Greed diagnosed in doctors' surgeries

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The Independent Online
A DEADLY strain of bacteria is stalking Japan's hospitals, infecting and killing patients admitted for other complaints - and greedy doctors are to blame. According to the Ministry of Health and Welfare, the bacterium, methicilin-resistant staphylococcus aureus (MRSA), is rampant largely because doctors have been over-prescribing antibiotics for decades, causing new drug-resistant forms of the bacterium to evolve. Under Japan's unique drug dispensing system, doctors receive a cut from the price of each drug they prescribe.

The problem of MRSA has been growing for several years, but it was only when a survey revealed that 61 elderly patients had died from the bacterium in a single prefecture and 2.3 per cent of all elderly patients tested were carrying the infection that officials finally acted. Late last month, the ministry urged doctors and hospitals to stop over-prescribing antibiotics, and ordered drug companies to print warnings on their products saying they should be used only when absolutely necessary.

MRSA is particularly dangerous to the elderly, very young children and people with low levels of immunity after surgery or illness. In January 1992 a couple sued a hospital in Tokyo, claiming it failed to protect their three-year-old daughter from MRSA. The girl had been admitted for heart surgery, but died while in the hospital from an infection of MRSA bacteria which she allegedly picked up either in the operating theatre or in the intensive care unit. Similar suits have followed against other hospitals.

A spokesman for the Ministry of Health and Welfare said yesterday they had no figures for how widespread MRSA was in hospitals throughout the country. But last year after 20 patients were revealed to have died of MRSA in a hospital for the elderly in Chiba, north of Tokyo, the director said 20 per cent of all patients were infected with the bacterium, and claimed this was 'not particularly higher than other hospitals'.

Medical experts have long criticised the over-prescription of drugs in Japan, and the close relationships that exist between drug suppliers and doctors. Most doctors' clinics and hospitals dispense their own drugs, for which they charge the recommended retail price to the patient, or more usually, to his or her insurance company. However, the drug companies supply their products to doctors at a discount, allowing the doctors to pocket the difference.

This discount used to range up to 30 per cent in some cases, although the ministry issued new regulations last April in an attempt to curtail the practice. But drug companies are keen to gain market share over their competitors, and many hospitals rely on the profits they make from dispensing drugs for a large part of their income.

According to Atsushi Saito, a specialist in internal medicine at the University of the Ryukyus in southern Japan, Japanese doctors prescribe four times as many antibiotics as their counterparts in the West. There are more than 150 different antibiotics used in Japan, and annual sales amount to 590bn yen (pounds 3.2bn).