Kiyoshi Kurokawa's blog （en）

‘Getting Health Reform Right; A Guide to Improving Performance and Equity‘： A monumental work.

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Health Reform is without doubt a great issue in any nation of the world.  In Japan and the United States, too, it is counted as one of the most pressing challenges in national political agendas.

In each country, there exist complicated elements – social, political, economical, cultural – unique  to each society and country, but on the other hand, medicine and health care technologies are developing faster in speed.  There is no such health system which fits to every society and country.  Developed nations are struggling on how to reform existing system, which is one of the greatest challenges for policy makers of today.   In the world where information spread with no time, the gap between expectation and perception of the society and actual reality of the health care as they see receive continues to widen.

Large numbers of books on health care system are available including those which illustrate the reform carried out in many countries.  Any universal model does not exist, so each ‘leaders/experts’ must learn as much as possible and speak from better perspective, not only from the value of one’s position.  As I often point out in this web-site and elsewhere (Ref.1, 2), it seems that too many leaders/experts in Japan speak only from their limited personal experiences or positions, thus tend to be less objective and not much perspectives, visions for a bigger picture or longer time frame.

This is one of weak points of ‘Tate shakai (Hierarchical society)’ of Japan where the great majority of people pursue their careers in a linear style (i.e. within the same organization and often seniority-based) within Japan.

Several days ago, ‘How to Realize Health Care Reform’was published from Nihon Keizai Shinbun sha.  This is the translation of ‘Getting Health Reform Right; A Guide to Improving Performance and Equity‘（2nd edition, 2008） by Professors of Harvard School of Public Health, Drs Marc Roberts, William Hsiao, Peter Berman, and Michael Reich.  Japanese students who were taught by the authors translated it.  Please search for this book at Amazon.

What makes this book unique from other books of the same theme is that the authors have rich experiences in many countries, understand the difference of social backgrounds of each country; they write not only about policies but also analyses of five ‘Controllers’, i.e. ‘Finance, Expense, Organization, Rules, Actions’, and discuss ethical, political aspects (of the policy) as well as the processes that explain how reform is possible.  The content is very rich and outstanding

The book also provides the analysis of issues and situations pertinent to Japan, how to make reform possible, how policies being developed and advanced on what basis…   Everything is so well thought-out; they encourage us to see the health policy from overall perspectives, stimulate our practical thinking.

I would sincerely like to express my deep appreciation and respect to the four Professors of Harvard University who had written such a wonderful book as well as those who planned and carried out the publication of its Japanese translation.  It was my pleasure and honor to be asked to write a ‘recommendation’（in Japanese ） in this book.

This is a book that I recommend strongly to anyone who cares about health policy.  The price seems a bit high (4,500 yen), but is well worth it.

Khalifa University, Abu Dhabi

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From Washington DC I took a flight to Dubai.  I was on the same flight 6 weeks ago, and flew to Dubai 3 weeks ago as well.  In total I flew to Dubai airport 3 times, once to visit Dubai and  twice to visit Abu Dhabi in the past 6 weeks.  Two of the return flights were from Dubai to Kansai Airport and another was to Singapore.

The purpose of visit is the same as my some previous ones; to support Khalifa University.  Dr. Elias Zerhouni, the former director of the National Institutes of Health joined our team starting from this meeting and his participation stimulated the discussion.  Dr. Zerhouni, originally from Algeria, moved to the United States after graduating from Medical School, worked at Johns Hopkins Univesity, then was appointed to the Directorship of NIH, the most distinguished and responsible position in medical research of US government.  I have had the privilege of knowing him for these years (in Japanese) and am quite impressed by his wonderful personality.

Khalifa University, which I have been helping, is one of important Projects of the government of Abu Dhabi. I have contacted Dr Zerhouni for his support since I thought that advice from a person at higher position, a person with distinguished and international reputation, who understands Arabic civilization and culture personally, would be very helpful.  It was a great joy when I received his immediate affirmative answer.

The meeting itself took place for only one day, but the discussion was very active and fruitful.  I firmly believe that participation of someone who is familiar with both Western values and Arabic values, who knows how to communicate with both sides is so very important and necessary for this kind of project.

Photo; At the lobby of the Emirate Palace, with Dr Zerhouni. 

