Changes in pharmaceutical market and “fake drug” problem in the Qing period / 의사학

Since ancient times, fake drugs have been on the market in Chinese society. However, during the Ming-Qing Dynasty, this problem intensified as the size of the pharmaceutical market grew, the collection and distribution structure of pharmaceutical products became increasingly complex, and the phenomenon of separation between the prescription and distribution of drugs advanced. Additionally, the government did not manage the manufacturing or quality of drugs and there was no law or institution designed to solve the problem of fake drugs. Furthermore, social opinion also criticized the widespread problem of fake drugs, and patients and doctors had to rely on various pharmacognostic books and medical knowledge to find reliable drugs in the drug market.Meanwhile, as merchants participated and invested commercial capital in the pharmaceutical industry, large reputable pharmacies began to emerge in large cities and produced drugs. With the commercialization of the pharmaceutical market, the public gained interest in drugs and consumed drugs produced by these pharmacies. Moreover, there were frequent problems in the market as fake drugs imitating popular drugs were distributed and the names of famous pharmacies were stolen. Although fake drugs were a universal social problem, the Qing government was reluctant to strictly control them tried to solve this issue by enforcing banning and punishment through local governments. Prominent pharmacies filed several lawsuits against the government over the theft of fake drugs and drug names. They also advertised the legitimacy and authenticity of drugstore to the public and customers.Doctors and merchants responded to the problem of fake drugs by following occupational morality, developing drug discrimination, cracking down on organizational discipline, filing complaints with government offices, and advertising their authenticity. However, the fake medicines did not easily disappear despite such a response, as there was no state control or legislation. Evidently, the pharmaceutical market was already highly commercialized and its structure were complex. Moreover, the financial benefits of fake drugs, competition in the pharmaceutical market, and public demand for drugs with similar effects at low prices also affected the popularity of fake drugs. Hence, the distribution of fake medicine in the Qing society can be seen as a phenomenon of separation between the prescription and distribution of drugs, commercialization and consumption of drugs, and competition on the medical market.

Changes in pharmaceutical market and “fake drug” problem in the Qing period / 의사학

Since ancient times, fake drugs have been on the market in Chinese society. However, during the Ming-Qing Dynasty, this problem intensified as the size of the pharmaceutical market grew, the collection and distribution structure of pharmaceutical products became increasingly complex, and the phenomenon of separation between the prescription and distribution of drugs advanced. Additionally, the government did not manage the manufacturing or quality of drugs and there was no law or institution designed to solve the problem of fake drugs. Furthermore, social opinion also criticized the widespread problem of fake drugs, and patients and doctors had to rely on various pharmacognostic books and medical knowledge to find reliable drugs in the drug market.Meanwhile, as merchants participated and invested commercial capital in the pharmaceutical industry, large reputable pharmacies began to emerge in large cities and produced drugs. With the commercialization of the pharmaceutical market, the public gained interest in drugs and consumed drugs produced by these pharmacies. Moreover, there were frequent problems in the market as fake drugs imitating popular drugs were distributed and the names of famous pharmacies were stolen. Although fake drugs were a universal social problem, the Qing government was reluctant to strictly control them tried to solve this issue by enforcing banning and punishment through local governments. Prominent pharmacies filed several lawsuits against the government over the theft of fake drugs and drug names. They also advertised the legitimacy and authenticity of drugstore to the public and customers.Doctors and merchants responded to the problem of fake drugs by following occupational morality, developing drug discrimination, cracking down on organizational discipline, filing complaints with government offices, and advertising their authenticity. However, the fake medicines did not easily disappear despite such a response, as there was no state control or legislation. Evidently, the pharmaceutical market was already highly commercialized and its structure were complex. Moreover, the financial benefits of fake drugs, competition in the pharmaceutical market, and public demand for drugs with similar effects at low prices also affected the popularity of fake drugs. Hence, the distribution of fake medicine in the Qing society can be seen as a phenomenon of separation between the prescription and distribution of drugs, commercialization and consumption of drugs, and competition on the medical market.

