Dr. Muto’s Challenge: Building Ageing Community Healthcare

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In Japan and other developed countries, the conventional healthcare system is facing its limit because of continuing expansion of the aging society, chronic diseases, and the limited public funding for healthcare(ref.1). 

I have been speaking on this issue for some time (the most recent articles  (ref.1:in Japanese)include), I’ve made policy recommendations, urging people to take action, but things are not moving as I hoped, because, I suspect, of oppositions from the conventional interest groups.

However, there are some people who are starting to take action in their own way to make change.  One example is Dr. Yu Muto.

Dr. Muto spent 10 years or so as an established medical doctor. But he left his career in hopes of achieving higher goals. During this departure, he worked outside medical practice for a couple years.
After this experience, he launched an innovative, urban-style community medical practice.

I was deeply impressed to hear Dr. Muto after he started this clinic.  He said, “I left medical practice to search and explore my life work.  As I resumed my work as a doctor in this city of an aging population, I now feel from the bottom of my heart that this is truly what I have wanted to do.” 

Dr. Muto and I had a dialogue (in Japanese) recently, and it is on his website. 

His words reflect his truest feelings. He is following his dream. This is the beginning of something wonderful.  I congratulate him wholeheartedly and will support him in anyway possible.

The See-D and D-lab Activities Continue

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Previously, I introduced the event called ‘Technologies Appropriate to Local Needs Will Save the World’ . It was held in July by the students’ initiatives of D-Lab at MIT and Kopernik, (in Japanese).

Their activities later developed into sending students to East Timor in order for them to see the place firsthand -  to feel the situation, identify the issues, search for solutions, and craft plans for possible projects.  The results of their observations and analyses were displayed and presented at GRIPS, my home institution, on October 22nd.

Participants commonly reacted with surprise to experiences in East Timor.  Much of this reaction was reflected in their work. They described the proposed projects with strong emotion ? with a passionate drive to introduce solutions to the issues they observed.

To have a discussion about their plans was part of their objectives and was also included in this event. Together, with the participation of commentators and Professor Yonekura of Hitotsubashi University (Ref.1), an avid supporter of this sort of activity, triggered not only great excitement, but also materialized great learning opportunities to all who participated.

A review  of this gathering is available at Kopernik, and ‘here’ (in Japanese) and ‘here’ (in Japanese)

Like the lively discussion that took place at this conference, I advocate for analyzing ideas in a serious but positive manner. Where there is room for support or opinion do so cautiously. Give constructive criticism that encourages the students to further think about the problems and tasks at hand. Refrain from merely providing the solution, especially since you don’t know if different sorts of creative solutions will emerge from those students, youth, or young professionals.  Provide support, but without too much meddling.  And most importantly, never discourage the youth. If you do so, the only service you will provide is to chill their passion. Encourage youth by helping them see for themselves the world around them. Be silent but strong for them, and remember that our future lies in their hands.

As for the young individuals you gathered in the conference room to discuss East Timor, each and every one filled to the rim with passion for what they spoke about. We need this sort of energy to be felt more.

 

Speech on Healthcare Policy

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My reports are somewhat delayed than usual, but I have returned home on October14th from a slightly long travel which started on 5th.

Next day in the morning, at the Denmark Embassy in Tokyo, I gave speech on ‘Healthcare Policy for the Aging Society’ to the audience of about 30 or so of legislators and other members of Denmark’s delegate visiting Japan.  I was told that  Ambassador Melbin  (Ref.1) and the audience enjoyed my speech.  (by the way, around April or so, I went to see the Ambassador to talk about the World Cup; and, of course, the Japan-Denmark match….)  The discussions in Seattle turned out to be very helpful in preparing my speech.

After leaving the Denmark Embassy, I headed to Haneda airport to fly to Matsuyama.  The Panasonic Shikoku in Matsuyama is focusing on healthcare and they asked me to speak on topics on ‘Healthcare Policy for the Aging Society’.

I was being so focused on this theme for these days, so I was able to learn much from these events, and also was able to develop new ideas.
 
Developed countries share common challenges; ‘1. Continuing growth of the aging society, 2. Chronic diseases as a major disease burden, and 3. Public funding for healthcare being hard to increase’.  I have written about the framework of my ideas in many occasions, and my view remains essentially the same as of today.  What I think is uploaded in recent On-line article of Nikkei (in Japanese), so please have a look.

