Earlier this month Kyoto University revealed that a study one of its researchers carried out to evaluate the effectiveness of the drug Diovan, which lower blood pressure, was probably “erroneous.” Though the university did not say the drug itself was ineffective, it did admit that the data of “those involved in the research” did not always agree with the conclusions of the lead researcher, Hiroaki Matsubara, which said that Diovan is “more potent in reducing angina and brain strokes than any other hypertensive medicines.” There are suspicions that Matsubara may have changed some of his data. In December 2012 he asked that his papers on the study be withdrawn.
Diovan, which is also sold generically as valsartan, was developed by the Swiss pharmaceuital giant Novartis Pharma K.K., which reportedly gave Matsubara a ¥100 million grant for his study. It wouldn’t have the first time the company has been accused of bribing doctors. Diovan is one of the company’s biggest moneymakers, especially in Japan where it generates ¥100 billion in sales.
Novartis isn’t the only drugmaker who does well with high blood pressure medications in Japan. Sales of hypertensive drugs amounts to more than ¥1 trillion a year, so even if Novartis had been trying to get researchers to post better results for their medicine, it seems that there’s enough of a market for every pharmaceutical company to make a lot of money with HBP medication. Some doctors, in fact, question the ease with which their colleagues prescribe HBP drugs.
In his bestseller, Isha ni korosarenai 47 no kokoroe (“47 Tips to Prevent Being Killed by Your Doctor”), controversial radiologist Dr. Makoto Kondo points out that there are 40 million people in Japan being treated for high blood pressure compared to 16 million in 1998. Why the big increase? In 2000, the health ministry, on recommendation from a panel of blood pressure specialists, changed the index for diagnosing HBP from 160/95 to 140/90, which is more in line with world standards. The new index immediately added 21 million people to the ranks of patients with high blood pressure, and almost all were prescribed hypertensive medication. Before the change, sales of HBP medicines was about ¥200 billion a year. Revenues have since climbed by more than fivefold. Kondo claims in his book that the specialists association from which the advisory panel was selected received an “anonymous” donation from a group of pharmaceutical companies beforehand.
Kondo believes that the dangers of high blood pressure have always been exaggerated, since blood vessels naturally become less elastic as people age and therefore the heart has to pump harder to achieve proper circulation. Reducing blood pressure too much can actually be dangerous, he says, since that could mean blood not reaching the brain and extremities in proper amounts, which may lead to senility and chronic loss of equilibrium. He cites a study in Finland that found elderly men with blood pressure over 160 lived longer than did those with blood pressure under 140. (Though it should also be noted that a more recent study in Finland found that people diagnosed with HBP who fail to take their meds have a higher chance of stroke.)
Kondo’s theories are generally dismissed by the medical community, but the Kyoto University scandal highlights an inconvenient truth about the financial connections between medical providers and pharmacuetical companies. Kondo says he has studied the literature extensively and cannot find reliable data that actually shows that a reduction in blood pressure leads to a reduction in the incidence of heart disease and stroke. Meanwhile, the Japanese government spends ¥37 trillion a year on medical care in the form of taxes and insurance payments, ¥6.14 trillion of which goes to drugs. That means hypertension medications account for one-sixth of all prescription drug sales in Japan.