The hospital is one place where people encounter highly advanced science and technology in their daily lives. In the hospital, patients come into contact with a number of highly advanced scientific innovations and newly devised machines and technologies, more so as computed axial tomography scanners (CAT) and magnetic resonance imaging scanners (MRI) have become indispensable tools for medical diagnosis. How are these scientific machines brought into hospitals and transformed into diagnostic and medical tools? Who initiates the use of these technologies? What are the respective roles of doctors, physicists, and scientific instrument companies in the introduction of new medical technologies?More generally, how did science-based machines transform medical practice and the post-war hospital?
To explore these issues, I am pursuing a historical case study on the development and use of a key medical technology, contemporary radiation therapy for cancer: the microwave linear accelerators (so-called clinac). The clinac was an electron-smashing machine invented and developed in the 1950s jointly by Dr. Henry Kaplan, then Head of the Department of Radiology at Stanford University Hospital, Dr. Edward Ginzton, a physics professor at Stanford, and a group of nuclear physicists at Stanford's Hansen Laboratory. This paper traces the history of clinacs from their development at Stanford University and Varian Associates in mid-1950s to their widespread adoption for the treatment of many forms of cancer in the late 1970s. In so doing, I have examined the processes by which physicists, medical doctors, and corporate engineers transformed a research instrument in nuclear physics, the microwave electron linear accelerator, into a highly effective clinical tool for the treatment of Hodgkin's disease and other forms of cancer. By conducting this case study, I have argued that the United States experienced a most dramatic transformation in medical care from the late 1950s onward. American medicine gradually came to be comprised of researchoriented practices that required the collaboration of other scientific fields such as physics, biology and chemistry, and treatment in big institutions (e. g. university hospitals).

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To demonstrate the economic impact of donepezil treatment for patients with mild-to-moderate Alzheimer's disease (AD) in Japanese clinical settings, we conducted a cost-effective analysis using the Markov model.
This analysis was made from the societal view point, and the cost was estimated based on the fee schedule of the Japanese national health insurance and the entitled amount of the long-term care insurance. The results of the phase III clinical trial of donepezil on AD in Japan were used to estimate the drug efficacy. However, the epidemiological data on the natural history in the U. S. was used because they were unavailable in Japan. Based on the quality of life survey, quality-adjusted life years (QALYs) were calculated as an effectiveness measure.
Under the base-case analysis with a 2-year time horizon, donepezil t r eatment for patients with mild-to-moderate AD was an economically dominant option compared to the conventional treatment; i. e. improved health outcomes and decreased costs. Further study will be needed when the data on the long-term effects of donepezil and the natural history data of AD patients become available.

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We analyze the communication pattern and effectiveness of the smoking cessation program that used Computer-Mediated Communication and Community (CMCC). This system is now spreading rapidly in our society as re sult of the internet era. Quantitative analysis of e-mail logs of the communications through a mailing list during the cessation program period shows that the utilization of an electronic community in the smoking cessation program is effective by achieving an individualized, timely and continuous intervention. Former participants of the program serving as volunteers played a major role. This decreased the burden for medical professionals, and at the same time, probably contributed to maintaining their smoking cessation.

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Although the Organ Transplant bill was passed by the Japanese Diet in 1997, organ transplantations from brain death are not popular in Japan. One of the reasons for this is that the brain death problem has not been raised at a social level in Japan, as contrasted with the United States.
Why has not the brain death problem bee n raised in Japan? I will try to explain it using the differences in constructing the brain death problem as a social problem. This problem was constructed as a public policy in the United States, while, alternatively, it was constructed as a life and death philosophy in Japan.
Then why was this problem constructed differently between the United States and Japan? To answer this question I would like to propose that this problem consists of three areas. These three areas are 1. the area of medicine,2. the area of legislation and 3. the area of culture. The construction of the brain death problem relies on the interaction between these three areas. So the differences between how the brain death problem is approached in the United States and Japan depends on the interaction of these three areas. In light of this concept, the comparison between the United States and Japan would explain the characteristics concerning the brain death problem in Japan.
In Japan, the Organ Transplant law will be revised this year (2000). I expect that this problem will come to be discussed among people again. So I hope this paper will contribute to the discussions.

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This paper discusses the investments of private hospitals, as they relate to the performance effectiveness of the Japanese health insurance reform. In response to the reformation, private hospitals need enough money to invest. Moreover, these hospitals should be selected by the capital market due to their economical efficiency.
Given th e present circumstances, private hospitals have only one channel for bank loans when financing a long term investment. And private hospitals have less financing methods than other industries.
For supply-demand analysis, t his paper roughly estimates the demand for investing in hospital re-construction, considering that the private hospital's useful life is 30 years and, after that, that all hospitals should re-construct. Resu lt of the estimation is that there is a supply-demand gap for the investment which amounts to a maximum of 2,600 billion yen up to 1999, double the average amount of hospital investment per year. The principal cause of the deman d gap is the information gap between private hospital and private financial institutions. That is caused by poor communication on both sides. This paper suggests that to solve this problem of information gaps, one must establish a “rating agency” and “credit assurance institution that works closely with said rating agency” for private hospitals. Furthermore, it is important to adopt a new financing method that uses these credit insurance systems.
This paper promotes the operation of these credit enhancing instruments by private sectors rather than by public sectors. Public sectors should pay attention to place equal footing with other industries in diversifing private hospital financing methods. Private sectors will try a variety of approaches to develop new financing methods for private hospital investments.

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Recently, marketing is a hot topic in medical institutions, and the actual number of organizations that practice marketing activities is increasing. In the late 1960's, the concept of social marketing was intro d uced. Up to then, people had thought that marketing concepts and skills were used only among commercial companies.
In the f i e ld of marketing, research suggests that the transactional paradigm is shifting from that of “stimulus-response” to “exchange” and “relationship”, as times and environments change. In the relationship paradigm, companies intend to build relationships with their customers based on trust for mutual benefits.
In this paper, we have examined the essential elements to build relationships between physicians, nurses, and staff and their patients.
Today, medical institutions are faced wit h intense competition because of excessive supply. Only the medical institutions that are always selected by patients can survive.
We studi e d the Nerima General Hospital from a perspective of relationship marketing. The outcome of the study has revealed the following five points.
1) Clarifying visions,2) Establishing management concepts,3) Reforming the employment situation,4) Enhancing communication,5) Creating trust.
Medical institutions (physicians, nurses, and staff) should m ake efforts to build long-term and good relationships with their patients with the aim of improving patient satisfaction which is the ultimate objective. For building such relationships, fostering trust between medical institutions and patients and trust between medical institutions and employees is important.

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