Recently, The U.S. Department of State announced the appointment of Science Envoy for Middle East, and Dr Zerhouni was among the three, with Dr. Bruce Alberts, Editor-in-Chief of ‘Science’ and Dr. Zuweil, a Nobel Prize laureate in Chemistry, originally from Egypt.  This is another significant step forward of US Science Diplomacy.

Such rich variety of human resource (Ref.1) without doubt serves as one of the strong core assets of a nation in this global era.  I met Dr. Zuweil several times in the past, and deepened relationship with Dr. Alberts during these 10 years, since he was the President of the National Academy of Science of USA, through many international scientific community works or events, often related to SCJ (Science Council of Japan).

Toyota Cup (FIFA Club World Cup 2009) was being held at Abu Dhabi during my visit.  As I watched in TV later in Tokyo, it was again Lionel Messi (Ref.1) that brought triumph to his team, as you all may know.

Asia Health Forum in Singapore

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From Abu Dhabi via Dubai airport, I flew to Singapore to participate Asia Health Forum organized by EDB (Economic Development Forum) of Singapore Government; I was a part of its planning discussion session. The venue was a beautiful Cappella Hotel on Sentosa Island.

The member consists of some 15 leading world experts from medical, pharmaceutical, public health and a team of McKinsey, an excellent consulting firm. This one day session began with a welcome by the Health Minister of Singapore , Dr Khaw followed by nearly 40 min discussion session with the Minster. The Minister is fully knowledgeable of the principle, unique historical legacy of Singapore health policy, details of current Singapore health policy and its issues, nonetheless considered perhaps the best service in the world  despite spending only 4% of GDP.

I fully enjoyed the meeting and took a late night flight finally back to Japan after 12 days of around-the-world tour which started from Ottawa. 

From San Diego to Abu Dhabi, Festival of Thinkers, and Bugatti

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From Toronto, I flew to beautiful and sunny San Diego, spending an overnight stay for two important meetings. One was on global clinical study called DOPPS, a major endeavor to valuate and compare clinical practice pattern of the world in the treatment of end-stage chronic kidney disease patients; the project began 10 years ago, almost the time when Google was founded, the fact I reminded to the participants indicating how fast the world has changed. Another meeting was consultative one for a pharmaceutical company with a few world leaders and a FDA consultant on a highly innovative medicine. After some time I felt at back home as a physician and a nephrologist or a kidney specialist. It is a good feeling.

Next day, I headed to Abu Dhabi, to participate Festival of Thinkers 2009; I participated previous one as reported earlier (Ref.1).  I was on the panel on Globalization and Culture and Language, the theme and the discussion I liked very much. The presence of Japan in this Festival was weak as you may imagine. It seems I was the only Japanese this time in contrast to the Festival of 2007..

Photos 1-7; Festival of Thinkers

Photos 8-12; Bugatti 1932

It arrived just one day after the final day of FI Grand Prix. Too bad, I missed the event. But in the lobby of Emirates Palace (Ref.1, 2) , the venue of the conference, about 12 F1 cars of old and current are on display. What lovely creatures they are. Let me share some of their beautiful bodies and mechanics.

Photos 13-18; Vintage Mercedez and newer F1 cars

One is Bugatti of 1932. For many years, I was intrigued by Jiro Shirasu, thus, when an opportunity arose I introduced books on him (in Japanese). Mr Shirasu studied at Cambridge University, owned a Bugatti and made an unbelievably crazy driving with his life-long friend Robin Byng, one of most notable families, to Gibraltar back to UK in two week through France, Spain, and other places, probably unthinkable speed particularly considering the roads of those days. Other cars on display include vintage Mercedez, Maserati, Ferrari and more recent models. Enjoy the photos.

The Gairdner Award

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The day of the award begins with a series of excellent lectures by 2009 Gairdner laureates, rich content of outstanding science with passion for science of those laureates who contributed and those who supported their work; each has his/her own beautiful stories to tell. Lucy Shapiro’s story was outstanding, of a bacterial 3 dimensional dynamic molecular mystery of her life work including collaborations of her husband, a physicist. I know her personally, and her one son is a urologist who worked recently for 3 years at US Naval Hospital in Okinawa, and her daughter-in-law is a marine officer just returned from Afghanistan. What a family she has!

Dr Mori’s story was also moving in that he left Japan from his tenured position because he felt what he was supposed to do then was something wrong and boring; he decided to venture to US; through a lot of struggles, but found a right career he loved as he told us. He was very grateful for his parents who are not wealthy, but supported him to go through university and let him go to US. He of course brought with him his parents, family, and several staff researchers, and it was good to congratulate his entire family.

