HEALTH CARE IN JAPAN: DRUGS, COMPANIES, VACCINATIONS AND TRADITIONAL CHINESE MEDICINE

PRESCRIPTION DRUGS IN JAPAN

According to a 2003 survey, 30 percent of the drugs used in the United States for cancer were barred in Japan . Most of the barred drugs haven’t been approved in Japan.

Reviewing a new drug generally takes a minimum of two years. But this is not always the case. Viagra was approved in six months. Birth control pills took almost 30 years.

Japanese doctors like to prescribe lots of drugs, partly because their salaries are linked to how many pills they dish out. It is not common for prescriptions to contain to 10 or more drugs. Until recently vitamin pills were counted as reimbursable prescription drugs.

There is a big market for "cerebral metabolism enhancers" which some doctors claim help diseases such as Alzheimer's disease.

Japan doesn’t develop so many new drugs and imports about $1.2 billion more in drugs than it exports. Japan is good at basic research but it doesn’t do so well at developing new drugs and carrying out clinical trials.

Japan Expands Routine Vaccinations

The Health, Labor and Welfare Ministry's Health Sciences Council task force called for including the following seven immunizations in the country's routine vaccination program: cervical cancer, Haemophilus influenzae Type B (Hib), pneumococcus among children, chickenpox, mumps, hepatitis B, and pneumococcus among the elderly. [Ibid]

“In May 2012 the Yomiuri Shimbun reported: “The health ministry has decided to add three immunizations--against cervical cancer and two infections that can cause bacterial meningitis--to its routine vaccination program for children as early as fiscal 2013. The decision will bring Japan in line with the United States and European countries, where the three vaccines are already part of routine immunization programs, according to the sources. The ministry's program will include vaccines for cervical cancer, Haemophilus influenzae Type B (Hib) and pneumococcus among children. [Source: Yomiuri Shimbun, May 18, 2012]

“The routine vaccination program consists of immunizations based on the law and administered regularly by municipal governments. They are divided into two categories. Many local governments offer free vaccinations against diseases in the first category, such as diphtheria and pertussis. Examples of second-category vaccines are flu shots for the elderly. [Ibid]

“In addition to the three vaccinations, the ministry will include four others in the routine vaccination program as soon as it can secure funding for them. Among the four, the ministry aims at prioritizing vaccines against chicken pox and mumps. After them, vaccinations for hepatitis B and pneumococcus among the elderly would be included, according to the sources. [Ibid]

“Currently, the four vaccinations are optional. However, there are gaps among municipalities in subsidies for them. Making all seven immunizations part of the routine vaccination program would cost 200 billion yen ($2.55 billion) per year, the sources said.Japan lags behind the United States and European countries in providing subsidies for the routine vaccination program because of long-standing fears about possible health risks posed by immunizations, according to the ministry sources. [Ibid]

“Niigata University Prof. Akihiko Saito, the vice head of the Japan Pediatric Society's committee on vaccination and infectious diseases, described the ministry's decision as "a huge step." At the same time, however, Saito expressed dissatisfaction with the ministry not expanding the routine vaccination program to cover all seven vaccinations at once. "It's strange to treat them differently just for budget reasons when they are all important vaccinations," the professor said. [Ibid]

Expensive New Vaccinations Place Burden on Local Governments

Tsuyoshi Nakamura and Sho Mizuno wrote in the Yomiuri Shimbun, Expanding the number of required immunizations, however, will likely result in increased financial burdens for municipal governments, given that most routine vaccinations are currently conducted for free. [Source: Tsuyoshi Nakamura and Sho Mizuno, Yomiuri Shimbun, May 27, 2012]

“The central government is currently subsidizing vaccinations against cervical cancer, Hib and pneumococcus among children through the end of fiscal 2012. Under the provisional measure, 90 percent of these three vaccinations' costs is equally shared between the central and local governments. Though the remaining 10 percent is supposed to be paid by children's parents or guardians, several local governments cover the extra costs, effectively making the vaccinations free. [Ibid]

“If the three immunizations become routine vaccinations, the central government will stop subsidizing them, putting a heavier financial burden on local governments.Routine vaccinations, which are conducted based on the Preventive Vaccination Law, are in principle under the jurisdiction of local governments. Most of the current routine immunizations, such as for diphtheria, are administered for free. [Ibid]

“Local governments will be asked to shoulder an estimated 120 billion yen more once the routine vaccination program is expanded to cover the three priority vaccinations. Costs will increase to 230 billion yen to cover all seven proposed vaccinations. "Since [the routine vaccinations are] free, local residents will not agree to pay for the new vaccinations," an official of the Kanazawa city government said. [Ibid]

