China has the second highest number of TB patients in the world, after India. When TB patients fail to follow treatment regimens, use inappropriate medications, or stop treatment prematurely, they evolve into drug-resistant TB, the latter of which is much more expensive to treat. The high cost of treatment may cause patients to automatically stop their drug therapy. The powerful side effects of drug therapy may lead to terrible suffering and financial burden, which may bring about physical and mental fatigue of the patient. However, if patients are not completely cured, TB bacteria can mutate, reappear later, and become resistant to small doses of treatment drugs. China currently has 4.5 million TB patients, with 1.4 million TB episodes each year. According to the World Health Organization (WHO), as many as 160,000 people died of TB in China in 2008. During the same period, there were 1.8 million TB deaths worldwide, or one death from TB every 20 seconds. This has not only wreaked havoc on poor countries, but has also resurfaced in Western countries in the last 20 years, as people with AIDS have weakened immunity and are more susceptible to TB infection. Because the number of people with drug-resistant TB has increased, treatment is more difficult and more expensive. Patients with this type of tuberculosis are on medication for up to two years, and the worst cases of drug-resistant tuberculosis are incurable, with one out of every two of them dying. Drug-resistant TB is from $100,000 to $300,000. The Center for Biomedical Sciences? The journal Infectious Diseases published an article showing that studies show that the proportion of TB patients in China who are drug-resistant is nearly twice the world average, and nearly 10 percent of patients are resistant to even the most effective first-line drugs. With an estimated 4.5 million TB patients, China is second only to India as the world’s top country for TB incidence. Researchers surveyed 10 provinces between 1996 and 2004 and found that multidrug-resistant TB patients accounted for 9.3 percent of all cases, 5.4 percent of new cases and 25.6 percent of treated cases. All three of these figures are higher than the global average. Worldwide, multidrug-resistant TB accounts for 4.8 percent of all cases, 5.4 percent of new cases, and 19.3 percent of treated cases. Patients with multidrug-resistant tuberculosis are resistant to the two most effective anti-tuberculosis drugs, and treatment of this disease takes two years and is costly, requiring second-line drugs with toxic side effects and a low survival rate. If treated properly, the proportion of TB patients who have been treated should be low. But the study found that 20 percent of all TB patients in China had been treated, compared with a global average of 11 percent. ”This may be related to inadequate use of anti-tuberculosis drugs in public hospitals, insufficient supervision during the treatment phase, inappropriate drug management, and lack of infection control measures,” the report said. ”In some parts of China, anti-TB drugs used to be available without a prescription, which may also have contributed to the increase in patients with drug resistance.”