INTERVIEW WITH DR. BA Deinian

Professor BA Denian is an elected member of the Chinese Academy of Engineering and the Institute of Medicine of the U.S. National Academies. He has dedicated his academic career to tumor immunology research. In the 1980s, he discovered a natural thymocytotoxic autoantibody, and proposed a theory to illustrate the relationship between abnormal immune function and hypertension, and thus is recognized as a pioneer of cancer biology and theory in China. Dr. Ba had practiced medicine for many years and trained numerous medical professionals. He served as the president for both Peking Union Medical University and the Chinese Academy of Medical Sciences for nine years. Dr. Ba served as the Dean of Zhejiang University School of Medicine from 2003 to 2009. Although Dr. Ba has retired from these positions, he remains active and at the forefront of health research in China.

中国工程院院士,美国医学科学院外籍院士,巴德年教授是免疫学专家,长期致力于肿瘤免疫研究。八十年代初,巴德年教授在世界上首次发现抗胸腺自家抗体,从而为高血压大鼠的免疫功能低下找到了原因,用胸腺移植等免疫重建方法,在国际上首次提示免疫功能异常与高血压的关系,并成为我国癌生物疗法的学术带头人之一。 他自己行医数年并且更为中国的医疗科研第一线培养了无数骨干精英。他曾经担任9年的协和医科大学校长和中国医学科学院院长,从2003年起担任浙江大学医学院院长直至2009年。年届七十,如今已辞去很多职务的巴德年老师仍然活跃在中国医疗卫生的前沿。巴教授努力为社会培养出优秀的行医者,优秀的医学管理人才;心系普通老百姓的医疗保障和医疗公平。

1. Educational Experience
求学路

Dr. Ba has mentioned his tough path to education when he was young in many of his speeches. After graduating from middle school, he planned to attend a professional program in order to support his family. Encouraged by his middle school teacher and financially supported with a scholarship, he chose to attend high school instead. He managed to fulfill the prerequisite requirements for medical school in one year and was admitted into Harbin Medical College. He was a graduate student at Beijing Medical College during the Cultural Revolution, yet was able to remain true to his dream of becoming a physician. In 1978, at 40 years old, he was selected to study abroad. It then took him a mere two years to become the first foreign medical doctor of Hokkaido University School of Medicine in Japan.

巴老师在曾经的演讲中曾经提及过儿时艰辛的求学路。初中毕业,他曾经想报考中专,早点工作挣钱补贴家里。因为中学老师的鼓励和助学金的支持,才选择上高中,尔后又仅用了一年的时间把所有的课程学完,考上了哈尔滨医科大学。在北医读研究生的日子正好是中国文化大革命的岁月,他仍然储备能量为实现自己当一名好医生的理想努力。在1978年开始选拔留学人员去国外进修的时候,这一年,他已经40岁了。他仅用了2年的时间从日本北海道大学的医学院获得了“外国人医学博士第一号”的荣称。

Yi: Dr. Ba, you are known as an expert in immunology and have dedicated yourself to the study of cancer immunology for decades. What prompted you to choose immunology as your life-long career?

潘羿:巴老师,我们知道您是免疫方面的专家,长期致力于肿瘤免疫研究。您能给我们介绍一下当初是为什么会选择上这样一个学术方向作为终身职业呢?

Dr. Ba: It was a special time when I first started my career. A lot of students nowadays may not understand what we were going through. Back in 1973, I was a surgeon and loved my job. I was asked to help establish a cancer institute in Heilongjiang Province as I specialized in tumor immunology. I switched from surgery operation to tumor immunology research because of duty assignments rather than personal interest. However, I have decided for myself that no matter what I work on, I should always try my best. If I had another opportunity to make the choice, I would have continued as a surgeon, working with patients to save lives.

巴德年:我们当时的情况很特殊,现在的学生无法理解。1973年,我是一名普通外科医生,我非常热爱自己的职业。当时黑龙江省组建肿瘤研究所,因为我是学免疫化学的,根据组织上的决定,我放下了手术刀,专门来做肿瘤免疫方面的研究。所以说这个选择最初并不全是靠兴趣,而是要完成任务。但是我有一个信条,无论干什么都要努力,好好干,争取干出成绩。但是如果给我再次选择的机会,我依然会拿起我熟悉的手术刀,当一个普普通通但受老百姓喜爱的外科医生,治病救人,为大众服务。

2. Class of BA Denian
巴德年班

Yi: Dr. Ba, although you did not have the opportunity to be a surgeon again, you served as the vice president of Harbin Medical College, the president of Peking Union Medical College, the president of the Chinese Academy of Medical Sciences for nine years and the Dean of Zhejiang University School of Medicine from 2003 to 2009. You have trained many talented researchers in medicine. In 2005, a special eight-year medical program named after you started recruiting medical students for a dual MD/PhD degree. Over the years, the college entrance exam scores of students admitted to this eight-year program ranked among the highest in Zhejiang University. What was your expectation about this program?

潘羿:巴老师,虽然您没再做回医生,可您从哈尔滨医科大的副校长,到协和大学的9年的校长,中国医科院的院长,再到您在2003年到2009年担任了浙江大学医学院的院长,可是为中国的医疗科研事业培养了很多人才。2005年的时候,以您名字命名创建的八年制巴德年医学班在浙大开始招生,培养医学博士。自开办以来,八年制班的录取分数线一直居于浙江大学历年招生的第一位。您当初的设想是什么?

Dr. Ba: At that time, the president of Zhejiang University, Dr. PAN Yunhe, proposed that we start a "southern Peking Union Medical College" at Zhejiang University. We knew that more than 100 years ago, the modern medical education system started in the United States. We truly hoped the eight-year dual MD/PhD program would continue its commitment to training future Chinese leaders in medicine for 20, 30 years and beyond. As to its name, I did not agree on naming it after me. But there was a mathematics program which was named after Dr. Shing-Tung Yau, a renowned mathematician, so they insisted on naming the medical program after me. It had already been printed in the national college enrollment brochure. Today I know this program attracts students with the highest college entrance exam scores in Zhejiang University. I am glad to see so many young students who have the determination and enthusiasm to join the medical professional in China, and yet I also feel a great responsibility. The better the students, the harder we need to work in order to train them to become the best doctors.

巴德年:当时浙江大学的校长潘云鹤主张想在浙大办出一所南方的“协和医学院”。我们知道100多年前美国就开始创办了先进的现代的的医学教育制度。所以这个8年制的医科班培养的是MD,又办了MD和PhD双学位教育体系培养双料人才,为中国未来的20,30年培养杰出的医生,医学人才。关于这个班的取名,我开始是不同意用我的名字。因为浙大同时还有一个以数学家丘成桐名字命名的数学班,他们坚持用我的名字命名这个医学班,并且已经写到全国招生简章中。我知道这个班的招生成绩连续7年招收了考浙大的最高分数的学生。我很高兴看见这么多优秀的青年学子有投身中国医疗事业的决心和热情,同时也感到自己的重任。因为越是好的学生,我们越要下功夫去培养他们,成为最好的大夫。

Yi: Dr. Ba, when you were the Dean of Zhejiang University School of Medicine, you always insisted on recruiting the best students to study in medical school, as well as training those students to become the best physicians. How has this been implemented in the eight-year Ba Denian program?

潘羿:巴老师,您在浙大当医学院院长时一直得主张是让好学生学医,把好的医学院学生培养成好医生。这点在这个8年制的巴德年班又是怎样实践的呢?

Dr. Ba: This has been successfully implemented in Zhejiang University by following two principles. First of all, we take advantage of the fact that Zhejiang University is a comprehensive university. We are able to provide diverse training for students in sciences, social sciences, arts and sports. This is important because we know that a good doctor not only has medical knowledge from books, but also has strong physical and psychological qualifications. So we have our best students be trained in science, art and sports at the Kezhen College of Zhejiang University. We do not focus on test scores. Instead, we stress the process of medical training, as we want to make sure that those young scholars can develop into excellent physicians and researchers. We have also adapted a training system from UCLA and we send several faculty members there every year. In addition, there are six affiliated hospitals in Zhejiang University which provide ample internship opportunities for our students.