“In May 2012 the heads of nine local governments in the Tokyo metropolitan area jointly submitted a request to Health, Labor and Welfare Minister Yoko Komiyama, asking the central government to secure financial resources as part of its responsibility to cover the costs of the new immunizations. They argue it will be difficult for local governments to cover their costs with the new additions. The central government, however, did not change its position and maintained the costs have to be paid by local governments. [Ibid]

New Polio Vaccine in Approved in Japan

In April 2012, the Yomiuri Shimbun reported: “The production and sale of an injectable inactivated polio vaccine is expected to be approved by the end of May. Currently, oral live vaccines are administered to infants and young children. But inactivated polio vaccines are deemed safer than live attenuated versions as there is no risk they will lead to a polio infection. [Source: Yomiuri Shimbun, April 21, 2012]

The ministry was reportedly rushing to approve the vaccines in response to an increasing number of parents who are reluctant to vaccinate children until the inactivated polio vaccines are introduced. Live vaccination causes paralysis in a child's hands and legs at the ratio of 1.4 per million people vaccinated. In Japan, 15 people who took a live vaccine developed polio during the decade up to 2011. This has led to growing calls for the introduction of inactivated vaccines that are free from the concern of developing polio. [Ibid]

“The country previously used inactivated polio vaccines, but their efficacy was weak compared to live vaccines.When Japan had a polio outbreak in 1961, the then Health and Welfare Ministry brought the situation under control by quickly importing live polio vaccines. Inactivated polio vaccines stopped being administered when the use of domestically produced live vaccines began in 1964. [Ibid]

“The number of children getting vaccinated for polio had fallen off because of concerns they might catch the disease. In October 2011, the Yomiuri Shimbun reported: “According to statistics published by the Health, Labor and Welfare Ministry this month, the number of infants who received group vaccinations this spring declined nearly 20 percent from the year before. The overall vaccination rate could drop from the 90 percent level of usual years to between 70 percent and 80 percent this year. [Source: Yomiuri Shimbun, October 6, 2011]

“Polio vaccinations in Japan involve the patient taking an oral dose of live-attenuated vaccine. Foreign countries mostly use inactivated vaccines. These vaccines have no pathogenicity because the virus is killed after being chemically treated. They have almost no danger of causing side effects. The government decided in the early 2000s to switch to inactivated vaccines. However, implementation of this plan has been delayed drastically because the government has failed to work out definite policies, including those on vaccine development schedules. [Ibid]

Japanese Drug Companies

20100501-13nara1  kantei drug plant.jpg
Prime Minister at Drug Factory
Japan's drug market is the second largest in the world, with $75 billion in sales in the 1990s. It is very profitable because the market is controlled by a limited number of manufacturers. According to the Economist, "In the past Japanese firms had a reputation of simply shoving lots of chemicals into animals to find ones that worked."

Largest drug companies in Japan (annual sales in billions of yen): 1) Takeda (774.78); 2) Sankyo (417.70); 3) Yamanouchi (335.84); 4) Elsai (287.49); 5) Shionogi (194.92) Other Major Japanese drug companies include Sato Pharmaceutical Co., Daiichi Sankyo Co.; Dainippon Sumitomo Pharma Co.; Aestealls Pharma Co. Sato’s little pink elephant Satako-chan is one of the most recognizable kawaii mascots in Japan. She has a big brother Sato-chan.

Japanese drug companies are being challenged more and more by foreign companies. By number of products subject to the price maintenance system, eight of the top 10 pharmaceutical firms are foreign affiliated companies. GlaxoSmithKline K.K. ranks first on the list.

Takeda Chemicals is Japan’s largest drug maker. Based in Osaka and more than 230 years old, it does a lot of business overseas and has an alliance with Eli Lilly. It has spent billions expanding in the United States where it believes it can make bigger profits than at home in Japan. In early 2011 Takeda Pharmaceutical Co. was the world’s 16th largest drugmaker. The $12 billion acquisition Nycomed made it the 12th largest. Takeda is looking for deals and acquisitions in India and plans to invest $300 million in China as it plans to expand beyond the Japanese and U.S. Markets.

Takeda produces Actos, a diabetes medicines widely used in the United States and abroad. The drug company hopes to USFDA approval for new diabetes medicines, alogliptin, It also makes the stomach ulcer medicine Prevais. As of 2008 these two drugs accounted for 40 percent of the company’s revenues. Takeda need to come up with new drugs soon. The patents on these drugs is set to expire in 2011.

Japanese Drug Company Business Deals

With their markets in Japan offering few growth possibilities and their patents expiring major Japanese drug companies have recently gone on a buying spree to open new markets and get their hands on promising new drugs. Eisai Co bought MGFI Pharma, a top U.S. producer of anti-cancer drugs, for $3.9 billion in January 2008. Takeda Pharmaceutical Co. bought Millennium Pharmaceuticals, a U.S. biodrug firm, for $8.9 billion in May 2008 and Nycomed, a Swiss drugmaker, for $12 billion. Shionogi & Co. bought Sciele Pharma, a U.S. firm known for its anti-diabetic drugs, for $1.4 billion in October 2008. Daiichi Sankyo Co. bought Ranbaxy Laboratories, and Indian firm and leader in emerging countries, for $5.3 billion in November 2008. Dainippon Sumitomo Pharma Co. bought Sepracor Inc., a firm that excels in producing drugs for the central nervous system, for $2.5 billion on October 2009. Aestealls Pharma Co. bought OSI Pharmaceutical. A producer of anti-cancer drugs, for $4 billion in June 2010.

“In 2011, Takeda Pharmaceutical Co. bought the Swiss drug firm Nycomed for $14 billion (1.1 trillion yen). On the decision to make the buy, Takeda president Yasuchika Hasegawa told the Yomiuri Shimbun, “It was a major decision for us. The purchase price was huge, and Takeda had operated until then without any debt, so all executives except me opposed buying the Swiss firm, saying it was not worth borrowing money to buy it. They probably thought it was like gambling. However, we badly needed to purchase a company that was strong in emerging countries. We also had surplus funds of about 500 billion yen. Judging that the possibility of making a successful purchase was 80 percent, I persuaded executives and others in the company, saying, "Sometimes the risk of doing nothing is greater than the risk of doing something. [Source: Yomiuri Shimbun, February 21, 2012]

In April 2008, Takeda bought Cambridge-Massachusetts-based Millennium Pharmaceutical for $8.8 billion in part to gain access to its cancer and inflammation drugs which are currently under trial.

Japanese Drug Firms Look to New Drugs In the Face of Government-Imposed Price Cuts

Naotake Katori and Katsutoshi Samata wrote in the Yomiuri Shimbun: “Developing original new medicine may be the key to survival for pharmaceutical companies as the government implemented an official drug price cut this month. Original medicines under patent protection are subject to the price maintenance system, under which the government refrains from cutting their prices. The price maintenance system was introduced on a trial basis to encourage companies to create new medicines. Official price adjustments for medicine were carried out in April, with the average price of drugs falling 6 percent. Official price adjustments are carried out once every two years. [Source: Naotake Katori and Katsutoshi Samata, Yomiuri Shimbun, April 10, 2012]

“Whether or not a pharmaceutical company is developing prominent new drugs is likely to be a determining factor in its success or failure, observers said. Eisai Co. faced a price reduction rate in the lower 11 percent level for its drug prices, significantly higher than the average rate of 6 percent. After patent protection expired for Aricept, a drug for dementia, the drug's price fell by 16.7 percent. Eisai plans to put most of its efforts toward developing other leading products such as an antiepilepsy drug. However, the company will not likely be able to avoid a decline in profits during fiscal 2012, observers said. [Ibid]

“Astellas Pharma Inc. also had to lower the price of Lipitor, a cholesterol-lowering medication, by 11.3 percent after its patent expired. However, the company succeeded in developing new medicine, lessening its total reduction rate to the lower 6 percent level. The reduction rate for Takeda Pharmaceutical Co., the nation's largest drugmaker, and Novartis Pharma K.K., were about 5 percent, lower than the average rate for all pharmaceutical firms. [Ibid]

“Of about 15,000 drugs whose prices are officially set by the government, 542 did not face price reductions this time around. Domestic pharmaceutical companies spend about 20 percent of what they earn from product sales on research and development. However, developing new drugs requires more than 10 years and tens of billions of yen. "Foreign-affiliated companies have an advantage as they have ample resources [to create new drugs]," an analyst said. [Ibid]

“Of eight major domestic pharmaceutical firms, seven companies expect a profit decline in fiscal 2012, due to the "Year 2010 problem" and appreciation of yen. The "Year 2010 problem" is a situation in which patents for a number of medicines developed by pharmaceutical companies began to successively expire from around 2010. [Ibid]

“Domestic drugmakers are likely to face a severe business environment in the future, the observers said. Therefore, an increasing number of companies have been trying to purchase foreign manufacturers or find a way to cooperate with universities or venture companies to develop new drugs. [Ibid]

“Last year, Takeda Pharmaceutical established a new research institute in Kanagawa Prefecture and carried out joint research with Kyoto University and foreign venture companies. Astellas Pharma also started joint research on an Alzheimer's drug with Riken, a major state-backed research institute. [Ibid]

Top Japanese Genome Researcher Quits, Wants to Develop Anticancer Drugs in U.S.

“In December 2011, the Yomiuri Shimbun reported: “Tokyo University Prof. Yusuke Nakamura will step down as head of the office promoting medical innovation in the Cabinet Secretariat and move to the University of Chicago. Nakamura, a leading authority on genomic research, hopes to put new anticancer drugs to practical use in the United States. His decision likely will cause controversy, as it means a leader of medical innovation in Japan has given up on research and development of medicine here. [Source: Yomiuri Shimbun, December 13, 2011]

“The government office was launched in January at the prodding of then Chief Cabinet Secretary Yoshito Sengoku. It appointed Koichi Tanaka, 52, a Nobel laureate in chemistry, as one of its acting chiefs. Sengoku hoped the office would lead efforts to strengthen the domestic medical industry's international competitiveness as a national strategy by eliminating barriers among ministries and agencies. [Ibid]

“However, Sengoku stepped down shortly after the office was launched, and no top officials from the Economy, Trade and Industry Ministry or the Cabinet Office attended the third meeting the office held in October, although at least one of these officials had attended the previous meetings. Nakamura said, "We couldn't draw a blueprint for Japan's future." As Japan's leading researcher in genomics, Nakamura played a central role in the International Human genome Project. He said he felt Japan was powerless in developing new drugs although he had made efforts to change the system. "It was my dream to deliver new drugs developed in Japan to Japanese people first. [As it was impossible here, I'd like to realize new drugs in the United States.” [Ibid]

“Jun Sugimori of the Yomiuri Shimbun wrote: “Prof. Yusuke Nakamura's decision to shift his research base to the United States to develop new drugs symbolizes the current status of medical research in Japan, where landmark achievements in basic science have not translated into practical application of innovative medicines. With Japan's population graying at an ever-faster pace, the government has positioned medicine as an important strategic sector and aims at cultivating the industry to develop strong international competitiveness. [Ibid]

“The government injected more than 1.6 trillion yen into life sciences from fiscal 2006 to fiscal 2010. However, the majority of innovative new anticancer drugs were developed overseas. Japan marked a 1.15 trillion yen trade deficit in medicines in the last fiscal year. The government hoped the medical innovation office would end this trend and make Japan a leader in creating new medicines. [Ibid]

Traditional Chinese Medicine in Japan

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Chinese medicine for diabetes
Chinese medicines (known as kampo) are widely used in Japan but less so than in China and South Korea. Sales of Chinese medicine increased 15-fold between 1974 and 1989 while Western medical products increased only 2.6 times.

Kampo has been used to treat hepatitis, menopausal disorders, asthma and digestive disorders. A total of 146 herbal medicines are covered by the national insurance system. The Kitasato Institute is one of two traditional medicine research institutes in Japan. Researchers there scrutinize Ancient Chinese textbooks for sources of new treatments.

The sale of herbal medicines and Chinese medicines increased from ¥14.5 billion in 2006 to ¥16.5 billion in 2008. Among the reasons for the increase were the brisk sales of an herbal medicines that claimed to help people burn fat and the packaging of products with the ailment they aimed to cure on the label rather than difficult-to-understand Chinese characters.

Among the traditional Japanese medicines are gennoshoko (Japanese germanism), an effective treatment for diarrhea and digestive infections; dokudami, a low creeping plant with white lowers and a nasty smell used to treat heart problems and counteract poisons; ukon (tumeric), helps the liver and fights bacteria; feverfew (bachelor’s button, or natsushirogiku), a popular relief for migraine headaches, Some questionable medicines include sumi, snakes roasted on a stick until black, which are added to food as a general tonic.

The Japanese herbal medicine market is expected to double between 2007 and 2015. The Japanese government is encouraging Japanese to produced their own ingredients as they are worried about a cut of supplies from China.

The Shuju Yaku Cho is a list of 60 Chinese medicines Empress Komyo dedicated to the Todaiji Buddha in 756. About 40 of the medicine remain in the Shoso-in repository. Among the medicines is a fossilized tooth from an Elephas naumanni---a prehistoric creature better known as the Naumann elephant that lived as 300,000 to 12,000 year ago in Japan. Shavings from the fossil were used as sedative and painkiller. A statement attached to the medicines said they should be given to anyone in need of them, indicating the Empress Komyo’s kind nature and how she contributed to social welfare.

