A Rare Insider's Account of Japan's Medical Cartel
Contributed by: Y.Yamamoto
It is more important to know what sort of person has a disease than to know what sort of disease a person has.
- Hippocrates (c.460 BC - c.370 BC)
Dr. Hiroshi Okamoto wrote
"You can cure 9 out of 10
illnesses all by yourself"
to explain why he quit
practicing medicine in 2001.
| One evening in mid-March, I was talking to the wife of the owner-chef at a small eatery I frequent over the five reasons I'm staying out of Japan's rotten health-care system. She is one of my local friends who helped me find a decent doctor in this neighborhood when my blood pressure had reached a critical level. (The systolic reading peaked at 240 mmHg.)|
A middle-aged man, who looked to be a regular in the shop, was in the middle of his dinner at a nearby table. When he finished, he joined our conversation. He introduced himself as a dentist who had recently abandoned the membership in Japan Dental Association, a cousin organization of Japan Medical Association. The independent-minded dental practitioner said, “Mr. Yamamoto, I think you are 100% right. Medical doctors, and dentists alike, are all swindlers in this country.”
After the wife of the owner left us to help her husband in the kitchen, he started telling me his experience with a medical doctor who had ripped him off a fortune when his old mother was dying of cancer. He said, "My mother died a couple of years ago, after fighting the illness for several years. The doctor certainly knew from the beginning that her days were already numbered. But he always fell short of explicitly telling me that was the case with my mom presumably because he thought that being a dental practitioner here, I could somehow afford to pay the hospital bill which the average Japanese could not. As a result, I was robbed of 4 to 5 million yen every year over the several years she stayed in the hospital.” His eyes were filled with tears.
The next time we met at the same restaurant, he said, “Stick around there for a minute, Mr. Yamamoto. I have something to give you.” He rushed out of the place and soon came back from a nearby parking lot with a pocket-sized book in his hand. It was titled "You can cure 9 out of 10 illnesses all by yourself"; its subtitle read, "Do you still want to remain a juicy patient?”. The dentist said, "This book vouches for your argument from a physician's point of view." This is how I came across the revealing book authored by Dr. Hiroshi Okamoto. Had it not been for the timely gift from the dentist, I would never have read it because in the past several decades I have believed it's a total waste of time and money to read a book written by a Japanese.
According to his autobio, Dr. Okamoto was practicing medicine for 12 years until around the turn of the century. One day in 2001, he asked himself: “Isn’t it enough to dupe thousands and thousands of patients into spending their hard-earned money practically for nothing?” That's when he made up his mind to quit practicing medicine and launched a website on which to provide medical consultations at a flat semiannual fee of 9K yen. In 2009, he published this book to explain what exactly had made him explore the untested business model.
Dr. Okamoto classifies illnesses into 3 categories like this:
Class 1: Illnesses which can be cured without the help of doctors.
Class 2: Illnesses which can be cured only with the help of doctors.
Class 3: Illnesses which cannot be cured even with the help of doctors.
I think his straightforward way of "triaging" illnesses is quite helpful in analyzing problems inherent in the Japanese medical system. Theoretically speaking, the divisions among the three categories are not always that clear. For one thing, Class 3 illnesses tend to move toward Class 2, and Class 2 toward Class 1, on the premise that medicine advances both in terms of technology and affordability. But in reality, this assumption cannot be taken for granted.
Dr. Okamoto recalls that an astounding 95% of his patients came to see him over "illnesses" that fell on the first category. On an educated guess basis, he puts the overall ratio of Class 1 illnesses in the order of 70-90% although he does not have data for his colleagues.
He calls them Oishii Kanja-tachi, literally translated as juicy patients. As the conscientious doctor observes, the single most important problem with Japan's medical system lies there.
In the last couple of weeks, some American regulars at my website have tried to educate me on the subtle difference between the two words, "psychogenic" and "psychosomatic". Although I am grateful for their effort to enlighten me, I still remain in the dark about the definitions of these adjectives, presumably because I, as an Asian, have never believed in any dualism. To me, when a man suffers a disease, he suffers it in his entirety. In this context, I would generically call Class 1 diseases hypochondria, or somatization of mental disorder inherent to hysteria. In other words, the explosion of the population of hospital goers over Class 1 illnesses is a social malady rather than a medical problem.
