in Japan • • •
drugs and pharmaceuticals by Kenji Takada
efore the 20th century began, drugs and medicines in Japan were purchased and sold only by drugstores which had been granted permission to conduct such business by competent feudal lords. It was not until 1890 that the legal terms "pharmacist" and " pharmacy" came into use. Because it was a longstanding custom for physicians to dispense medicines themselves, physicians' prescriptions were seldom filled by pharmacists even after 1890 . The Japan Pharmaceutical Association had long urged the separation of the dispensary from medical practice and this separation was at last effected in 1956. Nevertheless, even today, except in special cases, prescriptions are rarely given to practicing pharmacists to fill because the law provides that physicians may dispense medicines to patients upon request. The Ministry of Health and Welfare reports that the prescriptions handled in the pharmacies throughout Japan in 1958 totaled 27,992 or only one prescription per pharmacy on an average. More than half (54.7 percent) of the pharmacies failed to receive a single prescription. Furthermore, the fees are small for compounding medicines under the social medical insurance system. Consequently as a business policy most of the retail pharmacies do not depend on physicians' prescriptions but on cosmetics, sundries and patent medicines for their living. Today the title of pharmacist is granted to anyone who has been graduated at a four-year college of pharmacy and has passed the national examination of pharmacists. There is no intern system in force now. There are approximately two physicians to every pharmacist today (see chart 1 on page 772). Drugs and medicines in Japan are handled by pharmacies, wholesale dealers of drugs and medicines, non-
Combining west and east the sign on the Sankyo Pharmacy emphasizes the bond of unity which pharmacy provides around the world.
dispensing drug stores and dealers in limited items of drugs and medicines (see chart 2) . Pharmacies manufacture and dispense medicines prescribed and compounded by pharmacists, make chemical tests and sell all items of drugs and medicines. These are operated by pharmaceutical chemists . N on-pharmacists may , however, establish pharmacies by employing pharmacist s charged with dispensing. Wholesale dealers, not having di spensaries nor testing facilities, cannot dispense medicines or make chemical tests. Drugstores in this category, however, can be run by pharmacists or by non-pharmacists if they have responsible pharmacists in their service. N on-dispensing drugstores can be established and operated by nonpharmacists when they have passed the specified examination after dealing in drugs and medicines for one t o three years. There is, as a matter of course, a limitation on the items in which they are authorized to deal.
As a Japanese pharmacist in the Mizuno Pharmacy dispenses a prescription, an almost typical western atmosphere can be noted in this Tokyo scene.
Modern plant facilities at the Sankyo Co., Ltd., Tokyo, Japan help to increase efficient production.
VOl. 21 , NO. 12, DECEMB ER 1960/ PRACTICAL PHARMACY EDITION
1940 1950 1957
Number of physicians per 10,000 popu lation
65 ,332 76 ,446 98 ,268
9.0 9. 2 10 .8
23,214 27 ,420 31,971
31, 094 45,715 54,853
Number of physicians to pha rmacists 2.1 1.7 1.8
1940 1950 1957
Dealers in all items of drugs and medicines
Non -dispensing drug stores
Population per pharmacy
13 ,172 15 ,070 20 ,1 75
772 4,038 5,172*
30 ,929 10 ,749 14 ,350
44 ,101 25 ,819 34 ,525
5,507 5,521 4, 515
* Dealers exclusively engaged
in wholesale trade are supposed to be about ha lf the number
1956 1957 1958
Production (in U.S. dollars)
Amount of export (in U.S. dollars)
Amount of import (i n U.S. dollars)
$288,242,000 $347,631 ,000 $363,089,000
3,882,000 5, 258,000 4, 947,000
$9,378,000 $11,114,000 $11,183,000
The production of drugs and med. icines in 1958 totaled approximately $361 million- 20.3 percent of all chemical products (see chart 3). Principal pharmaceutical products in 1958 includein U.S. dollars Vita min p reparations $57,1 00,000 5 0,728,000 Antib iotics 45,53 3,000 Dermatolog icals Ce ntra l ne rvo us system drugs 32,3 19,000 2 8,897,000 Drugs fo r d igestive organs Chemoth e rap e utic pre pa ratio ns 22,044,000 13,711 ,000 Hormones
The drugs and medicines are manu· factured by 2,750 firms, about 50 percent being produced in the fac· tories of 11 companies. Recently there has been a marked increase in the production of preventives and tonics such as vitamin preparations, and hor mones. Beca use manufacturers and wholesaler s have tended to transact business directly with business centers, hospitals, clinics and consumers' cooperative societies, the channels of phar maceutical sales have been confuse d . As a result bargain sales a nd panic selli ngs often take place, especially in Osaka, Kyoto and Kobe.
in Yugoslavia ... an international trade fair "Pharmacies USA" was the title of the exhibit which greeted nearly a million and a half visitors at the main entrance of the U.S. pavilion at the International Trade Fair at Zagreb, Yugoslavia, September 10-25. A series of panels (Jeft) traces the history of American Pharmacy and presents a pictorial view of pharmacies in the United States today. Included on the panels are photographs of an exclusive prescription pharmacy, a hospital pharmacy and a small town corner drug store. The exhibit, developed by t he office of international trade fairs , U.S. Department of Commerce, was prepared with the technical assistance of the America n Pharmaceutical Association.
" Pharmacies USA " was one of the exhibits (right) v isited by President Tito (center) and his wife when they tou red the fair with George V. Allen, director of the U.S. Information Agency (shown walking slightly ahead of the president's wife). Note exhibit in background.
a ~Iittle Kefauver hearing' ••• T
he Canadian pharmaceutical industry is being subjected to a political probe on the cost and distribution of drugs . The Ontario Government Select Committee on Drugs is conducting the investigation primarily on the cost of drugs to hospitals and institutions. H.L. Rowntree is chairing the committee and has stated that the " ... investigation must of necessity go into the question of retail pharmacists ... " The committee is also delving into prescribing habits and is discussing generic vs. trademarked drugs. Horace J. Fuller, a University of Toronto professor, pointed out to the committee that he had analyzed 42,545 prescriptions and 41.3 percent had been dispensed at a loss. He also noted that only 0.4415 percent of the personal disposable income of Ontario residents was spent on prescribed medicines. Professor Fuller told the committee that the "practicability of the use of generic names is much overrated" and he based his statement on a study of a number of consecutive prescriptions being conducted to determine the feasibility of generic prescribing. Speaking on the cost of ingredients in prescriptions, Professor Fuller stated that the average cost has increased because of the change in the nature of the ingredient. The drugs prescribed
probe of Canadian pharmacy
today are just not the same drugs that were prescribed 10 or 15 years ago, he commented. Dr. Ian MacDonald, director of postgraduate studies in the school of medicine, University of Toronto, told the committee that his personal preference " ... is to order by generic name." " . . . as far as the generic names of drugs is concerned," he stated, "it is the preferable thing." However, Dr. MacDonald pointed out that he does specify the manufacturer on some drugs ". . . because on the basis of experience I have found that this particular maker makes something that is particularly reliable." Other facts brought out by witnesses before the committee were that the average Canadian spent $7.50 on prescription drugs in 1959. He spent five times as much on tobacco and eight times as much on automobile operations. And drug manufacturers realized a profit of slightly more than three cents of the retail sales dollar. Eleven of the Canadian pharmaceutical manufacturers reported total capital expenditure on research and development laboratories and equipment of $2,456,332 in 1959. The percentage of gross sales dollar allocated to research and development was 6.3 percent. The general manager of the Canadian Pharmaceutical Manufacturers Associa-
tion, S.N. Conder, told the committee that Canada offers its people one of the lowest medical care costs in the world, according to a study ' by the International Labor Organizations. He denied that 90 percent of the pharmaceutical preparations used in Canada was imported and stated that about 17 percent of the dollar value of drugs was imported in 1958, the last year for which complete figures are available. Of 28 pharmaceutical manufacturers surveyed, only six percent of their respective lines are imported, Conder explained. All of these companies also maintain their packaging operations in Canada and average 96 percent of their packaging on the premises. He also told the committee that the proper place to test and insure the quality of a drug is at its source of manufacture during the time it is being made. When the drug arrives in the hands of the doctor or patient, there should be no question whatever about the quality of the drug. Conder told the committee that the CPMA member firms would be willing to submit their products for government testing as long as they did not have to bear the cost. But, he stated, the economy of testing generic name drugs appears false because any savings that might be realized would be eaten up with testing costs. •
progress report • • • health for peace plan At a news conference on November 17, HEW Secretary Arthur S . Flemming reported that one of the most important missions of the Department of Health, Education and Welfare is to contribute t o the "health for peace plan." The funds devoted to Public Health Service activities in the international health field have increased about five-fold since 1958 and, according to Flemming-
The use of these funds will constitute 0 major contribution to human progress throughout the world, not only to health but to peaceful relations. Health is on indispensable link to worldwide understanding and goodwill. All notions wont better health for their people. Co.operation among notions-among their scientists, scholars, teachers, physicians-is the surest rood toward better health for all. like disease itself, scientific knowledge knows no geographic boundaries. All nations of the world can contribute, all can benefit. Mutual exchange, mutual aid, mutual cooperation-this is the key.
Surgeon General Leroy E. Burney noted that Public Law 86-610, the International Health Research Act of 1960, added some very significant elements to U.S. international research and training activities, not only within the Public Health Service but in other agencies of HEW as well. Under the provisions of the act, President Eisenhower was authorized to advance the international status of the health sciences through health research, planning and training in foreign countries. HEW, through the Public Health Service, was authorized to support medical research activities in foreign countries. In line with these principles, Burney notes that the National Institutes of Health proposes to use a majority of these funds to establish International Research and Training Centers. Dr. Colin McLeon, of the New York University School of Medicine, is chairman
of a special committee which will help establish policies and procedures for these centers. The Public Health Service has continued to participate in and support the research programs of WHO and has played an increasingly active role in the U.S.-U.S.S.R. medical exchange program. The U.S. is participating in the first International Health Fair, currently being held in Rome, Italy. The growing complexity and importance of our international health activities have made it necessary to strengthen U.S. organizational arrangements for these various programs and thus, Burney announced the establishment of an office for international research as part of the office of the director of NIH. This unit will be responsible for central planning, co-ordination and management of the international programs of the National Institutes of Health.
VOL. 21, NO. 12, DECEMBER 1960 I PRACTICAL PHARMACY EDITION