**4.1 Barriers built by medical hegemony**

The situation in which a hospital becomes huge and has an impact on overall healthcare could be defined as medical hegemony. According to WHO, universal healthcare can be determined by three critical dimensions: who is covered, what services are covered, and how much of the cost is covered [16]. In the US, hospitals, health insurance companies, and pharmaceutical companies have become huge after 1980. Such huge healthcare providers have taken medical hegemonies and guide policies. Eventually, lack of accessibility results in unsatisfactory access to the medical needs of the public. As a result, WHO and the National Academy of Medicine and others have concluded the US is the only wealthy, industrialized nation that does not provide universal healthcare in 2021.

Medical care has its own peculiarities. In the medical and long-term care fields, only the provider has the information. Patients have no choice but to believe and entrust without bargaining even if they lie. Therefore, those who provide low-cost and high-priced medical care services accumulate profits and dominate the market. Once become huge, they can affect various fields and the hegemony has been established.

Even if information is disclosed for the purpose of resolving information asymmetry, it is practically impossible for consumers to have equal bargaining power. Therefore, in free competition, the supply side has an absolute advantage in deciding what to do. In free competition in a state where information is asymmetric and bargaining power is imbalanced, prices rise by the following mechanism, resulting in the exclusion of consumers [17].


In the free competition market, there are many people who cannot receive satisfactory medical care because they cannot pay. On the contrary, those who can afford high treatment can enjoy exclusively top-level medicine. Thus, the barrier between supply and demand remains high. The gap in accessibility from consumers deepens and cannot easily repair once medical hegemony is fixed.

### **4.2 The source of hegemonic power**

Digital healthcare is expected to increase the accessibility of medical information and to remove the medical barrier. Although this optimism is believed, realworld healthcare can be severely affected by the knowledge and context shared in the healthcare industry and academia. The problem is that common knowledge is spread by mainstream people.

The use of patterned knowledge from mainstream facilitates the use of medical information. Further utilization of smart ICT will facilitate to realize the smart use of medical information in our daily lives and therefore improve the accessibility to healthcare information. Through this process, the central perception will quickly gain consensus in the industry and academic societies. Through such a process, practical knowledge is unified and spreads quickly. In this way, mainstream contexts quickly become more and more widespread. In other words, this makes it easier for mainstream to establish hegemony.

Hegemons have become the center of the world and gained centrality by setting a global standard. This strategy allowed hegemony to accumulate economic power and become the center of politics, economy, and society. To maintain centrality, hegemons have no choice but to do rent seeking for themselves, not for the total benefit. **Figure 3** illustrates the transition of hegemonic nations. The hegemonic nation is deprived of the next hegemony by a neighboring country across the sea. By imitating and improving the previous economic system, neighboring countries that do not interact directly have become hegemonic nations one after another [18].

1. Egypt prospered from the fertile land of the Nile and its slave civilization. 2. the Greek police nations become the center of trade, 3. Rome is based on the vast territory that supplies slaves, 4. Islam relays East-west trade, and 5. Spain mined gold and silver in South America and circulated minted coins in Europe. 6. the Netherlands

**Figure 3.** *Transition of hegemonic countries [18].*

#### *Medical Hegemony and Healthcare: Centrality in Healthcare DOI: http://dx.doi.org/10.5772/intechopen.99174*

became the global trade center with currency exchange, 7. the United Kingdom became the financial center (Citi) and the world's factory by Industrial Revolution, 8. the US became the world's factory by the mass production system and then global securities and financial center, 9. Japan realized mixed production system with smallvolume plus mass customization and became the world's factory, 10. South Korea, 11. Taiwan, and 13. China acquired the world market with imitation power.

A hegemon could become the center of the world by imitating and surpassing the previous hegemonic power [19].

The reason for the emergence of hegemonic states can be seen from the fact that the source of hegemony is not civilization but economic power.

