Yesterday, a government advisory panel to the Ministry of Health, Labour and Welfare recommended that doctors stop encouraging patients to be vaccinated against the HPV virus. Following a spate of reports of lingering pain from the shots and the organization of a parents support group of purported victims, the panel concluded that the ministry that should ask doctors to suspend the practice of telling patients and their parents that receiving the shots is a good idea. (Link - J)
An oddity in this story is the lack of agreement on how many cases of mysterious pains have been reported. NHK is reporting 33 cases, with 8 patients still suffering from unresolved pain. The Nihon Keizai Shimbun is reporting 38 cases out of the 3.28 million patients who have received the shots since November of 2010 (Link - J). The Asahi Shimbun is reporting 43 cases over the same timespan (Link). The Mainichi Shimbun is also reporting 43 cases, with 11 of them with still unresolved pain. (Link- J)
Ostensibly, all these news organizations had their representatives at yesterday's meeting, or received the reports of the advisory panel's recommendatoin. How can the numbers coming out of the meeting be all over the map?
Since the panel has not recommended a halt in the vaccinations, it is difficult to assess what it is recommending the MHLW ask doctors to do. The incidence of mysterious pains is around 1 in 100,000, with the instances of lasting pains less than 1 in 300,000. At the same time, known adverse reactions to the vaccine (such as anaphalactic shock) numbered over 10,000. That and the fact that cervical cancer kills 2,700 Japanese women every year seems to argue that panic in the face of pressure is...inadvisable?
Women's health advocates fought a long and costly battle to push the health industry and the government into including the HPV vaccine in the regimen of standard vaccines provided free for minors. It is both saddening and entirely in character that the advisory panel has chosen to delegitimize the program at the first sign of trouble, on the entirely political and utterly unscientific excuse of "Well, we do not know what is going on, but to cover our behinds let us retreat to the position of being neither for nor against the vaccinations."
Showing posts with label healthcare. Show all posts
Showing posts with label healthcare. Show all posts
Saturday, June 15, 2013
Friday, January 25, 2013
That Aso Slip Of The Tongue
Okumura Jun wonders (Link) why I did not dance a jig over Finance Minister Aso Taro's "my brainstem does the talking" attempt to link dying with dignity and the cost of life-extending technologies. (Link)
There are a number of reasons.
First is I like Aso-san, a lot. He is by his own admission a simpleton, the worst student he ever met. While a holder of reactionary views, he is inconsistent, liking many things other reactionaries find corrupt and immoral. I admire and cherish his insouciance and his patriotism -- qualities so lacking in most of the fanatics whose company he keeps.
Second, Aso has competition. While he has earned most of the attention this week for both his "hurry up and die" comment and for losing his shirt in negotiations with Bank of Japan governor Shirakawa Masaaki (Link), economic revitalization minister Amari Akira is probably still ahead on points. From his wandering off message as regards the strength of the yen (Link) to his incredibly bizarre four strategic targets for Government of Japan economic policy (Link) Amari seems intent on embarrassing himself and his boss.
The Abe Cabinet and the Liberal Democratic Party leadership are full of ticking time bombs: the poverty-scarred Shimomura Hakubun at MEXT, policy research chief Takaichi Sanae (Link), National Public Security Commission head Furuya Keiji, Shindo Yoshitaka at MIC...
Jumping all over Aso for his well-intentioned gaffe will only numb audiences in advance of the waves of nonsense that will be issuing from the Friends of Shinzo over the coming days, weeks, months and years.
Which brings up the third reason why I let Aso's comment slide: there is so much that is substantively wrong in what Abe and Company want to do to Japan that to pick apart a gaffe is to be complicit in a diversion of attention. That Aso said what he said does not reveal a heretofore dark hidden agenda or mindset anymore than Yanagisawa Hakuo's baby-making machines metaphor did (Link). What we learned is that Aso cannot express a thought to save his life -- which we already knew.
There are a number of reasons.
First is I like Aso-san, a lot. He is by his own admission a simpleton, the worst student he ever met. While a holder of reactionary views, he is inconsistent, liking many things other reactionaries find corrupt and immoral. I admire and cherish his insouciance and his patriotism -- qualities so lacking in most of the fanatics whose company he keeps.