Effects of garlic intake on cancer: a systematic review of randomized clinical trials and cohort studies

BACKGROUND/OBJECTIVES@#Due to the rapid increase of global cancer incidence and mortality and a high level of interest in cancer prevention, a systematic review of garlic intake and cancer risk is needed. @*SUBJECTS/METHODS@#We implemented a systematic review to examine the effects of varying levels of garlic intake on cancer. We conducted comprehensive literature searches in three electronic databases (MEDLINE, Embase, and Web of Science) for studies published between database inception and July or September of 2018. Two investigators independently screened abstracts and full-texts, extracted data, and assessed risk of bias (RoB). A total of one medium-quality randomized controlled trial (RCT) and 13 cohort studies graded as high RoB were included. @*RESULTS@#The 1-year follow-up results from a RCT showed that a significant decrease in the number and size of colorectal adenomas among participants with colorectal adenomas who received high-dose aged garlic extract (AGE) compared with those who received low-dose AGE (P < 0.05). The results of prospective observational studies provided inconsistent associations of colorectal cancer risk with garlic supplements and garlic intake as food. @*CONCLUSIONS@#In summary, the AGE was effective in reducing the number and magnitude of colorectal adenomas in one RCT, but there were inconsistent associations between garlic intake and colorectal cancer in cohort studies. Therefore, we could not draw a firm conclusion regarding the effects of garlic on cancer, because the current strength of evidence is inadequate due to a lack of number of high-quality RCTs.

Clinical Course and Outcomes of 3,060 Patients with Coronavirus Disease 2019 in Korea, January–May 2020

Background@#The fatality rate of patients with coronavirus disease 2019 (COVID-19) varies among countries owing to demographics, patient comorbidities, surge capacity of healthcare systems, and the quality of medical care. We assessed the clinical outcomes of patients with COVID-19 during the first wave of the epidemic in Korea. @*Methods@#Using a modified World Health Organization clinical record form, we obtained clinical data for 3,060 patients with COVID-19 treated at 55 hospitals in Korea. Disease severity scores were defined as: 1) no limitation of daily activities; 2) limitation of daily activities but no need for supplemental oxygen; 3) supplemental oxygen via nasal cannula; 4) supplemental oxygen via facial mask; 5) non-invasive mechanical ventilation; 6) invasive mechanical ventilation; 7) multi-organ failure or extracorporeal membrane oxygenation therapy; and 8) death. Recovery was defined as a severity score of 1 or 2, or discharge and release from isolation. @*Results@#The median age of the patients was 43 years of age; 43.6% were male. The median time from illness onset to admission was 5 days. Of the patients with a disease severity score of 3–4 on admission, 65 (71.5%) of the 91 patients recovered, and 7 (7.7%) died due to illness by day 28. Of the patients with disease severity scores of 5–7, 7 (19.5%) of the 36 patients recovered, and 8 (22.2%) died due to illness by day 28. None of the 1,324 patients who were < 50 years of age died; in contrast, the fatality rate due to illness by day 28 was 0.5% (2/375), 0.9% (2/215), 5.8% (6/104), and 14.0% (7/50) for the patients aged 50–59, 60–69, 70–79, and ≥ 80 years of age, respectively. @*Conclusion@#In Korea, almost all patients of < 50 years of age with COVID-19 recovered without supplemental oxygen. In patients of ≥ 50 years of age, the fatality rate increased with age, reaching 14% in patients of ≥ 80 years of age.

Assessment of relationship between the use of household products and atopic dermatitis in Seoul: focused on products with associated risks

