[KS] Re: doctors' strike (written six days ago)

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Mike Goodwin wrote:
> Hello:
> 
> I've been in a bit of a computer vacuum for several weeks now

I, too, was beginning to wonder if I'd been unsubscribed without my
knowledge.

> and I was
> just wondering whether anyone knows any of the "inside details"
> regarding the recent medical workers strike in Korea.

Doctors on strike, serious patients dying or being put in danger, public
turning against "greedy" doctors. As soon as the family reunions are over,
attention will turn once again to the strike. Unless a North Korean visiting
the South gets ill and ends up being endangered or dies because of the
strike, then we'll never hear the end of it. Doubt that will happen, though,
as the family reunion caravans seem to include a medical vehicle of some
kind (I've been stopped not once, not twice, but three times so as to let
the caravan go by unimpeded; apparently they don't want the Northerners to
think there's a traffic problem, although traffic problems would be IMHO a
sign of one's cup spillething over, in other words, a chance to show off).

> This day's KHerald states: "Tens of thousands of doctors, including
> interns and residents, went on a full strike ... protest a government
> sponsored medical reform program. The reform draws a clear line between
> the responsibilities of doctors and pharmacists, but doctors oppose the
> new system as it deprives them of the right to sell drugs, a major
> source of income. Under the new scheme ... doctors are prohibited from
> dispensing drugs while pharmacists are banned from selling drugs without
> doctors' prescriptions."
>
> Can anyone comment on the government's motivations here?

After I get back from a company-imposed retreat out at P'yongch'ang-gun
County in Kangwon-do, I'll address this more, but in a nutshell, they're
trying to make a serious effort to end a very big problem with Korea's
medical problem. In a nutshell, doctors make money by selling drugs
(presumably the job of pharmacists) and pharmacists, in turn, make their
money by diagnosing illness and prescribing drugs (presumably the realm of
doctors). The end result is that doctors may tend to over-prescribe medicine
in order to pad incomes (this may be true, but ethical doctors would avoid
this), AND, more seriously, pharmacists end up providing a large number of
"patients" with incomplete, inaccurate, or misleading diagnoses, meaning
they are not getting the health care they need.

Any Potong saram (the Average Cho) can walk into a pharmacy and complain of
this symptom or that, and get medicine. He/she may not tell all the
symptoms, is not getting a full examination (thus allowing that something
very important may be missed by the pharmacist's diagnosis), and often needs
nothing more than rest and relaxation (e.g., when having a cold). But the
pharmacist often prescribes antibiotics in such cases -- which are
completely useless in terms of a cold -- so as the patient feels good about
taking "something" for what ails him/her. The end result of prescribing
unnecessary antibiotics is that the bugs develop an immunity (the drugs wipe
out the bugs most susceptible to the effects of the antibiotic, leaving the
stronger ones to survive and propagate), and the antibiotic eventually
becomes useless for anything.

A related problem is that pharmacists in Korea who do diagnose and then
prescribe antibiotics tend to prescribe only a couple days' worth of the
drug (often asking the patient how many days' worth he/she wants). Even when
antibiotics are appropriate, the necessary regimen is at least two weeks,
until the bug is completely wiped out (lest we wipe out all but the most
drug-resistant). To be fair, this is a problem in the States as well, where
many patients stop taking antibiotics once they feel better, thus not
completing the prescribed regimen of antibiotics.

> Do these "reforms" herald the deregulation of the prescription drug
> industry in Korea; i.e., an imperative being --more or less-- imposed
> upon the Korean government by the large U.S. drug manufacturers whose
> interests must surely, somehow have been furthered by the general
> deregulation/liberalization package that was imposed on Korea by the
> WB/IMF back in '97?

Whoa! I'm sorry if I sound a little sarcastic here, but no, not every
disruptive thing that happens in Korea is the result of behind-the-scenes
forces in America. The goal in this case, in fact, is to dispense less
drugs, not more. Although the current plan is not perfect, this is a case
where the government finally decided to show a little backbone and made
necessary changes that made a potentially powerful lobby very unhappy.

Incidentally, I, for one, was happy about that "imposing" of
deregulation/liberalization. For years various government folks knew of the
benefits of liberalization the economy in precisely the way that the WB/IMF
imposed. Yet the circumstances made it difficult/impossible for them to do
anything about it. The US-led insistence of the WB/IMF liberalization
allowed these politicians to circumvent the need to develop a backbone, but
they still got the changes that would make the economy stronger with a
minimum of political baggage in the meantime. IMHO.

> Anyone no anything about the political economy of RX drugs in Korea?
>
> Thanks,
>
> Mike Goodwin
> (Toronto, CA & College Station, TX)

I always thought you couldn't be in two places at once.

K U S H I B O

in 95 places at once