I mention all this because as an American expat straddling two cultures, I inevitably compare the strengths and weaknesses of each. Of course I confess a bias towards an American viewpoint. But I am perfectly comfortable saying that the average Chinese person is healthier than the average American. And I think Americans could learn a few health tips from China.

Perhaps my readers may find that laughable! But after seven years of observations, I truly feel that it is true. I say this especially since my trip last year back to the east coast of America. It’s no secret that obesity in America is a serious health problem, with the majority overweight and more than one third obese. But last fall I was viscerally struck to see this in person. I kept thinking of the Pixar movie WALL-E, where in the near future mankind becomes so obese that no one walks anymore, spending every hour comfortably in their self-driven hovercraft as robots feed, clothe and bathe them. That’s supposed to be hundreds of years in the future, but Pixar’s gloomy vision of future America certainly seems prescient.

In China, it’s still quite rare to see obese people on the streets. This is changing recently, especially among children as families spoil their little emperors. But in general it’s still not common to be overweight in China. Data from the WHO shows an obesity rate of 32% in the USA and only 6% in China, and an overweight rate of 25% in China but a mind-boggling 69% in the USA. Diet differences are a major factor, but another major reason is that people in China move around a lot more, getting their “exercise” just from everyday routines. Clearly the evening culture plays a major role in this healthy activity. It’s such an ingrained part of Chinese culture that there’s a famous old proverb 饭后百步走，活到九十九 (take a hundred steps after eating, live to be 99).

There’s simply nothing like this social nightlife in America, and it’s a wonderful cultural tradition which I deeply wish we had in America. Even in enlightened and active San Francisco, there may be a few people walking their pets or jogging after dinner, but otherwise our American sidewalks are mostly empty at night. It’s a real shame because such daily activity can dramatically decrease your risk for heart disease, the world’s number one killer. A large 2012 study involving over 400,000 people confirms again that even only 15 minutes a day or 90 minutes a week of moderate exercise can reduce your risk of death by 14% and increase life expectancy by three years. A routine 20 minute brisk walk after dinner automatically gets you to that recommended 150 minutes a week of moderate exercise. Just have your nightly walk plus a daily bike commute and you have no need for that gym membership or that treadmill machine you picked up at a yard sale years ago but never use!

Besides the clear differences in weight and daily activity, the average Chinese person has a much healthier concept of nutrition and wellness than the average American. Many Americans are famously healthy with their fruit smoothies, organic supermarkets and extreme workouts. But that percentage of super healthy Americans is easily outmatched by the much more numerous obese, inactive Americans eating large portions and fast food. There’s a great dichotomy of wellness in America! But in China, I’ve noticed that people both rich and poor, from the countryside and the cities have an equally extensive knowledge about which foods are good for each season, which foods help keep you healthy and which help when you’re sick. Chinese also eat many more vegetable dishes with each meal than in America.

Much of all this involves traditional Chinese medicine concepts of balance, yin and yang, and hot and cold. And while I am skeptical of many of the specific medical claims of TCM, certainly the underlying concept of balance is a very powerful philosophy to underline anyone’s approach not just to their diet choices but their entire life. This ingrained Chinese concept of balance regarding foods is far more successfully integrated into people’s mindsets than the American approach. Americans also use the word balance when discussing a balanced diet, but that discussion clearly has failed to be internalized in the culture. So we tried the food pyramid for a while and that didn’t resonate, and now it’s the “MyPlate” campaign. American magazines and bookshelves are filled with health fads and diets that come and go, while the obesity rate and diabetes cases continue to skyrocket. Clearly all this American chatter about health and wellness is completely failing. There is something fundamentally wrong with our current culture’s lifestyle and philosophy of wellness which is hurtling most citizens backwards.

But what about the sorry state of food safety in China, or the massively polluted air and water? How about how the US towers above China in life expectancy, as well as in the World Happiness Report? How can Chinese men be healthier when over half of them smoke? These are valid counterpoints, but I argue that these are short term problems. Thirty or forty years ago American men smoked just as much as Chinese men, but after public education campaigns the rate is now much lower (but still too high). Regarding happiness, the number one factor is income, and China’s average income is still a small fraction of the average American. And while the World Values Survey also noted more happiness in Americans, more Chinese felt their state of health was good. And with the environment, China is going through the same pattern of self destruction as every other industrialized Western country did — and there’s no reason not to assume it will clean up just as well, in time.

