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Physician in charge: Yoshihiko Suzuki, diabetes specialist
Dr. Yoshihiko Suzuki's argument (above paper: main points only)
The debate over the authority of medical societies and doctors' free medical practice is calling into question the very foundations of Japanese medical care.
There is a movement to impose severe penalties, such as expulsion from medical societies, on doctors who prescribe diabetes medications such as Wegovy and Zepbound without insurance coverage. However, this measure seems to misunderstand the true nature of medicine.
The declining birthrate and aging population are putting pressure on medical finances, and private hospitals' management is steadily deteriorating. Remuneration from insurance-covered medical treatment alone is no longer sufficient to secure profits. Doctors' working conditions are becoming increasingly harsh, and morale is declining significantly. In this environment, private medical treatment is a valuable opportunity for doctors to demonstrate their expertise and offer a variety of options to patients.
The threat of revoking specialist qualifications could drive talented diabetes specialists out of the association and ultimately out of the medical field. Doctors have a responsibility to provide the best possible medical care for each patient. Uniform restrictions by the association infringe on that discretion and reduce the quality of medical care.
Ironically, while cosmetic surgeons who easily prescribe off-label medications and who are not familiar with the drug's efficacy and side effects continue to prescribe it, true experts in diabetes are being excluded. Given that tirzepatide can prevent the onset of diabetes by over 95%, where has the society's mission of prevention gone?
The word "outstanding" is interpreted as "superior" in the West, while in Japan it is seen as "outsider." This difference in perception symbolizes the sense of stagnation in Japanese medical care. Now is the time for the medical association to weigh the realities of the medical system, the responsibilities of specialists, and above all, the interests of patients, and seek a constructive path forward.
The current debate over elective medical treatment will be a test of the future of medical care in Japan.
Response from the Japan Diabetes Association (summary only)
The gap between academia and the field can sometimes be bridged through dialogue.
The response from the Japan Diabetes Society cleared up one misunderstanding and also highlighted a new issue.
The first thing that became clear was that no measures were being considered to expel members of the Society for the reason of prescribing medicines not covered by insurance.
However, the real problem lies elsewhere: Patients with type 2 diabetes and obesity can take Ozempic and Manjaro without being bound by the optimal use guidelines, while the association cannot recommend their use in obese patients without diabetes .
This line may be medically justified. However, the reality is more complicated. Careless prescription of medication for cosmetic purposes, especially when administered solely through online consultations, is certainly extremely dangerous. Side effects may be discovered late, potentially resulting in serious health problems.
As the academic community recognizes, even mild obesity can put people at high cardiovascular and metabolic risk. It is urgent to expand insurance coverage to these people and to revise the guidelines. Promoting research in collaboration with companies would be the first step.
In the world of medicine, there is always a conflict between principle and reality. While the academic society's cautious stance is understandable, at the same time, the needs of patients faced by doctors on the front lines cannot be ignored. What is important is to ensure safety while opening up the path to appropriate treatment for those who truly need it.
The dialogue has begun. We hope that this discussion will open up new horizons for obesity treatment in Japan.