Here’s this week’s Media Mix, which is basically about skyrocketing medical costs and the probable failure of Japan’s national heath insurance program to keep up. However, the heart of the matter is the priorities attached to medical care, and I admit that the examples I’ve offered create a slippery slope. Medicine’s purpose is to prolong life and to make it more comfortable, which could be taken as two distinct purposes. The conventional wisdom of the medical community says that the first purpose has a priority over the second; after all, without life there’s nothing. Consequently, any means of prolonging existence, even at the expense of the patient’s quality of life, is acceptable. Dr. Makoto Kondo’s assertion that there is no evidence that radical surgery and chemotherapy prolong life “meaningfully” for most tumor-based cancer patients is thus treated in the medical world as a form of sedition or heresy, depending on which metaphor you attach to that world. I am not a medical expert, and, were I to be diagnosed with cancer and told that my only chance of survival is surgery and/or chemotherapy, I would likely accept that line of treatment because we all want to live.
The point is not to deny anyone the full range of treatments possible, which is the usual issue when talking about health insurance, but rather to face up to fact that treatments are made available for a variety of reasons, not all of them having to do with the welfare of specific patients. Kondo has been accused of cynicism because he says the cancer treatment machine is dominated on the one hand by a pharmaceutical industry that has a lot at stake in anticancer drugs and on the other by an academic mindset that does not broach any contrary viewpoint. What’s truly troubling to the medical community about Kondo is that he’s quite dispassionate. He bases his argument on a close reading of clinical literature, which he says shows that while more and more people are being diagnosed at earlier stages for cancer, the absolute number of people dying from cancer has remained the same. His main bugbear is diagnosis, which, in terms of cancer, remains highly problematic. Moreover, he has little faith in the science of pathology as it’s taught and practiced in Japan. Because the purpose of cancer screenings is to find cancer, the likelihood of finding something increases, though Kondo believes in many cases what doctors actually find is a “cancer-like growth” (gan modoki), which will either vanish over time or remain without really doing harm to the host. If the person really does have cancer, the cancer is always present in the body and will either kill the person or not; but in any case, he says, current treatments don’t alter the outcome. Radical surgery and chemotherapy, if they don’t outright kill the patient, definitely lower the quality of that person’s remaining life. Last week, the NHK show “Tameshite Gatten” talked about new advances in early detection that practically claimed no one need ever suffer from bowel cancer ever again. The doctor who had helped develop this new technology was understandably proud. The cognitive dissonance between Kondo’s position and this doctor’s sunny outlook was deafening, except, of course, that it was only in my head. NHK would likely never invite Kondo to any of its programs.
These are difficult ideas to contemplate, but in terms of health insurance they need to be discussed more resolutely, otherwise resources and times and money may simply be propping up a medical model that doesn’t actually improve people’s lives.