Second, Aso has competition. While he has earned most of the attention this week for both his "hurry up and die" comment and for losing his shirt in negotiations with Bank of Japan governor Shirakawa Masaaki (Link), economic revitalization minister Amari Akira is probably still ahead on points. From his wandering off message as regards the strength of the yen (Link) to his incredibly bizarre four strategic targets for Government of Japan economic policy (Link) Amari seems intent on embarrassing himself and his boss.
The Abe Cabinet and the Liberal Democratic Party leadership are full of ticking time bombs: the poverty-scarred Shimomura Hakubun at MEXT, policy research chief Takaichi Sanae (Link), National Public Security Commission head Furuya Keiji, Shindo Yoshitaka at MIC...
Jumping all over Aso for his well-intentioned gaffe will only numb audiences in advance of the waves of nonsense that will be issuing from the Friends of Shinzo over the coming days, weeks, months and years.
Which brings up the third reason why I let Aso's comment slide: there is so much that is substantively wrong in what Abe and Company want to do to Japan that to pick apart a gaffe is to be complicit in a diversion of attention. That Aso said what he said does not reveal a heretofore dark hidden agenda or mindset anymore than Yanagisawa Hakuo's baby-making machines metaphor did (Link). What we learned is that Aso cannot express a thought to save his life -- which we already knew.
Tuesday, October 09, 2012
One Nobel Down
Yamanaka Shinya has won the Nobel Prize for Medicine for his development induced pluripotent stem cells (E). The news media is one big physiology fest, with an increasingly exhaused Yamanaka appearing on live feeds and answering idiot announcer questions on every network.
Not bad for a guy whose father, the owner of a small sewing machines parts manufacturer, told his eldest son, "If you do not take over the family business, fine. If you do take over the family business it would terrible" and whose collegues in orthopedics referred to him as "Jamanaka" ("So useless he is just in the way"-naka) because of his total incompetence as a surgeon, working so slowly patients would come out of anesthesia mid-operation.
The only negative is that Yamanaka should have receive the prize two years ago, or at least last year -- his discovery being the Holy Grail of cell development.
Now all the news media is salivating at the thought that Murakami Haruki might pick up the prize for Literature. That Murakami's public appearances over the last two years could be construed as campaigning for the Nobel is probably detrimental to his chances.
As for the right wing in this blessed land, it is chortling, as it usually does: "Nobel Prizes. Japan, 19. PRC, not in prison or in exile for political reasons, 0."
Not bad for a guy whose father, the owner of a small sewing machines parts manufacturer, told his eldest son, "If you do not take over the family business, fine. If you do take over the family business it would terrible" and whose collegues in orthopedics referred to him as "Jamanaka" ("So useless he is just in the way"-naka) because of his total incompetence as a surgeon, working so slowly patients would come out of anesthesia mid-operation.
The only negative is that Yamanaka should have receive the prize two years ago, or at least last year -- his discovery being the Holy Grail of cell development.
Now all the news media is salivating at the thought that Murakami Haruki might pick up the prize for Literature. That Murakami's public appearances over the last two years could be construed as campaigning for the Nobel is probably detrimental to his chances.
As for the right wing in this blessed land, it is chortling, as it usually does: "Nobel Prizes. Japan, 19. PRC, not in prison or in exile for political reasons, 0."
Labels:
China,
Dalai Lama,
healthcare,
image of Japan,
ineptitude
Sunday, June 29, 2008
A Wish List, Opened
How?
That is the inescapable question.
After the hoopla and security overkill of the Toyako Summit dies down, the Prime Minister and his Cabinet will be left with seven weeks of housekeeping duties and summer reading time before the start of the extraordinary session. The political classes will disperse to their home districts for seven weeks of vital constituent hand-holding and, when appropriate, backslapping—-an ominously long time for politicians to be immersed in a bath of personal and local complaints. In the absence of an election, the nation will largely put politics aside, focusing its attention on what is truly important: the Koshien high school baseball tournament--which probably will not, for demographic and wealth reasons, be won by a team from the Hokuriku, Chugoku, Shikoku or Tohoku regions.
