Healthcare quid pro quo in Japan

This article was originally published on LinkedIn on June 8, 2020. Thank you to the author for his kind authorisation to re-publish.

When a team of Blue Impulse fighter jets flew over the head of Tokyoites on May 28th, only a handful of people criticized the stunt to be a waste of taxpayer’s money. Without a doubt, it encouraged many HCPs battling against the epidemic of Covid-19, and the number of people receptive to the event was far greater than those who felt grateful for the two “Abenomasks” sent per household.

Although the method may differ with other countries, many Japanese are learning to cope with and control the spread of the virus while waiting for society to either establish herd immunity or pharmaceutical companies to develop a vaccine. Without one of the aforementioned outcomes, Japan’s surprisingly effective “whack-a-mole” method has been the only viable approach for the government and HCPs. Japanese people are being asked to anticipate future waves of the epidemic as we evolve our lifestyles to coexist with the virus. The Japanese mindset is to stoically do what we can for as long as the situation requires. In spite of our efforts, more and more people are growing pessimistic about Japan’s prospects for hosting the 2021 Olympics.

Amid this outbreak, one public discussion taking place is about telemedicine, specifically about a legal reform that will allow remote diagnosis and online medical treatments. The fatality rate of Covid-19 patients with underlying conditions is much higher than those without. For this reason, treatment of diabetic patients has become a hot topic. Recently, I had the opportunity to hear a speech by Dr. Satoshi Imamura, Vice Chairman of the Japan Medical Association (JMA). His specialty is anesthesiology, which means he has no special tie-ins with diabetes-related pharmaceutical or medical instrument companies. He is currently Director of the Imamura Clinic in Itabashi, Tokyo, and does not belong to any faction within the JMA organization or university hospital groups. Based on his background and credentials, he seems to be a credible HCP highly qualified to take on a leadership role in implementing such a project side-by-side with JMA’s Chairman, Dr. Yoshitake Yokokura.

Dr. Imamura has been directly involved with the activities of JMA since 2006 and has mainly associated himself with reforming healthcare policies and general affairs while becoming a core member of many committees hosted by the Ministry of Health, Labour, and Welfare. His two-year stint as Vice Chairman ends soon, although many HCPs are hoping he will become the next Chairman.

While Dr. Imamura earnestly works on instituting required reforms, some people within the JMA organization are quietly working against him to slow down the process. A conflict of interest seems to exist especially with the Japan Association for Diabetes Education and Care (JADEC). This is a Public Interest Incorporated Association (Koeki Shadan Hojin) headed by the Chairman, Dr. Yutaka Seino, President of Kansai Electric Power Hospital and Chairman of the Asian Association for the Study of Diabetes. Most of the important administrative matters are handled by the Kojimachi office in Tokyo, but the political matters are managed by Dr. Seino together with Mr. Tetsuya Yajima, a former bureaucrat of the Ministry of Health, Labour, and Welfare, along with Dr. Kenji Matsubara, who is occupying one of the three Vice Chairman seats at JMA.

What specifically is the impediment for Dr. Imamura? And what is JADEC so keen on protecting? Japanese public companies and Public Interest Incorporated Associations sometimes hire former government officials for the purpose of gaining political favors and influencing policy decisions. This hiring practice is called “Ama-kudari” which in Japanese literally means “descending from heaven“. It is not surprising that some JMA and JADEC officials may be simply paying lip service to Dr. Imamura’s appointment while actually undermining him. For more on this, check out this article by the Nikkei Newspaper titled, “Telemedicine Impediment is Ministry of Health, Labour, and Welfare” on April 3rd.

Dr. Matsubara has a track record of aggressively building and promoting JMA globally as a fair organization. In his presentation at the 2017 CMAAO General Assembly on September 13th, he proudly announced the World Medical Association’s acknowledgement of JMA as the only professional organization in Japan that physicians join in an individual capacity. Dr. Seino’s younger peers collaborate to support the periodical publication of “Diabetes Strategy” by Sentan Igakusha and share the cutting-edge research of IoT applications.

However, Dr. Seino and his team members seem to be neglecting to restructure JADEC’s revenue sources, one of which is the advertising & publishing fees derived from blood glucose memo books. Literally, all pharmaceutical and medical instrument companies annually pay JADEC fees that can reach eight to nine digits in Japanese Yen. Once the memo books are published, the sales reps distribute them to hospitals and clinics as sales-promotion material. A portion of these memo books is kept and distributed by JADEC to patient members of Tomono-kai Society together with their monthly magazine called “Sakae” for an annual membership fee of JPY3,500. JMA officials with no bias or prejudice, along with more than 170,000 HCPs registered under JMA, are starting to recognize this vested interest; they wish to prescribe Bluetooth embedded meters to measure patients’ blood glucose level, as it appears that a portion of patients are falsely recording their blood glucose levels simply to avoid hassles with their doctors. It would certainly be both accurate and practical for the doctors and physicians to be able to access their cloud server to see the blood glucose trends of their diabetes patients 24/7. This would allow the HCPs to proactively contact their patients when they think it is appropriate to examine them rather than do it on periodical pre-set dates. Dr. Imamura wishes to establish a platform that enables quality-minded interactions between the HCPs and the patients. The irony didn’t escape me when I read about this healthcare innovation project called “The Japan Vision: Health Care 2035” hosted by Ministry of Health, Labour, and Welfare.

While the monumental challenge of “untangling the spaghetti” takes place on the very top layer of the decision-makers, HCPs and patients are counting on a man that some consider a savior in changing the whole system. His name is Dr. Goichiro Toyoda of MEDLEY, a MediTech startup whose shares are publicly traded on Tokyo Mothers Market.

Dr. Toyoda’s credentials are impressive. He graduated from the University of Tokyo’s Faculty of Medicine in 2009, trained as a neurosurgeon at Seirei Hamamatsu General Hospital and NTT Medical Center Tokyo until 2012, studied at Children’s Hospital of Michigan for a year, worked as an industrial consultant at McKinsey & Co for a little over a year subsequent to joining MEDLEY in 2015. During his years as a neurosurgeon, he worked night and day, seven days a week. His monthly overtime often exceeded two hundred hours. This made him realize how the high quality of healthcare in Japan is maintained by dedicated professionals and their spirit of self-sacrifice.

Dr. Toyoda is currently MEDLEY’s “Representative Medical Doctor” and the founder and Representative Director of Kohei Takiguchi. Together, with a “devil-may-care” attitude, they are quietly expanding their services (called “CLINICS”). In April 2018, they launched a medical record system platform that allows HCPs to accommodate repeat-visiting patients who are physically reachable within thirty minutes. In December 2018, they successfully obtained ISMS cloud security certification. In April 2020, triggered by the COVID-19 outbreak, the aforementioned thirty-minute rule was abolished and, as a tentative measure, remote diagnosis will not be offered to first-visiting patients until the current pandemic is under control. Dr. Toyoda is currently preparing himself for the next step forward in September 2020 when pharmacists will be allowed to prescribe medications online. Unfortunately, both representatives of MEDLEY see the current pace of reforms to be far from their ideal future. They are not directly fighting the system, rather, they are strategically expanding their business coverage for the good of society.

Klaus Schwab, Founder & Executive Chairman of World Economic Forum said, “The pandemic represents a rare but narrow window of opportunity to reflect, reimagine, and reset our world.” Can Japan, Inc. implement essential reforms of its healthcare system by using this outbreak as an opportunity? We will soon find out.

Picture credits: Skywell Software