7. Grabbing a Tiger by the Tail
In Japan, Oncology Improvements Without Plans To Increase Spending
There is a parlor game in which players have to think of a link between seemingly unconnected words. Take, for example, tiger tail and cancer. One could answer that, in ancient China, the tail of the tiger, ground up and mixed with soap, was used to treat skin cancer.
A more current example comes from Japan: The government, by trying to improve cancer management—without increased funding—has
grabbed the proverbial tiger by the tail.
The Harbinger In June 2006, Japanese legislator Takashi Yamamoto, in a dramatic speech before Parliament, announced his own cancer diagnosis
and decried the nation's standard of cancer care, likening Japanese cancer patients to "refugees who wander in search of food,
water, and someone who can help."
Within two months, lawmakers passed legislation requiring the ministry of health to train oncology specialists while promoting
detection and treatment outside of the major cities. The goal is to transform the nation's capabilities for managing the disease.
The Change Japan's universal health insurance has long aimed to provide only a minimum standard of care. With regard to cancer, it has
succeeded in that goal. Cancer accounts for 28 percent of all deaths in Japan. Yet awareness remains so low that many are
diagnosed too late to be treated effectively.
Oncology became a board-certified specialty in Japan just last year, so surgeons frequently determine drug treatment. And
while oncology drug sales grew 7.3 percent last year, Japanese launches of new oncology treatments lag behind other markets
by almost four years. Patient activism is on the rise and beginning to have an impact. Progress will likely be fueled by a
ministry study group on early drug approval and a new five-year plan to stimulate clinical trials.
The Implication At first glance, all this suggests that oncology drug sales will accelerate. The catch? There are no plans for funding that
growth. After decades of exploiting the Japanese propensity for self-denial about cancer, the government runs the risk of
raising expectations only to fail to meet them. Should that occur, patient activism will grow—and cancer will return to the
center of the political stage. One probable outcome: the removal, finally, of financial inefficiencies that currently impede
the delivery of medical treatment.
The initiatives should also stimulate lagging Japanese cancer R&D. The prospects for major oncology players, none of which
are Japanese, have improved immeasurably. A sudden surge in oncology expenditures could also lead to more intensive price-cutting
in other areas. Japan has exhibited a great determination to curb the growth in sales of ethical drugs, and has been successful—aided
by biennial price cuts.
Oncology reform may become the wedge that opens the entire Japanese healthcare system to change, from faster regulatory approvals
and resolution of pricing issues to the use of health-technology assessments and the adoption of scientific selling techniques.
In short, oncology may become the catalyst that ultimately "tames the tiger."
8. No Longer Stranger Than Fiction
The Future of Protocol by Fiat
Within science fiction, there's a subgenre that first became popular in the late 20th century: medical totalitarianism. Authors
imagined a near-future society in which a political authority exercised absolute control over individual health and biological
functioning. "What if" themes included biogovernance, mind control through drugs, and state control of medical treatment.
The latter is no longer hard to imagine.