The prevalence of heart disease is on the rise in Asia, prompting some medical firms to explore the region’s growing markets.
Introduction
As Asian countries begin to adopt more western lifestyles and foods, “western” diseases are becoming more prevalent killers in Asia. In the 1940s, the main causes of death in Japan were tuberculosis, pneumonia, and gastroenteritis. However, beginning in 1958, heart disease became the third leading cause of death in Japan and by 1985 it had climbed to number two. In China, diseases such as cholera, typhoid, and scarlet fever have been all but eliminated by western medicines and preventative efforts such as vaccination. Instead, diseases such as cardiovascular disease and cancer are becoming more widespread.
Economic transition, urbanization, and technological development have brought about lifestyle changes that have increased the chances for heart disease in Asia. Developing countries are adopting a more “westernized” way of life. They are struggling to free themselves (or have already done so) of malnutrition and infectious diseases that stem from Third World living standards. However, as they are doing so, they are also entering a world of new risk factors such as increased tobacco use, lack of physical activity, and unhealthy diet. Western foods contain more high-fat and high-salt processed foods as opposed to traditional Asian diets of fish or fresh vegetables. Jiang He, associate professor in the Department of Epidemiology at the Tulane University School of Public Health and Tropical Medicine, commented, “I visit China every year. There are traffic jams, a lot of people getting fat. Same problems as in the United States. A lot of McDonald’s, Kentucky Fried Chicken and Pizza Huts. The Chinese eat a lot of Westernized food.” People are also experiencing higher levels of stress due to the quickened pace of life. As Asians adopt these western living and eating habits, western” diseases such as cancer and heart disease have become more prevalent in Asia. Three-fourths of all deaths by heart disease in Asia are caused by the known risk factors mentioned above.
Asia’s more developed countries have been endeavoring to find different means to battle heart disease through their own research. For example, Singapore announced on December 17, 2002, that it would be the first country in Asia to conduct clinical trials for a stent coated with an anti-cancer drug. The drug, Paclitaxel, is meant to prevent the narrowing of the arterial walls after a stent is inserted to unblock an artery. Paclitaxel is the active ingredient in the cancer medication TAXOL ™ produced by Bristol-Myers Squibb ( New York City, New York). Already more than 150 patients have been implanted with the drug-coated stent at Singapore’s National Heart Center and the National University Hospital.
In Korea, the Kwangju Institute of Science and Technology announced on August 12, 2002 that they have succeeded in uncovering the functional role of junctin, a protein believed to cause heart disorders. Professor Kim Do-han, the head of the research team at the department of life science stated that junctin significantly affects heart function. Junctin is an important membrane protein that can influence the contraction and relaxation of the heart muscles when it merges with calcium ions. It was discovered that the over expression of junctin in mice hearts has caused heart enlargements, decreased numbers of bradycardia (abnormally slow heart beat), and has also led to a disorder of calcium metabolism. Professor Kim commented, “The discovery of the functional role of junctin in the heart will help develop new drugs regarding human heart disease.”
| Leading Causes of Death in Regions | |||
| North America | Europe | Asia | |
|
1 |
Circulatory Diseases | Circulatory Diseases | Circulatory Diseases |
|
2 |
Cancers | Cancers | Cancers |
|
3 |
External Causes | External Causes | Respiratory Diseases |
|
4 |
Respiratory Diseases | Respiratory Diseases | External Causes |
|
5 |
Digestive Diseases | Digestive Diseases | Digestive Diseases |
|
6 |
Liver Disease | Liver Disease | Infectious Diseases |
|
7 |
Infectious Diseases | Infectious Diseases | Liver Disease |
| Source: 1995 World Health Statistics, World Health Organization | |||
| Note: Circulatory Diseases includes congestive heart failure as well as cardiovascular diseases and strokes. External causes include traffic accidents, war, murder, and suicide. | |||
Foreign Medical Companies and Successes in Asia
Japan
As a result of the prevalence of cardiovascular disease in Asia, foreign medical companies have entered the Asian marketplaces in order to fill the demands of the Asian people for western cardiovascular products. Western medical manufacturers are taking advantage of this opportunity in Asia by increasing their exports of medical products to the region as well as local production. In order to be successful in Asia, Western medical companies must determine an appropriate entry strategy that is compatible with the current economic conditions and regulations of Asian country’s medical market. In the past decade, most medtech companies have entered the Asian markets through the following methods among others: direct establishment of manufacturing facilities in the region, establishment of joint ventures with local manufacturers, and distribution agreements with local distributors.
