Patients with intractable neurological diseases require disaster preparedness plans for themselves and their families. However, implementing these measures is difficult, and various issues must be resolved. The Ministry of Health, Labour and Welfare's Research Project for Overcoming Intractable Diseases and the Disaster Committee of the Japanese Society of Neurology have discussed how patients with intractable diseases and their families, who are vulnerable to disasters, should prepare for disasters and what they should do when a disaster strikes. Through these discussions, effective preparedness and countermeasures are being developed. In light of the effects the COVID-19 pandemic has had on clinical practice in Japan since January 2020, it has been recognized that clinicians must consider how to deal with patients with intractable diseases in the event of a "combined disaster" (i.e. a natural disaster occurring during an infectious disease pandemic). Sanitary management and measures to prevent the spread of infection at evacuation centers during disasters must be implemented in advance. In addition, decentralized evacuation plans need to be made immediately in preparation for combined disasters. The Disaster Countermeasures Basic Act in Japan was revised in May 2021, and the most important point was that each municipality was obliged to make efforts to formulate individual evacuation plans. In view of the increasing number of natural disasters and the continuing COVID-19, it is necessary to incorporate a complex disaster evacuation plan into the formulation of individual evacuation plans. Medical professionals involved in treating patients with intractable diseases must raise their awareness of disaster preparedness and cooperate fully with people in other professions.
Diabetes mellitus is a chronic disease in which high blood glucose over long periods leads to diabetic complications including retinopathy, neuropathy, chronic kidney disease, and increased risk for cardiovascular events. Despite the availability of scientifically proven medical treatments, a significant number of patients with diabetes do not attain optimal glycemic control due to failure in self-management and nonadherence to medication. These behaviors appear irrational in terms of conventional economic theory. We applied the theory of behavioral economics, a new concept for clarifying irrational human behaviors, to investigating risk preferences in patients with diabetes. We found specific features in the responses of patients with diabetic complications. Many of these patients had low socioeconomic status, were reluctant to participate in the survey, and had difficulty in making decisions explicitly. Their choices under uncertainty often violated two axioms of the Expected Utility Theory (completeness and transitivity) and were therefore considered irrational, meaning that their choices were difficult to understand and differed from those that would be chosen by the majority of people. Health professionals should be aware of the propensity of such patients to make irrational decisions, which might be an important risk factor for the progression of diabetic complications.