The purpose of this study was to evaluate the relationship between the use of certain household products (HPs) at home and atopic dermatitis (AD) in adults. The study was conducted on 1,500 households in Seoul, South Korea. We obtained information on general characteristics, the use of HPs, and AD through an online panel survey in July 2018. HPs were selected as 23 kinds of products with associated risks that are management targets of the Ministry of Environment. The international study of asthma and allergies in childhood was used for the AD questionnaires. Logistic regression analysis was used to identify AD affected by the use of HPs. Average number of used HPs was 13.44 out of 23, and average usage frequency of HPs was 3.52 times a month at home in Seoul for the last 1 year. Compared with subjects with a low number of HPs used (reference), subjects with a high number of used HPs (4th quartile) were more likely to have lifetime diagnosis of AD (odds ratio (OR) = 1.77, 95% confidence interval (CI); 1.23-2.54), symptoms of AD in the last 12 months (OR = 2.66, 95% CI; 1.92-3.70), and treatment of AD in the last 12 months (OR = 2.37, 95% CI; 1.48-3.80). Compared with subjects with a low HPs usage frequency (reference), subjects with a high HPs usage frequency (4th quartile) were more likely to have lifetime diagnosis of AD (OR = 1.88, 95% CI; 1.31-2.70), symptoms of AD in the last 12 months (OR = 2.14, 95% CI; 1.54-2.96), and treatment of AD in the last 12 months (OR = 2.23, 95% CI; 1.39-3.60). Therefore, the use of HPs was significantly associated with AD. The findings of this study might be useful as basic data for managing allergic diseases and establishing preventive measures.

Neighborhood Deprivation and Unmet Health Care Needs: A Multilevel Analysis of Older Individuals in South Korea

OBJECTIVES: In this study the relationship between neighborhood deprivation and the unmet health care needs of elderly individuals (≥ 65 years) was examined. Some previous studies suggested that neighborhood characteristics affect access to health care, yet research on the unmet needs of older individuals is limited. METHODS: Multilevel logistic regression analysis was used to assess the relationship of neighborhood-level factors with unmet health care needs due to costs, adjusting for individual-level factors, in individuals ≥ 65 years in the 2017 Korean Community Health Survey (n = 63,388). RESULTS: There were 2.6% of elderly individuals who experienced unmet health care needs due to costs. Following adjustment for individual and neighborhood characteristics, the neighborhood deprivation in urban areas was found to have an inverse association with unmet needs (odds ratio = 0.50; 95% confidence interval = 0.24–1.06) for the most deprived quartile versus the least deprived quartile). However, in rural areas neighborhood deprivation was not a significant variable. Among the individual-level variables, household income was one of the strongest correlates with unmet needs in both urban and rural areas. CONCLUSION: The present findings suggest that targeted policy interventions reflecting both neighborhood and individual characteristics, should be implemented to reduce the unmet health care needs of elderly individuals.

Social Perceptions of Quack in Qing Dynasty and Its Transformation in the Late Qing Period / 의사학

“Yong-yi” means “quack” in English, which generally refers to a doctor who does not have good medical skills. In the Ming and Qing dynasties in China, various criticism about “Yong-yi” became popularized, and by the late Qing period, “quacks” had become a serious social issue. The theory of traditional Chinese medicine was developed during the Ming and Qing dynasties, and local medical resources also increased. Moreover, the prevalence of medical book publishing led to the openness and generalization of medical knowledge. As a result, not only the number of doctors increased, but also the number of doctors who lack medical knowledge and clinical experience increased. However, at the outset, “Yong-yi” did not only mean doctors with poor medical skills. “Yong-yi” also reflected conflicts and contradictions between doctors. Doctors consistently criticized quacks in an attempt to maintain their identity as a “good” doctor or a Confucian doctor. In this sense, “Yong-yi” was used among physicians as an expression of discrimination and exclusion. The concept of “quackery” was also determined by the relationship between patients and doctors. In general, itinerant doctors, midwives and shaman doctors were regarded as “Yong-yi”; however, they served the medical needs of various patients. Thus, to some extent, “Yong-yi” were also useful medical resources. On the contrary, in certain situations, “shiyi,” physicians who serviced a family for generations and were generally believed to be reliable and as trustworthy doctors, were also labelled as quacks, especially when the patient did not trust them or was not satisfied with the treatment. Therefore, doctors' thoughts about “Yong-yi” did not always coincide with patients' thoughts about “Yong-yi.” However, by the late Qing period, the description of quacks in media reports found a singular connotation, and the divergent social image of quacks disappeared. By this time, quacks were uniformly described as ignorant and irresponsible Chinese medicine practitioners. Specifically, in one murder case in which a “Yong-yi” was accused as the murderer, the report unilaterally reported the patient's claims. Consequently, Chinese medicine practitioners who failed in their treatment of patients became labeled as “quack” doctors. In newspaper reports, “Yong-yi” no longer simply referred to individual cases of “quacks” but had come to represent the entirety of the Chinese medicine practitioner community. On the contrary, Western medical doctors who replaced the status of traditional doctors were positively portrayed. Pictorials also had similar perspectives with newspapers, supporting the narrative of the news with ironic drawings and articles. Overall, media reports regarding “Yong-yi” did not focus on reporting facts, but they had the purpose of making quacks a serious social problem.