巴德年:这个在浙江大学我们是通过2点来贯穿的。第一,我们借助浙江大学是一所综合性大学的优势,全面培养学生自然科学,人文科学,艺术和体育上的全面发展。因为我们很清楚认识当一名好医生不仅仅是融会书本知识,甚至身体体质的强壮,心理素质的培养都十分关键。所以我们把最好的学生放在浙大最好的竺可桢学院全面学习文化,美术,体育各方面内容。我们不在乎学生的分数最终是否门门优秀,我们更在乎这个熏陶和锻炼的过程,能否在将来肩扛大任。其二,我们在平时教学的过程中运用了UCLA医学院的教学体系,并且常年派老师去UCLA交流教学情况。现在浙大有6所附属医院,所以我们的学生除了打下扎实的医学基础,也都有在这些附属医院实践的充分机会。

Yi (Zhuo): Dr. Ba, China’s medical education system is currently undergoing changes, and there are a variety of different training models. Can you share your thoughts on promoting the eight-year MD and the MD/PhD program?

潘羿(陈茁):巴老师,如今中国的医学教育体制还有待完善,因为有各种不同的培养计划,您觉得8年制的MD, 和MD/PhD制度值得不值得推广?

Dr. Ba: Yes, the Chinese medical education system has room for further improvement. My main proposal is as in the following: (1) General medical schools should continue to provide 5 years of undergraduate education. (2) We can try to promote the eight-year MD/PhD program in top universities, and particularly in comprehensive universities, such as Peking, Fudan, Nanjing, Shanghai Jiao-Tong, and Sun Yat-sen Universities. Currently, there are ten universities with an approved eight-year medical program. But I do not think that is enough and it should be extended to at least twenty schools.

巴德年:是的,如今中国医学教育制度还有待完善。我的基本主张是:(1)一般性的医学院继续5年制的本科教育。(2)非常好的大学,尤其是综合性大学,比如北大,复旦,上海交大,南京大学,中山大学等等,我们可以推广8年制的MD/PhD制度。现在国家批准的8年制的医学班有10所大学,但我认为还是不够的,至少应该扩展到20所。

3. The Development Path of China's Public Health System
中国公共卫生体系发展之路

Yi: You were active in promoting medical sciences, and now you are concerned about the development of public health policy and systems. What do you think is the biggest challenge to China's current medical and health system? You advocated universal health care in the past; what do you think about the current situation in China?

潘羿:您曾经活跃在医学科学的最前沿,现在又十分关心重视公共卫生政策和体系的发展。您觉得中国现阶段医药卫生体系面临的最严峻的考验是什么?您曾经呼吁要最终做到人人享有卫生保健, 您觉得现在中国的情形是怎样的?

Dr. Ba: Since 2001, I have started to address equity of the health system in order to let everyone enjoy the fruits of economic reform in China. I advocated universal health. Things has been improved significantly in the past ten years. This is mainly reflected in the following: (1) 96% of China’s population is already enjoying varying degrees of health insurance coverage. China's health insurance is now divided into three schemes-- one is rural cooperative medical insurance, one is medical insurance for urban residents, and the third is employer sponsored health insurance. I propose to merge the three programs to let Chinese people enjoy a unified health insurance program. Of course, this would take time. (2) Starting this year [note: 2012], farmers in most counties can be reimbursed at least 60,000 RMB if hospitalized for a catastrophic condition. This is a major progress, but it is still below what I hoped for. I was thinking, with the advances in modern information technology, we can use only one insurance card to receive medical care all over the country without out-of-pocket payment. Therefore, China's medical insurance has improved in terms of equity, but this can be improved further. (3) In recent years, the hospitals at the county level developed very well. The government has invested a lot in developing hospitals in each county, and as such has promoted standardization of medical care in the countryside. The salary and benefits are the same whether you are a physician at the county, township or village level. But there are too few qualified physicians and nurses. More medical professionals are needed in the rural areas. (4) Hospital reform in the cities is far from complete. Regardless of serious illness or minor ailments, people prefer major hospitals, which is inefficient. Many minor illnesses can be addressed at the community hospitals, and do not have to be brought to a major hospital. But the service in the community hospitals should be improved to attract more people from the major hospitals. In summary, there has been a lot of progress in healthcare reform since 2009 and the government has increased investment in solving the fairness and access in health system. But there are still a lot of things that need to be worked out.

