Search

Pancreatic cancer is ranked 4th in Japan in terms of number of deaths so far in 2019, surpassing liver cancer. Unlike other types of cancer, the number of patients in Japan is epidemiologically showing an upward trend, and 70% of cases are unresectable at diagnosis. Therefore, development of chemotherapy that improves the prognosis and maintains and improves the quality of life of the patient is a critical issue. Against this backdrop, the efficacy of nanoliposomal irinotecan(nal-IRI)in combination with fluorouracil and folinic acid(FF)for progressive metastatic pancreatic cancer after previous gemcitabine therapy was confirmed in Europe in 2015 ahead of Japan. In NAPOLI-1, an overseas phase Ⅲ study of this therapy, a significant improvement in overallsurvivalwas shown as compared with patients who received FF alone(median: 6.1 months for nal-IRI plus FF vs 4.2 months for FF alone, p=0.012). Therefore, this study yielded important evidence for second-line treatment of pancreatic cancer around the world. In Japan, a phase Ⅱ study was conducted to confirm the efficacy and safety of this therapy, which found a significant prolongation of progression-free survival(as assessed by the investigator)with this therapy as compared with FF alone(median: 2.7 months for nal-IRI plus FF vs 1.5 months for FF alone, p=0.039). In the latest version of Clinical Practice Guidelines for Pancreatic Cancer published in Japan in July 2019, nal-IRI plus FF therapy was included in a statement as a treatment option after a gemcitabine-based regimen. This paper provides an overview of development of this new nal-IRI plus FF therapy and relevant information. Drug therapies for pancreatic cancer currently being developed in Japan, as well as the position of this therapy in pancreatic cancer therapy in Japan and what the expectations are in the clinical setting, are also discussed.

In acute myeloid leukemia (AML), a number of chromosomal abnormalities and gene mutations associated with onset and recurrence were discovered by the recent progress of genome analysis technology. The founding did not only have clinical application as prognostic factors and minimal residual disease markers but also contributed to novel molecular targeted drug development. Many new drugs, such as first-generation FLT3 inhibitor, IDH1/2 inhibitor, and BCL2 inhibitor, have been developed in Europe and the United States. In addition, the second-generation FLT3 inhibitors, gilteritinib and quizartinib, were developed in Japan, which significantly improved the treatment outcome of AML. However, there is still a large disparity in drug availability between Europe and the United States and Japan. As a result, treatment guidelines in Europe and the United States cannot be applied to practical use in Japan. This paper presents an outline of the prognosis stratification and indication of allogenic hematopoietic cell transplantation for AML by gene diagnosis in Japan.

In Japan, working environment measurement is prescribed in the designated workplaces using hazardous materials. Measurements should be carried out periodically and countermeasures are performed depending on the results. By introducing such a system, working environments have remarkably improved. However, in the designated workplaces, measurements should be continued even in work environments found safe. On the other hand, measurement need not be obliged for non-designated workplaces even if hazardous materials are utilized.In the United States of America and many European countries, work environment management and work management are carried out by measuring personal exposure concentrations. In Japan, the Ministry of Health, Labour and Welfare is now discussing the introduction of personal exposure monitoring. However, many problems exist to prevent the simple introduction of American and European methods. This paper describes the brief history, present state and problems of work environment control in Japan, comparing with the systems of American and European countries.

Modern medicine was introduced in Japan in the second half of the nineteenth century. In order to investigate this historical process, this paper focuses on the dissemination of information of a new medical technology developed in the mid-nineteenth century; it does so by making comparisons of the access to medical information between Europe, the USA and Japan. The hypodermic injection method was introduced in the clinical field in Europe and the USA as a newly developed therapeutic method during the 1850s and 1870s. This study analyzed information on the medical assessments of this method by clinicians of these periods. The crucial factor in accumulating this information was to develop a worldwide inter-medical communication circle with the aid of the medical journals. Information on the hypodermic injection method was introduced in Japan almost simultaneously with its introduction in Europe and the USA. However, because of the geographical distance and the language barrier, Japanese clinicians lacked access to this worldwide communication circle, and they accepted this new method without adequate medical technology assessments.

As increased incidence of breast cancer, the concept of standard therapy based on the evidence based medicine (EBM) has been widely applied to breast cancer treatment in Japan. Since the major parts of evidences are common in Western countries and Japan,general treatment strategy for standard care seems to be identical in both countries. However, there are still some differences due to the limited usages of anti-cancer drugs and supporting drugs. We would discuss about these issues in this paper.

The leprosy policy of Japan began from when the government enacted "law No. 11 (The leprosy prevention act)" in 1907 (Meiji 40) and several leprosy sanatoriums were built to receive previously homeless patients. Then, with the rise of totalitarianism, the isolation policy of Japan gained national support under the slogan "Patient Relief", which would become a major factor behind the enactment of "Leprosy Prevention Law" in 1931 (Showa 6) by which the leprosy policy was changed to one of absolute isolation aimed at the internment of all leprosy patients. From recent research on the leprosy policy of Japan, the internment of all leprosy patients, isolation for life, social defense, and neglect of patients' human-rights had tragic results in many cases. However, there is little research which can reply clearly to the question of whether the leprosy policy of Japan was really original and what factors led to the formation of the absolute isolation policy. This paper focuses on the relation between leprosy policy and treatment, and from this, I make clear the similarities, or peculiarities, of the isolation policy between Japan and the rest of the world, while clarifying the factors associated with the progress of the absolute isolation policy. The processes involved were historical and medical historical in that the relation between the formation of a national health system and the progress of the isolation policy of Meiji Era, the proposal of the isolation policy by Dr. Keizo Dohi, Dr. Shibasaburo Kitasato, and Dr. Masatsugu Yamane; the practical application of this policy by Dr. Kensuke Mitsuda, and the decision to enact this policy and its support by the Health and Medical Bureau and the Department of the Interior, as well as many other factors, all contributed to the final implementation of the absolute isolation policy.