Assessment of relationship between the use of household products and atopic dermatitis in Seoul: focused on products with associated risks

The purpose of this study was to evaluate the relationship between the use of certain household products (HPs) at home and atopic dermatitis (AD) in adults. The study was conducted on 1,500 households in Seoul, South Korea. We obtained information on general characteristics, the use of HPs, and AD through an online panel survey in July 2018. HPs were selected as 23 kinds of products with associated risks that are management targets of the Ministry of Environment. The international study of asthma and allergies in childhood was used for the AD questionnaires. Logistic regression analysis was used to identify AD affected by the use of HPs. Average number of used HPs was 13.44 out of 23, and average usage frequency of HPs was 3.52 times a month at home in Seoul for the last 1 year. Compared with subjects with a low number of HPs used (reference), subjects with a high number of used HPs (4th quartile) were more likely to have lifetime diagnosis of AD (odds ratio (OR) = 1.77, 95% confidence interval (CI); 1.23-2.54), symptoms of AD in the last 12 months (OR = 2.66, 95% CI; 1.92-3.70), and treatment of AD in the last 12 months (OR = 2.37, 95% CI; 1.48-3.80). Compared with subjects with a low HPs usage frequency (reference), subjects with a high HPs usage frequency (4th quartile) were more likely to have lifetime diagnosis of AD (OR = 1.88, 95% CI; 1.31-2.70), symptoms of AD in the last 12 months (OR = 2.14, 95% CI; 1.54-2.96), and treatment of AD in the last 12 months (OR = 2.23, 95% CI; 1.39-3.60). Therefore, the use of HPs was significantly associated with AD. The findings of this study might be useful as basic data for managing allergic diseases and establishing preventive measures.

Assessment of relationship between the use of household products and atopic dermatitis in Seoul: focused on products with associated risks

The purpose of this study was to evaluate the relationship between the use of certain household products (HPs) at home and atopic dermatitis (AD) in adults. The study was conducted on 1,500 households in Seoul, South Korea. We obtained information on general characteristics, the use of HPs, and AD through an online panel survey in July 2018. HPs were selected as 23 kinds of products with associated risks that are management targets of the Ministry of Environment. The international study of asthma and allergies in childhood was used for the AD questionnaires. Logistic regression analysis was used to identify AD affected by the use of HPs. Average number of used HPs was 13.44 out of 23, and average usage frequency of HPs was 3.52 times a month at home in Seoul for the last 1 year. Compared with subjects with a low number of HPs used (reference), subjects with a high number of used HPs (4th quartile) were more likely to have lifetime diagnosis of AD (odds ratio (OR) = 1.77, 95% confidence interval (CI); 1.23-2.54), symptoms of AD in the last 12 months (OR = 2.66, 95% CI; 1.92-3.70), and treatment of AD in the last 12 months (OR = 2.37, 95% CI; 1.48-3.80). Compared with subjects with a low HPs usage frequency (reference), subjects with a high HPs usage frequency (4th quartile) were more likely to have lifetime diagnosis of AD (OR = 1.88, 95% CI; 1.31-2.70), symptoms of AD in the last 12 months (OR = 2.14, 95% CI; 1.54-2.96), and treatment of AD in the last 12 months (OR = 2.23, 95% CI; 1.39-3.60). Therefore, the use of HPs was significantly associated with AD. The findings of this study might be useful as basic data for managing allergic diseases and establishing preventive measures.