Psychoactive drugs - e.g., antipsychotics, antidepressants, antimanics, anxiolytic sedatives - are now widely prescribed in industrialized countries. However the misuse and frequent over-use of these drugs, especially the tranquilizers, has often been discussed in the extant literature. While the public's understanding of the negative aspect of taking psychoactive agents has become more widespread, physicians (not only psychiatrists) often remark that there is a tendency on the part of patients to demand and acquire these drugs by exerting great pressure on physicians for whom it is often difficult not to comply. J. D. Wallace, M. D., has dubbed this the "tranquilizer on demand" syndrome. However, the patient's demand should not in itself be simply rejected by the physician, rather his or her demand should be taken into account. We need to consider the basis for the demand. The literature suggests that patients' knowledge concerning their own mental health and its appropriate treatment (e. g., psychoactive drugs) is typically limited and not based on an adequate understanding of medicine. Therefore physicians should consider very carefully (within the context of the physician-patient relationship) each patient's autonomy and unique response to the treatment modality. If the patient's demand for psychoactive medication is not warranted on the basis of sound medical judgement, then the quality of the demand itself should be analyzed. Only then can the physician transform the "demand" into the most beneficial treatment plan. The necessary conditions for this transformation are : (1) that the doctor has sufficient knowledge concerning the natural history of the presumed psychiatric disorder, (2) that the patient is fully informed and understands the appropriateness of his or her original demand, and (3) that the patient is prepared to accept the authority (though perhaps only limited) of the physician.
The aim of this paper is to interpret "medical fashions" as the nature of medical practice. They have a powerful effect on how we treat, whom we treat, what we treat and even the directions of medical science. In this paper, I discuss fashions in treatments, fashions in laboratory tests, fashions in diseases, fashions in surgery, and the relationship between 'medicalization and medical fashions'. I came to the conclusion that the role of "medical fashion" is not necessarily negative, but is essential to creative evolutions or changes in medicine, and that this model of "medical fashion" is very important and useful in understanding medicine as 'a variable system without an everlasting center'.
Recently many publications in socio-culture and medicine have come out which assert the importance of "iyashi (healing)" in medical settings in Japan. Especially among traditional medical practitioners and their clients, such an assertion has been emphasized in connection with criticisms of modern medicine. They insist that there is not "iyashi (healing)" in modern medicine, but in their traditional medicine, although they never mention what "iyashi (healing)" is. This paper tries to clarify what "iyashi (healing)" means. It also argues against the view there is no "iyashi (healing)" in modern medicine. For this purpose, it describes the care given to patients having terminal cancer in modern Japanese medicine, by way of providing some "Medical Anthropology". Even today Japanese physicians deem it fatal and unethical to tell the truth about a diagnosis of terminal cancer to the patient. Instead, physicians give the patient a false diagnosis. For example they say that he has a benign ulcer when he has stomach cancer. Some physicians never give the patient any diagnosis of malignancy, just saying "No problem". But some members of the patient's family, usually elderly male members, are told the true diagnosis and are asked to conceal the truth from the patient. They are asked to support him by reassuring him that he will" recover, by physicians in charge. Nurses in charge obey the physicians' order to keep silence about the diagnosis. In this way, the dying patient is surrounded with "the lie" of his entourage, physicians, nurses and his family members, and goes without recognizing the terminal time and the true diagnosis. Focusing on this situation of patients having terminal cancer, this paper argues about Japanese "iyashi (healing)."
In Japan, the profession "pharmacist" as part of the medical care system was established in 1874. However, the object of this newly-formed profession has not been defined sufficiently at present. Because pharmaceutical practices have not been distinguished from the medical profession, pharmacists don't have their own practice in dispensing drugs, but work only as drug distributors. Consequently the profession of pharmacist is not regarded as a medical care activity, and the social position of pharmacist is appraised unfairly in Japan. The most important task, therefore, is to introduce the separation of pharmaceutical practices from the medical profession (BUNGYO) as in advanced countries. That system seems to be more reasonable not only for pharmacists but for both patients and physicians, even in Japan. And needless to say the pharmacist in Japan should study more, throughout their lives, in order to fulfill their obligations in the medical care system.
In order to look for a new image for pharmacists in medical service, I want to suggest the following from a legal point of view : First, a pharmacist should have the exclusive rights of dispensing over physicians. Secondly, a hospital pharmacist should have his own liability independent of his superior in the hospital. Thirdly, a pharmacist should have the freedom to open a dispensary anywhere, without control of others in the same profession.
In Japan, pharmacists are generally regarded as specialists only of the materials which they treat. So, they are differentiated from the physicians and nurses who have close relations with their patients. Such a general view makes the job of a pharmacist charmless and uninteresting. Having close contact with patients, observing the effect of their medicine and guiding them in how to take it, are the proper work for a pharmacist. Today it seems that the serving-systems for medicine are becoming more clinical, and in the great hospitals, pharmaceutical systems are separated into smaller units of clinical specialization. That is the only way to raise the level of the pharmacist's activities and responsibilities.
In 1872, the westernized Japanese government of the Meiji Restoration proclaimed a law which legalized the separation of pharmacy and medicine, imitating the tradition of western countries in those days. However, traditional Japanese (and also classical Chinese) medicine identified diagnosis with therapy, and most of the physicians had long been accustomed to compounding drugs by themselves at a patient's bedside. Even the westernized physicians continued to maintain the right to prepare drugs, which was permitted by an exceptional provision in the above-mentioned law. Moreover, the Japanese government in the Meiji era adopted the German medical system as a desirable model for Japanese medicine. This choice resulted in the introduction of a physiciancentered medical model following the German social system in the 19th century, in which doctors regarded other health professionals, including pharmacists as physicians' servants. Since then the social standing of Japanese pharmacists has been unduly low, far lower than in Europe, where this profession maintained a position called "the Great No.1 ", viz. the most trusted profession. For this reason the students of present Japanese pharmaceutical colleges have gloomy prospects for their future and have little pride in their profession. To overcome these gloomy prospects it is necessary to reform the physician-centered medical system, making it a patient-centered one based on equal standings of all health professionals. At the same time, more interest in human values should be introduced into both medicine and pharmacy, which are too science-oriented and dehumanized today. If the medical system is reformed in such a favorable way, the pharmaceutical students will have pride in their profession and will be able to take active parts in the clinical field. However there are still many obstacles to be overcome before the realization of this ideal.
Legal cases in the field of pharmaceutical affairs were analyzed and discussed on legal as well as ethical grounds to understand the identity and the raison-d'etre of the "pharmaceutical sciences provided by the college of pharmacy or the pharmaceutical faculty of the university", which should be called the "pharmaceutical sciences" proper. The results of this study indicated that 1) All of the legal topics arose from the "Separation between the law and the actual conditions", 2) The society and the law demanded "something" on the "pharmaceutical sciences" proper, and 3) This "something" differentiated the "pharmaceutical sciences" proper from the ordinary pharmaceutical sciences provided by the other colleges or faculties of the university. This "something" is not manifested in any tangible form or visible acts, but its essence can be defined as the deep and true recognition of "the dignity of human life". This concept can be called ethical, and it identifies the nature of the "pharmaceutical sciences" proper. The nature of pharmaceutical products can also be said to be ethical because of its close interrelationship with human life and health. Therefore, the nature of "pharmaceutical sciences" proper wholly dealing with pharmaceutical products should be "ethical". The raison-d' etre of the "pharmaceutical sciences" proper should be to create, produce and control pharmaceutical products using its own knowledge and skills based on sincere ethical considerations which can only be provided by the college of pharmacy or the pharmaceutical faculty of the university, and this is not comparable to the functions of other colleges or faculties.