Dr Yamanaka focused on how he came over through these years after 2 years of clinical training, graduate study in research in Japan, and moved to California for completely new research project. There, he encountered seemingly a totally failure, but hanged on to pursue what may be happening. From unexpected findings with full of struggles, he came back to Nara with three graduate students, then Kyoto, where he finally made his landmark discovery with a few graduate students and technicians in the last few years

Dr Sackett’s historical story of major errors made by excellent clinicians being observers, which includes William Osler. He told me personally, he was also surprised by his findings on Dr Osler.

All lectures reveal core personality of each laureate. The day was ended with unquestionably thoughts-provoking guest, Sydney Brenner, who talked about ‘Humanity Gene’ with his usual sense of humor, but a serious message.

 Photo 1：Honorable Ambassador Nishida and Mrs.Nishida
Photo 2: From left Dr. Pierre Chartrand, Vice-President, CIHR., Dr Peter Singer (Ref. １、２）

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In the evening, the award ceremony was held at the Royal Ontario Museum. Proud Ambassador Nishida was on the stage to accompany the ceremony of two Japanese laureates.

After return to the hotel, I had drinks in our hotel bar with Dr Yamanaka and his staff and Dr Mori just dropped by.

It was a very good few days in Toronto for me and for all Japanese science community. This year also celebrates Japan-Canada’s 80th year of Diplomatic Relation. As you may recall, earlier this year Emperor and Empress of Japan visited Canada (Ref.１ ）.

I will leave for San Diego early tomorrow morning.

From Toronto -2, Gairdner Foundation Global Health Symposium

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One major new initiative of the Gairdner Award at the occasion of its 50th anniversary is the launch of Global Health Award, an important issue and challenge for our global age, which thus is quite timely. The inaugural laureate is Dr. Nubia Munoz for her global epidemiological study to identify papilloma virus as the cause of cervical cancer and effects of its vaccine. 

Thus, in the afternoon of October 28th, Gairdner Global Health Symposium was held at the Dalla Lana School of Public Health, University of Toronto and Dr Munoz as our honorable guest. I moderated the first session (of two) with Drs Jeffrey Koplan of Emory University, Tachi Yamada,  of Gates Foundation, Mark Walport of Wellcome Trust, and Peter Singer (Ref.1), of University of Toronto, as panelists, a powerful quartet of Global Health. It was fun to moderate this powerful session; I felt enthusiasm of the full audience.

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Photo 1-4: At the reception, photo 1; Dr Oliver Smithie (humorous speech typical of him); photo 2; Dr David Sackett (left), of McMaster, well known to us for clinical epidemiology and EBM, of Gairdner Wightman award, and John Dirks (President of the Gairdner Foundation); photo 3; Dr and Mrs Ogawa, Dr Yamanaka and me; and photo 4; Drs Ogawa, Mori and me

The reception of the evening was held at MaRS of the University of Toronto. It was a very enjoyable evening with friends and many past Gairdner laureates and this year’s laureates. Three Japanese laureates are there, Drs Seiji Ogawa, Shinya Yanamaka, and Kazutoshi Mori .

Photo5: with Dr Blackburn

Among many guests was Dr Elizabeth Blackburn, this year’s Nobel laureate in medicine and physiology  for her discovery of telomerase; one of three co-recipients with her is one of her former graduate student, Dr Carol Greider.  Dr Blackburn is also a recipient of the Gairdner and of the L’Oreal Woman in Science Award at its 10th anniversary, which I served as a proud member of the Jury.

What a wonderful and stimulating day it was, indeed, my honor and privilege.

From Toronto -1, Encounter to a ‘Wikinomics’ figure

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As reported in my last posting, I am in Toronto working with University of Toronto for our collaborative program with GRIPS from early this year (Ref.1).

After my session at Munk Center, I was invited to dinner reception for the 50th anniversary of the Gairdner Award hosted by Rob McEwen, a major business leader of Canada (Ref.1), and a significant figure in the Wiki-age business as I will explain to you below.

His huge house is located in the most exclusive area of Toronto, as you may expect, as I know him one of major supporters of medical research and education. He founded McEwen Center of Regenerative Medicine focusing on stem cell research, at Toronto General Hospital, an affiliated hospital of the University of Toronto. I knew his support of medical research, thus he is particularly pleased to meet Professor Shinya Yamanaka of Kyoto University (Ref.1),  one of this year’s Gairdner Laureates; Dr Yamanaka made a landmark discovery of iPS, reprogramming of skin and other cells to stem cells, bypassing ethical issues of using embryonic stem cells.