Japan has a $23 billion medical device market, the second largest in the world. However, the Japanese medical environment is vastly different from that of the U.S. In Japan, doctors are “king” and patients rarely question a doctor’s diagnosis or treatment. This is the opposite of the U.S. where patients are encouraged to ask questions and understand the medical treatment they are undergoing. Due to the authority of medical doctors, the profits made on drug sales, and the acquiescence of patients, doctors prescribe three times more medication in Japan than in the U.S. The average hospital stay in Japan is also considerably longer at 38 days while in the U.S. average stay is 2.7 days. The Japanese government covers the majority of medical costs for its people through their national health insurance plan. In Japan, almost all medical procedures (including drugs, medical devices, etc.) are reimbursed including over-the-counter medication such as Tylenol ™. The Japanese government, however, is now in the process of restructuring its national health insurance in order to shift medical costs more toward the Japanese people. Regardless, demands for western medical products in Japan are rising significantly due to the effectiveness of these products, for cost-saving reasons, and the willingness of Japanese consumers to spend money for these western goods.
Due to the strong demand for western cardiology medical device products, foreign medical companies have increased their presence in Japan. On September 17, 2002, St. Jude Medical ( St. Paul, Minnesota), a market leader in the production of cardiac surgery products and pacemakers, announced their intention to acquire their Japanese medical product distribution company, Getz Bros. Co. Ltd. ( Tokyo, Japan). The two parties signed a Stock Purchase Agreement. The Japanese public company is the largest distributor of St. Jude Medical’s products and is also a distributor of several product lines of other medical device manufacturers. St. Jude Medical will pay $220 million by the second quarter of 2003 to obtain 100% of Getz Bros. outstanding common stock. St. Jude Medical’s mechanical heart valves and diagnostic electrophysiology catheter products are currently the top sellers in Japan while their pacemaker products are in the number two market position.
In addition, St. Jude Medical launched their 4F Spyglass™ angiography catheters and Maximum™ introducer kits into the Japanese market on November 11, 2002. The 4F Spyglass ™ provides excellent flow rates for angiographic images as a result of their proprietary braiding technology. The Maximum ™ introducer kit was designed to cater to the Japanese patients and is available in a variety of French sizes. The introducers are manufactured with a new dual-layer sheath cannula and dilator configuration that provides safer insertion into the vasculature. St. Jude Medical is waiting for the Japanese government’s (Ministry of Health, Labor and Welfare) approval so they can market the Angio-Seal™ vascular closure device in Japan.
China
China, the world’s most populated country, with 1.3 billion people, has the second largest medical device market in Asia worth over $2.2 billion in 2001. The State Drug Administration (SDA) regulates healthcare in China. The scope and the functions of the SDA in China are very similar to that of the Food and Drug Administration (FDA) in the U.S. Although not nearly as large as the Japanese market, some predict the size of China’s future healthcare market will surpass that of Japan in several decades. However, China is still behind in its ability to produce more technologically advanced medical products as well as in their research and development capabilities. The Chinese government is encouraging greater investment in the medical sector by providing incentives to foreign medical companies through tax breaks. Special economic zones and industrials parks have been established in many areas of China in order to attract foreign medical manufacturers.