This paper reviews the literature on health economics assessment (HEA) for liver transplantation (LT) in Europe and USA, and considers prospects in Japan where HEA is currently rarely performed. LT is one of the most expensive health technologies but the health outcome is generally good. It provides the only well-established treatment for end-stage liver disease (ESLD) in the Western world, while in Japan it has yet to be fully implemented because public acceptance is still very low. MEDLINE and Japana Centra Revuo Medicina WEB version Ver. 2 (JCRM2) were systematically used for the literature search. As a result, 6 original papers in Europe and USA that employed accurate methods for HEA were identified through MEDLINE, indicating that LT is cost-effective on long term follow-up. In Japan, however, only one study could be good which tried to estimate it's cost-effectiveness, and the methodology was different from that used in Europe and USA. Through accurate HEA for LT in Japan, we hope that this procedure may become a well-accepted health technology in the future.

The purpose of this paper is to clarify the differences in therapeutic strategies for adult leukemia and lymphoma between Japan and western countries. Since in Japan, high-dose cytarabine for acute leukemia is not covered by health insurance, post-remission therapy might be less intense compared to western countries and it takes a long time to complete the therapy. The results of chemotherapy for adult acute lymphocytic leukemia (ALL) in Japan have been inferior to those in foreign reports. Accordingly, many Japanese hematologists believe that adult ALL has a worse prognosis than acute myeloid leukemia (AML), and almost all young adult patients with ALL should receive allogeneic bone marrow transplantation (BMT) from related or unrelated donors. Japanese hematologists also consider that Interferon as the first-line chemotherapy for chronic myelogenous leukemia (CML), and that BMT from a HLA matched sibling donor should be done as soon as possible. Recently, some foreign reports of BMT from unrelated donors for CML revealed results comparable to BMT from related donors showing that even transplants from unrelated donors should be done as soon as possible. Since chronic lymphocytic leukemia and Hodgkin's disease are so rare in Japan, the available drugs for these diseases are limited. The quality and quantity of Japanese clinical studies in this field are inferior to studies in western countries. This, in fact, is a more serious problem than the differences in therapeutic strategies.

There is no general agreement on the concepts of chronic obstructive pulmonary disease (COPD) yet in Japan, although there have been significant advances in the understanding of its concepts in the United States and Europe. The purpose of this presentation as the opening remark to this panel discussion is to review the concepts and history of chronic obstructive pulmonary disease (Tables 1, 2), and also to summarize the general concepts concerning COPD in Japan at present. More than 30 years ago, a Ciba Guest symposium first proposed the main subdivisions of chronic non-specific lung disease (CNSLD), consisting of chronic bronchitis and generalized obstructive lung disease (GOLD). Many papers addressed this theme focusing on the definition and concepts of COPD for a long period after the Ciba Guest Symposium. The ATS and ACCP joint committee on pulmonary nomenclature (1975) reported that the term of COPD refers to diseases of uncertain etiology characterized by persistent slowing of airflow during forced expiration, and the committee recommended that chronic obstructive bronchitis or chronic obstructive emphysema be used, whenever possible. However, in many patients it is still difficult determine what extent the airway obstruction result from emphysema and to what extent it results from an accompanying chronic obstructive bronchitis, as Burrows described. Fishman (1980) and Burrows (1981) suggested that if the patient is thought to have a combination of chronic obstructive bronchitis and pulmonary emphysema, the case should be so diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)

The main aim of the Medical Humanics course, as well as that of this university, is to educate students so that they will continue philosophizing for themselves throughout their lives. Dr. Hisayoshi Omodaka, the founder of Japanese Medical Humanics (or Igaku Gairon), claimed that this discipline must be the philosophy of medicine. Medical Humanics should be the philosophy for physicians, researchers and all other health-related professionals. This philosophy is different from the philosophy which is taught independently to freshmen in the university. Thus the philosophy of medicine should embody those concrete materials which are harvested directly from the hot spots of medical practice. This paper is based on the author's series of lectures in medical humanics with the title: "Man and Medicine", given between October and December of 1982 to the 5th-year undergraduates. In this series the author attempted to express his own views, along with the philosophical thinking of many great physicians and thinkers, so far as they are reflected in the mirror of the history of medicine. The outline is as follows: (1) Usefulness of the history of medicine for medical students. (2) Origin of medicine and the occult sciences. (3) Western classic medicine: from Hippocrates to the Renaissance. (4) Chinese classic medicine. (5) Brief sketch of Japanese medicine: from ancient to Meiji period. There is a general tendency among both medical students and teachers to make little of the history of medicine. However, as William Hazlitt wrote in his poem, "By despising all that has preceded us, we teach others to despise ourselves".