These are without doubt one of the top priorities of political issues today.

 

The 100th Anniversary of the Swedish Hospital in the beautiful City of Seattle

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Recently, I have posted a series of reports from Seattle. The distinguished Swedish Medical Center (SMC), one of the oldest organizations in Northwestern America, invited me to participate in their 100th Anniversary celebratory Symposium (Ref.1)at the Bell Harbor Conference Center.  Since I have been interested in their activities for quite some time and the proposed program was quite impressive, I thought this was a good opportunity to experience SMC first hand. The overall theme was local health care systems, particularly in the Northwest regions of America. Experts in various fields joined to speak about their experiences so that they might apply their findings to the ailing American health care system.

The Symposium opened with these videos (Ref.1). I had the pleasure of being seated at the same table as Ms. Lisa Cohen, the Executive Director of the Washington Global Health Alliance and who appeared in the latter video. We spoke and found we had several friends in common. I enjoyed our conversation immensely and discovered that apparently she began her career as a journalist.  

Each person was wonderful in his or her own way. Aside from those in my field of medicine and health care, I was particularly impressed by Mr. Jeffrey Immelt, CEO of General Electric. There were also two congressmen from Seattle who appeared in the panels, Dr. Jim McDermott (Ref.1,2) and Mr. Jay Inslee(Ref.1). Their speeches were very inspiring and innovative.

I found the lectures so intriguing that I ask the organizers of the Symposium to let me know when the rest of the lectures are available on the web.  I would very much like to share them with my friends and the visitors of my web site.   The photos from the Symposium is uploaded on the web already.

There were many debates and conversations had throughout the Symposium, and though there were many things discussed, there were twelve ideas that seemed to be more or less ubiquitously agreed upon. 

Because the Symposium was located along the waterfront of downtown Seattle, I was able to take short walks between sessions. Luckily, the weather was bright and sunny. I enjoyed the views of the Puget Sound, and of the Olympic Mountains. I also stopped by the original Starbucks in Pikes Place Market. I also stopped in at the Seattle Aquarium and saw a variety of fish (I happen to quite like aquariums).  Also, as reported in my previous postings, I met several Japanese students (Ref.1,2) who took leave of absence from school and are currently studying in Seattle. Over the course of two evenings we had a wonderful time together during dinner.   In closing, I found Seattle a beautiful and tranquil city.

‘Recommendation to Take Leave of Absence from School’, Seeing Students….’, A Follow Up of Follow Up from Seattle

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Today is the last day in Seattle.  I found an e-mail message when I returned to my hotel room from the meeting.  It was from the senior student at Keio SFC (Ref.1) who is now studying at ISAYA, University of Washington  for a semester of 6 months.

The message went as follows;

? “How do you do?  I am a senior student at Keio University SFC.  Please forgive me for this abrupt contact.
? I am currently studying at University of Washington in Seattle, taking a leave of absence from school.  To my regret, I was not able to join the dinner you had because I did not find your message in twitter early enough.
? If you plan to have another such gathering, I would very much like to join.“

So, I quickly responded by e-mail; ‘I am having dinner with your ‘senior’, a Keio alumnus, so why not join?’; ‘Thank you. My class will be over in an hour, so I would be happy to join you then..’

It took a while for him to come because he took a bus, but he managed to arrive in time to the Waterfront Seaffod Grill  His ‘senior’ whom I mentioned, is Dr. Kubota, the founder of a Biotech Venture ‘ACUCELA’, formerly an ophthalmologist graduating from Keio University School of Medicine.  Another guest is Ms Claire Topal  of ‘National Bureau of Asian Research (NBR)',  an organization that started in Seattle, whom I have been working with for these 4 years.

Just as we were having a good lively conversation in Seattle, in Japan, my course at the Keio SFC was being held.  Today, the guest is Mr. Kazuhiko Toyama, well known for his open and frank remarks such as in his books; ‘Yubi ippon no syunen ga shyobu wo kimeru (A finger-tip of obsession decides the winner)’ and ‘Kaishya wa atama kara kusaru (A company will rot from the head)’.  I made a phone call to find out how things were going at the class, thanked Mr. Toyama over the phone and we had a good conversation.  Truly, the world is one world, and things are getting so convenient.  Lectures in my course are posted on this web site for free viewing.