But once this idyllic summer—possibly the last summer of the LDP's era of dominance—comes to an end, the Prime Minister, his Cabinet, his party and the ruling coalition will find themselves facing a daunting question.
How?
How will it be possible, in just a few months before the New Year, to draft and pass legislation
- reforming the payment system of the wildly unpopular eldercare system
- fulfilling the first phase of decentralization
- laying the groundwork for a fundamental rebalancing of the tax system
- renewing the Indian Ocean Maritime Self Defense Forces dispatch
- shifting the gasoline tax revenues from road construction to the general fund
over the determined opposition and delaying tactics of large segments of the Liberal Democratic Party, not to mention the knee-jerk opposition and delaying tactics of the majority in the House of Councillors?
And what about the big items on the agenda, the looming multifaceted issues requiring a flurry of action after years of benign neglect, such as:
- providing for the physical and financial needs of burgeoning population of the very old, at a reasonable cost
- righting the crippled, parasitic economies of the rural areas
- providing the legal and ideological framework for an influx of immigrant labor, both skilled and unskilled, temporary and permanent
-reversing the growing number of suicides
- fulfilling promises made at international events like TICAD and Toyako
- increasing the birth rate
- reversing the runaway destruction of the environment, both global and local
- preparing for a post-hydrocarbon-burning world
- providing for Japan's security as the world's power relationships undergo a phase of rapid realignment (and keeping the Americans happy with the Japan-U.S. security alliance through a more gradual and less episodic evolution)
all while the two largest parties in the Diet do not speak to each other...the bureaucracy is demoralized and despised...and the press and intellectuals are perceived to be shabby, corruptible and narcissistic?
How is it possible to change everything that must be changed--when everything that must be changed is .....everything?
That is the inescapable question.
After the hoopla and security overkill of the Toyako Summit dies down, the Prime Minister and his Cabinet will be left with seven weeks of housekeeping duties and summer reading time before the start of the extraordinary session. The political classes will disperse to their home districts for seven weeks of vital constituent hand-holding and, when appropriate, backslapping—-an ominously long time for politicians to be immersed in a bath of personal and local complaints. In the absence of an election, the nation will largely put politics aside, focusing its attention on what is truly important: the Koshien high school baseball tournament--which probably will not, for demographic and wealth reasons, be won by a team from the Hokuriku, Chugoku, Shikoku or Tohoku regions.
But once this idyllic summer—possibly the last summer of the LDP's era of dominance—comes to an end, the Prime Minister, his Cabinet, his party and the ruling coalition will find themselves facing a daunting question.
How?
How will it be possible, in just a few months before the New Year, to draft and pass legislation
- reforming the payment system of the wildly unpopular eldercare system
- fulfilling the first phase of decentralization
- laying the groundwork for a fundamental rebalancing of the tax system
- renewing the Indian Ocean Maritime Self Defense Forces dispatch
- shifting the gasoline tax revenues from road construction to the general fund
over the determined opposition and delaying tactics of large segments of the Liberal Democratic Party, not to mention the knee-jerk opposition and delaying tactics of the majority in the House of Councillors?
And what about the big items on the agenda, the looming multifaceted issues requiring a flurry of action after years of benign neglect, such as:
- providing for the physical and financial needs of burgeoning population of the very old, at a reasonable cost
- righting the crippled, parasitic economies of the rural areas
- providing the legal and ideological framework for an influx of immigrant labor, both skilled and unskilled, temporary and permanent
-reversing the growing number of suicides
- fulfilling promises made at international events like TICAD and Toyako
- increasing the birth rate
- reversing the runaway destruction of the environment, both global and local
- preparing for a post-hydrocarbon-burning world
- providing for Japan's security as the world's power relationships undergo a phase of rapid realignment (and keeping the Americans happy with the Japan-U.S. security alliance through a more gradual and less episodic evolution)
all while the two largest parties in the Diet do not speak to each other...the bureaucracy is demoralized and despised...and the press and intellectuals are perceived to be shabby, corruptible and narcissistic?
How is it possible to change everything that must be changed--when everything that must be changed is .....everything?
Monday, May 05, 2008
In Rude Political Health
In what is a probably astute gesture of restraint, the leadership of the Democratic Party of Japan has reportedly backed away from the plan for a vote of censure in the House of Councillors.
