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The beginning of modern anesthesiology in Japan dates back to 1950 when Dr M. Saklad of Rhode Island Hospital came to Japan to give his lectures on endotracheal anesthesia and related procedures. Since then, many Japanese surgeons visited the United States to learn anesthesiology in depth and they began to write their papers for foreign journals. According to my survey of the journal "Anesthesiology" from Vol 1 (1940) through Vol 21 (1960), I found 12 scientific papers written by Japanese. The first paper by Japanese appeared in this journal published in 1955 entitled as "Observations on the action of thiopental (Pentothal) on the laryngeal reflex" by Akira Horita et al. He was born in the United States in 1928 as a son of Japanese immigrants. He was graduated from the University of Washington at Seattle to become professor or pharmacology. The first paper based on studies performed in Japan by Japanese authors appeared in 1956. It was entitled as "The spread of drugs used for spinal anesthesia" by Kitahara et al. This paper is the English translation of their Japanese paper which appeared in Nippon Rinsho Geka Ikai Zasshi entitled as "Basic Study on Spinal Anesthesia in 1953".

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This paper attempts to answer the following question: "What type of people are likely to perceive the risk of crime victimization, and why?" Empirical research on the fear of crime in the West, which began in the 1960s, indicates that women, old people, and lower socio-economic groups have a tendency to perceive the risk of crime. Researchers have attributed the tendency in these groups to their physical and social vulnerability. In order to find out whether we can apply the results of the research conducted in the West to Japanese society, we compare the determinants of the perceived risk of crime in Japan with those of the perceived risk of crime in the United States. This comparison is conducted by analyzing the data of General Social Surveys (GSS) and Japanese General Social Surveys (JGSS) held in 2000. The findings reveal that in the United States, women, old people, and low-income groups are more likely to perceive the risk of crime; this perception can be attributed to their physical and social vulnerability. On the other hand, in Japan, it was found that young women, men having young children, and white-collar or highly educated women are more likely to perceive the risk of crime. However, their risk perception cannot be explained by physical and social vulnerability. This paper illustrates the unique factors underlying the perceived risk of crime in Japan: fear of sexual crime, vulnerability of the significant other, differences in the wording of GSS and JGSS, opportunities of walking alone at night, and the role of the media. [ABSTRACT FROM AUTHOR]

The phenomenal expansion of enrollment in graduate programs has brought about various disastrous consequences in the quality of postgraduate education in Japan. The "American" system of graduate education—in particular, its relatively high rate of enrollment—has often been quoted as the basis for the public policy on the expansion of graduate enrollment in Japan. On the other hand, the programs and curriculums characteristic of U.S. institutions have been hailed as the ideal model to be emulated. A close examination of the so-called American model of graduate education, however, reveals that the arguments for the American model have been accompanied by serious misunderstandings. This paper first delineates the causes and consequences of the expansion of graduate education in Japan. It then shows some of the research findings of a comparative study on graduate education in the U.S. and Japan. This paper concludes with the argument that blind mimicry of the American model would lead to detrimental consequences for students, teachers, and the academic discipline itself. [ABSTRACT FROM AUTHOR]

This paper aims to clarify how educational and occupational expectations of students are conditioned by school track under Japanese school-to-work linkage. We compare Japan to the US and Germany, which have specific characteristics of school-to-work linkage of their own according to the literature. Our analysis is based on Programme for International Student Assessment (PISA) data collected by OECD. Using indicators from the literature, we can define the institutional characteristics of each country as follows: all the indicators are high in Germany, and low in the US, but in the case of Japan, the indicators for stratification and standardization are high, while vocational specificity is low. From the patterns of these indicators, we construct hypothesis about the effect of school track on students' educational and occupational expectations in each country. From our analysis, we can see that tracking in Germany strongly affects the educational and occupational expectations, while tracking in the US did not strongly affect either expectation. In Japan, school track strongly constrained educational expectations, but not occupational expectations. These results can be consistently interpreted as a consequence of different school-to-work linkages in these countries explained by using three indicators above. Therefore, we can conclude that we succeeded in clarifying distinguishing characteristics of the school track effect on student expectations in Japan compared to the US and Germany in relation to the institutional differences. [ABSTRACT FROM AUTHOR]

