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Week 11: セルフメディケーション (Self-Medication) and CONCLUSION

As of 2009, there are four levels of over-the-counter drugs sold in Japan under the Pharmaceutical Affairs Law.
-Class 1: new OTC drugs or those with potentially serious side effects, which usually require a consultation with a pharmacist before they’re given to you
-Class 2: OTC drugs that have some side effects, but are not as serious as Class 1
-Class 3: OTC drugs with minimal/low side effects
-Quasi-drugs: products like cosmetics or energy drinks that have effects similar to drugs, but which can be sold outside of pharmacies
The system has a fair amount of regulation, and basically serves as another example of how Japanese healthcare is based around preventative or symptom-based care.

This week’s vocabulary:
医薬品 (いやくひん): medicine
That thing that looks like jelly is not food, it’s medicine.

新薬 (しんやく): new medicine
My grandmother’s stomach cancer has gotten worse. Is there a better and new drug?

薬店 (やくてん): drugstore (often with a more limited selection than a 薬局)
A “yakuten” does not usually have prescription drugs.

服用 (ふくよう): dosage
This medicine’s dosage is 3 times a day, 1 tablet each time.

医薬部外品 (いやくぶがいひん): quasi-drug
Soap, hair color, and energy drinks, among other things, are considered quasi-drugs.

Other sources on the subject:

The Japanese healthcare system is based around low-cost, publicly available healthcare with plenty of emphasis on preventative care. Healthcare is universal, insurance is taken out by the government or employers, and the Ministry of Health, Labour and Welfare sets prices for drugs and procedures, in a system similar to the UK’s National Health Service. Compared to other Western powers, though, Japan spends much less on healthcare than its contemporaries. This approach has some upsides, such as an emphasis on Chinese traditional medicine, self-medication and personal responsibility, but also some downsides, especially with regard to important aspects of care like hospital stays and the treatment of diseases like obesity and mental illness. Ultimately, the system will need to change in some areas in light of Japan’s increasing elderly population and decreasing workforce. In spite of some measures of personal responsibility being put into place, like the tokuho program and an emphasis on self-medication, there are still several problems with the system. The reforms from current prime minister Shinzo Abe’s “Abenomics” economic policies are one way that the government is readjusting the system, but it will take much more than this in order for the government to truly find a solution.

Week 10: 日本の健康的の食事 (Japan’s Healthy Diet)

This time, I’ve got two articles discussing one part of Japanese healthcare that I’ve overlooked up to this point: the traditionally healthy diet of the Japanese population. Although some foods (for example, miso and soy sauce) are high in sodium, and the staple of the Japanese diet—rice—is a simple carbohydrate, there are many different foods in the average Japanese diet, some of which are considered to be very healthy. The Japanese love soy, vegetables and fish, and on the whole eat less red meat and dairy than other Western societies, although their specialties in that regard are well-known. Green tea, a staple drink, is rich in antioxidants. On the negative side, also, many processed foods in Japan have MSG and high fructose corn syrup, but they make up for that by eating a variety of foods in small quantities.
Yet, unlike other Western countries, processed foods which can possibly provide beneficial effects are specifically certified as such through the government program 「特定保健用食品」or simply 「特保」(Foods with Special Health Qualities). These include things such as the beneficial microbes in Yakult, the fiber in Kirin’s Metz Cola, and certain kinds of tea. The labeling program was introduced in 1991, and now, over 1,000 products have the designation. There have been some controversial designations, though, including the Econa brand of cooking oil, which was found to have a carcinogen. In response, new rules were put in place in 2009.

This week’s vocabulary:
特保 (とくほ): food with a special health use designation
Look, that oolong tea has a tokuho label on it. It’s healthy!

タンパク質 (たんぱくしつ): protein
For the purpose of making your muscles stronger, you must eat protein.

脂/油 (あぶら): fat/oil
Recently, the fat content in the Japanese diet has increased.

炭水化物 (たんすいかぶつ): carbohydrates
Because you’re a diabetic, please be careful when eating carbohydrates.

繊維質 (せんいしつ): fiber
For my stomach and heart, I eat lots of fiber. For example, I think we should eat things like vegetables of wheat.

It’s interesting to see the impact of Japan’s diet on their healthcare. In all honesty, this system seems to place an emphasis on preventative care instead of going to the doctor for every single ailment, and the government stresses healthy eating through methods such as the Tokuho label. While not perfect, as the Econa scandal shows, it’a still fairly good on that front, and I wonder what it would be like if similar labeling systems are implemented in the West. For my last post about this topic, I think I’m going to discuss self-medication, another aspect of preventative care.

Other sources on these subjects:

Week 9: 人口減少 (Population Decline)

Another recent trend in Japanese society that will change healthcare is the population decline. This paper discusses several implications that come with the continued use of a low-expenditure healthcare system in a country experiencing a fairly steep population decline. According to the paper, there will have to be a 9-14% increase in taxpayer funding for the healthcare system by 2050 in order to compensate for the lower number of workers and accommodate the higher elderly population. Unfortunately, the potential reform policies, such as an increased consumption tax (which, after this was published, is starting to happen with Abenomics) and lower co-pays for some individuals, are not proving to be exceptionally popular to people over 35. This is disheartening, but something does need to be done about this, especially because the impact of Japan’s inverse population pyramid is so great.

This week’s vocabulary:

国民健康保険 (こくみんけんこうほけん): government-mandated health insurance
America has recently introduced a government-mandated health insurance system.

人口減少 (じんこうげんしょう): population decline
As Japan’s population decline increases, so, too, will the price on things like health insurance.

免責額 (めんせきがく): deductible
I had a car accident. But, because my insurance deductible is high, I’m fine.

自由診療 (じゆうしんりょう): treatment not covered by insurance
Drugs you buy at the pharmacy are one example of treatment not covered by insurance.

薬価 (やっか): drug price (under government-mandated health insurance)
The price of brand-name drugs is high, so please be judicious in prescribing them.

This is another political topic, but one that raises a point of contention. Indeed, the low-cost healthcare in Japan has been good and sustainable for quite some time, but I really do think there are quite a few changes that could be done. I knew the aging population could be a big factor, but the amount of labor tax needed to compensate is certainly high. This, as well as the low spending on healthcare anyway, provides a good reason as to why Abenomics is transforming the healthcare system in Japan. I still, however, have not looked much at the cultural factors behind how Japan views health, so that will be next week’s topic.

Other sources on the subject:

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: