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Let's Discuss the Money in Medication (Episode 93) The Ambivalence of Dealing with Pharmaceutical

Companies as a Breast Surgeon

Akihiko Ozaki, M.D., Ph.D.

Physician at the Medical Governance Research Institute


That's my impression against pharmaceutical companies. In 2018, I set up a breast surgery department in my workplace named Jyoban hospital in Iwaki City, Fukushima Prefecture, which has now become one of the largest in the prefecture. As a result, for my "delight", I am getting more approaches from these companies. Namely, I have finally caught their eyes.

What surprised me was the 31st Annual Meeting of the Japanese Breast Cancer Society held in late June, 2023. In front of my poster presentation, I saw a familiar face—it was a representative from Daiichi Sankyo. He had looked up my presentation time in advance and had come to listen to my poster presentation.

"I was looking forward to it," said the smiling man, who was a typical Medical Representative (MR). It is the least I can do as someone who criticizes the issue of pharmaceutical promotional activity on a regular basis to calmly deal with such blatant flattery.

However, if they show interest in my work, it's only human to be honestly happy. MRs understand well how to tame naive doctors.

In that regard, I, who deals with MRs while making excuses to myself that I will "call a spade a spade," is probably more inconsistent than pharmaceutical companies. Even a person like me, who is very conscious of the "line that must not be crossed" with pharmaceutical companies, behaves like this. This could be considered an incurable disease in the medical world.

As a check (or perhaps to remind my ambivalent self), I made the MR agree to provide information about this issue in the future, as I am leading the creation of a pharmaceutical money database.

However, he said, "I didn't know you were the one creating that famous database!" The MR, who kept his sales smile until the end, was obviously much better than me. If I didn't have a spiritual anchor like this, I would probably be easily manipulated.

What's difficult, however, is that it can't be said that the correct answer is to refuse to be "danced" at all. In fact, if you want to make a name for yourself in this field, you have to dance on the stage they provide.

In other words, it's only when you serve as a chairman or a speaker at a nationwide lecture sponsored by a pharmaceutical company, or when you curry favor with them in international clinical trials they host and get your name included in papers published in the New England Journal of Medicine or the Lancet as an "honorary white person", that you are recognized as a "top researcher".

Even if you adopt a cynical attitude like me towards pharmaceutical money, it brings "all harm and no benefit", and you'll be ostracized in the breast cancer community. So, how many doctors in the field of breast medicine are "being danced" by pharmaceutical companies?

This time, I analyzed the gratuity payments made by pharmaceutical companies from 2016 to 2019 for the 1733 doctors who were breast specialists as of 2021. The total amount was about 1.452 billion yen, and the median was about 220,000 Japanese yen. Also, 28 people received a gratuity of more than 10 million yen.

The company that paid the most in gratuities was Chugai Pharmaceutical (about 323.91 million yen), followed by Eisai (about 211.19 million yen), AstraZeneca (about 167.04 million yen), and Pfizer (about 152.07 million yen).

In the industry, Chugai Pharmaceutical has been making its presence known with anti-HER2 therapy, but Daiichi Sankyo, Pfizer, and others are also releasing new drugs, intensifying their marketing efforts. As a result, the "dancers" have become predictable, and there is a real demand for new "stars".

However, there is no need to worry. In the chaotic breast cancer community, there are no doctors who harbor ambivalence like me. Today, auditions for the role of the dancer are being held in the industry, and doctors are sweating to meet the expectations of the companies. Despite being amazed at the inconsistency of the breast cancer community, I, who find a certain pleasure in peeking at the shame of humanity, am probably the most inconsistent.

Originally published in Japanese in Iyakukeizai (Pharmaceuticals and Economics), July 15, 2023


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