A DPJ candidate's defeat of the Liberal Democratic Party candidate in the Yamaguchi #2 by-election and the prime minister's disastrous public polling numbers have robbed a bill of censure against the PM, a member of the other house of parliament, of much of its former luster. The DPJ has proven itself relevant: it does not need an act of political theater to convince the public of its sincerity and importance. On balance, a censure motion now poses more of a risk to the DPJ's standing than the DPJ can perhaps stomach. Proceeding to a vote on a legally dubious bill could boomerang, leading to the public to call into question the DPJ's credibility.
As if to balance its new restraint in regards the censure with excess elsewhere, the DPJ has announced a plan to proceed with a bill terminating the new over-75 elder care system.
The move is smart in seikyoku (political street fighting) terms. The elderly vote in far greater numbers, both in aggregate and proportionally, than the young. In terms of regional power, retirees are a larger fraction of the voting public in the low population rural prefectures, where the move of a few thousand votes from one column to the other could switch a district from LDP to DPJ control. Elderly-dominated districts are also over-represented in the Diet due to the incomplete equalization of the declining rural districts with stable or growing urban-suburban ones. Appealing to the old cannot only win you more votes within a district, it can win you more districts period, due the dominance of elderly voting a larger number of districts. Add to this structural justification for pandering to the retirees a tone-deaf ruling coalition incapable of even breathing without offending—and you have what must be a seductive opportunity to position the DPJ for a seizure of power.
Such positioning is Ozawaism at its worst. It is Tanakaism reversed: the irresponsible promising to undo all unpopular LDP policies—even the difficult and necessary ones—in order to win the next election. It is irresponsible and dishonest—justifiable only to revolutionaries to whom the end of winning political control justifies the means. That Kan Naoto—a former minister of health and welfare—should be the DPJ's spokesman for this facetious termination bill is disturbing. He of all the leaders of the DPJ should know that health insurance system is doomed to a financial unraveling unless fundamental reforms of elder care are undertaken.
In seisaku (political policies) terms, the recently instigated elder care system seems a fair solution to the looming elder care crisis. With the young a decreasing fraction of the total population, relying upon on the underconsumption of healthcare by the young as the subsidizer of the healthcare of the very old puts one on a collision course with reality—no matter what one may think of the social justice aspects of the intergenerational transfers...
(I am an apostate. I hold as self-evident that the young today have high paying jobs in an advanced industrial society thanks to the savings, self-sacrifice and hard work of preceding generations. Whining about being taxed to death in order to coddle rapacious old folks grants to the individual an unearned aura of autonomy across time.)
The decision to deduct (tenbiki) a regular extra insurance fee from the pensions of persons over 75 years of age in return for lowering the patient's visit costs to 10% of the total cost does penalize very healthy seniors. Then again, all insurance systems penalize the healthy.
Having a regular fee deducted from one's pension and a low per visit cost avoids a major problem with the elderly: self-rationing of healthcare. One wants the healthcare system to discourage frivolous visits to the doctor—one of the reasons (aside from the obvious fiscal ones) that the authorities over the last decade have increased the percentage an individual pays out of pocket from the original 10% to 20% and 30%. However, one would want the very old to seek treatment for minor ailments before they deteriorate into major and expensive-to-treat illnesses. One would want the system to stimulate the individual retiree into rationalizing a visit to the doctor as a way of recouping for himself or herself at least some fraction of the money the government has forcibly taken from his or her pension.
The regular pension deduction and lower per-visit cost also addresses one of the real problems of the cost curve of healthcare over time—that the last six months of a person's life are the most expensive. As organs and internal systems fail, doctors and hospitals deploy all kinds of life-prolonging medications and devices...
(One unfortunately misinterpreted gesture has been the government program encouraging physicians to give their patients questionnaires asking them to specify about what kind of life-prolonging treatments they would not want deployed in case of incapacitation. Some critics [Veracity Alert - The following is according to Shūkan Gendai - quote at your peril] of the system have depicted the gathering of this information as a preliminary step to charging higher monthly fees to those individuals expecting more aggressive and expensive life-prolonging strategies. They have pointed to the assigning of a point system to certain kinds of treatment as evidence--as if a person amassing a certain number of points after saying "yes" to a particular number of life-prolonging treatments would be then charged an "X" amount in fees. The actual goal of the point system is almost certainly to help hospitals decide on how much to spend on certain technologies and treatments, and avoid overinvestment into life-prolonging technologies the patients do not want employed.)