### **4.3 Success/failure judgment method for information issued by medical hegemony**

Can doctors adhere to justice fairly and selflessly in all situations? Hippocratic oath is an international norm that doctors should comply with. The ethical code attributed to the ancient Greek physician Hippocrates, adopted as a guide to conduct by the medical profession throughout the ages and still used in the graduation ceremonies of many medical schools. The oath dictates the obligations of the physician to students of medicine and the duties of pupil to teacher. In the oath, the physician pledges to prescribe only beneficial treatments, according to his abilities and judgment; to refrain from causing harm or hurt; and to live an exemplary personal and professional life (Encyclopedia Britannica).

In the medical world, the problem is physicians have never accepted novel approaches when treatments does not replace current therapy. Players in the mainstream (stakeholders such as opinion leaders, physicians, pharmaceutical firms, university professors etc.) are not only reluctant to try any noble therapeutic approaches, but they have always denied and attacked.

It is well-known that medical hegemony intends to stabilize its position by undermining the fair use of information. For judging the correctness of medical information, it is possible to check simply whether one piece of simplified information is yes or no. Yes/no methods can clarify responsibility in the event of an error. RNA injection is a typical example that used to be no but became yes. The properties of cells can be altered by introducing RNA instead of genetic engineering. Therefore, the rapid supply of corona RNA vaccine became possible. In addition, RNA injection can be used for in vivo production of pluripotent cells instead of in vitro production of iPS cells.

RNA injection method was denied by mainstreamers. This is explained by inevitable win-lose theory that indirect competitive innovation is neglected by mainstreamers. Surprisingly, in case of direct competition, mainstreamers accept new thing, but in case of indirect competition, they deny the new one [19–22]. The reason is that they will be replaced by challengers if they do not accept directly competitive thing. However, without exception, they deny new things that indirectly compete with. Usually they spread fake information. They choose the immediate stability because they cannot be replaced immediately. It often takes time to be replaced, but the mainstream faction changes. It should be noted that both actions are taken to defend the position of the championship.

Nevertheless, professionals will continue to disseminate the information claimed by the mainstream. This is because expressing disagreement has adverse events. Whenever novel treatments are discovered that do not directly replace traditional one, they are denied without evidence and prevent them from being adopted. **Table 4** shows categorized patterns of disinformation deliberately created by the mainstreamers [23].


**Table 4.**

*Disinformation on novel therapy created by the mainstream [23].*

1.CV (Cardiovascular) was the most major therapeutic area in the world. Ca blocker has created a market with a particularly high share in Japan. Authorities in the CV area were respected as representatives of physicians. This therapeutic area covers not only hypertension, but also all over the lifestyle-related disease. In this type of prioritized therapeutic area, companies create mainstream by writing treatises and giving research achievements to company-nominated opinion leaders, young doctors, and supporters based on each strategy. Therefore, major physicians in the CV field have kept a tight relationship with pharmaceutical firms and have received financial support especially as research fund. Pharmaceutical companies have also set up programs to train prominent young doctors for next new product developments and marketing purposes.

According to major Japanese pharmaceutical firms, fast onset was the key point of Ca blockers. Therefore, common opinion was that there were few cases to be targeted by a new ARB (Angiotensin receptor blocker) therapy because ARB is not fast-acting. However, the fact was exactly the opposite. Only amlodipine, which had a slow onset and a long half-life just like ARB, was increasing sales.

In Japan, all opinion leaders and major journals did not support ARB, even after ARB became the first choice among all other countries. By author's effort, a Japanese firm could get a license of ARB from a German big Ca player despite company-wide opposition.

Despite such industry-wide dissenting opinions, the share of the new therapy reached over 70% of the patients once the first ARB was launched. Although the overall evidence approved lifestyle-related diseases, professionals ignored the merit of organ-protective effect of ARB. Mainstream companionship is not evidence-based.