The aim of this paper is to examine the fluidity of youth employment and the tertiary industrialization that is part of international trade and the change in Japan's industrial policy. This process, known as "post-industrialization," occurred in every developed country; however, Japan contained the following unique characteristics: (a) a cruel division, known as "company-centricism," existed between employees inside/outside the companies; (b) the two Oil Crises had comparatively weak consequences in Japan because of the strong cooperation between capital and labor, so that the dominant position of existing large corporations did not collapse, as in the case of the United States and UK; (c) lower-class labor, which inevitably increases during the "post-industrialization" process, was supplied by the nation itself and not by immigrants. At that time, the increase in the fluidity of youth employment was explained by policy- makers as a positive contribution to the national economy, although the same phenomenon is viewed as a symptom of economic crisis today. [ABSTRACT FROM AUTHOR]

What kind of sociological knowledge is transmitted in college education? Introductory textbooks on sociology represent its identity as a discipline. In this paper, I analyze the contents of introductory sociology textbooks in Japan and the United States from a comparative perspective. I find different degrees of institutionalization or standardization of sociological knowledge between the two countries. Japanese textbooks cover fewer fields of sociological research and the demarcation between the different fields is weaker in Japan than it is in the United States, i.e., the textbooks are less standardized in Japan. I argue that these differences are derived from the different educational contexts of college education in these two societies. Japanese textbooks are increasingly shifting toward "perspective-oriented" knowledge from explanations of sociological concepts or theories. This tendency further reduces the standardization of sociological knowledge imparted in Japanese colleges. Finally, I raise a question about the direction Japanese sociological knowledge production will take and the extent to which this knowledge production is influenced by the changing styles of reproducing knowledge. [ABSTRACT FROM AUTHOR]

"Tobacco harm reduction" is defined as a method to minimize harm and risk of death and disease without eliminating tobacco and nicotine use. In Japan, where heated tobacco products (HTPs) are prevalent, the tobacco industry is progressively endorsing the concept of "tobacco harm reduction." Therefore, stakeholders in tobacco control must urgently share perspectives and experiences surrounding this issue.　This discussion paper aimed to propose four requirements for effectively implementing "tobacco harm reduction" as a public health measure: (1) disease risk reduction, (2) cigarette smoking cessation, (3) no additional public health concerns, and (4) regulatory authorities held by health agencies, and compile information on them regarding nicotine-containing electronic cigarettes (e-cigarettes) and HTPs. Another aim was to summarize policies related to "tobacco harm reduction" adopted by an international organization (World Health Organization (WHO) and health authorities in foreign countries (the United States of America (USA), the United Kingdom (UK), Australia, Italy, and the Republic of Korea) to explore the implications of these requirements on Japan's approach. Regarding the first three requirements, scientific evidence indicated that e-cigarettes offers some level of risk reduction and can assist with cigarette smoking cessation. The potential uptake of e-cigarettes among youth and their possibility to serve as a gateway to combusted cigarette use is a concern, though a definitive causal link is yet to be established between the uptake of e-cigarette in youth and the subsequent use of different tobacco products. There is insufficient scientific evidence for any of the three requirements for HTPs. Regarding the official policies, WHO took the position that the same regulations should be applied to all tobacco products. Only the UK and USA officially established a health system based on the concept of "tobacco harm reduction"; even in Italy and the Republic of Korea, where HTPs are relatively widespread, health authorities denied any risk reduction by introducing HTPs. The UK officially adopted a smoking cessation policy with e-cigarettes. The USA established a modified risk tobacco product system under federal legislation enacted in 2009, whereas of June 2023, no HTP or e-cigarettes were recognized as explicitly reducing health risk. Regarding the fourth requirement, the UK and USA institutionalized "tobacco harm reduction" under health authorities' regulation independent of the tobacco industry. The introduction of a tobacco harm reduction policy in Japan should be considered only in line with health authorities' regulation and implementation of comprehensive tobacco control measures independent of the tobacco industry.

