British Journal of Rheumatology 1996;35:579-580
INTERNATIONAL LETTER
SERIES EDITOR: F. WOLLHEIM
A LETTER FROM JAPAN
T. ABE
Department of Internal Medicine, Saitama Medical Center, Saitama Medical School,
1981 Tsujido-machi Krnnoda Kawagoe-shi, Saitama 350, Japan
IT is a great pleasure for me to introduce Japanese
rheumatology in the form of a letter from abroad to the
British Journal of Rheumatology. First of all, I have to
admit that 1995 was the worst year we have ever had.
A big earthquake hit the Kobe area in January and a
vast area has been destroyed. Although most of the
structural damage has been restored, many people live
with financial and mental burdens even at the present
time.
In March, the apocalypse-obsessed AUM Shinrikyo
cult attacked the Tokyo subway system with sarin gas,
leaving 12 people dead and 5000 seriously injured. We
do not understand what they are aiming at. More
seriously, the AUM Shinrikyo doomsday cult attracted
many young followers. They came from elite
universities and included physicists, chemists, doctors
and lawyers. Something must be going amiss with these
brightest of youngsters. There may be a failure of
education after World War II.
In November, Daiwa Bank Ltd, Japan's tenth
largest bank, was ordered to close its banking business
in the USA by 2 February 1996 as a result of their
unsafe and unsound banking practices. This is the
biggest fraud in history. Japan's 'bubble economy' is
now running away with a gurgling noise and Japan
seems to be devoid of a clear national vision. In this
sense, the Japanese political situation remains cloudy
and the government does not know how to solve the
domestic and international problems which we are now
facing.
Despite this rather pessimistic political and economic
situation, the medical community focusing on rheumatology and clinical immunology is developing
strongly. The participation of molecular biology as a
research collaborator in rheumatology and clinical
immunology has attracted young students into the
field.
In Japan, undergraduate medical education training
focuses on providing students with a good understanding of the basic science relating to medicine. With
increasing frequency, rheumatology training will be
undertaken through a contact with comprehensive
fields, such as internal medicine and orthopaedics. Not
many medical schools have a full-time rheumatologist
on their faculties. Since the amount of rheumatology
training given to medical students is roughly proSubmitted 23 January 1996; revised version accepted 5 February
1996.
portional to the number of rheumatologists in the
faculty, basic rheumatology education in Japan is
obviously inadequate. Therefore, a more detailed
knowledge of rheumatology and clinical immunology is
usually taught by postgraduate training.
The Japanese Society of Rheumatology has
approved 210 hospitals throughout Japan as training
or educational hospitals for rheumatology and clinical
immunology. The approved hospitals each have more
than three full-time staff rheumatologists and a
pathologist with special interest in rheumatic diseases.
The training hospitals have their own training
programme for 3 yr. Each teaching programme is
reviewed annually by the Committee of Postgraduate
Education of the Japanese Society of Rheumatology.
The objectives of the programme are to train doctors
to function as high-quality subspecialists in the field of
rheumatology and clinical immunology, and to teach
techniques which are necessary in clinical investigation.
Thus, training programmes consist of two parts: one
clinical and one research programme. The first and
second years of the clinical programme are mainly
devoted to clinical activities including in- and
out-patient care. Trainees are also required to teach
medical students and junior house officers rotating
through the rheumatology unit. Conferences covering
e.g. radiological, immunological and pathological
features of rheumatic disease are held regularly. The
third year is devoted to basic or clinical research
according to the trainee's preferences. Research
programmes include the following. Trainees are
exposed to information on basic statistics and the
appropriate design of clinical trials. Basic and clinical
immunology which is the usual research interest of the
faculty member in charge will be taught. This includes
the biology and biochemistry of cytokines, endothelial
cell/lymphocyte and fibroblast/lymphocyte interactions, clinical significance of autoantibodies and
methods pertaining to fundamental molecular biology.
Other activities are supplied by journal club sessions,
seminars, tutorials in autoimmunity and human
immunology, and course work in immunology and
molecular biology. In the annual meeting of rheumatology in May 1995, W. J. Koopman was invited as
guest speaker. He presented new data on the
pathogenesis of rheumatoid arthritis (RA) and, in
particular, on T-cell-dependent and T-cell-independent
joint destruction in patients with RA. An international
mini-symposium on rheumatoid arthritis was held on
© 1996 British Society for Rheumatology
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BRITISH JOURNAL OF RHEUMATOLOGY VOL. 35 NO. 6
15 October 1995. W. J. Willem talked about the
surgical treatment of the RA knee joint. This type of
international mini-symposium will be held each year as
part of the postgraduate training programme of the
Japanese Society of Rheumatology. The format is 1
day of update lectures. Usually two guest speakers
from abroad and 4-5 Japanese rheumatologists will
speak. The topics are the pathogenesis, diagnosis,
clinical features and treatment of rheumatic diseases.
Another international symposium on immunoregulation was held in Tokyo on 18 October 1995 with
guest speakers from abroad being D. A. Carson
(Immune Response Gene in RA), C. G. Fathman
(Peptide as Therapy of Autoimmune Disease),
E. Sercarz (Regulation Devices Controlling Autoimmune Diseases), G. J. Hammering (Regulation of
Peptide Loading on MHC Molecules) and W. E.
Seaman (Regulation of Natural Killer Cell Activity).
All speakers presented their own new data. C. G.
Fathman covered mechanisms underlying these forms
of peptide therapy from the standpoint of immune
deviation, anergy, apoptosis or active suppression.
Two international meetings relating to rheumatology
and clinical immunology are scheduled for 1996. One
is the International Symposium on the Pathogenesis of
Rheumatoid Arthritis on 28 and 29 February 1996. The
principal visitors from abroad include P. E. Lipsky,
J. R. Kalden, L. H. Calabrese and S. Gay. The other
meeting will be the 6th International Conference on
Human Leukocyte Differentiation Antigens on 10-14
November 1996. A new CD number will be given to
new monoclonal antibodies against cell surface antigen.
The International Congress of Inflammation will be
held in 1997. We would like many rheumatologists to
visit Japan on this occasion.
At the present time, medical research funding in
Japan is rather tight, which is similar to most other
countries. The Japanese Ministry of Education, Science
and Culture offers Grant-in-Aid for Scientific Research
as well as Grant-in-Aid for Specially Promoted
Research, Grant-in-Aid for Scientific Research on
Priority Areas and Grant-in-Aid for Cooperative
Research. These grants are supplied to a limited
number of scientists after review by the Committee.
The chances of getting the grant are not so high
(~30% of applicants). The Japanese Ministry of
Health and Welfare also provides grants, but the
amount distributed to each researcher is not satisfactory. Besides these official grants, private sources of
funding through the Japan Rheumatism Foundation
are also available. However, these funds became tight
because of economic recession. Finally, there are grants
from pharmaceutical companies and private investors.
To alleviate the tight funding situation, the government
should allow tax deductions for pharmaceutical
companies and private donators.
In Japan, there are an estimated 600 000 patients
with RA according to epidemiological data. The total
number of patients with rheumatic diseases is much
higher. We have 1400 doctors who are approved as
subspecialists in rheumatology by the Japanese Society
of Rheumatology.
Many teaching hospitals in Japan welcome foreign
doctors as fellows. Although Japan is located in the
Far East and living expenses are high, we are eager
to recruit such fellows. Since most Japanese doctors
speak English, there is no problem in communicating
either.
Visiting fellows at present come mostly from China
and only a few fellows come from other parts of the
world. We do expect many doctors from abroad to
spend time with Japanese rheumatologists.