Japan's cancer refugees

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At first glance, Japan's health-care system seems superior to America's. Its infant mortality rate is among the world's lowest. Japan's life expectancy is the world's highest for women (85.6 years) and the fourth-highest for men (80.4 years).

All this has been achieved at a fraction of what the United States spends. Only 9 percent of Japan's gross domestic product is spent on health care, while America spends almost twice that. It seems like the perfect system. For many, perhaps it is -- unless you actually need to use it.

Just look at cancer. U.S. deaths as a result of cancer have slowly and steadily fallen for years. Today, only 180 per 100,000 deaths are attributable to cancer -- a record low. Japan's cancer death rate, on the other hand, is actually headed upward. Over the last 10 years, its rate has climbed from 200 to 250 per 100,000 deaths.

In fact, cancer is Japan's leading cause of death, accounting for 326,000 deaths in 2005, more than heart attacks and strokes combined. In total, cancer accounts for 30 percent of Japan's deaths each year.

How did this happen? Like every other state-administered system, Japan keeps its health costs low by denying access to new and expensive treatments.

Only last April, for example, did a Japanese medical board begin certifying oncologists, the specialized doctors who administer chemotherapy drugs. That same certification process began in the United States nearly 35 years ago.

In Japan, a single doctor -- without any certification for specialized cancer therapy -- will often diagnose a patient's cancer and carry out his treatment. In the United States, it's not uncommon for entire teams of specialized oncologists, doctors and other health-care professionals to discuss treatment options for a single patient.

Certain cancer drugs have also been slow to arrive on Japan's shores. Genetech's Avastin, which treats several forms of cancer, was available for patients in the United States in early 2004. But Avastin costs thousands of dollars a month. The tightfisted health-care budgeters in the Japanese government have yet to approve it.

The colorectal cancer drug Eloxatin, which was approved in America in August 2002, only made it to Japan when desperate patients-turned-activists staged protests and pressured the government to finally offer the drug in 2005.

Last May, Japanese legislator Takashi Yamamoto addressed Parliament and used facts like these to call attention to the plight of cancer sufferers. To get the attention of his fellow lawmakers, he announced that he, too, had cancer. Denouncing the treatment available to Japan's "cancer refugees," Mr. Yamamoto called on his fellow legislators to support a bill that would both increase the number of cancer specialists and give patients a greater say in policymaking questions about their health.

Mr. Yamamoto's speech had a profound effect -- lawmakers were spurred into passing the law, and many came to believe the state needed to do more for its cancer sufferers.

But the pressure to keep the budget under control remains heavy. Many corporations, worried that higher health costs will drive businesses offshore, have lobbied against increased health-care spending.

There's a lesson here that both Japanese and Americans ought to take to heart -- when politicians and government policymakers make health-care decisions for their citizens, there are off-the-books costs. Complete information about illnesses and independent control of treatment are just two casualties of government planning that don't show up in budget annals or official government statistics.

A health-care system's success shouldn't simply be based on life expectancy and fiscal policy but rather on individual outcomes. Patients should be free to seek the best available medicine, and governments should ensure that markets are sufficiently free to allow those medicines to be invented.

Candidates in the 2008 presidential race have already begun vying for Americans' votes. Improving the nation's health-care system has already surfaced as a major issue for all those seeking the job. But it's hardly an improvement on our health-care system if politicians seek to turn our life-and-death health-care decisions over to bureaucrats and budget-crunchers.

Japan's cancer refugees have just issued a wake-up call to their own government. It would be a shame if we didn't heed their warning and ended up with cancer refugees of our own.

Peter J. Pitts is director of the Center for Medicine in the Public Interest and a former associate commissioner of the Food and Drug Administration.