2.GI (Gastrointestinal) area is the largest market in the world till around 2010. A world-top share H2 (Histamine 2 receptor) blocker was originated by a Japanese firm. It was well recognized among Japanese firms and mainstream professors that extermination of *H. pylori*, the causative bacterium, would completely cure the gastric ulcer and prevent stomach cancer.

Mainstream professors and physicians received financial supports. Running out of money is a problem. The world top share product, which is originated by a Japanese firm, suppresses the immune elimination of cancer cells by NK cell inactivation since histamine is essential to activate NK cells.

Japanese pharmaceutical firms advertised that new PPI (Proton pump inhibitor) therapy did not cure the symptoms. Eradication of gastric ulcer and gastric cancer causative bacteria, Helicobacter pylori, by PPI was a standard therapy in Europe and the US. Approval in Japan delayed more than 10 years. PPI became the first choice once the patent for top-seller H2 blocker expired. This witnesses the strength of dominance.

**Table 5** shows that the ratio of deaths by stomach cancer is the highest among other countries in 2005 (before the PPI era). The death rate of stomach cancer in Japan is 10 times higher than that of Americas. It is known in the pharmaceutical industry that this is due to the widespread of a top-seller H2 blocker in Japan.

3.Anti-cancer therapy is mainly by drug therapy in combination with surgery or radiation. Anticancer drugs control the growth of cancerous cells by toxicity.

When antibodies that suppress the growth factors of breast cancer cells had been developed, firms, professors and physicians have denied every time. As proof of lack of intension, they do not conduct in-hospital trials for applicants like toxic drug candidates. The drug delay has happened all over the world.

All professionals have denied the effectiveness of antibody drugs and the anticervical cancer vaccine mentioned above. HTLV (Human T) was first discovered as a causative virus of adult T-cell lymphoma (ATL) by Dr. Hinuma at Kyoto University in 1977. A negative campaign against cancer viruses' existence was held through the 20th century. Many scholars, who have been associated with the prestigious professors of the mainstream, have been openly, unfounded, and emotional, and have continued to deny until very recently. It has been proved that more than 30 percent of cancers have been caused by cancer viruses, which are increasing year by year.

4.Rheumatoid arthritis destroys joints due to autoimmunity, and eventually the organs are gradually destroyed, resulting in multiple organ failure and death. MTX (methotrexate), which have an immunosuppressive effect on symptomatic treatment, is widely used. New antibody therapy (anti-TNF antibody),


#### **Table 5.**

*The ratio of deaths by stomach cancer per 100,000 men in 2005.*

which blocked immune cells from killing patients' bodies, were neglected, despite mainstreamers watched an evidence that patients with difficulty of walking started walking quickly after injection. If they are cured completely, they do not need to visit doctors.

MTX therapy is practiced as a standard treatment all over the world and satisfied doctors. MTX is mildly toxic but are popular as a first choice, so the conclusion was there was no need to change treatments.

5.EPO(Erythropoietin) stimulates red blood cell proliferation (erythropoiesis) in the bone marrow. EPO is an alternative to blood transfusions, but it was denied that red blood cell transfusion is cheap.

EPO is now used in treating anemia resulting from chronic kidney disease, chemotherapy induced anemia in patients with cancer, inflammatory bowel disease (Crohn's disease and ulcerative colitis) and myelodysplasia caused by cancer chemotherapy or radiation.

The risk of viral infection is greatly reduced. If a cancer patient can be operated on without blood transfusion, the rate of recurrence and metastasis of cancer is greatly reduced because immune disturbance is not caused without blood transfusion.

6.Biopharmaceuticals are categorized 5 major classes; extracts from living systems, recombinant products, vaccines, gene therapy, RNA or DNA drugs (nucleic acid drugs).

G-CSF (Granulocyte Colony-stimulating Factor) is a type of growth factor. Patients might have G-CSF after chemotherapy to help their white blood cells recover after treatment.

It was rejected by mainstreamers except bio-venture firm, because of different treatment criteria. Mainstreamers and larger pharmaceutical firms resisted and opposed the new treatment to stimulate granulocyte proliferation.

Total market size of Biopharmaceuticals is beyond the half. This means the utility of biopharmaceuticals has been neglected by mainstreamers and professionals. According to IQVIA World Review Analyst 2020 forecast [24], the pharmaceutical market in 2019 was \$ 1.2624 trillion, up 3.3% from last year. The market share of the top 100 pharmaceutical sales items (hereinafter referred to as the top items) was about 32%. Total sales of top items in 2019 were \$ 401.3 billion, up 6.4% from last year. According to the technical classification of active ingredients (chemically synthesized drugs and biopharmaceuticals), there are 55 items of chemically synthesized drugs and 45 items of biopharmaceuticals, which is higher than the 2018 survey (59 items and 41 items, respectively). biopharmaceuticals increased by 4 items. Among the top items, 10 items have been replaced since 2018, of which 5 items have been replaced by 9 items and biopharmaceuticals items have been replaced by 5 items and 1 item has been replaced year by year. In addition, biopharmaceuticals sales accounted for \$ 209.7 billion, 52% of top item sales, and although synthetic drugs accounted for more items, biopharmaceuticals accounted for more than half of sales for the first time in previous surveys.

## 7.Regeneration

Regenerative medicine will be the ultimate medical treatment aiming at immortalization and complete cure. Drug companies and mainstreamers do not develop complete cures that will eliminate the need for drug administration and shrink the market.

Around 1988, the author applied to MHW (the Ministry of Health and Welfare), Japan Health Sciences Foundation, major firms and JPMA (Japan Pharmaceutical Manufacturers Association) a research project on the generation of pluripotent cells by gene transfer as an innovative research theme. The proposal was neglected to adopt as a research theme because complete cures eliminate the market.

All doctors have still denied that the cells were reprogrammed. This is incompatible with a basic principle of embryology, the developmental process of higher organisms repeats evolutionary process (the law of developmental repetition, Haeckel's Law). For biologists, regeneration overturns their basic assumptions.

That is why mainstreamers at Kyoto University still underestimate the possibility of iPS cells and overstate that the risk. Since the mutation rate of cells is higher in liquid culture than in vivo, they should develop a culture system like in the body. The creation of iPS cells or pluripotent cells by direct injection of RNA into the human body would reduce the risk of genetic mutation.

8.Oligonucleotide therapeutics uses basically RNA or DNA. Oligonucleotides are nucleic acid polymers with the potential to treat or manage a wide range of diseases and can be used to modulate gene expression via a range of processes including RNAi (RNA interference), target degradation by RNase H-mediated cleavage, splicing modulation, non-coding RNA inhibition, gene activation and programmed gene editing. As such, these molecules have potential therapeutic applications for myriad indications, with several oligonucleotide drugs recently gaining approval [25]. As shown in the above Nature Review [25], although the majority of oligonucleotide therapeutics have focused on gene silencing, other strategies are being delayed or neglected by mainstreamers.

Oligonucleotide drugs such as RNA or DNA injection for producing antibodies was supposed to be ineffective and risky without evidence. Well-known mainstream scholars slandered the developers. As a matter of fact, only venture companies were developing quietly.

Suddenly in early 2020, rapid vaccine development and urgent supply were needed to prevent the spread of coronavirus. Speed-up approval of RNA or DNA vaccines against coronavirus was given worldwide, but Japan was the lowest in the world.

As a matter of life and death, the clinical trials were urged to conduct development of coronavirus vaccine. Similarly, immunotherapy for cancer should be as safe and effective as vaccines in post-infection adverse effects. However, almost professionals and drug companies are still not willing to admit.

RNA produces iPS cells therapeutics will repair complete body and will pave the way for spontaneous healing with their own cells. There is some evidence that such treatments are effective. As an example, in our brains, 50,000 nascent neural stem cells are born every day. Even at the age of 80, the same amount of regeneration as young people happens. Full-function recovery therapeutics by oligonucleotide will become the ultimate complete cure treatment. Complete healing of aging or diseases is unacceptable to mainstreamers. They do not intend to contribute to human healthcare, because they will definitely lose the hegemony in the current system. How to solve the problem is the next issue to be discussed.

## **4.4 Freedom from the centrality of hegemony by setting network neutrality through commons of information**

Through the discussions so far, author has analyzed the actions taken by mainstream people in medical care and healthcare, which deal with life and health. The mainstreamers always win any new product developments that directly competes with and therefore replace the mainstream [19–22].

In case of indirect competition, mainstreamers inevitably lose any new product developments. As far as a new does not directly compete with the mainstream, they deny the fact until the mainstream is replaced. Even if treatments begin to be adopted, mainstreamers always deny and criticize the use of alternative treatments. For example, the evidence is that the discovery of the presence of a cancer virus, the ability to artificially generate pluripotent stem cells, and the fact that RNA can be used for treatment are not acknowledged and criticized.

Mainstreamers do not approve such facts until they understand that they will be replaced soon. Due to the dominant structure of the mainstream, novel therapeutics such as desensitization therapy using oral immunity for pollinosis and cervical cancer virus vaccination for men many innovative approaches delayed approvals by the Authorities. Many have been sacrificed by mainstreamers.

The method to eliminate such evils and realize truly useful healthcare is required. The effect and influence of the commons of information will become a solution to eliminating adverse events caused by the hegemonic mainstream. As the most effective means in the coming digital healthcare era, commons of information is now under construction. In July of 2020, Japanese Ministry of Health, Labor and Welfare confirmed its policy of intensively working over the next two years to operate a system that allows medical institutions and pharmacies nationwide to share medical information of patients online and use it for patient treatment and health promotion. Customers and service providers such as doctors pharmacists, health instructors, nurses in charge can check the treatment history. In these ways, the information that the doctor has kept secret is inevitably made public and reviewed, which can lead to criticism in some cases. Even if that patient can find a provider, the existing healthcare system is likely to create a lot of unnecessary impediment and expense in the US. Digital pharmacy expands access to professional healthcare. It would be a great start to access and utilize such kind of commons of information.

With the rapid penetration of the mobile Internet into everyday life, the ruler of the information is changing. Innovative ideas are realized instantly on the mobile and advanced media, according to instant innovation [26–28].

As various media are put to practical use in general life, the media affects not only on everything in our society and life. As a result of the widespread use of mobile terminals, advanced media has being breaking down the barriers built by the mainstream with hegemony by setting net neutrality in the instant communication through mobile.

Mobiles process various information in parallel and multiple parallel worlds exist at the same time. Information selection has made it possible for users to create necessary information from the side that creates information, and users have come to directly experiment and implement it. This kind of instant communication leads instant innovation [26].

Already, some app platforms for disclosure and use of medical information have been developed. Open information will be searchable in Information Commons, a platform for sharing information. There is no doubt that patients and end users who need information will become aware of everything from daily healthcare to disease information.

Instant innovation that happens on mobile is the opposite of traditional innovation, because end users choose their best. Moreover, the product is evaluated immediately. Therefore, the adjustment is performed so that it is easy to use from the customer side. A platform that is open and can bring the best solution survives automatically [26].

## *Medical Hegemony and Healthcare: Centrality in Healthcare DOI: http://dx.doi.org/10.5772/intechopen.99174*

The effect and influence of the commons of information eliminate adverse events caused by the hegemonic mainstream. As the most effective means in the coming digital healthcare era, the commons of information has instantly created network neutrality on the mobiles. The network neutrality is independent of the mainstream. Therefore, only the commons of information, which is a platform with the following three points, survive:

