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Correspondence

www.thelancet.com Vol 381 February 2, 2013 e4

Submissions should bemade via our electronicsubmission system athttp://ees.elsevier.com/thelancet/

Should cancer treatment be a matterof a countrys creditworthiness? As

Plato said, a good decision is basedon knowledge and not on numbers.I declare that I have no conicts of interest.

Ioanna G Tsiligiannii.tsiligianni@hotmail.grAsites Rural Practice, Agia Barbara Health CareCenter, Heraklion, Crete, Greece

1 Cancer and volunteer organisations openletter. ht tp://www.bestrong.org.gr/el/news/cancer_and_society/?nid=3973 (accessedDec 12, 2012).

2 Siebelt F, Bryan V. Germanys Merck haltssupply of cancer drug to Greek hospitals.ReutersNov 3, 2012. http://www.reuters.com/article/2012/11/03/us-greece-drugs-

idUSBRE8A205Z20121103 (accessed Jan 16,2013).3 Greek Statist ics Offi ce. Household research on

income and living conditions, 2011. http://www.statistics.gr/portal/page/portal/ESYE/BUCKET/A0802/PressReleases/A0802_SFA10_DT_AN_00_2011_01_F_GR.pdf (accessed Jan 16, 2012).

4 Government Gazette. Law 4093, FEK A222/12-11-2012. http://www.et.gr (accessed Jan 16, 2012).

Young Chinese doctorsand the pressure of publication

In recent medical job fairs, most largehospitals in China have consideredarticles listed in the Science CitationIndex (SCI) as a must or priority forcandidates. SCI articles are also the keyto a large bonus or rapid promotion. Itseems that SCI articles are controllingthe fate of young doctors in China,whose goal is to be a researchsuperpower by 2020.

As young doctors, we feel undergreat pressure to publish. However,basic scientic research is diffi cult,being almost outside the scope of our profession, and clinical researchrequires long-term follow-up orlarge case numbers, which are noteasy to achieve for a young doctor.In our graduate careers, many of ourclassmates spent a large amountof time in the laboratory doingunfamiliar experiments, just so thatthey could publish SCI articles. Evenin the hospital, SCI articles are stillan important indicator of successfor a department or doctor. Is thisreally more important than clinicalcompetence?

Such a requirement is unreasonableand completely unnecessary. Not onlydoes the pressure to publish take uptoo much energy and time, with littleprofessional help, it can also lead toan inappropriate medical atmosphere.Young doctors should be payingmore attention to the accumulationof medical experience and improvingtheir communication skills withpatients. Academic articles arewelcome, but they should be mainlyfor the purposes of communication,and should be non-mandatoryand derived from clinical practice.Moreover, articles should not bedistinguished simply by whether ornot they are cited by SCI.

Young Chinese doctors are en-countering more and more challenges.Chinas health-system reforms

should remove the SCI article burden,and build up a healthy assessment

mechanism for these doctors.We declare that we have no conicts of interest.

Heng-Feng Yuan, *Wei-Dong Xu,Hai-Yan Huxuwdshanghai@gmail.comDepartment of Orthopedics (H-FY, W-DX) andDepartment of Kidney (H-YH), Changhai Hospital,Second Military Medical University, Shanghai200433, China

Politics and cancermanagement: lessonsfrom Greece

Health should be managed accordingto evidence-based medicine andthe principles of health equity andsustainability. Human rights shouldbe respected, especially those of vulnerable cancer patients. However,political initiatives can easily under-mine the role of the doctor when thereare limited resources.

On June 11, 23 organisationsrepresenting cancer patients andvolunteers in Greece sent an openletter 1 to the government and leadersof the political parties in a last effortto convey the emergency situationcreated and the threats that patientswith cancer face not only to theirdignity and the course of the disease,but also to their lives. Why theanguished cry? Simple: pharmacistsand pharmaceutical companiesare not being paid, so some havestopped supplying drugs.2 This hasresulted in serious shortages. Furtherescalating these problems is the factthat consumables such as catheters,drainage bags, and tracheal tubesare usually paid for by patients,with the money being refundedseveral months later. However, theproportion of the population at riskof poverty has already reached 214%according to the Greek statisticsoffi ce,3 and the situation is set toworsen after the government agreedto more budget cuts on Nov 7, 2012.4