Monthly Archives: October 2014

Week 8: アベノミクス (Abenomics)

While most of what my research project has discussed is about Japanese healthcare as it is now, I now want to look at what it looks like for the future. Prime Minister Shinzo Abe, through his “Abenomics” economic reform, is doing a lot with so little. He already has “fired” two of the “arrows” that are part of his plan, but his third one is of most significance. Mainly, Abe wants to deregulate industries, including the Japanese pharmaceutical industry, which is dominated by drug companies such as Astellas, Takeda, Otsuka and Eisai, in order to bring forward more generic drugs. Since Abe is attempting to revitalize the Japanese economy, it makes sense that he would go after healthcare. After all, there’s very little spending on it anyway in Japan. But some, especially pharmacists and pharmaceutical companies, are concerned that placing an emphasis on generic drugs will decrease competition, as well as research and development. The Japanese government has also stated that pharmacists, who usually get a commission for sales of more expensive brand-name drugs, will get partially subsidized in order to counter the loss in profit from generic drugs.

This week’s vocabulary:
医療制度 (いりょうせいど): health care system
The Japanese health care system has gotten bad as of late. After Abenomics, what kind of health care system will it turn into?

保健所 (ほけんしょ): health care center
I’m always tired, but I got some good advice from the health care center about that.

ジェネリック医薬品 (いやくひん): generic drug
Why are generic drugs so cheap? The branded ones seem to work better. Perhaps.

処方 (しょほう): prescription
So, for your pneumonia I’ve prescribed penicillin. Please go to your pharmacist.

研究開発 (けんきゅうかいはつ): R&D, research & development
She’s not an “office lady.” She’s the chair of research and development at a good pharmaceutical company.

I know this topic is a lot more political in nature than the previous ones I’ve looked at on this portfolio, but it’s still a very important one, because it’s a potential way that Japan could fix its healthcare system. With these Abenomics reforms, Shinzo Abe has started to transform not just the Japanese economy, but also the Japanese healthcare system, because his goal to revitalize both is to increase expenditure. This is in spite of the fact that he’s implicitly discouraging competition with a new focus on generic drugs. In spite of their low-expenditure system, which I have been looking closely at since this portfolio started, I’m still surprised they’re going through with this sort of thing. It could not come at a better time, however, as next week I’ll look even deeper at the effects of Japan’s aging population on its healthcare system.

Other sources on the subject:

Week 7: 引きこもり (Hikikomori)

The term “hikikomori,” which literally means “pulling away,” describes a uniquely Japanese phenomenon where young adults close themselves off from the outside world. First described in the late 1990s by psychiatrist Tamaki Saito, it has been seen by some to be the result of the new socioeconomic tensions brought about by the worldwide increase in globalization and the pressure put on young adults to go to college and find work. But whether or not it is a mental disorder or a silent rebellion is up for much debate, as some hikikomori have shown obsessive-compulsive tendencies, while others have self-harmed. In spite of this fact, treating hikikomori has proven to be exceptionally difficult, as some have done so by treating it in a rehabilitative manner, that is, the people treating hikikomori believe they can reintegrate themselves into society. Because of the long-standing stigmatization of mental health in Japan, this has been the preferred method of treatment over, say, drugs. In the end, though, when the Japanese government backed a study showcasing how hikikomori become that way, they got as inconclusive of an answer as one would expect. In the end, both social pressure and economic prospects play roles, as well as schizophrenia in some cases. Add the relative lack of mental health care in Japan, and this phenomenon is rather unique.

This week’s vocabulary:
知能指数 (ちのうしすう、またはアイキュー): IQ, intelligence quotient
That guy’s IQ is 150, and he goes to the University of Osaka, so he can definitely get a good job.

社会不安障害 (しゃかいふあんしょうがい): social anxiety disorder
When I talk to anyone, I always get incredibly anxious. So, I have social anxiety disorder.

強迫性障害 (きょうはくせいしょうがい): obsessive-compulsive disorder
She always does chores, and usually washes her hands 4 times after going to the bathroom. She has obsessive-compulsive disorder.

治癒 (ちゆ): recovery
Your son’s a hikikomori. So, for the purpose of recovery, why don’t we accompany him on his day out?

甘え (あまえ): dependence on others (esp. used in context of motherly love)
Don’t depend on anyone. Your mom’s old, you know.

I remember learning about hikikomori in both my high school Japanese course and my Communications/Inquiry course, but I had no idea just how prevalent it really was, nor had it occurred to me the impact that Japan’s mental health infrastructure has on it was so great. Along with Japanese culture’s pride on both motherly love and success outside of the family, there are plenty of reasons why this phenomenon exists. The fact that some parents keep supporting their hikikomori children in spite of all of this is also interesting to me, but it also does not seem like this phenomenon is linked to affluence.

Other sources on the subject:

Week 6: メンタルヘルス (Mental Health)

Japan’s stigma towards mental health has been apparent since at least the 1900’s, when the Law of Confinement and Protection of the Mentally Ill was enacted. It more or less separated mental illness sufferers from the rest of the population, and prisoners with mental problems were first in line to be executed. Not to mention, Japan’s suicide rate is among the highest in the world, and probably the highest in a developed country. And it’s not just due to the notion of an honorable death; rather, the rate of depression in Japanese society is also very high.
Conversely, some Japanese have figured out the impact of mental illness on society. For instance, there has recently been an uptick in prescriptions for anxiety and insomnia drugs known as benzodiazepines (such as Xanax and Valium) in Japan, a phenomenon discussed in the Xinhuanet article above. These old drugs, while very effective in treating anxiety issues and sleep disorders, are also addictive, and this goes against the Western consensus that anxiety disorders should be treated with antidepressants on a long-term basis and, if benzodiazepines are used, it should be in the short term. Never mind that most Japanese doctors still have a limited understanding of how depression and anxiety work. Although mental health in Japan is better understood than before, the stigma attached to it is still great.

This week’s vocabulary:
うつ病 (うつびょう): depression
One of my patients with depression said he wanted to kill himself, and I’m worried.

不安 (ふあん): anxiety
Japanese doctors don’t often use medication for treating anxiety disorders.

不眠 (ふみん): insomnia
I have horrible insomnia before tests. What should I do?

精神科医 (せいしんかい): psychiatrist
When his mother died, he talked to a psychiatrist about it.

中毒 (ちゅうどく): addiction (suffix)
Why are you drinking so much coffee? Jeez, you’re such a caffeine addict!

The way Japan still stigmatizes mental illness is surprising, especially because of the country’s high suicide rate and development of phenomena such as hikikomori. It’s to the point where safe medications for mental illness are often overlooked. For example, Luvox/fluvoxamine, an extremely effective drug in the treatment of disorders like depression and OCD, was approved in Japan in 1999—over a decade after it had been introduced into clinical use. They still haven’t approved arguably the most well-known member of that drug class, Prozac/fluoxetine. Perhaps it is because of the treatment of mental illness, which is highly individual in nature, going against the one-size-fits-all collectivism present throughout Japanese society, that mental illness has been shut out of an otherwise advanced healthcare system. Next week, I plan to take another look at one mental health-related phenomenon unique to Japan: hikikomori.

Other sources on the subject:

Week 5: メタボ (Obesity/Metabolic Syndrome)

Why is Japan’s obesity rate so low compared to other world powers? This article from The Atlantic discusses a major reason: the so-called “Metabo Law.” メタボ is short for メタボリックシンドローム, or metabolic syndrome, which consists of high blood pressure, high blood sugar, high cholesterol and obesity. But the abbreviated term has become popular enough in Japan to refer to obesity itself.
Once again, the government mandate is the norm here, and any people suffering from obesity or any of the illnesses involved in metabolic syndrome have to go to mandated dieting classes or risk having their companies or city governments pay fines, and companies have to have a low percentage of overweight individuals or risk fines as well. Of course, such a stigma would never go over well in the United States, but it could incite some discussion.

This week’s vocabulary:

メタボ: metabolic syndrome/obesity
If you’re obese, you can’t miss those classes! Do you want to quit your job?

肥満 (ひまん): obesity (technical term)
People with obesity, please be mindful about your weight.

糖尿病 (とうにょうびょう): diabetes
My dad’s diabetes has gotten bad. He’s always injecting himself with insulin.

心臓発作 (しんぞうほっさ): heart attack/failure
Is your grandfather okay? I heard he recently had a heart attack. I think that’s scary.

菜食主義者 (さいしょくすぎしゃ)、または ベジタリアン: vegetarian
For my health, I want to become a vegetarian. But steak is too delicious (to give up)…

I am not a firm believer in government regulation, but I am certainly intrigued by the way Japan does it in order to combat their side of the worldwide obesity epidemic. But there is a weird paradox there, too, as I remember from my stay over there that going to restaurants was more of an occasional treat than an everyday thing, a far cry from the US point of view. And, of course, their diet is one of the healthiest in the world, another fact the article mentions. So, it’s all due to a combination of factors, really. Next week, I plan to take a look on another disease (well, disease segment) that the Japanese have a very different view on than the US: mental illness.

Other sources on the subject:

Week 4: たばこ (Smoking)

One of the major public health risks in Japan that has been treated differently, culturally speaking, than in the US is smoking. Until 1985, the Japanese government owned the largest tobacco company in the country, Japan Tobacco, and they still own two-thirds of it. Lawsuits calling for tighter regulation and even health warnings have been scrapped. How could a country known for being so healthy embrace a decidedly unhealthy habit? This article from This Japanese Life offers some insights on the matter.
As it turns out, there’s an interesting paradox when it comes to smoking in the Japanese population: they smoke more, but have lower rates of lung cancer (although smoking is the major cause of it by a large margin). There are several reasons as to why: Although the Japanese smoke more cigarettes, they usually do not finish them, leaving quite a bit behind. They start later, with about 60% starting after the age of 20 (the age of majority, and the age required to purchase cigarettes). And, perhaps most surprisingly, they drink lots of tea, which has been shown to be an excellent cancer preventative. Finally, Japan’s view of smoking as a moral choice rather than a disgusting habit, even now, is certainly an interesting one. And the smoker’s paradox is quite unlike anything in other powers of its size.

This week’s vocabulary:

肺 (はい): the lungs
Are you traveling to Beijing? Please check the air pollution levels. I’ve heard the air there can be bad for your lungs.

肝臓 (かんぞう): the liver
The liver is the largest of the internal organs.

胃 (い): the stomach
I ate a lot recently, and my stomach hurts. Do you have any antacid with you?

脳 (のう): the brain
I think doing math is a good idea. It’s important for your brain!

腎臓 (じんぞう): the kidneys
A: 腎臓が気になります。
B: もっと水を飲めばいいでしょう。
A: I’m concerned about my kidneys.
B: Then drinking more water would be a good idea.

Japanese attitudes towards smoking not as a health problem, but as a social/moral problem, would never fly in the US, Canada, or even other countries within Asia. Compared to stern warnings on packages and commercials that show, say, graphic images of diseased lungs, Japan gets a relative slap on the wrist. And the fact that their rate of lung cancer is low compared to other countries, which also shocked me. And yet, the rate of smokers keeps falling every year, which may suggest a shifting trend towards the other end of the scale. Then again, maybe this shouldn’t be all that surprising because of the very healthy Japanese lifestyle, but every country has their unhealthy habits. Next week, I think I’m going to take a look at how the Japanese look at another lifestyle-oriented disease common in Westernized societies: obesity.

Other sources on the subject: