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Medical education in Southeast Asia: emerging issues, challenges and opportunities.

CONTEXT: Medical education in Southeast Asian countries is undergoing rapid changes, with the realignment of medical schools' curricula to meet national needs and priorities, the adoption of and experimentation with innovations, and greater emphasis on staff development initiatives. The Medical Education Unit of the National University of Singapore undertook a project to compile the educational processes taking place in these medical schools. METHOD: This was a process-focused initiative. We developed a custom-made questionnaire that emphasised narrative description. We compiled profiles of 30 selected medical schools in the Southeast Asian region and, after editing and review, published these profiles. This report summarises the key findings from the project. FINDINGS: Medical schools in Southeast Asia are in a dynamic state. Schools are gradually adopting student-centred learning approaches, including problem-based learning. Many schools offer their students early clinical training, opportunities for out-of-hospital postings, and student-selected electives. Multiple-choice questions and oral examinations are almost universally used in student assessment. Portfolios and self- and peer-assessments are seldom used. Major challenges faced by the schools involve shortages of qualified staff and financial constraints. Major goals for the future include the implementation of student-centred learning, the revamping of the assessment process, and staff training. CONCLUSIONS: This is a compilation of self-reported profiles of selected medical schools where we encouraged self-reflection and analysis. As with other surveys, there could be potential self-selection bias. Nevertheless, the profiles of these selected schools provide a broad overview of the status of medical schools in Southeast Asia.

Asia, Southeastern↗

Fake antimalarials in Southeast Asia are a major impediment to malaria control: multinational cross-sectional survey on the prevalence of fake antimalarials.

OBJECTIVE: To assess the prevalence of counterfeit antimalarial drugs in Southeast (SE) Asia. DESIGN: Cross-sectional survey. SETTING: Pharmacies and shops selling antimalarial drugs in Myanmar (Burma), Lao PDR, Vietnam, Cambodia and Thailand. MAIN OUTCOME MEASURES: Proportion of artemisinin derivatives or mefloquine containing drugs of substandard quality. RESULTS: Of the 188 tablet packs purchased which were labelled as 'artesunate' 53% did not contain any artesunate. All counterfeit artesunate tablets were labelled as manufactured by 'Guilin Pharma', and refinements of the fake blisterpacks made them often hard to distinguish from their genuine counterparts. No other artemisinin derivatives were found to be counterfeited. Of the 44 mefloquine samples, 9% contained <10% of the expected amount of active ingredient. CONCLUSIONS: An alarmingly high proportion of antimalarial drugs bought in pharmacies and shops in mainland SE Asia are counterfeit, and the problem has increased significantly compared with our previous survey in 1999-2000. This is a serious threat to public health in the region.

Antimalarials↗

Behavioural heterogeneity of Anopheles species in ecologically different localities in Southeast Asia: a challenge for vector control.

In Southeast Asia the biodiversity of Anopheles species in the domestic environment is very high. Only few species are considered major vectors throughout the region, whereas the vector status of other species varies from area to area. Often it is difficult to identify an Anopheles species as a malaria vector in areas with low malaria incidence. The behaviour of Anopheles species largely determines their vector status, and insights into their behaviour are essential to evaluate the appropriateness of vector control measures. This study was conducted in six ecologically different localities in Southeast Asia to rank the different Anopheles species in terms of anthropophily and endophagy in order to estimate their current epidemiological importance. Concurrently, the biting and resting behaviour of the vectors was analysed to evaluate the appropriateness of insecticide-impregnated bed nets and residual house spraying in vector control. Anopheles dirus A was highly anthropophilic at all sites where it occurred. By contrast, the degree of anthropophily exhibited by An. minimus A depended on availability of cattle. Anopheles campestris, An. nimpe, An. sinensis, An. maculatus, An. aconitus showed a high degree of anthropophily in certain villages, indicating their potential of participating in malaria transmission, although the actual incidence of malaria in the study villages can be fully explained by transmission of the major vectors (An. dirus A, An. minimus A and An. sundaicus). Late biting of An. minimus A and biting activity throughout the night of An. sundaicus favour bed nets as a control method for these species, whilst exophilic and outdoor biting in combination with early feeding behaviour of An. dirus A will make both insecticide-impregnated bed nets and indoor residual spraying less suitable for controlling this species. Spatial variation in biting and resting behaviour was observed within almost all Anopheles species. These heterogeneities may result in the differences in epidemiological importance and in response to vector control of Anopheles species in different areas. Moreover, environmental changes and changes in human practice are expected to influence the behaviour, hence the role of the different species in malaria transmission. The effect of environmental changes on vector behaviour should be followed up carefully.

Animals↗

HLA-DR and -DQ DNA genotyping in seven populations of Asia-Oceania and Australia.

Haplotype patterns of HLA-DR and -DQ restriction fragment length polymorphisms (RFLPs) were compared in seven populations in the region of Asia-Oceania: Australian Caucasoids, Melanesians, micronesians, Polynesians, Chinese, Koreans, and Japanese. Several DR beta RFLP patterns, including those correlating with DR2, 4,5, w6, 7 and w8 in Caucasoids, were associated with multiple DQ alpha/DQ beta RFLP haplotypes, of which only two occurred universally - one associated with DR4 and one with DR5. RFLPs revealed new population or group specific characteristics, which had not been previously discovered using serological or cellular HLA typing techniques. The populations of Asia-Oceania have some features of the class II RFLPs in common, which are distinctly different from Caucasoids. On the other hand, a number of characteristics distinguish between the various Asian and Pacific groups. This study demonstrates the power of RFLP analysis of closely linked genes in population genetics, and shows the value of ethnic comparisons in further characterizing the polymorphisms of the HLA class II genes.

Asia↗

Non-alcoholic steatohepatitis in the Asia-Pacific region: future shock?

Clinicians in both the developed and also the newer industrial economies in the Asia-Pacific region will encounter non-alcoholic fatty liver disease (NAFLD) with increasing frequency. Although the region has been a significant contributor to the current state of knowledge, the spectrum of NAFLD, its severity and the potential for significant future morbidity and health costs are not widely recognized. Lifestyle changes, the epidemic of childhood and adult obesity and type 2 diabetes sweeping the Asia-Pacific represent the key substrates for the rising prevalence of NAFLD. Physicians in all disciplines need to be aware of clinical clues to the presence of NAFLD in the absence of other liver disease and in those with chronic viral hepatitis and they should be able to identify subsets at risk for liver-related morbidity. Given the scope of the problem, efforts should focus primarily on preventing or ameliorating the impact of risk factors; the key one is insulin resistance and its associates of diabetes and central obesity. Pharmacotherapy may play a role in selected individuals. A regional agenda for case definition, future study and public health initiatives is urgently required.

Age Distribution↗

The present and the future of sleep research in Asia.

In recent years, recognition of the importance of sleep, not only as a health problem but also as a social problem, has brought about worldwide growing interest in sleep and sleep research. In Asian countries, the number of sleep researchers is increasing rapidly and as a result the Asian Sleep Research Society (ASRS) was founded in 1994. This paper reviews the main topics of basic and clinical sleep research which have been investigated recently in Japan and in Asian countries. The subjects of sleep research in Asia in the future will be, in principle, similar to those in other countries of the world. However, the author suggests several subjects which are more or less specific to Asia and which should be studied in association, such as epidemiological longitudinal study of sleep disorders in developing countries, characteristics of sleep and dreaming in oriental culture and philosophy, etc. The roles of ASRS in dissemination of information, promotion of training and education, and enlightenment of public and government were also emphasized.

Asia↗

Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change.

The purpose of this international collaborative study was to investigate the prescription patterns of antipsychotic drugs for schizophrenia in East Asia and to analyze factors that affect these patterns. Prescription patterns for patients admitted for treatment of schizophrenia were surveyed using a standardized protocol from six East-Asian region/countries: China, Hong Kong, Japan, Korea, Singapore and Taiwan. Patients' social and clinical characteristics, psychiatric symptoms, course of illness, and adverse effects of medications were systematically assessed and recorded. Prescriptions of the first- and second-generation antipsychotic drugs were compared. A total of 2399 patients were recruited. The second-generation drugs comprised 28.1% of all prescribed antipsychotics, and 46% of the antipsychotic prescriptions were in the context of polypharmacy. The mean dosage of antipsychotics for the whole sample was 675.3 + 645.1 mg chlorpromazine equivalents. Japan had a high frequency of prescribing high doses and polypharmacy; Singapore had a high utilization of depot injections while China had a higher prescription of clozapine. Using multiple logistic regression analysis, distinctions in the prescription patterns of antipsychotic drugs were found: first-generation drugs were mainly for controlling aggressive behavior, while second-generation drugs were targeted at the alleviation of positive, negative psychotic symptoms as well as disruptive behavior in schizophrenia. The present collaborative study highlighted differences in the prescription patterns, especially the under-utilization of second-generation antipsychotic drugs in East Asia. The pattern of antipsychotic medication use varied from country to country and is likely to be influenced by the prevailing health-care system, the availability and cost of the drugs.

Adult↗

Diffuse panbronchiolitis in East Asia.

Diffuse panbronchiolitis is characterized by chronic sinobronchial infection and diffuse bilateral centrilobular lesions consisting of peribronchial infiltration of inflammatory cells. At present, it is known that diffuse panbronchiolitis is relatively restricted to East Asia. This uneven distribution is suspected to be highly associated with genetic predisposition located between human leucocyte antigen-A and -B loci. Low-dose, long-term macrolide therapy for the disease was suggested from a detailed observation of a single case that significantly improved by erythromycin therapy. Otherwise simple bactericidal activity of macrolides has been assumed as a candidate because of their clinical effect on the pathogenesis. In the last 10 years, the possible mechanism underlying the effectiveness of macrolide therapy has been dynamically investigated. To understand the pathological features and potential targets for macrolides in diffuse panbronchiolitis, the authors introduce the incidence of diffuse panbronchiolitis in East Asia, the profile of the disease and then trace the history of macrolide therapy in this review. The proposed mechanism of action includes the inhibition of excessive mucus and water secretion from the airway, the inhibition of neutrophil, and sometimes of lymphocyte and macrophage accumulating in the airway, the inhibition of transcription factors expressing several cytokines and the attenuation of bacterial virulence. Intracellular mechanisms of the action of macrolide are a hot topic of interest in research. The anti-inflammatory activity of macrolides is independent of their bactericidal effect, and a new anti-inflammatory analogue without antimicrobial activity should be developed to minimize the emergence of macrolide-resistant microorganisms and to maintain the safety of this treatment.

Bronchiolitis↗

Nutrition and diabetes in the Asia-Pacific region with reference to cardiovascular disease.

In many parts of the Asia-Pacific region, diabetes prevalence is increasing and seems destined to become a major risk factor for cardiovascular disease. The phenomenon seems predicated on insulin resistance (IR), partly attributable to an early impact of abdominal (visceral) adiposity than in Caucasian populations. Food intake along with physical activity and emotional stress are all determinants of glycaemic status. The glycaemic index (GI) of foods indicates that a number of food factors other than glucose content are important for good glycaemic response to foods and meals. These include (i) low GI foods could also be ones low in fat, (ii) foods that have the lowest GI which include lentils, pasta, noodles, multigrain breads and some fruits (e.g. grapefruit, plums) and (iii) fruits are to be preferred to their juices. The nutritional management of diabetes is best served by counselling changes in a sociocultural context and step-wise fashion by negotiation rather than prescription. It needs to be accompanied by advice to engage in regular physical activity, both aerobic and strength training. The same concept applies to the prevention of abdominal adiposity and diabetes mellitus type II in the Asia-Pacific region, but with particular reference to protective regional food.

Abdomen↗

Cardiovascular risk in the Asia-Pacific region from a nutrition and metabolic point of view: abdominal obesity.

The level of obesity within the Pacific Islands is extremely high and so is the prevalence of weight-related morbidity and mortality. In contrast, the level of obesity, as defined by the standard WHO classification, remains relatively low in most Asian countries, yet rates of obesity-related disease, such as diabetes and cardiovascular disease are increasing rapidly. Many Asian races appear to be susceptible to the development of excessive abdominal fatness, even at low levels of body mass index (BMI). In addition, the health consequences of weight gain appear to occur at much lower levels of BMI and are more intense than in those of European origin. The exact reasons for these ethnic variations in the development of coronary heart disease (CHD) remain unclear. It is likely that genetic differences contribute to this variation in CHD risk, but different dietary and physical activity patterns may also play a role. The advent of modernisation has resulted in marked changes in the level of physical activity and the food supply available throughout the Asia-Pacific region. There has been a shift towards higher intakes of fats (particularly animal fats and vegetable oils) and sugars. Urbanisation and occupational restructuring have reduced daily physical activity levels. As a result, the population mean BMI and consequent illness is increasing in many countries within the region. Recent studies have shown that infants who were undernourished in utero and then born small have a greater risk of developing abdominal obesity and related morbidity as adults. As undernutrition coexists with overnutrition throughout the Asia-Pacific, focusing efforts to improve nutrition during pregnancy will need to be combined with programs to prevent weight gain in adults if CHD and other chronic diseases are to be effectively tackled in the region.