Photo; with Rob McEwen

As I discussed with Rob various issues of mutual interests including his business, suddenly it occurred to me that he MUST be a person who appeared as a major innovator entrepreneur on Open Innovation in a book ‘Wikinomics’, in its Chapter one. I asked him ‘Is that YOU?’’ and his reply was’ Yes.’ In my recent speaking engagements I often cite him as a most remarkable ‘out-of-box’ thinker which saved and led to his gold-mine company, Goldcorp. This was a huge success as one can imagine based on the performance of the company. We had quite an enjoyable chatting session over how he thought of it and how he did it.

It is always fun to encounter unexpected encounters enriching your own thinking as I often posted in my blog posting. So I say “Think and Act Global, it a lot of fun.’

Ottawa, on Global Health, and Toronto, on Innovation

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Canada will host G8 Summit next year (could be the last G8 and first G20). Naturally, as part of effort to make Global Health as a major agenda for the Summit, various efforts, negotiation, processes must have been taking place among various sectors of Canada.

CCGHR hosted one of such meetings (October 25th). The meeting is more research oriented, with about 150 member attendance with 25% being members abroad and I was invited to give a keynote. It was full of enthusiasm and I joined a couple of workshops, its board meeting as a guest, and a private session for Canadian perspective for G8 agenda setting. It was a very interesting and learning day getting to know many new friends and colleagues.

Ottawa in late October is reasonably cold, but weather was nice. I met a Japanese scholar, a woman, well educated undergraduate at McMaster and at MS and PhD in Epidemiology, Biostatistics and Occupational Health at McGill; she lived only several years when she was very young, now studies as a post-doctoral fellow in South Africa participating a joint project with UK on Mental Health and Poverty Project in Africa. A challenging mission!

Next day, I flew to Toronto as my re-visit (Ref.1)  to join a few activities. Munk Center of the University of Toronto was kind to host a dinner in honor of me at Massey College. Next day, a panel was held at Munk Center on ‘Innovation, Globalization and the University’; after my brief keynote, the panel session was quite lively and constructive. It seems everyone agree that leading universities must become an open ground to nurture, connect, and prepare future leaders in more and more interconnected world. We must realize that problems of the developing and underdeveloped countries and the regions are not theirs, but ours as well in interconnected global world. There, I met another women medical doctor radiologist from Tokyo Woman’s Medical College, just began her study on Medical Education Research as resident junior fellow at Massey College. Such is a valuable opportunity to widen her vision and scope for her career.  University of Toronto is a great institution which is characterized by heterogeneity, diversity and a wide spectrum of programs and courses.

Communication with students, a new friend through blogs, an encounter from the past

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It is always a pleasure to see and talk with students.  The day after my return from Paris, October 4th, I went to Osaka.                                                                                                                                               

Professor Kurachi,  an old friend of mine and director of the Division of Molecular and Cellular Pharmacology at Osaka University, took initiatives in organizing annual forum for students from 5 universities in Osaka and invited me as a speaker this year.  Core message of my talk was almost the same as what I write in my blog, and I enjoyed greatly talking with the students at the reception afterwards.
It is always my impression, as I point out in every occasion, that female students are more lively and active. (Ref.1, 2) Male students standing around wouldn't easily respond even if I urged them to come and join in the conversation.  There was one very outgoing male student however, and he apparently had a concrete vision on what he want to do.  Why?  Answer to this question is again the　‘3 speeches’, especially the ‘Last Lecture’ by Randy Pausch and in this case not the speech by Steve Jobs.
                                                                                                                                                                          I also had the pleasure of seeing Dr. Inoue at the reception.  She had written in her blog that she was looking forward to coming to my lecture.  This kind of unexpected encounter is another example of the power of sending out messages in this ‘flattening’world.  You experience connecting to people in an unimaginable way.
　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　On 5th, I went to a session of STS Forum in Kyoto with ‘Young Scientists’.  This was also something very nice.  I will post a separate column on this later.
　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　On 9th, I went to Mie University to give a lecture at its 60th anniversary.  My message was focused mainly to the students, but the President and professors seem to have enjoyed it as well.  There were also guests from Thai and Spain to congratulate the occasion.  Students entertained audience by their brass band performance (I learned that this band is well known as a topclass among Japan college bands), chorus, and dance.  Some students came up to me with my book in their hand and asked for my autograph.  This made me very happy.
                                                                                                                                                                                     I met a lady in the eaudience who once had visited my house in Los Angeles when she was an elementary school student.   I vaguely remembered her, but a memory came up more clearly after some time.  Time flies so quickly.