I advise you all to go ‘out’ of Japan, just as this student at Keio did.  Something good will happen.

 

‘Recommendation to Take Leave of Absence from School’, Meeting Students Who Took Leave of Absence From School and Are Studying in Seattle

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I posted in my twitter from Toronto that ‘I will be leaving for Seattle.’  Two Japanese students (one of them is a graduate student) currently studying at the University of Washington  in Seattle sent me responses via twitter.  I replied on the spot and we arranged to meet in two days.

On the evening of 10th, the day of my arrival at Seattle, we had a dinner at The Edgewater Hotel (top photo) where I stayed.  One more student joined and four of us had a good time together.

Two of the students were juniors at class of undergdates.  They took leave of absence from Japanese university and are studying here from this September.  Since their home university will not admit credits earned at University of Washington, they decided to take leave of absence.  However, I am sure that they are having opportunities to study many things, and moreover, will be able to acquire broader perspectives, to see Japan and themselves in the global framework.  They will also build networks of friends from all over the world.  All of those things are very valuable for their future careers.

One other student, a graduate school student, is doing research for one year.  She said that she enjoys being here very much.  She also feels that things are very different compared to Japan.  That reminded me of a student I saw at Harvard University this January, who was a Post-doctoral fellow, saying that ‘So far, in the not so many years I have lived, having earned Ph.D. in Japan is the only thing that I regret.’  I think this young doctor was able to feel that way because he was in a US leading university research environment where MDs and PhDs from variety of universities gathered as Post-docs; the ‘Place’ for ‘open competition with many MD and PhD peers from different insitutions’. ‘A frog in a well does not know the great sea’ – just as the proverb goes.  I expect a lot from you, all professors and teachers of Japan. ‘Students are Mirrors that Reflect Their Teachers’ – your ability as a mentor/educator/researcher is judged by the PhDs you have supervised.

By the way, I hear many comments worrying about Japanese youths not going abroad, but we should also be aware of the fact that the number of researchers going abroad is also sharply declining. (in Japanese) This is horrible.  Do professor want to keep their students under his/her supervision as subordinates?   The two Japanese Nobel laureates  of this year also have overseas training as their backgrounds, I understand.  One of them built his career in the U.S.  Professors of Japanese Universities, I urge you to encourage youths to mix with other students or researchers for training and competitions as samurais did.  ‘If you love your child, let him/her travel (kawaii ko ni wa tabi wo sasero)’, ‘speech by Steve Jobs of Apple’…their points are all the same.

The three students seemed to be enjoying their leave of absence from school in Japan.  It may be a rare but a great opportunity to find your ‘self’.

 

From ‘Healthcare System’ Reform to ‘Health and Healthcare System’ Reform: My Basic Idea

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Healthcare system reform is a huge political issue not only in developed countries but also in emerging or developing countries and in global society.  This is because of the rapid changes taking place in the structure of major diseases based not only on the progress of healthcare technologies but also on the enhancement of life expectancy, changes in social structure and in lifestyle.

In addition many societies share the problem of aging population.  Since public funding for healthcare expenditure is already pretty much to its limit even in developed countries this is another big challenge.  Also it is clear that income inequality within and across the countries continue to expand in this global world.

So, Japan is not the only nation that faces problems related to healthcare.  However, there are some reasons particular to Japan that make system reforms particularly difficult here.

This is one of the main themes that we work on at the Health Policy Institute, Japan.

However, in view of such major changes in our society, it is clear that healthcare system must be structured with more attention to social aspects.  In other words, we must take into consideration ‘Social Determinants of Health’ (Ref.1) in our policy, thus we must create not ‘Healthcare (Medical, in principle) System’ as it is but rather ‘Health and Healthcare System’. Otherwise I suspect that winning public support for policy or its implementation would be difficult.

Here, I will introduce to you my recent interview (in Japanese) reflecting such thoughts.

Same perspective is also expressed in my book ‘University Hospital Reform (Daigaku Byoin Kaikaku)’ (in Japanese).