09年以来的医疗改革有很大进步,国家加大了投入,在解决公平性和可及性上有了提高,但是“革命尚未成功,同志仍需努力!。

—巴德年教授,浙江大学

巴德年:我从2001年就开始呼吁解决医疗保障公平性,想让中国普通老百姓享受改革开放的成果,能享受国家富裕的成果,体现公平。我主张的医疗保障能覆盖所有人群。这十多年里进步是非常大的。这主要体现在以下四点。(1)全国有96%的人已经享受到不同程度的医疗保障了。现在中国的医疗保障分成了3种,一种是农村的合作医疗,一种是城市的医疗保障,还有一种是职工的公费医疗。我现在的主张是如何统一这三种保障,让中国国民享受统一的医疗保障,这个还需要时间。(2)今年的数据显示大多数的县和农民,如果住院得大病,至少可以报销6万块钱。这是很大的进步,但距我想象的全民平等的医疗保障还有待实现。随着现代信息科学的发达,我主张每个人只要有一卡通,到全国任何地方都可以看病,都不需要交钱。所以可以说中国的医疗保障在公平性上有所提高,但是与我想象的公平还有差距。(3)近几年基层乡镇卫生院的建设发展得很全面。现在国家大力投入,每个乡镇都有卫生院,并且好多省实行了县乡村一体化。就是说在县,乡,村当大夫福利待遇都是一样的。但是现在存在的问题是真正合格的全科医生实在太少了,真正合格的护士不够用。所以现在的政策走向还需要呼吁更多的人去为农村,基层服务。(4)现在城市医院的改革还很不彻底。不管大病小病都要到大医院,这是不对的。但是这个问题的解决应该靠提高服务来解决而不是靠限制来解决。很多小毛病在基层就能解决,不用去大医院。但是现在可能基层的水平不高,老百姓还要去大医院。总而言之,09年以来的医疗改革有很大进步,国家加大了投入,在解决公平性和可及性上有了提高,但是“革命尚未成功,同志仍需努力!”

Yi: What role do you think the field of public health policy and health systems play in China's health care reform? How important is policy, knowledge and talent in this area?

潘羿: 您认为公共卫生政策和体系这个学科在中国医疗改革中应扮演怎样的角色?这方面的政策,知识和人才有怎样的重要性?

Dr. Ba: This is extremely important. I will attend a national conference on October 8th and 9th (2012). I plan to propose a new program to train public health professionals. I do not think it is a good idea to enroll public health students from high school graduates. I believe that it is better to recruit public health students from those who have already been trained in medicine. There are two individuals I admire the most, Dr. Margaret Chan, Director-General of the World Health Organization, and Dr. Lincoln Chen, the President of the China Medical Board. Both are prominent graduates of MD/MPH programs. I argue that we need to select the best medical graduates to work in public health after further training in leadership, vision, and management. Such talents will be the backbone of China’s healthcare reform and future development.

巴德年:这方面是最重要的。我10月8,9号要在浙大开一个全国性的会,我要办一个新的班,专门培养公共卫生人才。我反对从高中毕业生中招生专门搞公共卫生。我觉得搞公共卫生的人一定是学医非常好的,其中一部分去做公共卫生。就像我最佩服的两个人,一位是世界卫生组织的总干事陈冯富珍女士,还有一位我们熟悉的CMB的主席陈致和先生,他们都是杰出的MD/MPH的代表人物。我主张一定要选拔最优秀的医学毕业生去做公共卫生,进一步培养他们的组织领导能力,前瞻性,计划性。这样的人才在中国的医疗改革和未来发展中会是中坚力量。

Yi: China Health Policy and Management Society (CHPAMS) is a fast-growing professional society. Do you have any words to our members and readers?

潘羿: 中国卫生政策和管理学会是一个迅速发展的专业社团。您对我们的会员和读者有任何期望与建议吗?

Dr. Ba: The Chinese Health Review is great and informative. I hope it can be more objective, in-depth and honest, keep track of the development in China's health sector, attend to China's healthcare reform, and introduce health management to Chinese medical scholars,  and serve as a platform of exchanges between China and the world in the area of public health.

巴德年:我认为中国卫生评论办得很好,具有指导意义。我希望她能更客观,深入和诚实,更关注中国卫生方面的进展,关注中国的医疗改革,为中国的医学学者多介绍一些卫生管理的知识,成为中国和外界公共卫生管理的交流纽带。

By Yi Pan, PhD, Emory University
潘羿,博士,艾默里大学

   
  
 
 
  
    Dr. BA Denian

Dr. BA Denian