Dr. Masahiro Kami's Diagnosis of the Japanese Medical Society (Episode 34)
The background of successive arrests and indictments in the Japanese medical society: Corruption is Structural, and the Judiciary is Unhesitant in Making Incisions
Masahiro Kami, M.D., Ph.D.
President, Medical Governance Research Institute, Tokyo, Japan
The judicial eye is becoming stricter towards medical care. On June 8, 2023, the former head of the Policy and Technology Evaluation Research Department of the National Institute of Health and Medical Research was arrested for violating the Act on Prevention of Official Collusion. This person is a doctor who graduated from the University of Tokyo School of Medicine in 1986 (Showa 61). This means that an elite doctor working in the "Facilities and Institutions" of the Ministry of Health, Labour and Welfare was arrested.
Furthermore, on June 19, 2023, an ophthalmologist at the Yamato Takada City Hospital was indicted on suspicion of accepting 800,000 yen in return for selecting intraocular lenses used for cataract treatment.
This money was provided by Star Japan, a medical device manufacturer, in return for providing surgical video footage. Regardless of the clerical procedures within the hospital, this is not a "kickback". Whether or not this matter is made into a case depends on the resolve of the police executives. It's fair to say that the police are actively intervening in healthcare.
Impact of the Verdict in the Ohno Hospital Incident in Fukushima, Japan
The situation was different 10 years ago. In February 2013, a doctor working at the National Cancer Research Center in Tokyo was dismissed for disciplinary reasons due to the private misuse of 5.78 million yen of health and labor scientific research funds. The money that was misappropriated was reported to have been donated to his multiple lovers, but this case was not prosecuted.
This doctor's issue wasn't just that. He was conducting a doctor-led clinical trial using a certain anticancer drug with the health and labor scientific research funds, but he was also employed as a part-time employee of the company that sells this drug. According to the October 2013 issue of the general information magazine "SENTAKU (CHOICE)", this anticancer drug was already approved overseas, and it was said by a health and labor bureaucrat that "if you just do a clinical trial at the National Cancer Research Center, the drug will definitely be approved". It is known that the pharmaceutical company "entertained the doctor in question under the direction of the president of the company (from "SENTAKU")".
By the same standards as today, this matter wouldn't be strange if it was accused of bribery. When I asked a police acquaintance, they said, "At that time, it was somewhat hesitant to prosecute medical professionals, especially doctors, for bribery. Even if the evidence and confession were in place and the policemen in charge said 'we want to do it', the upper management often hesitated."
This is due to the influence of the arrest of a gynecologist at the Fukushima Prefectural Ohno Hospital in 2006. A pregnant woman who had combined placenta previa and placenta accreta died of bleeding, and the Fukushima Prefectural Police arrested the doctor in charge on suspicion of professional negligence resulting in death. The sight of the doctor being handcuffed and taken away was widely reported in the media.
The Japanese medical society was outraged by the unreasonable response. I, along with Dr. Akira Sato, then Professor of Obstetrics and Gynecology at Fukushima Medical University, who was the mentor of the arrested doctor, founded the "Association to Prevent the Collapse of Perinatal Medical Care" and carried out activities such as signing petitions.
Such movements occurred nationwide, and those outside the medical profession also shared the issue's consciousness. The late Yukio Edano, a lawyer who later served as Chief Cabinet Secretary, expressed his opinion in a parliamentary question, saying, "I think this case, which I don't know which will become a case next, may become a case caused by the prosecution or the police in the future."
Later, influenced by this incident, a number of obstetricians closed their practices, which also led to a complete change in the media's narrative. The discourse of "medical malpractice" that was prevalent immediately after the incident disappeared, and in 2006, articles on "suspension of childbirth handling at hospitals" surged. By 2007, the "collapse of medical care" had become a national consensus. Then, on August 20, 2008, the Fukushima District Court acquitted the doctor. The prosecution did not appeal, and the verdict was finalized. This is linked to the previously mentioned comment about "senior management hesitating to prosecute".
Police are also susceptible to public opinion. I'm keenly aware of this because many of those around me are in the police force. I was a member of the Kendo (traditional Japanese style fencing) club's sports festival (referring to the athletic club) while I was studying at the University of Tokyo. The master of the University of Tokyo Kendo Club is designated as the chief instructor of the Tokyo Metropolitan Police Department's Kendo Instruction Room, and the University of Tokyo Kendo Club has deep ties with the police.
This is related to historical circumstances. The police were at the heart of the old Ministry of Home Affairs before the World War II. Those who managed it were originated from Satsuma domain in the Edo era. The traditional arts of Satsuma include swordsmanship, such as Jigen-ryu, a traditional martial art famous for its aggressiveness. The Meiji government, plagued by the rebellion of disgruntled samurai, employed former samurai as police officers and gave them the job of swordsmanship teachers. This is the origin of police Kendo. The University of Tokyo Kendo Club serves as an elite training institution for the old Ministry of Home Affairs.
Currently, Mr. Takaji Kunimatsu (a law graduate of the class of 1960) is the representative of the police connections of the University of Tokyo Kendo Club. He is famous for being targeted and shot while serving as the Commissioner General of the National Police Agency by the religious cult called Aum Shinrikyo. In response to media inquiries, Kunitatsu mentioned that he was encouraged to join the National Police Agency by his Kendo club seniors, Kuniyasu Tsuchida (later Superintendent General of the Metropolitan Police Department) and Jiro Kageyama (later Director of the Kanto Regional Police Bureau). Mr. Kageyama (a law graduate of the class of 1939) served as the sixth president of the All Japan Kendo Federation, and Mr. Tsuchida lost his wife to a pipe bomb sent by the New Left while serving as the director of the police affairs department of the Metropolitan Police Department in 1971.
Although I can't reveal their names in this article, many graduates of the University of Tokyo Kendo Club still go on to work at the National Police Agency. They unanimously say that the impact of the Ono Hospital incident judgment is enormous. That's probably why they couldn't file a case for the National Cancer Research Center incident in 2013. Incidentally, the specialty of this doctor is pediatrics. Conversations like, "If you arrest someone carelessly and the patient gets angry, can you take responsibility? Choose an industry that's easier to understand" are said to unfold.
However, the atmosphere has been changing in recent years. The trigger was the Novartis Pharma scandal around 2010 in Japan. The sight of university professors tampering with data in exchange for money from pharmaceutical companies was widely reported in the media.
In January 2019, the Medical Governance Research Institute that I run, in collaboration with Waseda Chronicle (now TANSA), founded by Makoto Watanabe after leaving the Asahi Shimbun, launched the "YEN FOR DOCS". By entering a doctor's name, you can see how much money they receive from which pharmaceutical companies. When we made the database public, we received contact from many people. Among them were police officers. They said it could be used to "look for bribery cases," and I felt that the impact of the Ono Hospital incident was diminishing.
The atmosphere completely changed with the Mie University incident.
This recognition by the medical community likely came from a bribery case involving the anesthesiology department at Mie University. In January 2021, two employees of Ono Pharmaceutical were arrested on bribery charges, and a former professor at the same hospital was arrested on charges of third-party bribery.
The issue at this time was scholarship donations provided as a return for promotion. Unlike lecture fees paid to individual doctors, scholarship donations are money that is publicly disclosed. Furthermore, the recipient of the donation is not an individual doctor but a university. It had traditionally been considered outside the scope of bribery. Moreover, Mie Prefecture has a shortage of doctors. If an anesthesiologist is arrested, it would likely have a significant impact on medical practice. The threshold for filing a case should have been high.
The person in charge of this case at the Tsu District Public Prosecutors' Office in Mie Prefecture was Prosecutor General Hiroshi Morimoto, an ace prosecutor who has handled many major cases, including the arrest of former Nissan Motor Co. chairman Carlos Ghosn. "In industries other than healthcare, such as the nuclear power industry, you can question bribery in any form if money is exchanged" (according to a police officer), and Mr. Morimoto seems to have applied strict standards without regarding the medical field as special.
Then, on January 19th, 2023, Makoto Shibata, the presiding judge of the Tsu District Court, found the former professor guilty, sentencing him to two years and six months in prison, suspended for four years, and acknowledged the prosecutor's argument. The atmosphere surrounding medical care has clearly changed.
However, the medical community does not seem to have this understanding. In May 2022, staff from the National Hospital Organization and in June, 2023, staff from the National Center for Global Health and Medicine were arrested on bribery charges. This is likely just the tip of the iceberg, and the corruption is probably structural. I hear that investigations into several bribery cases are still underway. The self-regulated medical community is on the verge of collapse in Japan.
Originally published in Japanese in Iyakukeizai (Pharmaceuticals and Economics), July 1, 2023