                                                                                                                                                                          I sincerely wish that each student grasp their bright future.  ‘Go out and see the world, make lots of friends in this wide world – this is the way things should be in this global age’; this was my core message. My message remains the same anywhere, anytime.  Universities must open up their doors to the world.  They should also mind their great responsibility in educating and nurturing young students because our future is in their hands.  I made several suggestions on what they can do.

Now, a year later, what will be happening here?  I will be expecting a lot from every and each one of you!

Paris, UNESCO-L’Oreal Award, and “Soft Power”

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Photo 1: In front of Saint-Germain-des-Prés Church

Paris in autumn is lovely.  I was there on September 28th .  L’Oreal Award selection committee is scheduled to meet on 29th to select and honor female scientists that performed wonderful achievements.  I have written on this several times in my blog (Ref.1) before.

In the evening of 28th, the day of my arrival, I had dinner with Dr. Mimura and his wife.  Dr. Mimura finished his clerkship in America and has recently assumed a position at American Hospital of Paris.  I have been corresponding with this hospital for more than 10 years now.  By the way, Dr. Mimura and I are friends but so are our families.  Especially my family and I have a long history of friendship with Dr. Mimura’s wife Nacchan (who is also a medical doctor) and her family.

After dinner, the three of us went for a walk to St Germain de Pres near my hotel.  The photo at the top is Saint-Germain-des-Prés Church (Vicor Hugo was active in the restoration of this church, I hear.)  Paris in autumn is beautiful.

Photo 2: With Drs. Mimura at a Café in St German de Pres

At the selection committee of 29th , we selected 5 wonderful winners.  Although the discussion was heated during selection, in the end we came to unanimous decision.  I will write on this again after the winners are announced officially.  Activities such as this L’Oreal Award have a great IR impact that appeals to the world. This is a true soft power.

Photos 3, 4: Snap shots from the selection committe

In the evening, like 2 years before, L’Oreal invited us to a concert. (Photo 5).  Last time I had to leave for the airport during intermission, but this time I was able to listen to the end.  I came across Mr. Akiba of UNESCO embassy at the concert.  We had a cocktail together at intermission, went for dinner in the concert hall after the program, and departed some time after 12pm.

The artists of that evening were; Piano、Daniel Barenboim, Conductor, Christoph Eschenbach, with Orchestre de Paris.  Several Japanese were playing also.

The program was：　
Berlioz; Benvenuto Cellini, ouverture, op. 23; Carnaval romain, ouverture, op 9
Chopin ; Concerto pour piano n. 2 en fa minerur, op. 21 ; 　n. 1 en mi mineur, op. 11

Barenboim was wonderful.  I felt his character being reflected in his music.

Photo 5; Barenboim (center) and Eshenbach (left end)

It was an evening full of lovely, rich experience.  I think what I experienced that night was truly what we call a “soft power”.  Tradition and sophistication were there, and yet the building of the concert hall was not overwhelmingly magnificent. In comparison, I thought about a system of a country somewhere, that in the name of “soft power” builds a ‘box’ for animations, big ‘National’ or ‘Local’ ‘boxes’ of art museums and theaters of various names just to increase debt on its people. But then, we do not have enough “softs” to fill in.  So, we invite famous artists from overseas and charge senselessly high fees.  I tell you, I heard from a specialist of European music that reputation among musicians of performing in Japan is “lucrative".

Let’s expect our new administration to stop carrying out such weird policies (we had enough of them), and start a “change” to policies that fit our time.  Several shady stories are coming into light already, like relations between airport and special account, strange tricks hidden in dam constructions and other civil engineering.  We have so many stories that make us ashamed, in fact, too many.
 
On a television broadcast of a press conference, I noticed that the newly appointed ministers were answering to the questions of correspondents in their own words, not holding on to memos prepared by bureaucrats.  You may not have noticed it, but I think many people felt this as a fresh scene. I have told you my thoughts on this issue before (in the 2nd paragraph....)  What do you think?