Worldwide, research based on geographic information of official statistical data, including cancer registries, is utilized for cancer control and public health policies. The National Cancer Registry of Japan was launched in 2016, making it possible to use data on cancer incidence systematically. Given the nature of this comprehensive survey, the usefulness of the National Cancer Registry would be further enhanced when it is utilized at small-regional levels, such as in municipalities or even smaller geographical units. It is essential to maintain a balance between privacy protection and data usability. Currently, the national and prefectural councils determine the availability of the data from the National Cancer Registry at the small-regional level on an individual application basis. Under this framework, use of the data is often restricted or declined. This paper showcases three model countries where geographic information obtained from cancer registry data are widely utilized: the United States, Canada, and the United Kingdom. It further discusses measures to ensure that data are effectively used, without compromising data privacy. In the three countries, data-providing systems have been established to compile the necessary data from the cancer registry and other linked databases, in accordance with the purpose of use. The relationships between healthcare access and various outcomes are elaborately examined at the small-regional level. In Japan, similar utilization of data has not been fully implemented, and there remain many hurdles to the application of the data use. For the National Cancer Registry to promote research and further enhance cancer control, it is necessary to establish a system that enables effective and safe utilization of the data from the National Cancer Registry, including linkage with other data and on-site use.

In recent years, consumer interest in health and health foods (e.g., dietary supplements) has increased, and the types of and market for health foods have also expanded rapidly. The safety of health foods is a significant concern in many countries. Numerous adverse events associated with the consumption of health foods have been reported. There are cases that have resulted in serious liver failure, renal failure, and death in other countries. These products may contain undeclared medical ingredients and toxic chemical compounds that are illegally and intentionally added or contain natural plant toxins. Products containing high levels of heavy metals have also been reported to cause such adverse events. Some products remain on the market, even after regulatory agencies alert consumers and issue warnings to their sellers. Moreover, because people can buy health foods from sources overseas via the Internet, adverse effects associated with the use of such products remain a concern. Two cases of adverse events were reported in Japanese individuals who purchased "OxyElite Pro" products imported privately. They are advertised as weight-loss and muscle-building products and have been associated with many cases of liver failure and hepatitis in the USA. In this paper, regulatory systems and adverse events associated with the use of health foods in other countries are discussed.

Radiation protection standards for the general population have constituted one of the most controversial subjects in the history of atomic energy uses. This paper reexamines the process in which the first such standards evolved in the early postwar period. While the existing literature has emphasized a "collusion" between the standard-setters and users, the paper seeks to examine the horizontal relationship among the standard-setters. It first examines a series of expert consultations between the United States and the United Kingdom. Representing a different configuration of power and interest, the two failed to agree on the assessment of genetic damage and cancer induction whose occurrence might have no threshold and therefore be dependent on the population size. This stalemate prevented the International Commission on Radiological Protection (ICRP), established in 1950, from formulating separate guidelines for the general public. Situations radically changed when the Bikini incident in 1954 led to the creation of more scientific panels. One such panel under the U.S. Academy of Sciences enabled the geneticists to bridge their internal divide, unanimously naming 100 mSv as the genetically permissible dose for the general population. Not to be outdone, ICRP publicized its own guidelines for the same purpose. The case examined in this paper shows that the standard-setting process is best understood as a series of "epistemic negotiations" among and within the standard-setters, whose agendas were determined from the outset but whose outcomes were not.

Therapeutic applications of repetitive transcranial magnetic stimulation (rTMS) have long been awaited for not only neurological but also psychiatric disorders as a low-invasive transcranial brain stimulation. In 2008, the Food and Drug Administration (FDA) of the United States finally approved repetitive transcranial magnetic stimulation (rTMS) for medication-resistant patients with major depression. More recently, at the beginning of 2013, a deep TMS device with the H-coil received FDA approval as the second TMS device for major depression. In Japan, it is estimated that more than 200,000 patients with medication-resistant major depression could be candidates for rTMS treatment. To promote the clinical introduction of rTMS for major depression, joint discussion has been ongoing including the Japanese Society of Psychiatry and Neurology (JSPN), the Japanese Ministry of Health, Labour, and Welfare (MHLW), and the Pharmaceutical and Medical Devices Agency (PMDA). On the other hand, some corporate efforts have begun to get MHLW/PMDA approval for a few types of rTMS device. In 2013, the JSPN established a new committee in order to discuss the introduction of neuromodulation methods such as rTMS in Japan. The committee has been discussing how rTMS should be introduced appropriately with expedition, considering the MHLW regulations for the expedited introduction or provisional use of advanced medical technology. Also, the MHLW has required related psychiatric societies to formulate clinical guidelines of rTMS for major depression in order to avoid any potential overuse or misuse. A number of controversies are ongoing, such as standards for the appropriate clinical application of rTMS, a suitable position of rTMS within the comprehensive treatment algorithm of major depression, and bioethical standards for brain stimulation (neuroethics). Moreover, there are some pragmatic issues. For instance, the Japanese Society of Clinical Neurophysiology (JSCN) has restricted repetitive TMS administration to medical doctors due to safety concerns. In order to disseminate rTMS in Japan, it should be discussed how to reduce the work-load of psychiatrists who administer rTMS on a daily basis. For this purpose, standards should be established by the JSCN to qualify non-MD rTMS operators under the supervision of psychiatrists. In this paper, recent progress in the clinical introduction of rTMS for major depression in Japan is reported, in order to facilitate future discussion about how rTMS should be introduced for patients with major depression in Japan.

