors don’t know what they are talking about. And of course, that can apply to what I’ve said here. Do your homework, ask questions, and be cautious about what others declare.