Intended for healthcare professionals

Letters Too much medicine

Direct to consumer unproved screening tests turn a profit in Japan

BMJ 2013; 347 doi: (Published 30 July 2013) Cite this as: BMJ 2013;347:f4725
  1. Yasuharu Tokuda, internist1,
  2. Mitchell D Feldman, professor of medicine2
  1. 1University of Tsukuba, 3-2-7 Miya-machi, Mito, Ibaraki, Japan
  2. 2University of California, San Francisco, 1545 Divisadero, Suite 315, San Francisco, CA 94143-0320, USA
  1. yasuharu.tokuda{at}

Japanese doctors and patients face much the same problem of too much medicine outlined by Glasziou and colleagues.1 The Japanese healthcare system is rightly lauded as a model of cost containment while achieving better outcomes on many key health indicators than the United States and other developed nations do. However, the use of unnecessary diagnostic tests driven by aggressive direct to consumer advertising has greatly increased in Japan over the past decade.

On the basis of data from the Japan Brain Dock Society and Japan PET Scan Net,2 3 220 screening centres in Japan provide brain magnetic resonance imaging (MRI) and 200 cancer screening centres offer positron emission tomography (PET). Healthy people without symptoms are urged to undergo MRI screening to detect possible asymptomatic stroke or unruptured aneurysms. PET screening is advocated to screen for asymptomatic occult cancers. Neither of these screening tests is supported by evidence, and both are likely to lead to harmful adverse effects from downstream invasive work-up of the results and unnecessary surgical procedures.

Most of the screening centres are operated by hospitals, including university hospitals and academic medical centres. The tests are advertised direct to consumers and the hospitals make a profit from direct payment for the test and the costly and usually unnecessary “self referrals” for work-up of the incidental findings. Japanese doctors and medical bodies should withdraw from the unethical business of promoting unproved and potentially harmful screening tests.


Cite this as: BMJ 2013;347:f4725


  • Competing interests: None declared.


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