China has experienced rising demands for Cardiodynamics BioZ Systems. Cardiodynamics International Corporation ( San Diego, California) is a major player in the Asian market for cardiovascular devices. Cardiodynamics is the world leader of Impedance Cardiography (ICG) technology and the manufacturer of BioZ® noninvasive digital cardiac function monitoring systems. On October 29, 2002, Cardiodynamics signed an amendment with its Chinese distributor, Beijing Changsheng Medical Equipment Co., Ltd. (located in Beijing, China, and CardioDynamic’s distributor since 1998), that extends their current distribution agreement for 3 more years. Beijing Changsheng has agreed to purchase a minimum of $2.25 million in BioZ Systems over the next 3 years. “There is a serious need for the BioZ, with heart disease being responsible for over nine million deaths in China every year.” stated David An Wei, General Manager of Beijing Changsheng Medical Technology Co., Ltd. “The BioZ provides our physicians quick noninvasive, and cost-effective access to vital data about the heart and is needed in over 10,000 hospitals here in China.”
Another company increasing its presence in China is Siemens Medical Solutions ( Erlangen, Germany). In 2002, Siemens Medical Solutions and Shenzhen Mindit Instruments Co. Ltd.( Shenzhen, China), established a joint venture called “Siemens Mindit Magnetic Resonance Ltd.” The joint venture was established for Magnetic Resonance Imaging (MRI) systems. The joint venture was set up to produce 0.35 Tesla permanent magnet systems in China. Siemens Mindt Magnetic Resonance Ltd. will be one of the first Chinese companies to manufacture and sell the systems in China.
On October 7, 2002, Computer Motion, Inc. ( Goleta, California), a leading developer of surgical robotic systems, announced that the two leading cardiac centers in China have successfully performed cardiac procedures utilizing Endo-ACAB (Endoscopic Atraumatic Coronary Artery Bypass). The procedure, developed by Computer Motion, Inc. and the world’s leading cardiac surgeons, is performed using Computer Motion, Inc.’s AESOP® Robotic Endoscope Positioner and procedure kit. Dr. Qiang Zhao of the Zhong San Hospital in Shanghai remarked “I have found the procedure to be an excellent minimally invasive treatment for heart disease patients requiring a left internal mammary artery to left anterior descending coronary artery bypass graft. The addition of AESOP provides me with the image steadiness to perform the procedure safely and comfortably.”
Taiwan
Taiwan’s medical device market, although considerably smaller than Japan’s at about $800 million (2002), is important to foreign medical companies because more than 85% of medical devices in the country are imported from abroad. The Taiwanese government also covers much of the medical expenses of its citizens. Costs for drugs and medical treatment are reimbursed according to government guidelines. However, similar to Japan and Korea, Taiwan is also undergoing a restructuring process aimed at decreasing the government’s responsibilities to shoulder medical cost burdens. Despite the increases in healthcare prices, particularly of products made by foreign medical manufacturers, the Taiwanese enjoy a high living standard and continue to demand western medical products that have proved to be more effective than local, generic products.
Similar to China, Cardiodynamics has also been performing well in Taiwan. Cardiodynamics has been selling in the Taiwanese market since August 2000. Despite Taiwan’s poor economy in 2001, Disney Distribution ( Taipei, Taiwan), Cardiodynamics’ Taiwanese distributor, ordered 15 extra BioZ Systems from the company due to increasing demands. Cardiovascular disease is the third leading cause of death in Taiwan.
Philippines
At the other end of the Asian medical markets spectrum is the Philippines. Unlike Japan or Taiwan, the Philippines does not have a very large medical device market (only about $250 million in 2001) and the per capita income is very low at $1,050 compared to Japan where per capita income is about $28,000 and Taiwan at $13,000. However, due to its historical connections with the U.S. and its highly educated, English-speaking population, the country is also a prime location for investment by foreign medical manufacturers. Johnson and Johnson Medical Philippines ( Manila, Philippines) has recently introduced a heart device called the Cypher Sirolimus-eluting stent into the local market. The stent is used to permanently prop open a coronary artery preventing the need for repeated procedures to clear out arteries. Johnson and Johnson’s stent is coated with a drug called sirolimus that acts as an immune-system suppressant. It is considered the first of its kind approved by the Filipino Bureau of Food and Drugs. Studies showed in a clinical trial in the United States that the use of the sirolimus-coated stent led to a 72% reduction in restenosis, a condition where already treated heart vessels once again become narrow. This new technological breakthrough is of considerable value to the Philippines where heart disease, including coronary artery disease is currently one of the leading causes of death.
Other Treatments for Cardiovascular Disease in Asia
Besides treatment of cardiovascular disease through medical devices and surgery, treatment through medication also plays a large part in coronary disease. In the past, cardiovascular disease was seen in China as being caused by a “stagnant chi” or life energy. Conditions such as heart attacks, blocked arteries, or heart weakness were treated using traditional Chinese medication and practices. These included herbal remedies, massage, acupuncture, and changes in diet. For example, ginseng is believed to stimulate blood circulation and dispel stagnation. In many parts of China, this root is still used as medication against heart disease. However, treatment for heart disease in China has advanced significantly and doctors have also adopted more western medical practices.
Asian pharmaceutical manufacturers have also been active in developing pharmaceuticals for cardiovascular disease. For example, Sankyo Pharma Inc. ( Tokyo, Japan), Japan’s second largest pharmaceutical company, announced in August 2002 that it has filed a supplemental new drug application with the U.S. Food and Drug Administration (FDA) for Benicar HCT ™ (olmesartan medoxomil-hydrochlorothiazide). Benicar helps to reduce blood pressure by blocking angiotensin II, a potent vasoconstrictor. The drug product is already on the Japanese market and has recently been introduced into the U.S.
Another example of a pharmaceutical company in cardiovascular treatment in Asia involves Endovasc Ltd, Inc. ( Montgomery, Texas). Endovasc, a biotechnology company, entered into a three-year licensing agreement on October 9, 2002, with NOF Corporation ( Tokyo, Japan), a leading chemical company in Japan. NOF Corporation will assist Endovasc in manufacturing and marketing Liprostin ™, a cardiovascular drug. The drug prevents restenosis, increases blood flow, prevents clotting, and reduces leg pain by increasing oxygen and nutrients in blood.
Conclusion
As heart disease continues to be one of the leading causes of death in Asia, more western medical companies will enter into the Asian medical markets (or expand their current operations) to respond to the growing demands for foreign medical products. Foreign medical companies will assist in the fight against heart disease in Asia through their cooperative efforts with local companies as well as through their own initiatives. At the same time, local Asian medical companies will also continue to develop their abilities to find their own solutions to heart disease.
Additional Information
| Cardiology Associations in Asia | |||
| Country | Association | Contact Info | Website |
| Hong Kong | The Hong Kong Tuberculosis, Chest and heart Diseases Association | 266 Queen’s Road, East, Wanchai, Hong Kong Tel: (852) 2572-3466 Email: antitb@ha.org.hk | http://www.ha.org.hk/org/antitb/e_greeting.htm |
| Japan | The Japanese Circulation Society | Kinki Invention Center, 14 Yoshida Kawahara-cho, Sakyo-ku, Kyoto 606-8305, Japan Tel: +81-75-751-8643 Email: webmaster@j-circ.or.jp | http://www.j-circ.or.jp/english/index.htm |
| Philippine | Philippine Heart Association | Suite 1108 , 11th Floor, PSE Center East Tower, Exchange Road, Ortigas Center, Pasig City 1605, Philippines Tel: (632) 634-7437 Email: secretariat@philheart.org | http://www.philheart.org |
| Singapore | Singapore National Heart Association | Level 1, Heath Promotion Board, 3 Second Hospital Avenue, Singapore 168937 Tel: (65) 6236-0630 Email: info@snha.org | http://www.snha.org/ |
| Taiwan | Taiwan Society of Cardiology | 7F, No. 27, Ming Chuan W. Road, Taipei, Taiwan 104, R.O.C. Tel: (02) 25976177 | http://www.tsoc.org.tw/ |
Source: PBI-collected data