Previous basic, clinical, and population sciences have advanced the modern treatment of heart failure. However, its efficacy is still limited especially in the “real world” patients. The clinical characteristics and prognosis of patients with heart failure have been described by a number of previous studies, which have been performed mainly in the United States and Europe. Very little information is available on this issue in Japan. We determined the clinical characteristics and prognosis of 230 patients consecutively hospitalized with HF at 5 teaching hospitals in Fukuoka, Japan in 1997. Patients were elderly and made up of a larger population of women especially at a higher age. The major causes of heart failure were ischemic, valvular, and hypertensive : 35% of HF patients had a normal ejection fraction by echocardiography, in which heart failure might be mainly attributable to diastolic dysfunction. Readmission due to the exacerbation of heart failure is common. Noncomplicance to the treatment is the most common precipitating factor for readmission. Regular medical follow-up and social support are important for the disease management program of heart failure. A nationwide survey of the “real world” patients needs to be performed in Japan to establish the most effective and efficient treatment strategies.

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In this paper the evidence necessary to justify interventional prevention for cancer is discussed. In Japan, to date few trials with a design of RCT have been conducted in the field of cancer prevention. However, as it has been shown that preventive measures such as cancer screening and chemoprevention generally cause some harm and they are not always effective in reducing mortality, there should be evidence from good-quality RCTs showing that they do more good than harm before any new cancer screening and cancer prevention measures are implemented as public health services.

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Little pharmacoeconomic data is available in Japan. Numerous studies of economic evaluation of medications have been published in major English language journals to date. In order to effectively utilize the economic evaluation, information previously reported in many types of medical journals, we must evaluate and appraise them according to medical trends in Japan. It is necessary to have skills to critically appraise the validity of published literature and to strictly validate their quality. As a result, it will become possible to make many types of pharmacoeconomic data applicable to each clinical practice by using a criterion on pharmacoeconomic research from the perspective of a pharmacist.

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According to the on-going discussion in ICH E2E, in future PMS studies, it will be necessary to specifically address the problem and the best study method for the specified problem must be properly selected. In this article, the design for a nested case-control study using countermatching is introduced as one of the best candidate methods for future PMS studies.
In the method, a cohort is stratified by the exposure status and a control is selected from the stratum with the exposure status opposite to that of the “counter-matched” case.
It has been shown that this method can increase the efficiency of the study. In addition, it will give those involved in the PMS studies the confidence that the use of the nested case-control study design is valid in the PMS studies where the cohort consisting of a group of patients with the study drug and another group of those with the comparator drug is observed.
However, to make this method realistic in the Japanese PMS milieu, the following two conditions must be satisfied. First, those involved in the PMS studies should realize the importance of the comparison of two drugs while the comparison of two similar drugs has been to date carefully avoided in Japanese PMS studies. Secondly, a method to identify two comparable groups should become possible. The latter may be accomplished by establishing the infrastructure for the mechanism where the prescription data in hospital/community pharmacies are used to identify those who recently started either of the two drugs compared in the study.

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