Maurer has been a prominent figure in Japan’s pharmaceutical industry for more than 35 years. He worked first with Eli Lilly and Company, then with Merck & Company. He served on the board of seven joint-venture companies in Japan since 1970, and founded International Alliances Limited in 1989 to facilitate international collaboration with Japan in the area of innovative life science technology. In addition, he served for seven years as the first representative in Japan for Pharmaceutical Research and Manufacturers of America.
A native of Pennsylvania, Maurer earned a Master of Science degree from the University of Pennsylvania and subsequently served as an associate professor of embryology and genetics at Bucknell University.
His new book titled It’s Worth Doing was published this month by The Japan Times.
Majirox News recently sat down with the still youthful-looking and energetic Maurer in Tokyo.
Q: I always thought drugs were over-prescribed in Japan?
No, the Japanese patient and doctor do not like side effects, so they tend to give low doses, which might not be so effective. If that doesn’t work they will add another drug, but still at a low dose. For example, our son had asthma and allergies. In Japan, if a child has an asthma attack, they are reluctant to prescribe steroids. However, in Hawaii where we see a specialist for our son who has asthma, he slams the patient with protozone.
Furthermore, if they give steroids at Hiroo Hospital in Tokyo they will keep the person in the hospital. I asked our doctor in Hawaii how many patients he had in the hospital right now and he said the last time [he hospitalized a patient] was three years ago. This is because the [U.S.] doctor will knock it out right away with a much higher dose.
Q: How about the side effects?
My wife was concerned about it stunting the growth of our son, but the doctor showed us the literature and went through it all with us. He said, “Would you rather have a child’s lung damaged because of coughing and not getting enough air?”
Q: So what do you think is better — a lower or higher dose?
Let me say there is another side to this, which is follow the money, although not for a hospital doctor who is on a salary. There are doctors who have an interest in the pharmacy, which becomes a profit center. The doctor will be reimbursed by the pharmacy. Let’s say the doctor can sell the drug at $100 but he can buy it for $90, which means he will make $10 for every prescription he writes, so he’s motivated to prescribe more.
Overall, if you look at putting all these things together it is difficult to suggest that the Japanese are taking too much medicine. Also, the number of refills has come down; it used to be 5, it’s now 3 per prescription.
Q: How long can doctors prescribe medication for an individual in Japan?
Doctors cannot prescribe for more than three months, but usually it’s less than a month. In the U.S. I can get a prescription for a year.
It’s follow the money again. The Japan Medical Association put it into effect. The doctors want to see the patient because they receive a fee when they do, and many patients are just going back to get a new prescription. There’s another side to this, maybe the doctor in Japan only sees you for three minutes, but at least he checks your blood pressure and pulse as things like that can change in a year. Maybe this is one of the reasons why they catch illnesses before they get too serious.
Q: Any other big growth areas in Japan?
You have conditions where there are unmet medical needs, the so-called niche segment of certain blood cancers is certainly very difficult and there is no therapy. This is a big area for many companies because there is a lot of pressure from patient groups to get something to treat that condition. If I was a pharmaceutical company in Japan this is the area that I would focus on. In addition, don’t license out your drugs to Japanese companies.
Q: Why is that?
Because it is a huge market, the second largest in the world, after the U.S. This is a very rich society and they want the best the world has to offer and they are willing to pay for it — it’s insured for everyone. Access is universal whether they live in Hokkaido or Okinawa. You have access to health care at a very low out-of-pocket cost.
It shows up in some of the metrics: Japan has the longest lifespan in the world, lowest infant mortality rate — it is a very healthy population.
Q: What else would you recommend?
Set up your own operations here because foreign companies can recruit good people — in the old days, any warm body with a Japanese face that walked in the door you would hire. This was because the Japanese didn’t know who the foreign companies in Japan were at that time. Of course, that’s changed today.
A foreign pharmaceutical firm in Tokyo recently hired 30 local new employees — they had 3,000 applicants. I hear this all the time. However, these are entry-level employees, but if you talk about 40-year-olds who are experts at developing drugs, it is harder to get those people as they are not moving around too much. But in marketing, sales and administration it’s easier to recruit rather than in the scientific area of doing trials and regulatory affairs.
Q: Is Japan behind in research and development?
No, there are three parts of the world where new drugs are discovered: the U.S., Europe and Japan, and the rest of the world doesn’t matter at all. Maybe in the future China, not yet, in India.
Q: Where do you think the ideas are coming from?
From academia and individuals. What is lacking in Japan is a bridge to turn those ideas into drugs. The U.S. has a very lively active bio-venture, but Japan is still not there. It will come but not right now.
The U.S. has the National Institute of Health. Japan has the Ministry of Health, Labor and Welfare, which is not focused and there isn’t any good venture capital that is willing to take the risk of investing in the seeds of bio-venture. They are more risk-adverse; they want to invest in something that is pretty far along.
Also, Tokyo’s Stock Exchange says we will list you if you have a drug marketed. Duh, if I have a drug marketed I don’t need the money, that’s terrible. So nobody is getting listed to get IPOs to get money to invest in developing these seeds and the money that did invest got burned; the value of their investments was way down. Bio-venture is risky business.
What’s lacking here is people who are willing to take that risk. The large pharmaceutical companies feel comfortable investing in a bio-venture in the U.S. but not in Japan, not Japanese companies.
Q: Why is that?
Because Japan is a vertical society. If you’re in academia and you’re a Keio University man you stay a Keio man. If you’re a Todai University man you stay a Todai man, and you don’t go to Takeda Pharmaceutical you stay at your university. In the U.S. you have people move to Mass General Hospital and then back to Harvard all the time, so they feel more comfortable working in different places.
But Japan will get it right. They’ve only been in it for 10 years whereas in the States it’s 30 years old. The ideas are not going to stop coming here in Japan as there are too many bright people.
Q: What else would you recommend to companies?
Tie into universities where a lot of these ideas are coming from.
Q: Bring these people into companies?
No, I mean bring their ideas in, because the Japanese companies aren’t doing that and the professors are looking for recognition of their work more than the money. Roche Pharmaceuticals has a very active team in establishing relationships with academia and Merck is more active today.
Also, get to know the patient groups because they can influence the Ministry and they are very vocal.
Q: Is that a new thing in Japan?
Yes, patients here don’t typically talk to the doctor, but now through networking, though the Internet, they are talking to each other and putting pressure on the politicians. The Japanese are breaking barriers. These people are well organized.
Also, I would tell companies to get to know the key opinion doctors who are specializing in a particular area.
Foreign companies are growing faster than the market, so they are increasing their share of their market. It’s because they have new drugs. New drugs drive growth.
Q: What would be your final message about Japanese healthcare?
The bottom line is many of us are very fortunate to be living in Tokyo with access to world-class medical care and an insurance system that does not result in personal bankruptcy.
Part One: http://www.majiroxnews.com/2011/05/31/a-pharma-guy-speaks-p-reed-maurer/