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.
Nice to meet you and thanks for an interesting perspective on a really delicate matter. As you say, most patients who are told their only chance to survive cancer is chemotherapy actually believe it and go through that therapy. And the number of people diagnosed with cancer has increased dramatically in recent years. The medicine industry is powerful, and economy and politics are deeply intertwined when it comes to health policies. I think it can’t be denied that for phamaceutical companies the business is huge.
It’s ironical that a country with a long history of traditional medicine and a rich knowledge of alternative therapies is being swallowed by aggresive and market driven medicine policies. But it is also the citizens’ duty to discuss and get informed about what is good for them.
Realizing this is an important issue would be a good first step.
As a cancer survivor of 12 years (metastatic melanoma) , I know from experience that it depends entirely on the cancer. Had I not been operated on, and I was probably 6-months past the time I should have received treatment, I would have died because the cancer would have spread to organs.
However, there are cancers that if not discovered until the later stages for which surgery and chemo (which actually works poorly against most cancers and not at all on some) are useless. They are costly procedures that do nothing to improve the quality of what life the patient may have left.
I know that your recent article on kpop has been getting much heat, especially from Tohoshinki/JYJ fans. It might be slightly confusing as to why we are getting so upset, so please let me try to explain it a little from our point of view.
I suppose we get upset that JYJ are called “traitors” because these three men filed a lawsuit against Human Rights Violations in their company and unfair contract lengths.
The Korean Free Trade Commission actually agreed with JYJ on these points and forced their former company, SM Entertainment, to change the contracts in order to make them more fair to the artists.
So for us fans to see JYJ called “traitors” when in reality they actually stood up to a company for their fellow artists and were able to create better working conditions for them is hard for us.
And I know that this might seem like a small issue to for us to get angry over, but Korea has a history of trying to bring down any artist that stands up for their rights. And now that JYJ is doing that, seeing them called “traitors” in a newspaper that will reach many international fans, just seems to be continuing that.
Sorry for the length of this. I know you might get many angry tweets, so I just wanted to let you know what it was that us fans are upset over and why we got upset.
FROM : @@DoctorHenri
This tweet says all what i want to say to you. Sorry for randomly post in your blog like this.
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I have only read the Kindle free sample of one of Kondo’s recent books, but while Tokyou Journal (and to a far lesser extent this articel, and also the first comment) relatess Kondo’s assertions to *Japanese* cancer treatment, everything I read in the free sample (including a synopsis of the rest of the book) seemed to apply to cancer treatment in general. I wondered if there is an English version of Kondo, advising UK or American citizens to avoid chemo, extensive surgery, and even early detection.
None of Kondo’s writings has been translated into English, as far as I know. I dedicated a full column to his pariah status in the J. medical community back in the lat 90s, but Japan Times online archives only go back to about 2000. Still, his theme, as you’ve outline it, has influenced a lot of my writing when the subject is medical care in Japan. Some of this writing is on our money blog, Yen for Living. http://blog.japantimes.co.jp/yen-for-living/
Thank you. Interesting.