This paper gives an account of Prof. Dr. Kinji Shimizu, the first president of Nagoya Institute of Technology, and his establishment of Nagoya Municipal Science Museum. After graduating from the Electrical Engineering Department of Kyoto Imperial University in 1923, Shimizu was impressed by the German Museum in Munich during his stay there as a student in 1932. It's the first time that he learned the education in cooperation with industries. Just after the Second World War, he became director general of the Ministry of Education. However, new education system given by the United States focused not on developing practical ability but on gaining the basic knowledge, which is contrary to what he expected. Then, he contributed to the establishment of the Japanese Society for Engineering Education, besides working as the president of Nagoya Institute of Technology in the earlier 1950s. His idea was supported by industries for the economic growth. Throughout his career, Prof. Dr. Shimizu was convinced that practical engineering education would benefit Japan, and wanted to introduce cooperative education between universities and industries, along the lines of the same system in Germany and the United States. With this vision he founded Nagoya Municipal Science Museum in cooperation with local industries and local government as his final achievement. The museum was completed in 1964.

Japan and the United States signed in 1968 a new atomic energy agreement through which US light-water nuclear reactors, including those of the Fukushima Daiichi Nuclear Power Plant of Tokyo Electric Power Company, were to be introduced into Japan. This paper studies the history of negotiations for the 1968 agreement using documents declassified in the 1990s in the US and Japan. After the success of the Chinese nuclear test in October 1964, the United States became seriously concerned about nuclear armament of other countries in Asia including Japan. Expecting that Japan would not have its own nuclear weapons, the US offered to help the country to demonstrate its superiority in some fields of science including peaceful nuclear energy to counter the psychological effect of the Chinese nuclear armament. Driven by his own political agenda, the newly appointed Prime Minister Eisaku Sato responded to the US expectation favorably. When he met in January 1965 with President Johnson, Sato made it clear that Japan would not pursue nuclear weapons. Although the US continued its support after this visit, it nevertheless gave priority to the control of nuclear technology in Japan through the bilateral peaceful nuclear agreement. This paper argues that the 1968 agreement implicitly meant a strategic measure to prevent Japan from going nuclear and also a tactic to persuade Japan to join the Nuclear Non -Proliferation Treaty.

In this paper I review the present condition of the regeneration medicine research using pluripotency and a somatic stem cell, and I describe the subject of the science and technology policy in Japan towards realization of regeneration medicine. The Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT) supported research promotion by the prompt action in 2007 when establishment of the iPS cell was reported by Shinya Yamanaka. Although the hospitable support of the Japanese government to an iPS cell is continued still now, there are some problems in respect of the support to other stem cell researches, and industrialization of regeneration medicine. In order to win a place in highly competitive area of investigation, MEXT needs to change policy so that funds may be widely supplied also to stem cell researches other than iPS cell research.

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.

Purpose: To investigate the conditions that would allow for coercive measures for persistently non-adherent tuberculosis patients., Method: Literature review of the jurisprudential and medical papers, mainly of the United States., Result: We found relevant items in the following categories related to conditions allowing for coercive measures: truthful adequate purpose of the coercive measures, scientific evidence or prospects of effectiveness of the measures, individual risk assessment, existence of significant risk, proportionality principle, least restrictive alternative principle, and procedural due process., Conclusion: To establish a system of coercive measures for persistently non-adherent tuberculosis patients in Japan, we would first need to accomplish many tasks, including a significant broadening of the support services for tuberculosis patients.

Objectives and Results: Globalization has progressed tremendously resulting in far-reaching changes in the work environment. In Japan, occupational health and safety (OSH) activities are performed under and improved by regulations. However, this system is not likely to satisfy the unceasing diversification of social demand for OSH in recent years. The US adopts a self-imposed OSH system with responsibility carried by employers under a system of minimum regulation. This paper introduces the systematic training for occupational physicians in schools of public health in the US, which is creating a base of OSH professionals who can meet social demand., Discussion: To satisfy the diverse demand for recent OSH, it is essential to improve the basic skills of occupational physicians and other OSH professionals by offering systematic training in Japan. Some examples of systematic training for occupational physicians in schools of public health in the US are discussed with the goal of improving Japan's future OSH.

Umeko Tsuda (1864-1929), a pioneering educator for Japanese women and the founder of Tsuda College, was a scientist. As an English teacher at the Peeresses School in Tokyo, the young Tsuda was granted a leave of absence by the government to study "teaching method" at Bryn Mawr College, a women's college near Philadelphia. During her stay in Bryn Mawr(1889-1892), however, she majored not in pedagogy but in biology, despite the fact that the Peeresses School officially banned science education for noble women. Following the vision of the feminist Dean Carrey Thomas, Bryn Mawr College offered full-fledged professional education in science comparable to that of Johns Hopkins University. Bryn Mawr's Biology Department was growing; there, Tsuda took courses from such notable biologists as Edmund B. Wilson, Jacques Loeb, and the future Nobel Laureate Thomas H. Morgan. In her third year, under Morgan, she carried out experimental research on the development of the frog's egg, which was published in a British scientific journal as their joint paper two years later. Tsuda was considered one of the best students in the department, and Bryn Mawr offered her opportunities for further study. However, after much consideration, she chose to return to Japan. Although Tsuda gave up a possibly great career as a biologist in American academe, she knew that it was almost impossible for a woman to pursue a scientific career in Meiji Japan and wanted to develop her dream of establishing an English school for women. Her experience of "forbidden" scientific study at Bryn Mawr seems to have given her great confidence in realizing her feminist ideal of enlightening Japanese women at the women's school she founded in 1900, the forerunner of Tsuda College.

In this paper, through a detailed comparison between a translated book on nursing and its original American source, I examine the position of nursing in the mentality of a Japanese doctor at the beginning of the Meiji Era. In 1877, Dr. Yunei Ota published a translated version of a book on nursing titled "Kango-Kokoroe." The original book, titled "A Universal Formulary, 3rd. Edition," was written by R. E. Griffith and published in 1873. Further, I show that Yunei Ota translated a part of its introduction. These two books differ in terms of their target audiences and purposes for publication. From the viewpoint of the doctor-nurse relationship, Yunei Ota described his unique mentality in his translation; that is, he stressed the importance of nursing by stating that nurses were for doctors as wings were for birds. This mentality was rarely found in the original American book. Moreover, Yunei Ota did not make a literal translation; instead, he selected, added, and deleted contents from the book in keeping with a practical standpoint. Yunei Ota recognized that nursing was an indispensable part of medical treatment and he advocated the necessity of nursing education before systematic nursing education had been established in Japan.

The purpose of this paper is to present the differences and similarities in the roles of occupational health nurses (OHNs) between the United States and Japan by reporting the results of interviews with seven OHNs who work at seven industries in the city and the suburbs of San Francisco. Four out of seven OHNs responded that one of their essential roles was "Case Manager", in regard to the prevention of work force reduction and the scaling back of workers' medical expenditures associated with work-related accidents. Only one of them responded that "Health Promotion Specialist" was the leading role, whereas 30% of the Japanese OHNs were engaged in this role, according to the results of a previous study. Similarly to the other roles of the Japanese OHNs, they also consider Clinicians, Managers, and OHS Coordinators as their important roles. Together, the result of interviewing the nurses indicated that the differences in the role delineation of the OHNs between the two countries depend upon their educational system of licensing as well as implementation of their responsibilities to the laws and regulations, including the Occupational Health and Safety Act, health examination of the OSHA Standard and employment of occupational medical doctors, medical insurance and compensation for workmen's accidents, etc. Furthermore, this visiting opportunity gave the authors suggestions for the advancement of educational programs to reinforce the professional activities of occupational health nursing in Japan.

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.

