AIM： To clarify the prevalence of defensive medicine and the specific defensive medicine practices among gastroenterologists in Japan. METHODS： A survey of gastroenterologists in Hiroshima, Japan, was conducted by m...AIM： To clarify the prevalence of defensive medicine and the specific defensive medicine practices among gastroenterologists in Japan. METHODS： A survey of gastroenterologists in Hiroshima, Japan, was conducted by mail in March 2006. The number of gastroenterologists reporting defensive medicine behaviors or changes in their scope of practice and the reported defensive medicine practices, i.e., assurance and avoidance behaviors, were examined. RESULTS： A total of 131 （77%） out of 171 gastroenterologists completed the survey. Three （2%） respondents were sued, and most respondents （96%） had liability insurance. Nearly all respondents （98%） reported practicing defensive medicine. Avoidance behaviors, such as avoiding certain procedures or interventions and avoiding caring for high-risk patients, were very common （96%）. Seventy-five percent of respondents reported often avoiding certain procedures or interventions. However, seasoned gastroenterologists （those in practice for more than 20 years） adopted avoidance behaviors significantly less often than those in practice for less than 10 years. Assurance behaviors, i.e., supplying additional services of marginal or no medical value, were also widespread （91%）. Sixty-eight percent of respondents reported that they sometimes or often referred patients to other specialists unnecessarily. CONCLUSION： Defensive medicine may be highly prevalent among gastroenterologists throughout 3apan, with potentially serious implications regarding costs, access, and both technical and interpersonal quality of care.展开更多
Although the Japan Society of Obstetrics and Gynecology （JSOG） endorses new-type PGD using CGH for only carriers of balanced chromosomal translocations, it is against the ethical guidelines of the JSOG to decide whe...Although the Japan Society of Obstetrics and Gynecology （JSOG） endorses new-type PGD using CGH for only carriers of balanced chromosomal translocations, it is against the ethical guidelines of the JSOG to decide whether or not embryos should be implanted due to aneuploidy discovered as a result of new-type PGD. In the author＇s opinion, it should be at the discretion of the JSOG＇s own randomized controlled trials, which should involve multiple facilities, whether or not a scientific basis can be found for the value of the new-type PGD in cases of recurrent miscarriage, in cases of implantation failure, and in cases where the women are of advanced maternal age. Dr. Netsu＇s 36 cases of selective reduction may be against the Japanese Maternal Health Protection Law that prohibits abortion due to congenital disease, but with the backdrop that there are many abortions that are performed as a result of parental convenience in Japan, it is difficult to understand the difference between the over 300,000 abortions that are performed every year in Japan and Dr. Netsu＇s prescribed surgery which is designed to selectively reduce fetuses with congenital disease for the purpose of evading physical danger for women with multiple gestations.展开更多
The growing number of people suffering from depression has become a social problem in Japan. The problems associated with depression in Japan have been influenced by the pharmaceuticalization of mental health. Since s...The growing number of people suffering from depression has become a social problem in Japan. The problems associated with depression in Japan have been influenced by the pharmaceuticalization of mental health. Since selective serotonin reuptake inhibitors were introduced to Japan＇s pharmaceutical market in 1999, demand for anti-depressant medications has rapidly expanded. It seems likely then that the efforts of pharmaceutical companies, as part of their marketing strategies, to increase people＇s awareness of mental illness have led people who are not actually depressed to have medical consultations and drug treatments for it. This phenomenon is known as ＂disease mongering＂ and has been reported on. Problems exist from the medical perspective also and include the following： expansion of the diagnostic criteria for depression as formulated in the American Psychiatric Association＇s Diagnostic and Statistical Manual of Mental Disorders; treatments that rely heavily on drugs; and biomedicalization. Another reason for the increase in medical consultations is the declining function of communal bodies. This has resulted in individuals struggling psychologically, for example, with anxiety, worry, and depression. In summary, this sociological research analyzed the problems of depression in ｜apan and revealed how the pharmaceuticalization of mental health accelerates the individualization of social problem.展开更多
文摘AIM： To clarify the prevalence of defensive medicine and the specific defensive medicine practices among gastroenterologists in Japan. METHODS： A survey of gastroenterologists in Hiroshima, Japan, was conducted by mail in March 2006. The number of gastroenterologists reporting defensive medicine behaviors or changes in their scope of practice and the reported defensive medicine practices, i.e., assurance and avoidance behaviors, were examined. RESULTS： A total of 131 （77%） out of 171 gastroenterologists completed the survey. Three （2%） respondents were sued, and most respondents （96%） had liability insurance. Nearly all respondents （98%） reported practicing defensive medicine. Avoidance behaviors, such as avoiding certain procedures or interventions and avoiding caring for high-risk patients, were very common （96%）. Seventy-five percent of respondents reported often avoiding certain procedures or interventions. However, seasoned gastroenterologists （those in practice for more than 20 years） adopted avoidance behaviors significantly less often than those in practice for less than 10 years. Assurance behaviors, i.e., supplying additional services of marginal or no medical value, were also widespread （91%）. Sixty-eight percent of respondents reported that they sometimes or often referred patients to other specialists unnecessarily. CONCLUSION： Defensive medicine may be highly prevalent among gastroenterologists throughout 3apan, with potentially serious implications regarding costs, access, and both technical and interpersonal quality of care.
文摘Although the Japan Society of Obstetrics and Gynecology （JSOG） endorses new-type PGD using CGH for only carriers of balanced chromosomal translocations, it is against the ethical guidelines of the JSOG to decide whether or not embryos should be implanted due to aneuploidy discovered as a result of new-type PGD. In the author＇s opinion, it should be at the discretion of the JSOG＇s own randomized controlled trials, which should involve multiple facilities, whether or not a scientific basis can be found for the value of the new-type PGD in cases of recurrent miscarriage, in cases of implantation failure, and in cases where the women are of advanced maternal age. Dr. Netsu＇s 36 cases of selective reduction may be against the Japanese Maternal Health Protection Law that prohibits abortion due to congenital disease, but with the backdrop that there are many abortions that are performed as a result of parental convenience in Japan, it is difficult to understand the difference between the over 300,000 abortions that are performed every year in Japan and Dr. Netsu＇s prescribed surgery which is designed to selectively reduce fetuses with congenital disease for the purpose of evading physical danger for women with multiple gestations.
文摘The growing number of people suffering from depression has become a social problem in Japan. The problems associated with depression in Japan have been influenced by the pharmaceuticalization of mental health. Since selective serotonin reuptake inhibitors were introduced to Japan＇s pharmaceutical market in 1999, demand for anti-depressant medications has rapidly expanded. It seems likely then that the efforts of pharmaceutical companies, as part of their marketing strategies, to increase people＇s awareness of mental illness have led people who are not actually depressed to have medical consultations and drug treatments for it. This phenomenon is known as ＂disease mongering＂ and has been reported on. Problems exist from the medical perspective also and include the following： expansion of the diagnostic criteria for depression as formulated in the American Psychiatric Association＇s Diagnostic and Statistical Manual of Mental Disorders; treatments that rely heavily on drugs; and biomedicalization. Another reason for the increase in medical consultations is the declining function of communal bodies. This has resulted in individuals struggling psychologically, for example, with anxiety, worry, and depression. In summary, this sociological research analyzed the problems of depression in ｜apan and revealed how the pharmaceuticalization of mental health accelerates the individualization of social problem.