To expect an individual to have liquid savings able to cover 20% or 30% of the cost of these end-of-life treatments, especially as life-prolonging technologies advance in their ability to increase lifespan, is simply not reasonable. Better to have each person pre-paying over the course of her or his retirement into a general fund, creating a special drawing right for the individual for the time when her or his vital systems begin to shut down, leaving the individual at that time liable for only 10% of the cost out-of-pocket.
Now, if the above is indeed a proper description of the new elder care system, it would take a special kind of genius to be so unnerved as to never, ever attempt to explain it. Perhaps the LDP and the New Komeitō deserve to be sent to perdition for having both delayed the introduction of this system and left it to the bureaucracy to justify.
However, the cowardice of the ruling coalition is no excuse for the DPJ's turning its back on reform. The public is not stupid: it will ask what the DPJ's plan is for the long-term financially stability of the healthcare system. Being in an advantageous position on the electoral map is a fine and wonderful thing—and elections are about winning. However, as a party that will win at best a plurality of seats in the House of Representatives, requiring the cobbling together of a coalition in order to form government, the DPJ should be at least considering the possibility that a reputation for conscientiousness could make the signing up of allies a slightly easier task.
Kan Naoto speaking out in favor of reverting to the previous system puts pressure on the DPJ's House of Councillors membership to speed up the consideration of the termination bill. Submitted to the House of Councillors in February, the bill has yet to see the inside of a committee chamber. A suspicious mind could even posit that the DPJ councillors have been stalling on their allies—all of whom are enthusiastic supporters of a rescinding of the new system.
Perhaps being in charge of one of the houses of the Diet has made DPJ's House of Councillors members the party's "responsible wing" —which would be a neat reversal of the traditional image of the House of Councillors membership as the breakfast cereal (i.e., the flakes and nuts) of every political party.
A DPJ candidate's defeat of the Liberal Democratic Party candidate in the Yamaguchi #2 by-election and the prime minister's disastrous public polling numbers have robbed a bill of censure against the PM, a member of the other house of parliament, of much of its former luster. The DPJ has proven itself relevant: it does not need an act of political theater to convince the public of its sincerity and importance. On balance, a censure motion now poses more of a risk to the DPJ's standing than the DPJ can perhaps stomach. Proceeding to a vote on a legally dubious bill could boomerang, leading to the public to call into question the DPJ's credibility.
As if to balance its new restraint in regards the censure with excess elsewhere, the DPJ has announced a plan to proceed with a bill terminating the new over-75 elder care system.
The move is smart in seikyoku (political street fighting) terms. The elderly vote in far greater numbers, both in aggregate and proportionally, than the young. In terms of regional power, retirees are a larger fraction of the voting public in the low population rural prefectures, where the move of a few thousand votes from one column to the other could switch a district from LDP to DPJ control. Elderly-dominated districts are also over-represented in the Diet due to the incomplete equalization of the declining rural districts with stable or growing urban-suburban ones. Appealing to the old cannot only win you more votes within a district, it can win you more districts period, due the dominance of elderly voting a larger number of districts. Add to this structural justification for pandering to the retirees a tone-deaf ruling coalition incapable of even breathing without offending—and you have what must be a seductive opportunity to position the DPJ for a seizure of power.
Such positioning is Ozawaism at its worst. It is Tanakaism reversed: the irresponsible promising to undo all unpopular LDP policies—even the difficult and necessary ones—in order to win the next election. It is irresponsible and dishonest—justifiable only to revolutionaries to whom the end of winning political control justifies the means. That Kan Naoto—a former minister of health and welfare—should be the DPJ's spokesman for this facetious termination bill is disturbing. He of all the leaders of the DPJ should know that health insurance system is doomed to a financial unraveling unless fundamental reforms of elder care are undertaken.