See China, Education Health, Health Care, Chinese Medicine

Japanese herbal medicine website; University of Maryland, www.umm.edu/altmed/

Massage, Acupuncture and Shiatsu in Japan

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Shiatsu pressure points
The Japanese are great believers in massage when it comes to beauty and health. Children are taught to give their fathers shoulder massages after a tough day in the office. Mothers massage the stomachs of constipated infants. Fathers massage the feet of children they want to be athletes and elderly massage their face to keep their skin looking good.

Professional massages and acupuncture have traditionally been done by blind people. Shiatsu is a kind of acupuncture without needles, using the fingers to put pressure on meridians. Reflexology, or foot massage, has become a popular method of reducing stress and treating a variety of ailments. Practitioners believe that different sections of the foot are linked to various parts of the body. Many new massage salon are guided by refloxogy, which operates under the belief that massages to certain parts of the body stimulates internal organs inside the body.

Akasuri (literally "red scrub") is a full body massage with an abrasive cloth that removes bacteria and dead skin and leaves the body red. It is usually given after a person at a sauna bathes . A 30-minute massage cost around $45.

A wide variety of massage machines are available: massage chairs with massage balls for the shoulders, waist and neck that sell for $3,500; massage beds that have air bags that inflate and contract and foot baths about the size of a microwave oven with Jacuzzi-like jets.

The Japanese also into using magnets and medicated pads that are pressed on the body to combat are number of ailments and pains.

Quack Medicine in Japan

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Chinese medicine for strength and endurance
Quasi drugs and quack medicines are widely available A woman was arrested in Aichi prefecture for caring out fake treatments in which she massaged patients bodies and then showed them "cotton pads dipped in pigs' blood and wrapped in chicken skin," saying they were tumors. The woman charged $265 for each treatment, sometimes performing 50 such treatments on a single patient. The woman reportedly had a 100 clients in Japan and around 1,000 in the Philippines.

In 2001 and 2002, hundred of people became sick and four people died from liver problems after taking Chinese-made diet pills purchased over the Internet. The pills escaped regulators scrutiny by being classified as a diet aid rather a drug.

One woman told Reuters that after she took the controversial diet pills said she quickly lost weight after taking them, b ut not long afterwards she started to feel lethargic and nauseous. She was convinced that she might have died if she had been warned that they were dangerous.

In the late 2000s a number “genetic-testing services” via the Internet began showing up that promised online screening that did everything from evaluate the risk of getting Alzheimer’s disease and cancer to assessing the intellectual potential of children. A government investigation of unregulated businesses that offered these services found their tests were “dubious at best.” One company, for a fee of about $650, evaluated a child’s intelligence as “excellent,” “good,” “ordinary” or “disadvantaged” using a sample collected with a cotton swab from inside a child cheeks that was sent to a firm in China for analysis.

See Religion, Cults

Setai

Setai is a kinds of massage and medical treatment that claims to cure all kinds of ailments---from acne to cancer and is particularly popular with overworked, stressed out women. Setai rough means “cleansing and straightening the body” and is based on the philosophy that the body’s restorative powers and stronger than Western medical treatments and that these powers are particularly strong with women.

The main proponent of the treatment is Takumi Terakoda, author of Cute Body and Cute Skin. Kaori Shoji wrote in the International Herald Tribune: “Terakado’s clinic draws up a patient’s “body needs” according to symptoms, then prescribes a series of treatments to alleviate problems: hot water soaks from the waist down; adjustments in diet; stretching; changing the way one walks. Patients follow the guidelines for six months to a year while Terakado urges them to “believe in their inherent beauty.” He also tells women to improve their sexual skills and go hunting for men who give them adequate sexual satisfaction.

Image Sources: 1) Visualizing Culture, MIT Education 1.5) Japan-Photo.de, 2) Nature Products 3) Golden Bamboo 4) Iron Palm Arts 5) 6) 7) and Japan-Photo.de

Text Sources: New York Times, Washington Post, Los Angeles Times, Daily Yomiuri, Times of London, Japan National Tourist Organization (JNTO), National Geographic, The New Yorker, Time, Newsweek, Reuters, AP, Lonely Planet Guides, Compton’s Encyclopedia and various books and other publications.

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© 2009 Jeffrey Hays

Last updated October 2012

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