Abdomen↗

Epidemiologic survey of lower urinary tract symptoms in Asia and Australia using the international prostate symptom score.

BACKGROUND: The prevalence of lower urinary tract symptoms was determined by survey as an initial step in estimating the significance of benign prostatic hyperplasia (BPH) in Asia and Australia. METHODS: The symptom index (0 to 35) and quality-of-life (QOL) index (0 to 6) of the international prostate symptom score were measured in 7588 men in 9 Asian countries and 146 men in Australia. RESULTS: The percentages of Asian men considered to be symptomatic (symptom index > or = 8) were 18%, 29%, 40%, and 56% in the age groups of 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years, respectively. For Australian men, these figures were 36%, 33%, and 37% in the 50 to 59, 60 to 69, and 70 to 79 year age groups, respectively. CONCLUSIONS: Our estimates indicate that the prevalences of symptomatic men in Asia and Australia are similar to or greater than those in Europe and America, and suggest BPH is similarly common in these areas.

Adult↗

Gastric cancer in Asia: progress and controversies in surgical management.

Considerable controversy surrounds the management of gastric cancer and this has largely overshadowed recent progress in our understanding of the epidemiology and molecular pathogenesis of the disease, and improvements in diagnostic and staging techniques. Differences identifiable in the molecular pathogenesis of the 'intestinal' and 'diffuse' types of gastric cancer may help to unravel the biological behaviour of variants and ultimately influence therapeutic strategies. Endoscopic ultrasound is well established as being accurate for T staging and the introduction of laparoscopy, with or without ultrasound, is obviating unnecessary laparotomy in non-bleeding, non-obstructed patients. Controversies in surgery encompass the role of laparoscopic surgery in early gastric cancer, the extent of lymphadenectomy including para-aortic nodal dissection, resection of en bloc contiguous organ involvement, pancreatosplenectomy, left upper abdominal evisceration, and modes of reconstruction (pylorus-preserving gastrectomy, pouch formation) to enhance quality of life. Whereas adjuvant chemotherapy does not impact favourably on survival, emphasis has now shifted to neoadjuvant (induction) chemotherapy to downstage the disease. Preoperative regional chemotherapy and intra-operative hyperthermic chemotherapy or irradiation may prove to be of benefit in patients with resectable disease, but some scepticism still exists as to the usefulness of biological response modifiers (e.g. OK432, PSK) for adjuvant treatment. Ethical issues relating to cultural differences in Asia sometimes mitigate against adequate trial design (e.g. a surgery-alone control group or a no adjuvant therapy treatment group may be considered inappropriate) and this has understandably hindered acceptance in Western countries of the value of current management practices in Asia. These issues and the need for ongoing well-conducted randomized trials with prospective subset analysis are now being addressed.

Antineoplastic Combined Chemotherapy Protocols↗

Current status of assisted reproductive technology in Asia and Oceania.

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technology (ART) initiated in Asia-Oceanic region in 1992 and 1993. DESIGN: Data were collected on an annual summary form and submitted to the Reproductive Biology Committee of AOFOG. PARTICIPANTS: Twelve member countries of AOFOG submitted data on ART procedures performed in 1992 and 1993-Australia, Egypt, Hong Kong, India, Indonesia, Japan, Korea, New Zealand, Pakistan, Singapore, Taiwan, and Thailand. Data were collected in 1995 so that the outcomes of all pregnancies established would be known. MAIN OUTCOME MEASURES: Clinical characteristics of patients, causes of infertility, protocols and outcomes of controlled ovarian hyperstimulation (COH), and outcomes of clinical pregnancy including abortion, ectopic pregnancy, multiple pregnancy, and congenital malformation were measured in each ART procedure. RESULTS: In 1992, 23,872 cycles of IVF-ET were performed with 21.8% clinical pregnancy rate (PR) per ET, 4,840 cycles of GIFT with 29.5% PR per transfer, 1,136 cycles of simultaneous IVF-ET and GIFT with 29.9% PR, and 1,563 cycles of ZIFT with 23.1% PR. Total 575 clinical pregnancies were achieved in cryopreserved ET program, 96 pregnancies in oocyte donation program, and 87 pregnancies in microassisted fertilization (MAF) program. In 1993, 24,571 cycles of IVF-ET were performed with 21.6% clinical PR per ET, 5,240 cycles of GIFT with 28.2% PR per transfer, 1,063 cycles of simultaneous IVF-ET and GIFT with 32.0% PR, 1,005 cycles of ZIFT with 21.6% PR, 5,562 cycles of cryopreserved ET program with 12.8% PR, and 2,198 cycles of MAF program with 11.6% PR. Total 117 clinical pregnancies were achieved in oocyte donation program. CONCLUSIONS: Although the concepts as well as the status and results of ART are continuously changing, this report may be helpful in planning the future of ART in Asia-Oceania by analyzing the past history.

Asia↗

Hypertension in pregnancy: a study of the Asia-Oceania region.

A review of the management practices and problems surrounding hypertension in pregnancy in the Asia-Oceania region was made. This review was achieved by surveying institutions in the region. Sixteen countries responded to this survey and the results were analysed. Both rural and city hospitals were involved in the survey. The centres were selected by members of the Maternal Perinatal Committee of the Asia-Oceania Federation of Obstetrics and Gynaecology (AOFOG) under whose patronage the survey was performed. Analysis of the survey revealed a number of problems which could be addressed by appropriate educational interventions, these included drug therapies and protocols, deficiencies in governmental support especially in transport and centralised intensive care facilities. Public awareness was also a priority to be addressed. The role of the traditional birth attendant has been increasingly recognised as a resource which could be utilised. This is highlighted in this survey where there are countries who will be dependent on these carers for the next 10 years at least. Their place in the management of hypertension is discussed.

Asia↗

Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean.

OBJECTIVE: To present estimates of maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean, and to discuss strategies to prevent these deaths. DESIGN: Retrospective review of all available data. SETTING: Database of the World Health Organization's Maternal Health and Safe Motherhood Programme. MAIN OUTCOME MEASURES: Estimates of the total maternal mortality and the proportions of deaths associated with hypertensive disorders of pregnancy. RESULTS: Estimates of mortality associated with hypertensive disorders of pregnancy were similar in Africa, Latin America and the Caribbean, despite considerably higher total mortality in Africa. Variations in both overall mortality and that associated with hypertensive disorders of pregnancy were greatest in Asia. Despite their limitations, these data suggest that between 10-15% of maternal deaths are associated with hypertensive disorders of pregnancy, and that 10% are associated with eclampsia. CONCLUSIONS: Where maternal mortality is relatively high, the excess is likely to be due to a high mortality associated with haemorrhage and infection and reductions are most likely to come from reductions in these deaths. Evidence from both developed and developing countries suggests that deaths associated with hypertensive disorders of pregnancy are the most difficult to prevent. More rigorous assessment of interventions designed to prevent these deaths is urgently required.

Africa↗

Albuminuria predicting outcome in diabetes: incidence of microalbuminuria in Asia-Pacific Rim.

Microalbuminuria is not an unusual finding in the general population, even in individuals without diabetes, hypertension, or cardiovascular risk factors. Prevalence studies in the United States, such as NHANES III, reported an overall incidence of microalbuminuria in 22,244 patients, with and without diabetes, of 7.8%. In those individuals with diabetes, the prevalence was 28.8%. Even in patients without diabetes, cardiovascular disease, or abnormal serum creatinine levels, the prevalence of microalbuminuria was still 5.1%. Similarly, a large Dutch study of 41,000 participants demonstrated a 7% incidence of microalbuminuria. In those individuals with diabetes, the microalbuminuria rate was 16%. Thus, in both the United States and Europe, prevalence studies indicate that microalbuminuria is not uncommon. In southeast Asia and the western Pacific, the incidence of type 2 diabetes is rapidly escalating. It is expected that by 2025 the major prevalence of type 2 diabetes in the world will not be in North America or Europe but in Asia-Pacific Rim. Consequently, there is great interest in evaluating the incidence of microalbuminuria in this region. In the Microalbuminuria Prevalence Study (MAPS) the prevalence of macroalbuminuria was noted to be 18.8% and microalbuminuria 39.8% in a total of 6800 hypertensive diabetic adult patients from 10 Asian countries. Thus, there is important evidence that the substantial prevalence of microalbuminuria and macroalbuminuria in the Pacific region indicates an impending pandemic of diabetic cardiovascular and renal disease.

Albuminuria↗

What is next for pharmacoeconomics and outcomes research in Asia?

OBJECTIVES: Pharmacoeconomics and outcomes research have the potential for rapid adoption in the Asia Pacific region. Nevertheless, the region is characterized by great diversity in social and economic development, ethnicity, population size, health-care system, culture, language, and religion. Thus, the rate of adoption is also quite diverse across the region. METHODS: Among the countries reviewed in this article, governments take varying levels of interest in applying this research in health policy decisions. For example, some countries have already implemented systems that require pharmacoeconomic studies as one component of a new pharmaceutical product's approval for reimbursement, whereas others recommend such data but do not require it in policy and medical decision making. The literature in the countries reviewed is actually quite robust given the early stages of development of this field in most countries. The academic community has members trained in this field of research in all the countries reviewed and some universities have established departments whereas others have just introduced a few classes in the area. RESULTS: At the moment, pharmacoeconomics and outcomes research are being conducted mainly by academics. In addition, some pharmaceutical researchers are active and pharmaceutical companies are currently preparing to conduct more of this research as part of their strategy for Asian drug development. CONCLUSIONS: Prospects for future growth and development in this field are quite good in Asia as rapid healthcare inflation, increasing rates of chronic conditions and aging population, and increasing technology diffusion will underpin the need for greater awareness of the need to incorporate economic efficiency into the health-care systems.

Aged↗

Update from Asia. Asian studies on cancer chemoprevention.

In Asia, nontoxic dietary products are considered desirable primary prevention vehicles for conquering cancer. As early as 1978, investigators in Korea carried out extensive long-term anticarcinogenicity experiments using the mouse lung tumor model and observed an anticarcinogenic effect of Panax ginseng C.A. Meyer extract in 1980. The results showed that natural products can provide hope for human cancer prevention. A newly established nine-week medium-term model using mouse lung tumors (Yun's model) could confirm the anticarcinogenicity of ginseng that varies according to its type and age. Subsequently, the ginseng was shown by epidemiological studies to be a nonorgan-specific cancer preventive agent associated with a dose-response relationship. The anticarcinogenic effects of vegetarian foods common at every dining table in Korea and some synthetics were also studied using Yun's nine-week model. In brief, ascorbic acid, soybean lecithin, capsaicin, biochanin A, Ganoderma lucidum, caffeine, and a novel synthetic 2-(allylthio)pyrazine decrease the incidence of mouse lung tumors, whereas fresh ginseng (4 years old), carrot, spinach, Sesamum indicum, beta-carotene, and 13-cis retinoic acid do not. This result regarding beta-carotene is consistent with the ineffective findings of the ATBC trial, the CARET trial, and the Physicians' Health Study. In 1983, a cancer chemoprevention study group was first established in Japan. Subsequently, (-)-epigallocatechin gallate, cryptoporic acid E, and sarcophytol A from natural products, and synthetic acyclic retinoid and canventol were shown to be anticarcinogenic or chemopreventive in human subjects. Despite the frequent consumption of tea wordwide as a beverage and current experimental evidence of anticarcinogenesis, including controversial results of epidemiological studies, more systematic clinical trials for confirmation of preventive activity of tea against cancer are needed. Placebo-controlled intervention trials of dietary fiber are under study in Japan. In the past decade, new triterpenoids were isolated from various natural sources, and its biological activities were investigated in Asia. In the late 1970s a comprehensive chemoprevention program was established at the Institute of Materia Medica, Chinese Academy of Medical Sciences. Since then, many retinoid compounds have been synthesized and screened in the search for chemopreventive cancer agents. The National Cancer Institute (USA) and China are jointly engaged in the two-nutrition intervention in Linxian, China. The results of joint study of the general population and of dysplasia in China should stimulate further research to clarify the potential benefits of micronutrient supplements. We need to clarify if there is a connection between the lower rates of cancer mortality in Korea and the frequent consumption of anticarcinogenic vegetables or traditional foods, including ginseng and Ganoderma lucidum. The constituents of the nontoxic stable dietary products promise to be the future hope for conquering cancers in the coming years.

Animals↗