I graduated from Kyoto University Faculty of Medicine in 1952. Following neurological residency training, I received neuropathological training at Montefiore Hospital under Dr. Zimmerman since 1956. During 1959-65, on the recommendation from Dr. Zimmerman and Dr. LT Kurlands, I was engaged in Guam project of NIH, as a visiting scientist, investigating ALS and parkinsonism-dementia complex, endemic fatal neurological disorders among the native Chamorro population. In 1965 I was appointed as head of the Division of Neuropathology at Montefiore Medical Center. I have been Professor of Pathology at Albert Einstein College of Medicine since 1971, Professor in the Dominick Purpura Department of Neuroscience at Albert Einstein College of Medicine since 1974, and The Harry M. Zimmerman Professor of Neuropathology, Montefiore Medical Center 1995. For over four decades, with the late Dr. Zimmerman, I have been host to 40 Japanese neurologists who have come to Montefiore for training in Neuropathology. Over 700 papers, 20 books have been published in our laboratory. Personal recollections of selected episodes devoted to study of neuropathology are described in this communication. These include fine structural investigation of brain edema demonstrating electron dense hematogenous edema fluid spreading expanding extracellular space in white matter, application of model of unrolled myelin sheath for elucidate structural alteration of myelin, the independent development of the pre- and postsynaptic terminals, study of SOD1 positive Lewy body-like inclusion in familial ALS and Hirano body.

The Committee for Prevention of Nosocomial Infection organized by national university hospitals has developed guideline for preventing hospital acquired infections. This was developed after intensive and systematic reviews of the existing scientific papers, followed by a consensus meeting with presence of the infection control specialists. The guideline consisted of following categories: standard precaution, causality organism, urinary tract infection, ventilator associated pneumonia, surgical site infection, catheter related bloodstream infection, and accidental contamination by needles. We also plan to evaluate the effectiveness of this guideline, and continue to update it by our consistent review of scientific papers.

Many medical organizations have passed resolutions banning participation of psychiatrists in legal executions, such as the Madrid Declaration of World Psychiatric Association. The Criminal Procedure Act of Japan prohibits the execution of the insane. Although the USA and Japan are both among the few so-called developed countries that have a system of capital punishment, many disputes about psychiatrists' participation in death penalty cases have occurred in the US, but few in Japan. This author has reviewed papers addressing this issue. The U.S. Supreme Court decided in Ford v. Wainwright that the execution of an "insane" inmate was not constitutional. The rationale for excluding the mentally incompetent from execution, however, is not completely clear. The most compelling reason is that execution does not satisfy the requirement for "effective retribution," since the insane criminal is not capable of understanding the implications of the death penalty. Nonetheless, there are those who dispute this interpretation and offer other explanations. Psychiatrists may be called upon to assess a criminal's competency for execution. Some find no problem with this practice, while others object to it stating that it conflicts with the ethical tenet to "first do no harm." Those who argue from a middle position insist on assessing competency while recognizing the existence of problems in making such an assessment. Furthermore, there is controversy over which factors exactly constitutes "competency to be executed." Usually, it is thought to be one's capacity to understand the nature of the death penalty and the reasons why the penalty is to be inflicted, but other arguments exist, including the capacity to assist legal counsel in last minute appeals. The question of whether to offer treatment to death row inmates who have been found incompetent to be executed is also under debate. The first position argues that they should "never be treated", because such prisoners would be executed when treatment restores competency. The second, always-treat-position, asserts that psychiatrists are responsible for treating severe mental illness whenever possible. The third, intermediate position, insists upon treatment with several conditions, which entail, for example, respecting the prisoner's autonomy and/or selecting forms of treatment that are unlikely to restore competency. When treatment is given, assessment as to whether competency has been restored is then required. This is still a troublesome issue. The decision in Perry v. Louisiana dealt with the question of whether the state may forcibly treat prisoners incompetent for execution. There were reports about ambivalence and anger among the staff of a psychiatric hospital where an inmate found incompetent for execution was treated. More than a few disputes insist that the ethical dilemma can only be resolved by commuting the sentences of incompetent death row prisoners to life imprisonment. This author further asserts that the secretiveness with which the Ministry of Justice of Japan handles these types of cases should be abolished as soon as possible.

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.

Toward the 21st century, subjects and methods of hygiene and public health will be specialized and subdivided. However, practical approaches to human health need an integrated method focusing to a structure of human life. Under these circumstances, the concept of 'health culture' becomes prevalent. The role of hygiene related to the improvement of life style, the development of re-cycle system, and fulfillment of a barrier-free system focussed on the handicapped and the elderly have become increasingly important. Therefore, an increase in the recognition to the concept of 'health culture' is essential to the research of hygiene. The purpose of this paper is to make a historical and theoretical analysis of health culture', in order to promote it as the leading concept of all activities concerned with health in the 21st century. The methods of this paper are mainly historical and theoretical review. 'Health culture' was introduced in American and European societies a hundred years ago. Health culture in the USA involves knowledge and skills applied to actual daily life, refrecting pragmatism as the ideal feature of American society. In Germany, the concept of 'Hygienishe Kultur' was established at the field of social hygiene by Grotjahn and by Fischer in the early 20th century. This concept recognized the importance of the development of culture and independence of life in labour based on the evolution of the concept of 'Hygienishe Kultur'. In Japan, under the influence of German social hygiene, the social hygienic theory flourished. A social hygienist, Tetsuo Hoshino used the term 'hygienic culture' in the context of life creation toward a healthy life. Health culture is the total system concerning knowledge, experience, skill, and norms related to health, which has developed with the development of society. It has fundamental function promotes the creation of culture and self-cultivation of living man, whereas, it contributes to the realization of health based on individuality, in conjunction with the co-operation of medical and health sciences. The contemporary representation of health culture includes new health care activities such as self-care, a self-help movement, and health volunteer activities. It means the basic shift of the function of health culture is from that of life style to life movement. Nowadays, the role of hygiene in the total health care system is seriously considered. The goal, objects, and methods of hygiene should be re-evaluated under the concept of 'health culture', in order to re-define hygiene as the science for people living in a society.

Ocular diseases have some characteristics that are different from diseases of other organs. First, patients clearly can judge for themselves whether or not they can see better postoperatively. Second, because several parameters such as visual acuity and intraocular pressure, are obtained from patients, patient's families and others can objectively judge the post-treatment status. Therefore, clinical information is easily available to others besides the physician. Third, except for acute ocular diseases such as retinal detachment, acute glaucoma, and ocular trauma that easily can result in blindness, ophthalmologists usually treat eyes that will maintain a certain visual acuity level. These are the primary reasons why patients and families complain about unfavorable post-treatment subjective symptoms. Because of these three characteristics of ocular disease, informed consent (IC) is extremely important in the field of ophthalmology. I studied ophthalmology and IC at Harvard Medical School, Boston, from 1980 to 1983, and again in 1989. Strict IC is mandatory in the United States. However, the concept of IC in the US cannot always be adapted to fit Japanese culture. The different legal concepts of IC in the two countries are discussed in this paper. Since I returned to Japan, our Department of Ophthalmology incorporated several new concepts into our clinical practice. For example, we now broadcast live surgeries of patients with severe proliferative diabetic retinopathy by closed-circuit TV to their families in the hospital. This has fostered great communication and confidence among patients, their families, and doctors. In 1994, we also began inter-hospital and international IC via telemedicine and telescience. The video conferencing system VisionSeries (Panasonic Broadcast and Television System Company) is used to communicate between Asahikawa Medical University and 10 branch hospitals. INS net 1500 or INS net 64 (3 lines) transmits full-motion (30 frames/second) color fundus images and biomicroscopic images. Ocular surgeries performed by ophthalmologists using operating microscopes at each branch hospital also are transmitted to Asahikawa Medical University to facilitate consultation with more experienced ophthalmologists. The transmitted images of the fundus and biomicroscopic findings are satisfactory, and they allow surgeons to conduct useful discussions among themselves and with the family members during the surgeries in real time. When the patients' families are in local cities, surgeons can transmit the operations via the telemedicine system link to the nearby hospital, and the ophthalmologists there can narrate the surgeries in real time. On November 14, 1996, our technology was used internationally for the first time to transmit ocular images and live ocular surgeries between Asahikawa Medical University, Japan, and the Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA. Telemedicine and telesurgery will be useful scientific tools in the field of Ophthalmology in the near future. We believe that this technology literally opens up the world to scientific and medical collaboration. Patients with vision deficiencies and blinding disease are certain to be the ultimate beneficiaries of these interactions. Lastly, ideal implementation of IC in the field of Ophthalmology are discussed in this paper.

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)

During the past ten years bioethics has gradually become an important subject for discussion in Japan. However these discussions are quite different from those in the United States where bioethics has been a major field of study for some time. The purpose of this paper is to show the differences between the Japanese and American ideas regarding bioethics by studying the social environment in the United States. When compared to Japan, there is a great difference in this environment and the American views on ethics. Japanese studying bioethical problems should study them by first comparing the points of differences stated in this paper and then applying their conclusions to the bioethical problems here in Japan.