Dr. Okamoto suspects that as a result, hospitals are always so overcrowded with these super-suggestible people that the norm for outpatients is now "a 3-hour wait for a 3-minute treatment" as the Japanese always say without exaggeration. That, in turn, makes the sufferers of Class 2 diseases shy away from hospitals.
On the other hand, these juicy patients are constantly subjected to overtesting and overprescription, because otherwise hospital operation would never be that profitable.
Perhaps to avoid directly criticizing gullible and sheepish outpatients, Dr. Okamoto attributes this phenomenon to the perpetual efforts made by the medical cartel (he doesn't use these words, though) formed by doctors, pharmaceutical companies, medical equipment manufacturers and bureaucrats at the Ministry of Health, Labor and Welfare, and equally important, by the media.
In this relation. the author of the book stresses the fact that these dupes always take it for granted that all the numeric criteria given by Japan Medical Association and the health ministry for such diseases as hypertension and diabetes are authentic and trustworthy. But nothing is farther from the truth, according to Okamoto.
Take hypertension, for example. All of a sudden in 2000, the lower threshold value for the systolic reading of high blood pressure was lowered from 160 mmHg to 140 mmHg. As a result, the number of patients supposedly suffering hypertension jumped up 30 million overnight. Okamoto says now 50 million (see NOTE below) out of 127 million Japanese are supposedly suffering high blood pressure.
NOTE: Today (May 17) falls on what "World Hypertension League" calls "World Hypertension Day." On this occasion, the Japanese media revised, with an innocent face, their bloated estimate of the hypertensive population downward to 40 million, and added it's worrisome that 80% of them remain untreated right now.
The same can be said of the blood sugar levels for diabetics. On May 1, 1999, Japan Diabetes Society lowered out of the blue the cutoff value for diabetes from 140 mg/dL to 126 mg/dL. By the sudden change, tens of millions of Japanese officially became diabetics overnight.
Without doubt, 9 out of 10 illnesses can be cured all by yourself is one of the greatest Japanese nonfictions I've ever read. If it still leaves something to be desired, he should have shown more relevant data, which have rarely been discussed in public, in a more coherent way. He talks about the fact that the average Japanese doctor treated 8,421 outpatients in 1998 whereas the average number of outpatients his OECD counterpart treated in the same year was 2,421, or the average medical cost for the treatment and diagnosis of the Japanese outpatients was 7K yen per session while it cost his American counterpart 62K.
But these spotty figures fall a little short of entirely discrediting widespread fallacies about Japan's medical system. For instance, the World Health Organization always places Japan at the top of the list when measuring the overall effectiveness of health-care systems. Aside from the fundamental question about whether we need such an organization as WHO under the U.N., which is supposedly overseeing medical systems in 193 member countries, we should question its sanity when it proclaims the Japanese medical system is the undisputed best because the doctors are 3.5 times more efficient than their OECD counterparts, the medical cost is 89% lower than in other OECD countries, and "as a result," Japan's "healthy life expectancy" is the longest in the world. Actually those who are doing this ranking business at the international organizations are the same bunch of idiots as those who still maintain GDP is an primary indicator of the economic vigor and people's well-being of a nation.
It's especially outrageous to know not a single medical expert has ever asked the most relevant questions such as:
- What should the "healthy" longevity Japan boasts mean when one out of four Japanese is seriously considering suicide?
- How can Japan's overall medical achievements be considered outstanding when every third Japanese is supposedly suffering hypertension?
- Are Japanese doctors considered really productive when the norm for their outpatients is "a 3-hour wait for a 3-minute treatment"?
- Does it make any sense to evaluate the Japanese medical system, in the first place, when 70-90% of outpatients are just pretending to be physically sick, but in fact, mentally ill?
I thought I could expect saner feedback from my local friends and that I could somehow contain the cost of 3 copies of the intriguing book (1,800 yen) within my household budget. The first person I ordered Amazon Japan to send a copy was (Lara) Chen Tien-shi, up-and-coming anthropologist and dedicated humanrights activist.
Recently she and her predominantly Japanese colleagues in an NPO headed by Lara, where I am an associate member, took a research tour to Thailand. When they came back, they gave us a presentation on their findings about the distress being suffered by minority tribes, such as the Aka people, who mostly inhabit the northernmost area of Thailand. At that meeting someone stressed the fact that the Aka people are not granted access to nation's health-care entitlement programs. This woman wanted to tell us how they are alienated from the entire system. At that time I asked them: "Am I supposed to sympathize with them? I'm also medically uncovered." No one answered my question. But I am certain Lara understood what I meant because the ethnic Chinese is far more intelligent and down-to-earth than her Japanese colleagues.
Another thing I expected from her was her take on 易筋功 (Ikinko), literally translated as muscle-relaxing routine. Dr. Okamoto introduces this as useful for the prevention of Class 2 illnesses and the self-cure of Class 1 illnesses. I am an extremely skeptical person who never believes in any magic until it's fully proven with myself.
Lara strongly recommended I regularly do the Chinese routine similar to Tai Chi because a little different version of the Chinese exercise is actually helping her keep in shape. She said her 90-year-old father told her to do the routine because it had proved effective with him. I said to myself: "Why don't I give a try to Lara's advice?"
I know American people would respond to Dr. Okamoto's recommendation in two different ways. The first group would just shrug it off, saying it's nothing but a superstition when compared to jogging or aerobics they are currently doing. Simply it never crosses the minds of these empty-headed guys that jogging and aerobics can also be superstitions. That's quite OK with me because their physical and mental health is none of my concern.
The other group of Americans would instantly be hooked on the Ikinko routine, because to them anything exotic and mysterious can serve as an "alternative" medicine. Actually, a good part of the likes of yoga and Zazen is an Oriental rubbish reinvented in the West. These ignoramuses should learn the Traditional Chinese Medicine existed centuries before Hippocrates. The Western medicine is the alternative to TCM, not the other way around.
Weeks afterward I ordered Amazon to send another copy of the book to my elder son, who has been brought up by my ex-wife into a perfect people person, i.e. conformist. For that reason, I subtly disowned him several years ago. More specifically, I told him, and his younger brother as well, not to look for my body when I disappeared, because I don't want to be incinerated and buried in the pseudo-Buddhist format. That is why I didn't tell him my blood pressure had shot up to the levels the doctor called a hypertensive crisis until after I came back alive from the emergency room.
The day after I was ambulanced into the hospital, he, along with his younger brother, came to my apartment to find out if his dad was getting well. When we went out on foot to have lunch together and buy stuff like a digital blood pressure monitor, he pissed me off the way he always does. Every time we met my neighbor, he said: "I'm awfully sorry my dad caused you so much trouble." (That was not the case at all.) He never failed to add, "I also apologize to you in advance because I'm afraid he will cause you some more trouble in the future." (That will not be the case, either.) Needless to say, he kept bowing all along. It's as though it's a sin for me to stay alive, and to be dying in the near future, too.
Believe it or not, my biological son is not alone in acting unnecessarily apologetic and thankful especially toward authoritative figures such as superiors and Westerners. Quite naturally most foreign residents here love this Japanese "virtue" very much. They know they can never expect the same obsequious politeness coupled with servile hospitality anywhere else in the world, including their home countries. That is why they always pretend not to notice the ugliest side of the rotten culture.
Here's another case in point. In the days I was in business, Japanese businessmen often bowed to the receiver of the telephone, wearing a phony smile all the time, especially when talking to their bosses or customers. Even today, it's commonplace that a Japanese youngster bows to his handset when in the same situation as if using Skype. My biological son is no exception.
Recently he is also suffering hypertension as a complication of diabetes. He is only 43. You may not know it, but susceptibility to psychogenic, or psychosomatic diseases is a people person's destiny. I thought he would certainly find Dr. Okamoto's revelations relevant to him in one way or the other. I still don't know if he is going to read the book, but when I asked for his comment, he said, "I've let Yumiko read it first because she wanted to." Yumiko is his wheelchair-bound wife who has long been suffering from an "intractable" illness called Complex Regional Pain Syndrome.