Ohya Stone Underground Mining Pit Remain, Teleconference with Canada, and To Mishima

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In the afternoon of September 24th (Fri.), I headed to Utsunomiya to give a lecture at the Japanese Society of Nephrology Eastern Regional Meeting.  Nephrology had been my main background, so it was nice to see Dr. Kusano, the President, and many colleagues at the venue.

Reception was held at a huge underground hall about 15 minutes’ travel by car from downtown Utsunomiya which was originally remain of a mining pit of Ohya stone (Ohya Ishi).

The place actually had quite a good atmosphere.  I found many photos at the blog site of a person who had been here before. (in Japanese)

Underground was quite cool (around the year average temperature is ８℃ (46F)).  Gyoza, the local specialty, beer, wine were served at the reception as well as the special flamenco show.  We spent a good time.
 
The schedule of events at this underground space, as I saw it, seemed to have room for more variety of activities.

I suggest that you visit here when you have an opportunity to go to Utsunomiya area.

After returning to the hotel, I participated in a teleconference on Grand Challenge Canada  for two hours from 10pm to midnight.  Toronto served as the hub for this telecommunication.

On the next day, September 25th (Sat.), I returned home briefly and then headed to Mishima city in Shizuoka Prefecture.  This trip was to give a lecture at the Japanese Telemedicine and Telecare Association (JTTA) (in Japanese) organized by Professor Nakajima, who created telemedicine and telecare training program at Tokai University School of Medicine mainly for international students.  I owe Professor Nakajima for his presence at the Pacific Science Association in which I am part of, in Okinawa  and Tahiti  (Ref.1, 2, 3).  By the way, although this meeting displayed a number of interesting corporate exhibitions they seemed somehow to be intended only for Japanese audience (users) from the start.   I think this is a pity since the world is broad and there must exist great needs.

Giving lectures at annual meetings of scientific societies was something I have done less for a while.  I enjoyed and appreciated these opportunities of two days in a row.

Hayman Island, ADC Leadership Retreat -2

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Please click here for the photos.

The 2nd day at Hayman Island was beautiful.  We should be outdoors in such day.

However, the program was quite packed.  I was scheduled to be at the ‘Kailis Oration’ (Session 6) (cf. the program).  This opening session of Day 2 was again hosted by Nik Gowing.  It was an exciting session starting with questions raised by Bjorn Stigson, the photos linked above which I appear are of this panel (also included are the 2 photos of Nick Stern (facing backwards), myself, and Bjorn Stigson after the panel).

Clyde Prestowitz, whom I met in Tokyo a few weeks ago, is also participating in various discussions starting today.

For lunch session, I joined session 9.5, a panel surrounded by beautiful greens.  Somehow the discussion focused on the issues of Australia.  My colleague William Saito was also on the panel with me.  Chris Selth said that there were few targets for VC, was quite critical in that sense pointing out how dependent Australia was on its rich natural resources for its economic growth…. Then followed the plenary lecture by Richard Wilkinson  (right after session11).  I think that producing such type of academics as Dr. Wilkinson represents one of the strengths of British academic community.
 
Another session was ‘Cybersecurity’ (session 12.2) hosted by Nik Gowing.  William Saito did a very good job here.

On the 3rd day, 29th, I was especially impressed, among many, by Stephan Bungay in session 16.3, and Bror Saxberg of Kaplan (I felt that the power of the US lies in the fact of having quite a volume of extraordinary, brilliant and ‘crazy’ people like him) in session 17.3 ‘Education futures’ whom I have introduced to you in my last report , and my old friend Jeff West (another brilliant and ‘crazy’) in session 20.3.   These sessions were all very moving and thought provoking.

There were of course many other sessions that I would have liked to join, but as you see from the program, doing so was not easy.

My last appearance in the afternoon was with William Saito at ‘Japan -Perspectives on Change’ (session 19.3).  Australia, the host country, has just gone through the federal election which ended in an unexpected result and people here were talking about it excitedly.  On the other hand our story is; ‘Japan?  Well, we had 5 prime ministers in these 4 years.  Maybe the 6th is coming soon?’ ? isn’t this a bit sad?  I tried to include many comparisons and metaphors to make my points of Japan clearly understandable to non-Japanese intellects; perhaps, I somewhat succeeded since after the session I was told by several people that my discussion was ‘very persuasive, clear, and easy to understand’.  I do think that the current (and even the last 50 years') situation of Japan is difficult to understand if we do not present them in a sound logical manner, focusing to the basic issues and from outside perspective.
 
