By Adam Jourdan
SHANGHAI (Reuters) - For student Wei Zexi, the lure of a miracle cure was hard to resist: he was dying from a rare cancer and a well-known Beijing hospital was offering treatment with an 80 percent chance of success and no side effects. It was, the hospital said, the ideal choice.
There was a problem: The military-run hospital did not have regulatory approval to offer the immunotherapy course it sold to Wei at a steep fee. The treatment itself - while promising - is widely considered by global cancer specialists to be at the experimental stage.
Wei died at the age of 21, and the outcry his case provoked has thrown a spotlight on hundreds of hospitals run by branches of China's armed forces.
Reuters’ interviews with patients, doctors and lawyers show that military-run medical facilities across the country regularly provide – and advertise – treatments that are not approved by the Chinese Health Ministry.
Among a sample of around two dozen of the hundreds of military hospitals around China, Reuters found roughly four-fifths offered some kind of immunotherapy on their websites. Some of them said they had used it to treat thousands of patients.
The ready availability of unapproved treatments at major hospitals around China underlines serious regulatory blind spots in a healthcare system treating 1.4 billion people and which is the world’s second largest drugs market behind the United States.
Military authorities have acknowledged fault at the Second Hospital of Beijing Armed Police Corps, where Wei was treated. They would not comment on practices at other facilities. The hospital itself did not respond to requests for comment.
China's health ministry said that, while immunotherapy had great potential, there were still question marks around safety and effectiveness. It has never been approved for commercial clinical use in China, the ministry said in a statement to Reuters. Immunotherapy is classed as a category three treatment, meaning it is “ethically problematic", "high risk" or "still in need of clinical verification".
However, China's health ministry has little oversight over military hospitals because its jurisdiction largely concerns the civilian health system. The military facilities come under the control of the armed forces.
Lawyers involved in the healthcare sector say the combination of military oversight and the frequent civilian use create gray areas about whether national laws apply and how they should be enforced.
The health ministry would not comment on the wider issue of regulation of military hospitals. The defense ministry referred Reuters to a statement made at a regular news briefing in May in which it acknowledged the hospital in the Wei case had acted illegally. It said oversight of such hospitals would be improved, but did not say how.
The Reuters review also showed that many of the hospitals surveyed offered patients stem cell therapy, a treatment which is only approved in China for clinical trials. The health ministry said in August last year research into stem cells to treat or prevent diseases was developing fast, but it was concerned some hospitals were violating government regulations to offer such treatments to boost profits.
Shanghai-based Yuan Liming, a partner at law firm Jones Day, said there is another problem: military hospitals often allow third-parties to operate clinics within the hospital grounds. The health ministry told Reuters it was illegal for hospitals to sub-contract certain therapies to private clinics and that it would investigate any public hospitals doing so. "It clearly violates Chinese law, but it's common," said Yuan.
Some military hospitals are regarded, alongside university hospitals, as among the country's best medical facilities.
They are overseen by military bodies such as the People's Armed Police, a paramilitary force that answers to the powerful Central Military Commission headed by President Xi Jinping.
"Military hospitals, generally speaking, are not subject to administration and monitoring by the health ministry, but are subject to supervision by the Central Military Commission," said Yuan.
There is no indication any of the military hospitals contacted by Reuters had special exemption to offer immunotherapy treatment. The Second Hospital of Beijing Armed Police Corps was not approved.
Another hospital, the General Hospital of Shenyang Military, said on its website it treated more than 1,600 people with a number of immunotherapy treatments. No one at the hospital was willing to comment.
Others, including the 302 Military Hospital of China in Beijing, the 101st People's Liberation Army in Wuxi, the Nanjing General Hospital and People's Liberation Army No. 202 Hospital said on their websites they had used immunotherapy treatment.
Repeated calls to the Nanjing hospital and the No. 202 hospital went unanswered. The 302 Military hospital and the 101st PLA hospital said they had stopped offering the therapy and declined to comment further.
Gong Xiaoming, a senior Beijing-based gynecologist and former physician at the prestigious Peking Union Medical College Hospital, said the main problem was the small private clinics used by military hospitals. Without tighter regulation the illegal provision of immunotherapy and other banned treatments would likely continue, he said.
Such clinics, though separate businesses, often operate on a hospital's premises and under its license, putting them in another regulatory gray area, say lawyers and doctors.
"It's like guerrilla warfare," said Gong. "Every few years they change location or change name and emerge once more."
In Wei's case the hospital had contracted Shanghai-based private immunotherapy technology company Shanghai Claison.
Claison was not available for comment and a guard who answered the phone said everyone had "gone on holiday".
Other patients complain of being given pricey and unnecessary treatments by military hospitals.
A receptionist at a steel trading company, who asked to be identified only by her family name Xu, went to the People's Liberation Army (PLA) 411 Hospital in Shanghai in 2014 seeking treatment for ovarian cysts, a common condition.
The doctor suggested infra-red therapy and she underwent three days of treatment at 700 yuan ($105) per session, eventually spending a total of 8,000 yuan.
Concerned with the ongoing treatment, she went to another doctor and was told she had only needed a small surgical procedure costing 500 yuan. That treatment was successful, she said.
"Everyone trusts doctors," Xu, 25, told Reuters. "With this infrared therapy, they make you do it every day, and every day they charge you hundreds of yuan. It's all about making money. "The PLA 411 Hospital said it was not aware of the case and hadn't heard of any other patient complaints.
Before he died, Wei accused the Second Hospital of Beijing Armed Police Corps, and the search engine Baidu Inc that he had used to find it, of misleading advertising and disseminating false medical information.
China's health ministry said an investigation after Wei's death revealed "serious problems" at the hospital. It was found to have been illegally working with a private healthcare partner, unlawfully advertising services and using unauthorized clinical technology, the ministry said.
The hospital did not respond to repeated calls seeking comment.
China's cyberspace regulator has since imposed limits on healthcare adverts carried by Baidu, which controls 80 percent of the Chinese search market, and the company's CEO has called on employees to put values before profit.
Baidu, which has since cut its revenue forecast, has said it accepted the regulator's decision and it would implement the requirements placed on it following the investigation.
As with other forms of immunotherapy the treatment given to Wei, known as "DC-CIK", uses the patient's own immune system to fight disease.
Archived articles and posts on the official website of the hospital that treated Wei, currently blocked, describe the treatment as well-proven. One, dated Aug. 12, 2013, said the success rate was more than 80 percent.
In another article, dated Sept. 26, 2015, it wrote that immunotherapy treatment had saved a late-stage cancer patient who had been given six months to live. Another patient with kidney cancer was completely cured.
Doctors questioned by Reuters, however, said the claims made by Wei's hospital overstated the potential effects.
"Response rates to DC-CIK which are not approved - and in fact to all current immunotherapy - are modest," said Andrew Furness, an immunotherapy expert at University College London.
"Patients coming towards the end of their life or having exhausted all treatment options should not be given false hope," he said.
($1 = 6.6881 Chinese yuan)
(Reporting by Adam Jourdan; Additional reporting by SHANGHAI newsroom and BEIJING newsroom; Editing by Alex Richardson and Martin Howell)