In seisaku (political policies) terms, the recently instigated elder care system seems a fair solution to the looming elder care crisis. With the young a decreasing fraction of the total population, relying upon on the underconsumption of healthcare by the young as the subsidizer of the healthcare of the very old puts one on a collision course with reality—no matter what one may think of the social justice aspects of the intergenerational transfers...
(I am an apostate. I hold as self-evident that the young today have high paying jobs in an advanced industrial society thanks to the savings, self-sacrifice and hard work of preceding generations. Whining about being taxed to death in order to coddle rapacious old folks grants to the individual an unearned aura of autonomy across time.)
The decision to deduct (tenbiki) a regular extra insurance fee from the pensions of persons over 75 years of age in return for lowering the patient's visit costs to 10% of the total cost does penalize very healthy seniors. Then again, all insurance systems penalize the healthy.
Having a regular fee deducted from one's pension and a low per visit cost avoids a major problem with the elderly: self-rationing of healthcare. One wants the healthcare system to discourage frivolous visits to the doctor—one of the reasons (aside from the obvious fiscal ones) that the authorities over the last decade have increased the percentage an individual pays out of pocket from the original 10% to 20% and 30%. However, one would want the very old to seek treatment for minor ailments before they deteriorate into major and expensive-to-treat illnesses. One would want the system to stimulate the individual retiree into rationalizing a visit to the doctor as a way of recouping for himself or herself at least some fraction of the money the government has forcibly taken from his or her pension.
The regular pension deduction and lower per-visit cost also addresses one of the real problems of the cost curve of healthcare over time—that the last six months of a person's life are the most expensive. As organs and internal systems fail, doctors and hospitals deploy all kinds of life-prolonging medications and devices...
(One unfortunately misinterpreted gesture has been the government program encouraging physicians to give their patients questionnaires asking them to specify about what kind of life-prolonging treatments they would not want deployed in case of incapacitation. Some critics [Veracity Alert - The following is according to Shūkan Gendai - quote at your peril] of the system have depicted the gathering of this information as a preliminary step to charging higher monthly fees to those individuals expecting more aggressive and expensive life-prolonging strategies. They have pointed to the assigning of a point system to certain kinds of treatment as evidence--as if a person amassing a certain number of points after saying "yes" to a particular number of life-prolonging treatments would be then charged an "X" amount in fees. The actual goal of the point system is almost certainly to help hospitals decide on how much to spend on certain technologies and treatments, and avoid overinvestment into life-prolonging technologies the patients do not want employed.)
To expect an individual to have liquid savings able to cover 20% or 30% of the cost of these end-of-life treatments, especially as life-prolonging technologies advance in their ability to increase lifespan, is simply not reasonable. Better to have each person pre-paying over the course of her or his retirement into a general fund, creating a special drawing right for the individual for the time when her or his vital systems begin to shut down, leaving the individual at that time liable for only 10% of the cost out-of-pocket.
Now, if the above is indeed a proper description of the new elder care system, it would take a special kind of genius to be so unnerved as to never, ever attempt to explain it. Perhaps the LDP and the New Komeitō deserve to be sent to perdition for having both delayed the introduction of this system and left it to the bureaucracy to justify.
However, the cowardice of the ruling coalition is no excuse for the DPJ's turning its back on reform. The public is not stupid: it will ask what the DPJ's plan is for the long-term financially stability of the healthcare system. Being in an advantageous position on the electoral map is a fine and wonderful thing—and elections are about winning. However, as a party that will win at best a plurality of seats in the House of Representatives, requiring the cobbling together of a coalition in order to form government, the DPJ should be at least considering the possibility that a reputation for conscientiousness could make the signing up of allies a slightly easier task.
Kan Naoto speaking out in favor of reverting to the previous system puts pressure on the DPJ's House of Councillors membership to speed up the consideration of the termination bill. Submitted to the House of Councillors in February, the bill has yet to see the inside of a committee chamber. A suspicious mind could even posit that the DPJ councillors have been stalling on their allies—all of whom are enthusiastic supporters of a rescinding of the new system.
Perhaps being in charge of one of the houses of the Diet has made DPJ's House of Councillors members the party's "responsible wing" —which would be a neat reversal of the traditional image of the House of Councillors membership as the breakfast cereal (i.e., the flakes and nuts) of every political party.
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