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Sunday, June 7, 2009

MEDIA MIX

Our columnist's 'drug runs' are happily over


Whenever I visit the United States, friends ask me to pick up things for them, usually over-the-counter (OTC) drugs that are cheaper in the States than they are in Japan. I always return with this booty as nervous as if I were carrying a brick of hash, having once been told by a colleague how customs intercepted some contact-lens solution he had shipped over and then charged him a hefty fee to have it "destroyed."

Now that a new revised pharmaceuticals law has gone into effect, I have an excuse to refuse those requests, since presumably the cost of OTC drugs will drop considerably. Any sort of retail outlet can now sell OTC drugs as long as they have a "licensed drug-sales clerk" on the premises. These outlets will be slashing prices left and right in order to undersell competitors, thus benefiting consumers who used to pay through the nose even for something as prosaic as aspirin.

Larger drug stores, like industry leader Matsumoto Kiyoshi, have already reduced OTC prices by as much as 20 percent, and the huge retailer Aeon has announced that it is coming out with its own line of OTC drugs. Interviewed on the Nihon TV wide show "Omoikkiri Don," pharmaceutical-business journalist Mitsuji Takazawa predicted OTC prices would drop as much as 50 percent.

Drugs are seen as being a recession-proof market, and some commentators believe that the main reason for the new law is to stimulate one of the few areas of the economy that can realistically register growth. However, there is another reason. The government, because of national health insurance, has a stake in the drug market since it partly pays for the medication that doctors prescribe to their patients. The government has already increased the share of medical costs that patients pay and wants to reduce its burden even more. By liberalizing OTC sales, it is trying to discourage people from visiting clinics for everyday maladies such as common colds and encourage them to "self-medicate" using OTC products.

Before the revision went into effect, OTC drugs could only be bought in stores that employ or are owned by licensed pharmacists. Genuine pharmacies that fill prescriptions tend to belong to specific hospitals or clinics, and are located either on the premises or nearby. Pharmacists who work for drug stores don't fill prescriptions, and ostensibly they are there to advise patrons about OTC medications. However, the vast majority of people get their information about OTC drugs from advertisements, so they rarely seek a pharmacist's advice when purchasing them.

Pharmacists are expensive to employ, and the revision allows stores to sell drugs if they hire specially licensed clerks. In order to qualify, a person has to have worked with a pharmacist in a drug store (even if it's just sweeping the floors) and pass a test. One of these new licensed salespeople who is now working at a discount store told Nihon TV that he is paid more than the other employees but "substantially less" than a pharmacist would receive.

Though the new system should make OTC drugs cheaper, it may also make the process of buying them more complicated. The pharmacists and licensed-sales clerks are required to be in the store whenever OTC drugs are on sale, since the law stresses "face-to-face" encounters between customers and staff. All OTC drugs have been reclassified into three types. Type 1 includes drugs "that carry some risk of side effects" and should be kept behind the counter or otherwise out of reach of the customer. A pharmacist, not a licensed-sales clerk, must be on hand to explain Type 1 products to the customer with written aids. Type 2 drugs include most cold remedies and analgesics, while Type 3 covers things like vitamin supplements and eye drops.

This reclassification appears to be the health ministry's response to complaints from consumer groups who insist that some OTC drugs be more strictly regulated, but the most controversial aspect of the revision is that the face-to-face proviso makes mail order sales illegal for Types 1 and 2. Some mail order outlets, including a large one that deals in Chinese herbal medicines, are protesting the revision, saying that most of their customers live in rural areas and have no access to drug stores. These businesses employ pharmacists who can advise customers over the phone, but that isn't enough according to the revision. The ban seems especially arbitrary when you realize that "face-to-face" doesn't mean it has to be the user's face that meets the pharmacist's. The user can send a proxy to pick up the medicine and receive the instruction.

And while the revision itself was passed by the Diet in 2006, many of the more contentious details were added subsequently as ministry directives. A lawyer on TV Asahi's "Super Morning" speculated that these directives benefit major retailers, but the face-to-face rule could be a disadvantage to retailers since it forces consumers to ask for specific Type 1 medicines they may not feel comfortable talking about. A commentator on NHK Radio pointed out that some people are too embarrassed to ask for things like hemorhoid treatments and laxatives, so retailers could probably sell more if they were classified lower. But many are classified as Type 1, as are hair-growth treatments and feminine hygiene ointments.

If the revision is indicative of anything, it's the bureaucratic penchant for over-reaching gestures, as demonstrated by the fate of my friend's contact-lens solution and the response to the recent flu scare. When we arrived at Narita from overseas last month, my partner and I were questioned perfunctorily by quarantine officials, who then gave us yellow papers "clearing" us. When my partner then attempted to give her papers to the passport-control officer, the woman said, "Just carry it around until you leave the building. Everybody's really nervous right now."



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