As I observe, my daughter-in-law is increasingly getting hooked on a wider variety of prescription drugs and irreversibly developing more and more dependency on her caring husband. Most recently she developed an allergy to eggs in addition to other allergies she had already had. But I doubt it's genuine. When she is shown albumen (egg white) or vitellus (egg yolk), she winces or even vomits. But when she is given a meat bun which unnoticeably contains egg, she won't grimace or will even eat it. Now I am reasonably sure her mysterious pains and other symptoms are all fake as is her conjugal love of her husband.
I know very little about the pathology of CRPS, but I know a lot about human nature, if Hippocrates' insight into it should eclipse mine. Since the disease my daughter-in-law is suffering is a psychogenic, or psychosomatic disorder, she can overcome it if she really wants to be a self-reliant person. So the real question is whether Yumiko can emancipate herself from the barbed-wire fence she has built around her. My tentative answer to my own question is, "No, that's quite unlikely." Here's a reason:
In his 1983 book titled How to Break Your Addiction to a Person, Howard M. Halpern, Ph.D. theorized that there is no fundamental difference between addiction to a chemical substance and addiction to a wrong mate, or any other incongruous partner. But I think Halpern's theory has an important flaw. Actually, Yumiko and her husband have developed a mutual dependency, which cannot be the case when you get addicted to a chemical substance.
That is why I don't think I can realistically assume their diseases will be cured sooner or later. Now they are Siamese twins that cannot be separated if you want both of them to survive the operation. I even suspect the 5-decade-old addictive alliance between the two failing countries have taken a heavy toll on marriages or other personal relationships among the Japanese.
In the last several years, my daughter-in-law has been on special benefits meant for the disabled. When her husband triumphantly reported to me that he had finally succeeded to convince the municipality to add CRPS to the list of "designated diseases," I said, "So she is now eligible for disability benefits at the cost of un-handicapped people like me." He laughed and said, "So it seems." But actually it's not a laughing matter. For one thing, there is not much difference in amount between her benefits and my annuities from the contributory pension program. Such a downright injustice is the dominant norm in this terminally-ill welfare state.
I thought at least she should reciprocate my generosity by giving me a sensible feedback to my gift on behalf of her husband. Some weeks later I asked my son, "What did she say?" His answer: "Nothing in particular. Maybe she thought what the author says in the book had nothing to do with her chronic pains. By the way, I took our dogs to the vet today....."
Finally I had the book sent to Dr. Shiono. But the last time I saw him, he was still in the middle of it. He just said, "Many thanks, Mr. Yamamoto. It's really a page-turner. I'm learning a lot from the book."
I think it's a pity that none of my American friends have Japanese-literacy, and all they hear about the reality behind the facade of the medical systems in North America are allegations against conspirators who suspectedly keep spreading new strains of viruses that cause such diseases as SARS, avian flu, and swine flu, along with fake anti-virus drugs such as Tamiflu which allegedly cause an additional hazard.
In fact, these medical conspiracy theorists help conceal truth more than they reveal it. As I always say, it's not only useless but also harmful to arbitrarily or opportunistically single out a certain part of a broader plot, making believe it's not just the tip of the iceberg. Every time I ask them, "Show me what is NOT a conspiracy," they pretend not to hear me.
I sometimes ask myself how he would respond when one of those super-credulous guys who blindly believe in medical conspiracy theories saw his blood sugar level hit, say, 180 mg/dL. It's for sure that he would rush to a nearby hospital and subsequently become addicted to insulin without asking if he is falling into the trap of a conspiracy. As Ron Paul kept warning, before quitting the race in a disgraceful way, prescription drugs are sometimes much more dangerous than illegal drugs.
That is why I thought Dr. Okamoto's revelations about Japan's medical cartel are worth introducing to my audience in the West.
For my part, I have taken care of myself, body and soul, since my early adulthood, if not from the cradle, and I'll continue to do so certainly to the grave. To that end, I don't want to be told by my biological sons, my doctor, or anyone else for that matter, when to die, how, and where. ·