The closing ceremony ended by a very moving speech by Michael Roux, the host.

We enjoyed a nice dinner reception in the evening.

I would say that this 3 days’ retreat was a very nice event of a good size which made it possible to share much more intimate time, even more than the World Economic Forum in Davos (which I posted for many years), with truly wonderful participants to exchange different and common views and share new ideas. I was able to see my old friends, make new friends, see ‘great’ people such as those whom I have introduced to you in my report postings ‘1, 2’ and Gita Wirjawan  (Ref.1) of Indonesia.  I learned a lot from each of them.  Also, I was lucky enough to be asked to join in many good sessions in earlier phase (opening panels of day 1 and day 2) so many new friends noticed me from early of this three days Retreat  I sincerely thank Michael Roux for his invitation and thoughtsfullness.

 

Japan-Korea Exchange, Happy Gatherings

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Speech by President Lee on August 15th was for about 20 minutes.  Regarding the relations with North Korea the President expressed 3 strategic steps of partnerships based on ‘Peace’, ‘Economy’, and ‘Korean Reunion’.  I would like to read it if English and/or Japanese translations of the full text were available.

During my stay at Seoul, I was given lots of opportunities to meet people.  To my lecture at the Seoul National University, my old and new colleagues in nephrology, the science of kidney, gathered on the occasion and Dr. Narry Kim (Ref.1,2) a L’Oreal Prize Laureate of the year 2008 kindly came to the confenerce.

In the evening of 13th, the day I arrived at Seoul, I had dinner with Dr. Ju (Ref.1) whom I have introduced to you before.  Dr. Sumio Ishida, the specialist of the history of medicine in Korea (Dr. Ishida has many writings on the history of medical educations in The Netherlands and Korea) and Professor Lee, Heung-Ki (who studies history of hospitals in Korea at the Seoul University) (Dr. Lee’s photo is uploaded at the top of the previous column posting) also gathered and we all celebrated the happy reunion.  Dr. Ju is now 89 years old, but he is still very clear-headed; a truly wonderful person.
 
In the evening of August 15th, we invited a Korean female sophomore student of Waseda University who is currently spending her summer vacation with her family in Seoul.  She used to live in Japan until 5 years old because of her parents’ work and her Japanese is impressive.  Her older brother is studying in Canada.  She is very focused about her career goal and told me that she chose Waseda because of that goal.  She was selected to be a recipient of the scholarship (in Japanese) offered this July by the alumna of Waseda University  (in Japanese). I was very delighted to learn this good news.  I would like to see more and more of such mutual exchanges of young students to take place.

In the morning of 16th, the last day, I came across by chance with Dr. Tsutomu Nakada (in Japanese)(Ref.1) at the Executive Lounge of the Hotel.  I talk to him once in a while over a telephone but he happened to arrive at Seoul the day before yesterday and was leaving for Japan today.  What a coincidence!  This kind of unexpected encounter is apparently one of the hidden pleasures of traveling.  We enjoyed a brief catch ups.

Lunch was with Dr. Han Seung-Soo.  Dr. Han had been appointed to a series of ministers of the Government of Korea, is well known in international arena, was President of the 56th session of the General Assembly of the United Nations (on the very morning of his inauguration ceremony the September 11 happened in NYC….), was a Professor of the Seoul National University.

Dr. Han Seung-Soo published a book ‘Beyond the Shadow of 9/11’  which records one year of his experience as the President of the General Assembly of the United Nations.  This book is a very impressive work which I highly recommend especially to those who seek careers in diplomacy or United Nation and other international istitutions.

Japan and Korea are neighbors.  We share and have long history of deep relations in various fields such as economy, politics, and culture….for over 1,500 years.  We are the most important partner to each other in this globalizing world.  To perceive whatever issue as ‘two neighbor nations in a big framework of the world that is changing dramatically’ and to think accordingly is crucially necessary and important.

This was also one of main messages of my lecture at the Seoul National University which I have reported to you in my previous posting.