Let’s assume that in a couple decades these obvious environmental and social differences will be improved, along with economic parity. What will we see? Will we see China’s obesity rate also catch up to the west? I think not. Actually, I prefer to think not. I would like to be an idealist and say that even with economic parity, Chinese will still preserve their concepts of wellness and balance, still eat their vegetables even if surrounded by KFC and Starbucks. And I hope more than anything that both American and Chinese streets will be filled at night with singing and dancing.

For routine vaccines, which start during childhood, most countries cover the same basics. If you are unsure if your vaccines are up-to-date, check your home country’s vaccination schedule. A typical problem with adults is that they may not know about adult boosters or new recommendations. For example, most need a tetanus booster every ten years. Also, many countries, including the US, are recommending a pertussis booster for adults. Fortunately, there’s Tdap, an easy combination booster for adults that combines tetanus and pertussis into one quick jab. Unfortunately, at this time the international private clinics in China are not allowed to give imported vaccines such as the Tdap, and there is no Chinese version yet. I now recommend adults try to get this back in their home country when traveling. This booster is especially important given the recent waves of pertussis infections in California and other areas.

Another common issue involves people who began their Hepatitis B vaccine series but never finished the three-shot series. It’s very important that people are fully vaccinated for this, as chronic HBV infections are a serious public health issue in China. Also, for all my patients, I recommend a vaccine against Hepatitis A.

The rabies vaccine is the most controversial. The following scenario is common in clinics: a parent comes in and their unvaccinated child was bit by a neighbor’s dog while playing around. Unfortunately, if we don’t know the dog’s history, the child needs the entire five-shot rabies series, plus a painful and very expensive rabies immunoglobulin shot. If the child had already been vaccinated against rabies, he would only need a post-bite treatment.

Rabies is not common but is found all over China, especially in rural areas, and a few thousand people die from it annually. The scary thing about rabies is that it may take over a year to develop symptoms — and it is 100 percent fatal. And yes, expats in Beijing have died of rabies. The vaccine is a three-shot series given over one month.

I often recommend a rabies vaccine for patients, especially children. Children are the most vulnerable to rabies as they often play with stray dogs and cats, and parents may not even be aware that their child was bitten. However, it’s a risk-and-benefit analysis each family needs to make. If you think your exposure is very small, then the vaccine may not be for you. But if you plan to hike around rural China and India for a few weeks, you should definitely consider it.

Another controversial vaccine is Japanese Encephalitis. It protects against a mosquito-born virus that can cause a serious brain infection, and is fatal in some cases. It’s more of an issue in southern China and tropical Asia, but Beijing has had cases, and it’s a required vaccine for Beijing infants. This vaccine series is good if you plan to live here for a few years, and will also protect you during your travels around Asia.

For those of you concerned about vaccine safety and side effects, I always recommend you read the evidence-based sources online, including the US CDC vaccine page at www.cdc.gov/vaccines. All vaccines have side effects, but I am convinced that vaccines have been dramatically effective all over the world in eradicating many terrible childhood diseases, saving millions of lives.

For more information on vaccines, please read my previous articles about vaccines.

(This article was originally printed in Beijing Kids magazine, where I am a contributing editor. You can click here to read the rest of my BeijingKids “The Doc Is In” columns.)

But the situation in China is very different and much more serious. Each year, over 3,000 people in China die from the rabies virus, the vast majority from dog bites. And children by far are the most vulnerable population, as they love to play with animals, and many wouldn’t even mention a slight bite or scratch to their parents.

That’s why it’s crucial for expat families to seriously think about getting the 3-shot rabies vaccine series now, for all of their children, before they get exposed. The vaccine protects them from the 100% fatality rate of this all-to-common disease in China. The vaccination rate among expat families is quite low, but rabies is common in the Beijing area among both stray and pet dogs. And those who feel ”protected” in your Shunyi communities need to know that expats have died of rabies in China. In one sad case, an expat husband and father died 10 months after buying a harmless-appearing puppy from their local pound. He didn’t even report ever being bitten by their pet, and most likely got infected from playful licking and innocuous-appearing scratches. Please don’t let this happen to you or your loved ones! Rabies is 100% fatal, there is no cure, and it’s a painful and slow death.​​

The American Academy of Pediatrics also mentions some helpful tips to share with your kids to prevent pet bites, especially dogs:

• ​Socialize your pet. Gradually expose your puppy to a variety of people and other animals so it feels at ease in these situations; continue this exposure as your dog gets older.
• Train your dog. Commands can build a bond of obedience and trust between the dog and owner. Avoid aggressive games with your dog.
• Vaccinate your dog against rabies and other diseases.
• Neuter or spay your dog. These dogs are less likely to bite.
• Never leave a baby or small child alone with a dog.
• Teach your child to ask a dog owner for permission before petting any dog.
• Let a strange dog sniff you or your child before touching it, and pet it gently, avoiding the face and tail.
• Never bother a dog if it is sleeping, eating or caring for puppies.
• Do not run past a dog.
• If a dog threatens you, remain calm. Avoid eye contact. Stand still or back away slowly until the dog leaves. If you are knocked down, curl into a ball and protectyour face with your arms and fists.​​

Rabies is a serious issue but definitely not the most common pet-related problem I see. I often treat serious skin infections from bacteria such as staph, especially in the hands, from pet bites and scratches. In almost all cases, the cuts were from typical playful fun with their own pet. The #1 treatment in all cases of bites and scratches is immediate washing out with soap and water!

(This article was originally printed in Beijing Kids magazine, where I am a contributing editor. You can click here to read the rest of my BeijingKids “The Doc Is In” columns.)

Before I give my answer, I thought all this was such an unusual media crescendo that I thought I’d ask all of my readers the same question, to assess whether the media is manufacturing its own reality or are they tapping into something real. So please take the poll below and answer one question: Does The Recent Airpocalyptic Pollution Make You Want To Leave China? If you cannot see the poll below, click here to vote.

Regarding my answer to most of these reporters: yes, since January I’ve definitely noticed an uptick in such conversations with many of my patients as well as Beijing friends, both local and expat. Certainly last winter’s air pollution was unusually serious, and I’ve never felt such collective anxiety in Beijing as I felt then. Bulletin boards, TV, radio, Weibo, my blog — the conversations were filled with anxious moms desperately looking for sold out air purifiers; frantic discussions about pollution masks for their children; tense Q&A sessions at multiple embassy and business events.

I myself must admit that while I still intend to live here many more years, even with my newborn son, January’s nightmare was very difficult to gloss over. Health and wellness, and a sense of happiness and fulfillment in life, are much more complex than just one issue such as pollution. Our minds are powerful mediators of our physical health. But daily stress and anxiety from constantly waking up to dangerously grey skies and not being able to send your kids outside… all that stress takes a major toll on your physical health and immune system. Everyone needs hope and silver linings, and I desperately hope dramatic steps can soon be taken to improve this situation.

What do you think? Please leave comments below.

Eyes on the prize…

作为一个老外，我感到自己有一定的自由度去做些古怪的事情。我最喜欢的一项古怪活动就是去北京的街道、郊区和山区，测量那里的空气污染水平。我是在2008年北京奥运会的前一年来到北京的，而自那时起，我就对空气污染产生了兴趣（抑或是迷上了？）。有时候，我也会从某空气净化器品牌队那里借一台手持微粒监测仪，需要指出的是，这种手持监测仪测量的是空气中PM0.3的指数，这种微粒比常见的PM10和PM2.5都要更小，但同样也可以作为空气污染的参考数据。

周末的时候，我和妻子会驾车环游北京，我用一只手开车，用另一只手将微粒检测仪的细小管嘴伸到窗外，让它就像狗一样嗅闻空气。有时，我也会骑着自行车穿越北京的大街小巷，时不时地停下来，然后从包里取出这个大装置，监测空气中微粒的水平，并在笔记本上记录。旁边经过的人都会很有礼貌地避免与我目光接触。但这并没有必要，因为我通常都会戴着防空气污染口罩和自行车头盔；早在几年前，这两者在北京街道上都是很罕见的（遗憾的是，现在头盔仍然很罕见）。

在这些冒险活动期间，我记下了有关空气污染的诸多细节，而这些数据也着实令我吃惊——在2009年到2011年，我在北京各地进行了三次、每次为期一周的测试，结果我发现，空气质量几乎持续保持恶劣水平。而最令我失望的发现之一就是京西群山庙宇一带秀美山区的空气情况。我的期望当然是山区的空气比北京的“黄雾”更干净。山中景区不就是远离烦恼的地方吗？不幸的是，那里的空气污染数值与北京城区的数值并没有什么区别，同样高得令人失望——根据新闻报道，其中一个原因可能是焚烧落叶。在官方网站zx.bjmemc.com.cn于去年底上线后，我也会去看上面的空气质量图。根据我这几个月的观察，我注意到官方的数据与我当年的测量结果一样：郊区空气监测站的PM2.5水平同城区几乎一样，不过在有风或晴朗的天气下，郊区的空气质量通常会更好一些。一年四季，尤其是在炎炎夏日，人们还是很喜欢外出“爬山”和兜风，但我们不要期望那里的天会更蓝。

此外，我还花了大量“极客”时间去监测北京各商场和街道的PM2.5数据。一个令人惊讶的发现是，繁华街道的PM2.5水平与僻静的小巷并没有太大的区别。我常常在论文中读到，距繁忙街道150米内的地段会出现污染峰值，这种情况在伦敦的研究中曾证实过，但在北京，从环路走到运河岸边树木成行的林荫道，我从未发现空气质量会有超过10%的提升。我猜测这是因为我的手持监测仪只测量PM0.3一种污染物，而如果加上一氧化碳、二氧化氮等在城市主干道上更为普遍的污染物数据，或许结果就不是这样了。此外，瑞士热带病研究所(Swiss Tropical and Public Health Institute)等机构在美国加州洛杉矶郡所做的研究发现，居住在繁忙街道75米以内的人群中，成人心脏病和儿童哮喘病等重大疾病的发病率要高得多。所以，我认为这个一般规则仍是适用的：避免在繁忙街道上从事剧烈运动、骑车或散步。

而如果你必须要去这些主要街道或沿着这些街道走，那么一定要考虑戴正规的N95防护口罩。在北京，爱丁堡大学(Edinburgh University)和协和医科大学等机构进行了研究，他们征集了15名健康的年轻人于2008年8月参加试验，受试者在早上8点到10点，沿着二环路和其他繁忙街道走两小时，并对其呼吸、心率和血压进行监测。你可以想象一下他们的形象：背着一个巨大的包，各种天线伸在外面，而且还戴着口罩！但好消息是，当他们戴上口罩（3M N95防护口罩）时，他们的血压和心率变异性都有所降低。这项研究可以说是提供了目前最为有力的证据，即一个合适的N95口罩确实会对你起到保护作用。

在监测期间，另一个让我非常失望的发现是，在污染非常严重时（即空气质量指数超过300时），就大多数商店和餐馆而言，其室内空气的危险程度与室外空气几乎一样。我发现，室内空气的污染程度通常是室外的50%-80%。在西安，西安交通大学等单位曾在2008年对三间办公室和室外同时采样，结果表明，室内外颗粒物浓度具有相同的变化趋势，3个房间内PM2.5与室外的比值分别为79.7%、50.1%、83.0%。但要记住，这是在一个空气质量指数动辄就超过300的环境，所以室内空气也是很不健康的。最让我感到吃惊的是，有一天我去北京最出名的进口书书店，发现那里的室内空气竟然比户外还要糟糕！看来文学也逃不过现实。我认为，出现这种情况的原因可能是室内吸烟，而一些研究报告也支持我关于吸烟危害室内空气的猜想。幸运的是，此后不久这家书店完全禁止了室内吸烟。在中国，企业的一举一动都不是小事，我非常希望其他的公司也能够以它为榜样。

同样是在那一天（那是一个极其糟糕的日子，空气质量指数超过400，达到“非常危险”的程度），我发现“绿区”内没有一家商店和建筑物内的PM2.5水平是安全的。三里屯Village商场尤为严重，每家店内的空气都十分糟糕。那些敞开的大门和露天走廊侵害了我的肺，同时也侵害了店铺雇员的健康。

在这一天，我认为最好的地方就是我自己的家，尤其是卧室。对大多数成人来说，大量时间都是在室内度过的，而在我们生命中，有三分之一的时间是在睡觉的；因而，在卧室中安装空气净化器来保护家人也就理所当然了。打开净化器，关上门，然后睡觉。瞧！这样的话，在中国，有三分之一的时间就可以免于污染了。我的这种生活并不是靠想象而来的；在选购空气净化器时，我个人就对多个品牌产品的性能进行了严格比较。关上卧室门，开上一台净化器，两小时后室内PM2.5水平较室外降低了95%—99%。而这还是在静音设置下所取得的效果；对其他很多机器来说，这并非易事。我现在已经习惯了它们的嗡嗡声，并将其视为让人得到放松和保护的白色噪音。

这就是一个人在北京所沉迷的冒险之行。虽然我的很多数据都会让人感到担忧，但我仍认为这些坚实的数据会在一定程度上让人得到安心。至少，我现在知道了情况有多么糟糕，而且我也知道我能够改善多少。

现在，在中国食品安全不断受到人们的质疑，你是否考虑过只买有机食物？或者索性开始素食？也许以前很多中国人都不会考虑这些问题，但很多移居国外的人在权衡自身健康以及与自然的和谐并存问题时候开始选择有机食品或者成为一名素食者。但这样的改变是否真的能获得更为健康环保的生活吗？这里我从医学以及个人的角度谈谈这个问题。

成为一个素食者或者放弃绝大部分的肉食，是非常重大的生活改变，但很多人发誓他们因此感到生活更加健康并充满活力。我是个无肉不欢的人，如果从今以后都不能吃肉，我觉得自己可能做不到，但我也开始重新考虑，因为饲养动物，特别是牛等给环境造成的巨大负面影响。我并不认为“红肉”象有些人描述的那么不健康，但我们现代西式节食方式确实非常不平衡，在患心脏病的几率上大大高于仅吃蔬菜谷物的古人。在过去的一百年里，人类食谱最大的变化就是涵盖了更多的肉类，而水果，蔬菜，谷物和坚果类则大量减少。现在很多动物都使用非自然的农业化农场养殖出来，它们经常被注射了激素以达到迅速成长的目的，而且机械化喂食代替了在草地上吃草的传统方式。有研究证明，许多的医生的看法：我们现在从食物中吸取的OMEGA 6脂肪量已经大大超过了对心脏健康有非常大帮助的OMEGA 3的量，后者主要来源于常见植物，鱼类和坚果类食品。而OMEGA 3和6之间的比例失调，被认为是导致心脏疾病的主要罪魁祸首。
这也是为什么我推崇“素食周一运动”的主要原因，他们的建议是每周的周一是禁食肉类。这项运动由约翰霍普金斯大众健康学校开始，并且通过口口相传的方式在缓慢展开。你可以通过他们的网站meatlessmonday.com获得一些很好的资讯，包括儿童食谱，餐馆菜单等。我认为这是一个相对来说更易接受的改变家庭日常饮食习惯的好方法，并且借这个机会你也可以试着体验一下自己是不是真的能够更进一步成为一个素食者。

有机食品也成为我们平时热议的话题之一。美国儿科研究所最近发表了一项有关儿童食用有机食品的报告，非常值得父母们读一读。美国儿科研究所在报告中提到，有机食品很大程度上并不比传统食物更有营养，大多数孩子并不能从仅食用有机食品中受益。这也许颠覆了很多人的想法！尽管有机食品能够降低

儿童血液中的农药量，但美儿研所并不认为这对健康就一定有利，最好的研究报告在这一点上也含糊其辞。诸如谷物或者洋葱这类食物里不会含有大量的农药，但苹果或者葡萄就可能有较高的农药含量，所以如果可能，这两种食物应尽量食用有机的。美儿研所同时也认为有机牛奶并不比传统牛奶更有营养，但理论上说喝那些无抗菌素奶牛的奶也许会降低对抗菌素的抗药性，而这种抗药性正迅速成为全世界范围内值得关注的问题。

美国儿科研究所的这项报告可能让一部分人感到可靠，别忘了这项结论是建立在美国市场以及美国农牧场上的报告。我个人认为农药使用量，化学试剂我呢替以及抗菌素的过量使用的问题上，中国的问题比美国要严重得多。因此在中国购买有机食品要比在美国更有现实意义，在考虑营养问题前，还是先避免有害物质吧!

原文链接：Healthy Food for Your Kids in China: Where To Start?
编辑：桑原
翻译：王小燕

When I was growing up, I often played in our woods or picked blueberries just along our fence, and more often than not I’d develop that classic raised, shiny, wet, and super itchy rash. My mom still gets really bad attacks and often needs to take steroid pills to cool it off. Some very unlucky people get the rash in their eyes and mouth and may need prescription medicines, injections or even hospitalization. That’s why the #1 way to prevent this nuisance is to follow the quote — and avoid touching them!

