We reviewed the literature regarding Japan's contribution to research in medicine in 1991-2000. Japan contributed 7.6% of all articles in English listed in the Medline database. The contribution ranged from 0.6 to 11.4% for various clinical science fields and 3.8 to 11.9% for basic science categories of reputable journals. The lowest contributions were in the categories “General and General Internal Medicine” and “Epidemiology”, where Japan contributed only 0.6% and 1.1% of the articles, respectively. The Japanese contribution to high quality clinical research (randomized controlled trials, case-control studies, cohort studies) was meager, while that to the basic sciences was more satisfactory than to the clinical science categories. Appropriate academic and social initiatives should be made to accelerate clinical research in Japan.

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BACKGROUND: In Japan, there have been few reports about drug compliance, which is an important determinant of effectiveness, in the management of bronchial asthma patients. To clarify drug compliance and its relationship with various aspects of asthma management, a questionnaire survey was performed on asthmatic patients and their pharmacists.
METHODS: This survey was carried out, from October to November in 2001. The subjects were limited to the regular inhaled corticosteroid (ICS) users, and were restricted to patients whose medication had not been changed for at least 6 months before the survey. The questionnaires inquired about asthma status, various factors that have been reported to be associated with drug compliance and asthma management. Patients' pharmacists were asked about prescribed medications and drug compliance based on the pharmaceutical records.
RESULTS: Completed questionnaires were received from 610 patients. ICS compliance was not lower than that of anti-allergic drug but lower than that of oral sustained-released theophylline (OSRT) . Multiple regression analysis revealed a significant correlation between ICS and OSRT compliance.
CONCLUSION: These results might suggest that OSRT could improve patient's compliance to drug therapy through its bronchodilatory effect, thus resulting in better compliance to ICS. If this were the case, OSRT would play an important role in asthma management.

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BACKGROUND: physicians' awareness regarding evidence-based medicine (EBM), clinical practice guidelines, and clinical information resources were rarely examined in Japan. We need to know them prior to the initiation of the Medical Information Network Distribution Service (Minds) by the Japan Council for Quality Health Care (JCQHC) .
METHODS: A total of 10, 000 directors/owners of private clinics (CDs: clinic physicians) affiliated with the Japan Medical Association (JMA) and 8682 physicians working for hospitals certified by the JCQHC (HDs: hospital physicians) were randomly selected and surveyed by a mailed questionnaire.
RESULTS: The response rate to the questionnaire was 18.7% (n=1865) among CDs and 67.8% (n=5885) among HDs. The percentage of respondents who uses internet was 39.9% among CDs and 69.3% among HDs. The information resource most commonly used by all respondents was medical journals, followed by textbooks. The percentage of respondents who used medical literature database was 10.8% among CDs and 49.7% among HDs, respectively. Approximately 80% of all respondents approved implementing EBM in daily practice. Fifty percent of all respondents indicated to have used clinical practice guidelines, and 90% of all the guideline users replied that clinical practice guidelines are useful tools for clinical decision-making. Over half of HDs required to access to the abstracts of the literature cited in the guidelines.
CONCLUSIONS: Many physicians who responded to the survey acknowledged that EBM will contribute to improving the quality of medical services. They are positive in using clinical practice guidelines that include a series of recommendations proposed by specialists in the relevant field (s) in accordance to the reviewed evidence.

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A 31-year-old Japanese female came to our outpatient clinic because of a 15-year history of recurrent episodic chest pain accompanied by fever, each lasting for three days. The patient was diagnosed with familial Mediterranean fever (FMF) because of the following: 1) short attacks of fever recurring at varying intervals; 2) pleuritic chest pain accompanied by fever; 3) the patient's sisters had similar episodes of fever accompanied by abdominal or chest pain; and 4) absence of any other causative factors responsible for her symptoms or pathologic findings. Although FMF has been described primarily in several limited ethnic groups, only a few cases have been reported in Japan. No diagnostic tests are commercially available for FMF so identifying the characteristic clinical picture of FMF is important.

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Despite large revenues in terms of reimbursement from health insurance, many cardiovascular centers in Japan are losing money. On the other hand, manufacturers of cardiac interventional devices are making money in Japan. A big price disparity exists in the field of cardiac interventions between Japan and the West according to many surveys, the first among them being published by JETRO (Japan External Trade Commission) in 1996. Since then, the Central Social Insurance Medical Council has been discussing this issue, but the gap has not been dissolved. The IHEP (Institute for Health Economics and Policy) report on the actual condition of distribution channels for medical devices in 1997, describes several reasons for the high prices of medical equipment and devices in Japan. Among them, the high prices are best explained for by well-acknowledged fact that the sole importing distributors, which are often subsidiaries of the US manufacturers, set high prices (70% of the purchase price of hospitals) when the devices reach Japan. While we proposed several practical approaches to address this problem, we consider the high government-set prices of the devices must be dealt with first. Why is it bad to leave the government-set reimbursement price of medical devices so high, given the fact that hospitals are able to earn the margin profit because the actual price that they pay to distributors is significantly lower than the reimbursement price ? Because, if the total health expenditure of Japan can not be increased in amount due to the government budgetary problems, then the remaining budget left over to cover physician fees will likely be decreased and will eventually hurt the hospitals financial state. The government should take quick action to eliminate the existing price disparity.

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We describe our experience with a left atrial (LA) myxoma in a 15-year-old female who experienced abdominal symptoms so prominent that she was initially thought to have an inflammatory enterocolitis.
The patient's young age and predominant abdominal symptoms in the absence of any cardiac symptoms made it difficult to diagnose the LA myxoma early in the present case. This experience underscores the need for an intensive search for cardiac myxomas in patients with findings suggestive of inflammatory diseases or collagen disorders.

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