After achieving a spectacular economic growth through 60's to 80's of the 20^th Century, Japan seems to have lost its momentum and stays stagnant in the last 10 years of so-called ‘a lost-decade’. What has been wrong? Here, I will discuss the historical background and the social structure of modern time Japan and their relevance to the global changes driven by information and transportation technology which affected political, economical, and social environments of the world or so-called ‘globalization’. In this context, it will become clear that the mechanism that has supported the success of modern time Japan will no longer be workable in this time of ‘globalization’ of 21^st Century and will left alone even in Asia. To avoid such perspective, radical changes in nurturing future leadership is urgently needed.

The Committe of the Ministry of Education, Sience and Culture of Japan on “Medical Education and Health Care of 21st Century” has specifically made a recommendation, in June, 1996, that Japanese medical school should consider adopting a system similar to that in the USA in that medical school may become 4 years curriculum accepting graduates of 4 years non-medical university curriculum. There are many features in contemporary Japan which make this “4+4” years medical education system highly meritorious.

Background : With a support from Ministry of Health and Welfare (MHW) Japan, we embarked on a pilot study for Prescription-Event Monitoring (PEM) adapted to Japanese environment.
Methods : A pilot study was conducted according to the report on this subject to MHW in 1996.
Results and Conclusion : PEM using monthly claims called as “Rezept” issued by individual hospitals and clinics is judged to be difficult unless the use of the claims for epidemiological studies is legally separated from the examination process of the medical cost claimed. PEM using the prescriptions dispensed by individual pharmacies is easier to conduct. Some progress has been attained by employing the latter scheme in the pilot study where approximately 1300 patients with a new antidiabetic agent, troglitazone, are compared with 1300 patients who have recently started one of “old” antidiabetics.

Background : With a suppport from Ministry of Health and Welfare (MHW) Japan, we studied the feasibility of conducting event monitoring in Japan similar to Prescription-Event Monitoring in England. The manuscript presented is a report to MHW in 1996.
Methods : Means available in Japan to identify drug, patient and doctor are examined. In addition, any modification needed to make on a questionnaire sent to doctors in PEM conducted in Japan is examined.
Results and Conclusion : Monthly claims called as “Rezept” issued by individual hospitals and clinics and sent to insurers and outpatient prescriptions issued by hospitals to be dispensed by the pharmacies outside the hospitals are considered to be two available means to identify drug, patient and doctor. To have a sample representative of all drug users, the use of “Rezept” is needed as only a fraction of outpatient prescriptions are dispensed by independent pharmacies. However, the use of prescriptions dispensed by the independent pharmacies together with the cooperation of individual pharmacies is capable of finding a contemporary control which is a group of patients who have recently started “old” drugs comparable to the new “test drug”. In Japan no doctor may have a complete list of the hospitals and clinics a patient has visited and it is mandatory to ask doctors the last date when the patient visited the doctor. To clarify what problems arise when a PEM-like study is introduced to Japan, a pilot study is going to be done during 1997 and the feasibility will be examined further based on the results.

The working group on the medical education system in the Japan Society for Medical Education had 2 meetings in 1997. In those meetings, members of the working group discussed on the following 4 problems related to the medical education;
1) System to accept the graduates of other departments (Gakushi) into medical school
2) Clinical professorship
3) Post-graduate universities
4) Education in the department of general medicine (Sogo-shinryo-bu)
The results of the discussions are reported.