In Memoriam
Tribute to Dr. Chuichi Kawai — A Great Cardiologist in Japan —
2025 年 89 巻 1 号 p. 2-5
詳細
2025 年 89 巻 1 号 p. 2-5
Professor Emeritus Chuichi Kawai of Kyoto University’s Third Department of Internal Medicine passed away on February 19, 2024, at the age of 95, living his allotted lifespan. While praying for the soul of the departed, we respectfully offer this memorial as junior members and disciples of him.
Dr. Chuichi Kawai (Figure 1) was born in Kyoto, Japan, in 1928. In his book, he relates that he became a doctor because he had experienced tubercular osteomyelitis, which was said to be difficult to cure at that time, as well as because he had become a Christian and had been baptized.1 Even though all values were reversed after the war in Japan, he continued to hold on to his ideals and worked hard at his studies, graduating from Kyoto University’s Faculty of Medicine in 1953. In 1962, he studied abroad as a Fulbright Exchange Researcher at Stanford University School of Medicine in the USA, followed by Harvard Medical School, and returned to Japan 3 years later in 1965 as a lecturer at Osaka Medical College (now Osaka Medical and Pharmaceutical University). On his return home, he saw the situation in Japan with new eyes, and his already strong desire to introduce new, clinical-centered American-style medicine to Japan became even stronger. In 1974, he became a professor at Kyoto University, succeeding Professor Takayasu of the Third Department of Internal Medicine, and a role he served for 18 years, until 1991.
Dr. Chuichi Kawai.
Dr. Kawai served as President of the Japanese Circulation Society in 1986, when the 50th Annual Scientific Meeting of the Japanese Circulation Society was held at the Kyoto International Conference Center (Figure 2). He also served as the Chief Director of the Japanese Circulation Society for 2 terms (6 years), from 1988 to 1993. Furthermore, in 1987, he became the 5th president of the International Society & Federation of Cardiology (ISFC), and was awarded the Japan-US Cooperative Medical Sciences Program Award. He was also a board member of the Cardiovascular Pharmacotherapy International Symposium (CPIS). In 1989, he held the CPIS at the Kyoto International Conference Center as the third president (Figure 3).
At the 50th Annual Meeting of the Japanese Circulation Society, where Dr. Kawai served as president. Dr. Kawai is on the left, and Dr. Kambara, the Secretary General, is on the right.
At the Cardiovascular Pharmacotherapy International Symposium (CPIS) at the Kyoto International Conference Center in 1989, where Dr. Kawai served as president. Dr. Kawai is third from the right.
He also served as the Director of Kyoto University Hospital for 3 years from 1989.
After his retirement in 1991, he became a professor emeritus at Kyoto University, director of the Foundation for the Promotion of Longevity Science, director of the Kyoto Regional Study Center of the Open University of Japan, member of the Science Council of Japan (16th term), an honorary member of the Japanese Society of Cardiology, honorary member of the Japanese Society of Internal Medicine, and director and advisor of Takeda General Hospital. In 2009, he was awarded the Order of the Sacred Treasure, Gold Rays with Neck Ribbon.
He conducted research on cardiomyopathy as his life’s work, and as the head of the Ministry of Health and Welfare’s research group on “idiopathic cardiomyopathy”, he worked to investigate the actual condition of cardiomyopathy in Japan and to develop a treatment for it. Elucidation of the immunologic mechanisms of dilated cardiomyopathy2 and the therapeutic utility of β-blockers3 were presented as homework reports at the 1989 Annual Meeting of the Japanese Society of Internal Medicine. In 1993, Dr. Kawai received the Japan Medical Association Medical Award for the subject of “Basic and Clinical Research on Cardiomyopathy: Proposal and Demonstration of the Theory of Immunology of Viral Infections”. At the same time, he also paid attention to thrombolysis in the acute stage of myocardial infarction and percutaneous coronary intervention (PCI) for coronary artery disease, which had just started, and he worked to establish a nationwide research group and spread the use of PCI in Japan.
He was an invited speaker on these topics as a special international memorial speaker at the 1986 American Heart Association (AHA) Scientific Session. The poster displayed at the venue where he gave his lecture was brought back to Japan and kept as a treasured possession. Its details were published in Circulation in 1994 and can still be read today.4 In fact, his report on ApoAI, a component of HDL-C that stabilizes PGI2 as one of the mechanisms of myocardial infarction, is still relevant.5 Furthermore, he attempted to purify nitric oxide synthase (NOS) as an endothelium-derived relaxing factor, and succeeded in purifying NOS from rat macrophages and neutrophils for the first time in the world.
There are countless memories of Dr. Kawai that we will never forget, but we would like to introduce the following in particular.
When Dr. Kawai was appointed Professor of the Third Department of Internal Medicine (Cardiology, Nephrology, and Neurology) at Kyoto University, 50 years ago, his philosophy and basic principles that he presented to his staff were:
(1) have an international perspective, study in the USA as much as possible to learn new clinical and basic medicine
(2) do world-class research
(3) research focus should be patients: identify issues directly from patients you are currently treating, and conduct clinical research to solve those issues
(4) promote international academic exchange, especially with the USA.
At that time, Japanese medicine was transitioning from German-style medicine, which had focused on basic medicine since the Meiji era (1868–1912), to American-style medicine, which focused on clinical practice; lectures were also shifting from being held in German to English. Therefore, Dr. Kawai’s philosophy and basic principles were very fresh in the minds of the staff members.