But to avoid these ubiquitous plants, you first need to know what they look like. Thus the quote: both poison oak and poison ivy have a classic clustering of three leaves, so if you see any shiny ”leaves of three” along your path or in the vines and low trees, it’s definitely safer to avoid them. They are usually along the ground but definitely can climb up other plants, so it’s very easy to brush past these if your hiking path is a bit overgrown with plants.

It’s inevitable to come into contact with these plants, so it’s always best to keep well covered when trekking outside. Wearing socks helps a lot, otherwise it’s very easy to get the rash on your ankles and feet. Moms need to know that these plants’ itchy oil can cling to clothes for days, so it’s best to wash the day’s outdoor clothes in hot water to dissolve the oils. And don’t forget that your dog’s hair can definitely carry the oils into the house and spread to anyone petting him, so he may need a good soap and water bath.

It takes at least a few hours to days to develop the rash, so it’s a must to use soap and water after your outdoor activities to get off that oil before it absorbs into your skin. Once the oil is gone, it can’t spread anywhere else.

If you’re unlucky enough to get the rash, there are many home remedies and over the counter (OTC) medicines you can try. My favorite is the pink stuff — calamine lotion. It’s extremely soothing and cooling, and every home’s medicine cabinet should have a bottle of this. The other must-have is a topical steroid cream such as hydrocortisone 1%. This directly helps reverse or control the body’s allergic reaction. Other important medicines may include the anti-allergy medicines, especially the older versions such as diphendydramine (Benadryl) pills and syrups. These work great for a few hours and also help kids sleep better, as they are very sedating. The newer allergy medicines such as Clarityn cause less sedation and are only taken once a day, but they may not be as effective. If you or your child are still miserable, or if it’s around their eyes or in their throat, it’s definitely time to see the doctor.

As you can see, this “rite of passage” is best avoided, so let’s all chant together with your kids: “leaves of three, let them be”!

(This article was originally printed in Beijing Kids magazine, where I am a contributing editor. You can click here to read the rest of my BeijingKids “The Doc Is In” columns.)

Presently I manage two popular, mature social media sites: my Weibo for Chinese readers, and my older health blog for expats. But as I pop open the baijiu to celebrate, I can’t help but wonder what impact have these sites truly had? And what lessons, if any, can help other doctors interested in social media?

I believe the first question is the easiest to answer, with a resounding yes: a doctor’s social media writings can have a major positive influence on a community — much larger than their clinic population of a couple thousand patients within a few square miles radius. My blog’s articles have been read almost a million times by readers in 198 countries and territories, and some of my articles helped improve public health awareness on hot issues such as air pollution and food safety in China. It also provided helpful information during times of crisis such as the Fukushima radiation scare — as well as our current crisis with H7N9 avian flu.

While my expat blog found instant impact, I was always acutely aware that my audience was relatively small, consisting only of the few hundred thousand English speaking expats in China. What about the other 99% of Beijing, who are just as hungry for information about the same issues? I was especially disturbed that I could instantly flash emergency air pollution AQI from the US Embassy site to my expat readers, but local Beijingers around me usually had no clue about these ‘crazy bad’ emergencies.

So how could I reach the rest of China even if I didn’t know much Chinese? It certainly wasn’t Facebook or Twitter, the obvious choice in many other countries but a non-starter here. The answer was obvious: Sina Weibo. All the newspapers and marketing reports had breathlessly covered Sina Weibo’s meteoric rise and impact in China, so I opened an account and started typing away. The language barrier wasn’t insurmountable, because even if only 5-10 percent of Weibo readers can read English, that is still a potential audience of tens of millions. That dwarfs the entire population of expats in China.

Weibo’s reach and impact truly is amazing. On my expat blog, a successful article will be read a couple thousand times over its first month. On Weibo, my most popular posts receive tens of thousands of views — often in just the first couple hours. It’s an extraordinarily rapid and powerful tool to share information.

Two years and 3,000 posts later, I must admit that I now have a lot more fun writing on my Weibo than my blog. Weibo is much more intimate, interactive and immediate, and also is fast to write — no small benefit for a busy physician. I also feel a deeper satisfaction from my Weibo, mostly because I sense that my Chinese audience is even more starved for credible health information than most expats. In a country where only 10 percent trust their doctor, my Weibo audience is truly grateful to find an online doctor they feel they can trust. Expats know they can turn to trusted, famous health websites like the Mayo Clinic, US CDC, and many others. I occasionally ask my Weibo fans if there are similar trusted health sites in Chinese, and sadly no one can come up with one.

My Weibo is also very satisfying because in China there are so many health issues that seem basic to expats but have little awareness in China. Air pollution and food safety discussions on my Weibo are just as popular as from my blog. However, I find more satisfaction discussing less obvious issues, such as using proper car seats for infants, which is scandalously uncommon in China, with only 3% use reported in a recent China Daily poll. I still find it frightening to watch grandparents hold infants in the back seats, truly having no idea their precious grandchild is totally unprotected in any serious crash. Every few weeks I repost a graphic video showing test dummy babies fly into front windows, and another handful of parents will rush out to buy a car seat. I’ve pushed multiple similar issues such as bicycle helmets, another depressingly neglected issue in China. I snap a photo of me in my bike helmet, upload instantly to Weibo, and spark a healthy discussion all over China. In the same vein, I upload a photo of water jugs baking in the summer sun at an uncovered warehouse, and thus spark a debate about bacterial contamination of delivered water jugs — an issue that few still seem aware of, given the massive and increasing popularity of delivered water. Or I post images from the supposedly upscale Sanyuanli food market in the summer, showing piles of unrefrigerated, uncovered meat, and my followers will discuss the virtues of proper food safety.

Doctors: Engage

As a family doctor, my judgment of a patient’s health involves not just their symptoms but also their relationships with their family and their community. Therefore, a good family doctor actively strives to improve the health of their community. Because of my social media, I am deeply satisfied that I have helped improve the health and wellness of many more people than just my clinic patients. There are a lot of smart primary care providers out there, energized with ideas and helpful advice they would love to share with a group much larger than their clinical load of patients. My general advice for anyone interested is to go for it, but be careful. First, you will need to review your hospital’s social media policy, if they have one. If you work in an enlightened organization such as mine, hopefully you would be encouraged and supported in your efforts.

As you can see, there is nothing in their green zone of therapies proven “likely safe and effective”. Their highest level is American ginseng, listed as “possibly safe and effective”. Then we have a slew in the “insufficient evidence” pile including ALA, garlic, lactobacillus and others. You will probably be surprised to find that the most commonly used preventive medicines such as echinacea, vitamin C and zinc all are considered “possibly ineffective”, lower than many other herbals. You’re welcome to disagree, but they always back up their findings from a continuing review of the latest research. Here is a snippet of their details:

Echinacea is widely used to prevent upper respiratory infections including colds and flu. In vitro research suggests that echinacea stimulates the immune system, causing macrophages to produce tumor necrosis factor, interleukin-1, and beta-interferon.^6388,6389 Echinacea has been studied for prophylaxis against the common cold, but has consistently been shown to be ineffective.^{3281,3282,6386,6417,8228,10782,12354,13419,14419} Don’t recommend echinacea for PREVENTING colds and flu.

American ginseng might also be beneficial. Some evidence suggests that taking a specific American ginseng extract called CVT-E002 (Cold fX, Afexa Life Sciences, Canada) 200 mg twice daily over a 3-4 month period during influenza season might decrease the risk of developing symptoms of an upper respiratory tract infection such as the common cold or flu in adults aged 18-65 and older.^{11351,13192,14345} It might not reduce the chance of getting the first cold of a season, but might reduce the risk of getting repeat colds in a season.¹³¹⁹² When respiratory infections do occur, this extract seems to reduce the symptom severity and duration of symptoms.^13192,14345 More evidence is needed to confirm these findings before American ginseng can be recommended for this use.

Probiotics are gaining interest for reducing the risk of upper respiratory tract infections such as the common cold. Some research suggests that milk fortified with a specific strain of probiotic, Lactobacillus rhamnosus GG (Culturelle) seems to modestly reduce the incidence of respiratory infections in young children in day care.⁸⁵⁶⁵ Lactobacillus GG seems to stimulate some measures of immune function.^7756,7757 Some clinical research also shows that children attending day care who drink a milk product containing a specific combination of Lactobacillus acidophilus plus Bifidobacteria animalis (HOWARU Protect, Danisco) for 6 months have a 45% lower risk of developing flu-like symptoms compared to placebo. This is promising, but still preliminary.

Zinc inhibits rhinovirus replication in vitro, but there’s no evidence this happens in vivo. Some evidence suggests that zinc might also increase cell-mediated immune response in elderly people. But there’s also no reliable evidence that taking zinc supplements can help prevent a cold.^{10780,10783,10784} Zinc also does not seem to decrease the chance of getting the flu in vaccinated, institutionalized elderly patients.⁶⁵⁶³

Vitamin C has long been promoted for colds and flu and has generated lots of controversy over the years. Vitamin C might help immune function. It seems to increase T-lymphocyte activity, phagocyte function, leukocyte mobility, and possibly antibody and interferon production.^1963,1965 But most evidence suggests that even in doses up to 1 gram/day, vitamin C does NOT prevent colds.^{1966,1967,1968,1987,3042,6458,7101,9832} Likewise, increasing DIETARY vitamin C intake does not seem to affect the risk of getting a cold.¹⁰⁷⁸⁰

What Else Works?

The most common sense preventive measure by far is hand washing. This is a crucial, simple idea that really does cut down on passing along the infection via handshaking or touching. This has been proven for almost 200 years, ever since Dr Lister proved that hand washing with antiseptic dramatically cut down on surgical infections (be thankful you didn’t live back then!). Many studies since then have shown decreases in hospital acquired infections with simple hand washing. But people should not waste their money on the trendy anti-microbial soaps with triclosan and other ingredients as they don’t have much evidence of effectiveness, and they likely will lead to a worsening of the already serious worldwide problem of antibiotic resistance. Simple soap and water also does the trick — but I actually prefer the alcohol gels as they work quicker and wipe out a much larger percentage of viruses and bacteria than soap.

Another interesting idea is daily gargling, with simple salt water, during the entire winter season. In a 2005 published study in the American Journal of Preventive Medicine, people who gargled up to three times a day had a 40% decrease in respiratory illness and symptoms during the winter. Gargling also is a simple way to help improve sore throat pain and swelling, and it also loosens up mucus.

And of course, the basics

Don’t forget the obvious concept of a healthy immune system, via exercising, a good diet full of antioxidants, and not smoking!

Background  Sleep quality is thought to be an important predictor of immunity and, in turn, susceptibility to the common cold. This article examines whether sleep duration and efficiency in the weeks preceding viral exposure are associated with cold susceptibility.

Methods  A total of 153 healthy men and women (age range, 21-55 years) volunteered to participate in the study. For 14 consecutive days, they reported their sleep duration and sleep efficiency (percentage of time in bed actually asleep) for the previous night and whether they felt rested. Average scores for each sleep variable were calculated over the 14-day baseline. Subsequently, participants were quarantined, administered nasal drops containing a rhinovirus, and monitored for the development of a clinical cold (infection in the presence of objective signs of illness) on the day before and for 5 days after exposure.

Results  There was a graded association with average sleep duration: participants with less than 7 hours of sleep were 2.94 times (95% confidence interval [CI], 1.18-7.30) more likely to develop a cold than those with 8 hours or more of sleep. The association with sleep efficiency was also graded: participants with less than 92% efficiency were 5.50 times (95% CI, 2.08-14.48) more likely to develop a cold than those with 98% or more efficiency.

This study also was addressed in an article from the New York Times, which offered a less dry summary:

In a recent study for The Archives of Internal Medicine, scientists followed 153 men and women for two weeks, keeping track of their quality and duration of sleep. Then, during a five-day period, they quarantined the subjects and exposed them to cold viruses. Those who slept an average of fewer than seven hours a night, it turned out, were three times as likely to get sick as those who averaged at least eight hours.

Sleep and immunity, it seems, are tightly linked. Studies have found that mammals that require the most sleep also produce greater levels of disease-fighting white blood cells— but not red blood cells, even though both are produced in bone marrow and stem from the same precursor. And researchers at the Max Planck Institute for Evolutionary Anthropology have shown that species that sleep more have greater resistance against pathogens.

The fascinating part is that all test subjects had the rhinovirus dripped into their nose (!), so all were equally exposed — but the sleep deprived got actual cold symptoms 3 times more than the well rested. I think it’s dramatic evidence of the power of our immune system to keep us healthy. So get your sleep!