Because at that time it was difficult to establish an intensive care unit dedicated to cardiology (i.e., CCU) and a cardiac catheterization laboratory capable of performing coronary angiography (CAG) at Kyoto University Hospital, Dr. Kawai went beyond the institutional boundaries and established a cardiology department with a CCU and dedicated CAG room at a hospital near Kyoto Station, where he sent his staff and went himself to visit patients every week. Using the same approach, he established similar departments of cardiology at 3 other hospitals in Kyoto City, creating a system of acute cardiology care at 4 hospitals located in the north, south, east, and west of the city. This collaboration between the university and city hospitals has become a model for the rest of the country. According to what we have heard, during the professor’s rounds at that time, attending physicians were asked questions about clinical points to keep in mind, and if they neglected their routine, they were given strict instructions, making the rounds a tense learning experience for them.
With a “free spirit of creativity”, which was also the title of his retirement commemorative lecture, Dr. Kawai often said, in the words of Mencius, “If I am right when I reflect on my own heart, I will boldly and willingly face it, even if the opponent is ten million people.” Dr. Kawai did his utmost to fulfill his mission to create and disseminate new cardiovascular clinical medicine in Japan, overcoming the resistance of those around him.
When he was appointed 50 years ago, Dr. Kawai told graduate students, “There are many excellent professors in basic medicine at Kyoto University who are conducting international research. You will first study for four years in a department of basic medicine to learn the latest advances in medicine from the fundamentals, obtain a degree, study in the U.S. to broaden your international perspective, and then return to Japan to serve as the chief of the Third Department of Internal Medicine Research Group. Of course, you may express your preference as to which department in the basic medicine departments you would like to study in.”
Specifically, Dr. Hisayoshi Fujiwara (one of the authors), who later became a professor of cardiovascular medicine at Gifu University, was asked, “Where do you want to go in the basic medicine department?” When he expressed his desire to study cardiovascular clinical pathology under Professor Hamashima of the Department of Pathology at Kyoto University, whom he already knew well, he was immediately contacted by Dr. Hamashima and assigned to spend his graduate life there. As a result, Dr. Fujiwara was able to publish papers in Circulation and other journals, which was rare in Japan at the time,6 and he also studied in the USA as planned. After returning to Japan, he became chief of the Cardiovascular Clinical Pathology Laboratory of the Third Department of Internal Medicine, where he was allowed to freely and spontaneously conduct research. Dr. Toru Kita, who later became a professor of the Department of Cardiovascular Medicine at Kyoto University, studied on campus under Professor Numa in the Department of Biochemistry, and later went to the United States to study atherosclerosis.
Many other graduate students have studied the on-campus department of basic medicine. Such a grand design for training graduate students (having them study elsewhere for 6 years, including 4 years of graduate study in on-campus departments of basic medicine and about 2 years in the USA, and then putting that learning into practice in their original department) is not easy to achieve and is something that only a person with strong beliefs and persistent patience such as Dr. Kawai could have done.
Dr. Kawai believed that the senior staff of a university hospital should not only be good medical doctors and researchers, but also be able to manage the hospital, outpatient clinics, and hospital wards in response to the medical needs of the times; in other words, medical management skills. About 40 years ago, immediately after Dr. Fujiwara became a lecturer, Dr. Kawai said to him, “I want to make you a ward medical director. On the other hand, many of the doctors around you disagree, saying that you are not suited to a ward management position such as a ward medical director because you are concentrating only on research. However, when thinking about your future, you should experience being a ward medical director now, because it will definitely help you. Make sure to balance your medical practice and research with being a ward medical director!” At that time, Yoshiki Takatsu, a young assistant professor, became the deputy ward medical director (a position created by in-house measures), and Dr. Fujiwara always went to the ward’s medical staff room at 8:00 a.m. every morning to hold a detailed meeting with the nursing department, accepted emergency patients without refusal, and received calls about any problems on Sundays, holidays, and even at midnight. Fortunately, the number of inpatients with acute myocardial infarction and other cardiovascular emergencies, the number of CAG examinations, and the occupancy rate of the ward all reached record highs and were recognized by Dr. Kawai.
The experience of ward medical director is still a very important part of the senior staff experience at the university and is an essential link to their subsequent careers. Professor Kawai had foresight to appoint this person as the head of the ward, even against the objections of those around him, and he also had foresight to develop people. The position of deputy ward medical director, which was created at that time, is still in place at the Department of Cardiovascular Medicine at Kyoto University.
Dr. Kawai said that it is the doctor’s duty to challenge new knowledge throughout his life.
Even after his retirement, he continued to practice his principle, even at the age of over 75 years, and we had the pleasure of meeting him in various academic settings until his death. At the Annual Scientific Meetings of the Japanese Circulation Society and regional meetings, he asked many questions, even though he was over 80 years old, and when he heard about progress in the treatment of aortic stenosis, he immediately came to Kyoto University Hospital to see transcatheter aortic valve implantation. Furthermore, until the age of 95, he participated in in-house abstract reading sessions as an advisor to Takeda General Hospital, and he always diligently read papers at home the day before preparing for these sessions. With the warm support of his family, he lived out his allotted life span, following his own motto of “staying active throughout your life, studying all your lifetime.”
We express our sincere gratitude to Dr. Kawai for his guidance of us, the staff of the Department, over the past 50 years. As a strict professor, senior professor whom we could never surpass, and cardiologist, he taught us so much that neither of us can say enough about him. On behalf of all the members of the department, we give our hearty thanks for the enthusiastic guidance we received from Sensei. We will continue to follow Dr. Kawai’s lead and return to Kyoto University’s founding spirit of “free spirit of creativity” to manage the department in such a way that each member can fully demonstrate his or her individual talents.
Finally, we once again offer prayers for the repose of Dr. Kawai’s soul and our sincere condolences to his family.
