Asahi: Joe Kurosu MD on ineffectually low doses of medicine for NJ patients and bureaucratic intransigence

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Hi Blog. In our previous blog entry, Debito.org Reader StrepThroat brought up the issue of Japanese medical prescription doses being too low to be effectual for some larger patients, particularly larger NJ patients used to larger doses overseas. Some respondents recommended taking double the dose and going to the doctor again for refill of the prescription, while others self-medicated with overseas supplements, and still others mentioned falling through the system entirely (particularly when it came to painkillers).

Joe Kurosu MD, who runs a clinic in Shimokitazawa, adds to this discussion in a January 2010 series of opinion pieces in the Asahi Shinbun, by saying:

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Asahi:  “For reasons that are unclear, however, the indicated maximum dose is often significantly lower than that which is standard in other parts of the world. Difference in physical frame and incidents of side effects are some of the purported reasons, but a scientifically convincing basis is lacking.

“A significant number of resident foreign nationals currently receive health care through the Japanese national health insurance system, but are ill-served because of these dosage standards.

“The maximum daily doses indicated on package inserts of standard medications for high blood pressure, diabetes and depression, for example, are one-quarter to one-half of the standard doses in other countries for the identical drug. […]

“In any case, if the government requires foreign nationals to join the [National Health Insurance] system, it must be willing to provide services appropriate to that population. If this is not possible, then buying in the system should be voluntary […] I urge the government and relevant authorities to return autonomy to the physicians so the medications can be prescribed appropriately for the patient, whether or foreign or Japanese, based on science and clinical judgment, rather than [mechanically applying the dosage levels indicated on the package inserts].”
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Here are scans of Dr. Kurosu’s articles in English and Japanese, courtesy of Dr. Kurosu himself (pctclinic.com) and RJ.

PDF versions here (click on link):
Kurosu2
KurosuArticleJP

There was another question as to whether Japanese medical testers screen for Japanese as an ethnicity (or “race”) when it comes to clinical trials.  Well, yes they do — as demonstrated here in Hawaii when I saw an ad in our campus newspaper back in 2012 calling for “Japanese” people to volunteer for a series of clinical trials “to help Japanese people”, sponsored by Covance.  I inquired (as a Japanese citizen), but was told that they were only interested in “ethnic Japanese” (including those who didn’t have Japanese citizenship, but had “Japanese blood”).  Oh well.  Missed out on my body mass.

Many thanks to everyone for helping make Debito.org a valuable resource and forum. Dr. Debito Arudou

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20 comments on “Asahi: Joe Kurosu MD on ineffectually low doses of medicine for NJ patients and bureaucratic intransigence

  • Dr. Arudō,

    The point I was making in my comment was that A) there is no group called “ethnic Japanese” (the Japanese ethnic majority are “Yamato,” or Wajin, even according to your own work, as far as I’m aware), and B) judging from the advertisement you posted, any Ainu, Ryukyuan, Okinawan, or Ogasawaran person would qualify, despite not being Wajin. If we say they’re screening for ethnicity, this would of course obligate them to acknowledge the above minority ethnicities’ existence (which most Wajin do not want to do), and then of course ask the candidates, “Do you belong to an ethnic minority?” It doesn’t look like that’s happening, based on the advertisement you posted.

    Additionally, if we assume candidates are screened out simply on basis of where they or their ancestors were born (like the advertisement says), race doesn’t even necessarily factor in. I have a white friend who was born here in Japan. Unless there’s an asterisk somewhere requiring one be Asian, he would qualify, despite not being Wajin, and technically, not even holding Japanese citizenship.

    Still, all that aside, my overall point was that there is not a group called “ethnically Japanese,” and screening for ethnic minorities requires one to admit that the majority group Wajin exists, and the participates to voluntary identify themselves as belonging to one of the subjugated minority ethnicities (whose very existence is denied), which again, does not appear to be happening.

    Reply
  • Anonymous says:

    @ HJ

    Firstly, Japanese culture defines “Japanese” not as “Japanese nationality” but as “Japanese RACE/ETHNICITY”. Although it pains white citizens of Japan, black citizens of Japan, and any such minority-race citizens of Japan, the fact remains that the Wajin majority still maintain “Even though you are a Japanese citizen, you are still NOT Japanese. We can see that you are NOT Japanese, based on your skin. You are an outsider, based on not looking like the Yayoi-Jomon perfect-blend descendants. You may have Japanese citizenship, but still you are a Gaijin. Japanese is a race, and you are not in it.”

    Posters here who mention the fact that such a definition of “Japanese” is currently limited to “Japanese race/ethnicity” are doing their best to complain about that definition, and to demand that ALL Japanese citizens be considered Japanese, and to demand that Japan legislates a Civil Rights Law outlawing businesses from denying-entry-based-on-race, and prosecutes perpetrators of any such appearance-based-exclusion actions. That Civil Rights Law should protect all citizens of Japan, regardless of race, and should even protect all residents of Japan, and should even protect all humans (even tourists) existing in Japan.

    Secondly, Japanese culture for a long time excluded Ainu (“too much white-race in them”) and Ryuukyuuu (“too much dark-race in them”) from the definition of the “Japanese” race. The majority group who tried to exclude those minorities were proud to be appearing to have “sufficient purity of Yamato [Yayoi+Jomon] ancestry”, and only begrudgingly were forced to quite recently to state that “OK, for legal purposes, Japanese citizens with Ainu or Ryuukyuu ancestry are now to be considered honorary ‘members of the Japanese race’ which we sneakily shorten to ‘Japanese’ (although we, the wajin majority, still don’t consider Ainu or Ryuukyuu people to be ‘real’ Japanese.” So, the average person of Japanese culture would still try to quietly exclude such minority “too-light Japanese citizens” and “too-dark Japanese citizens” from medical trials concerned with studying the effects on the majority of Japan (although, since, as mentioned, Japan was forced to give Ainu citizens of Japan and Ryuukyuu citizens of Japan “equal rights as ‘Japanese’ under the constitution” such exclusion of them is done nowadays quietly WITHOUT admitting it in writing, just as excluding Burakumin from equal hiring consideration is still done in Japan quietly WITHOUT admitting it in writing. So just because the advertisement doesn’t state “No Ainus, No Ryuukyuus, No Burakumin” that doesn’t prove that the medical trial wajin are being 100% inclusive. And let’s remember that what Debito rightfully is bringing up is the fact that he, a Japanese citizen, is still being excluded from the definition of Japanese. And thus in the end the “dosages per person” are being limited in a way which damages people in Japan who happen to be taller/larger/heavier than “the ‘real’ Japanese race.”

    So the large problem being mentioned in this thread is: Japanese citizens still being excluded from the definition of Japanese. And the second problem is even the “Japanese Race” minorities are still quietly excluded by the wajin “Yayoi+Jomon perfect Yamato Damashi Japanese Race” majority. And the third problem is doctors in Japan and pharmacists in Japan refusing to do the correct calculation of dosage, which would require taking the “standard dose per 60kg Japanese person”, dividing that by 60 to get a “per kilogram dosage” and then multiplying that times the number of kilograms which the patient (regardless of race/ethnicity) weighs. And then, a bonus problem is Japanese culture pretending that “that’s not happening” or “that’s not a problem” or “that’s a good thing” or “that’s done elsewhere so let’s not improve” or “that’s the way the law is” or “that’s the way the law should be” or “you are the problem-maker for pointing out the problem.”

    Reply
    • Firstly, Japanese culture defines “Japanese” not as “Japanese nationality” but as “Japanese RACE/ETHNICITY”.

      First, “firstly” is not a word. Second, I don’t think it’s going to be very helpful in our efforts to educate people and eliminate racism to attribute racism to “Japanese culture.” Racism is just that–racism. It is not an inherent, unchangeable feature of Japanese culture, but rather a worldwide social phenomenon that arises among different groups of people in the midst of their interactions with other groups of people whom they have come to perceive as fundamentally different from themselves.

      In the particular context of Japanese society, the paradigm you are describing is most accurately expressed as “Wajin do not recognize non-Wajin as fellow Japanese, even when the non-Wajin hold Japanese citizenship.” This is a fact I am aware of and have not contested.

      Although it pains white citizens of Japan, black citizens of Japan, and any such minority-race citizens of Japan, the fact remains that the Wajin majority still maintain “Even though you are a Japanese citizen, you are still NOT Japanese…

      And here you have re-written your above claim using the correct terminology.

      …We can see that you are NOT Japanese, based on your skin. You are an outsider, based on not looking like the Yayoi-Jomon perfect-blend descendants. You may have Japanese citizenship, but still you are a Gaijin. Japanese is a race, and you are not in it.”

      I understand your use of the expression “Yayoi-Jōmon perfect-blend descendants” as an effort to convey the presumed origins of the Yamato ethnic group, but it’s really an unnecessary point. Not only is it probably inaccurate, but also really just about any “Asian”-looking face will be treated as an equal, provided her/his Japanese sounds native. On the flip-side, any “known”
      “outside heritage” will automatically disqualify a person as a Wajin, even if that person is an Asian, speaks native Japanese, and was even born and raised in Japan (e.g. Zainichi Koreans). So, looks alone may (or may not) be sufficient to receive treatment as an equal. At this point, any rational person should start to realize how arbitrary and meaningless the definition of who is or is not Wajin is.

      Posters here who mention the fact that such a definition of “Japanese” is currently limited to “Japanese race/ethnicity” are doing their best to complain about that definition…

      Your language is self-contradictory. You use the expression “Japanese ethnicity” or “ethnic Japanese” without problematizing it, then turn around and acknowledge that it’s actually an inaccurate expression, then attempt to defend your inaccurate use of it.

      Based on what you’re saying, minute details aside, I think you and I are basically in agreement about the reality of ethnic diversity and oppression in Japan. My point is, let’s not play along with the ethnocentric, racist Wajin and use the inaccurate term “ethnically Japanese” or “Japanese ethnicity.” Let’s use the correct terms, and refer to the oppressive majority and its entitled members as “Wajin” or “Yamato people,” and within the context of the correct terminology point out that people are being excluded for the real reason–that they are not Wajin, not that they are “not ethnically Japanese,” as again, that group does not exist.

      Even if we do borrow the (inaccurate) terms you are using, you are basically just positing the same thing as I, except you are using the word “ethnically Japanese” to mean “Wajin,” on the basis that Wajin will not recognize any non-Wajin as “true Japanese” anyway. This terminology debate as, whether we accurately say Wajin or submit ourselves to the ethnocentric “ethnically Japanese” label that the Wajin have assumed for themselves, the point remains that the only stated criteria for inclusion in the test is ones place of birth. Which brings me to your next point:

      So just because the advertisement doesn’t state “No Ainus, No Ryuukyuus, No Burakumin” that doesn’t prove that the medical trial wajin are being 100% inclusive.

      This is a great point, and if you had simply posited this in the first place instead of trying to explain a bunch of stuff to me that I already know, the conversation could have moved in a productive direction much more quickly.

      You’re right, just because there’s no explicit exclusionary policies, doesn’t mean there is no de facto segregation going on in spite of the stated criteria. There might be, and it wouldn’t surprise me, but at this point no one has produced any such evidence (or even made any such assertion, either).

      And let’s remember that what Debito rightfully is bringing up is the fact that he, a Japanese citizen, is still being excluded from the definition of Japanese.

      He is being excluded, although it is because he was not born in Japan, not because of his ethnic identity directly. Again, my Japan-born white friend would qualify, barring the above mentioned possibility of unstated exclusionary policies.

      And thus in the end the “dosages per person” are being limited in a way which damages people in Japan who happen to be taller/larger/heavier than “the ‘real’ Japanese race.”

      Well, really it causes problems for anybody who is bigger than average, including fellow Wajin. I have a Wajin co-worker who is huge; I seriously don’t know how he buys pants and shirts. Yet despite being a Wajin, as a large person, he would be negatively impacted by this bureaucratic catastrophe. This is most certainly a human rights problem, and I think it deserves attention here, as it presumably affects minorities even more than Wajin, but in the end it is a governmental and bureaucratic failure more than anything.

      Absolutely, there is a huge element of racism here. After all, the whole reason there are restrictions on who can be a test subject for these clinical trials is because the racist Wajin right-wing nuts in power are trying to establish a standard based on the (as you have above explained) fictitious “Japanese ethnic group” (read: Wajin), on the principal that members of that group are somehow different than all other human beings, and thus data from outside that group shouldn’t be included in trials. (As it presumably wouldn’t be applicable to the magical “Japanese ethnic group.”) However, because that group in reality doesn’t exist and so therefore cannot be defined, arbitrary standards were enacted about who may be a test subject.

      Even still, the ultimate problem is, as Dr. Kurosu explained, that doctors aren’t given leeway to establish any other dose outside of the bureaucratically established maximum printed on the paper insert in the medicine box. Ultimately, who participates in the clinical trials is not quite as crucial as making sure the government isn’t handicapping doctors from being able to use their discretion and judgment to deliver appropriate treatment to patients based on individual needs, as even within the Wajin group, as I mentioned, there are people who do not fit the (government-prescribed) “norm.”

      And the third problem is doctors in Japan and pharmacists in Japan refusing to do the correct calculation of dosage…

      Unless I misread Dr. Kurosu’s words, it is not that the doctors are unwilling to correctly assess a patient’s needs; it is that they are bound by arbitrary insurance and dosing laws to only dispense to a certain amount, beyond which if dispensed, the patient will become responsible for 100% of costs, in a wonderful all-or-nothing scheme. Again, this is bureaucratic nightmare more than anything else.

      And then, a bonus problem is Japanese culture pretending that “that’s not happening” or “that’s not a problem” or “that’s a good thing” or “that’s done elsewhere so let’s not improve” or “that’s the way the law is” or “that’s the way the law should be” or “you are the problem-maker for pointing out the problem.”

      Well, yes, Japanese culture, and also just lazy human beings who don’t care about problems that are not directly affecting their lives, combined with being too busy with too much work and too much economic hardship to spend much time paying attention to these things, not to mention a mass media bound and gagged from excessively criticizing the right-wing government, in a social climate where students are not taught to question or think about these things when they are at school. Again, action is necessary, to be sure. Let’s just make sure we’re not playing along with the oppressors by buying into their inaccurate characterizations of society.

      Reply
      • Jim Di Griz says:

        I disagree, respectfully.
        One function of the Meiji-era oligarchy’s nation building (that is to say, the creation of the basis of modern Japanese identity) was specifically to create a ‘new’ Japanese identity based on myths of ‘traditional’ Japaneseness directly and expressedly in opposition to ‘non-Japanese’ identities and cultures. The goal was to create a ‘new’ Japanese nationalism for the newly invented international actor known as the state of ‘Japan’. Nationalism was essential for the fascist Meiji state that wanted its subjects to unquestioning (voluntarily?) pay tax and give their lives to the creation of a ‘Japanese Empire’.
        So, yeah, I’d argue that racism is an inherent part of Japanese culture since it was an inherent part of Japan’s incarnation as a modern nation state.
        Go and read Steve Vlastos; Mirror of Modernity to see how the Meiji era state BS’ed Japanese people as to what ‘being Japanese’ was all about.

        Reply
        • Ah, yes, you have a great point here, Jim. As Dr. Arudō has stated as well, racism is very much ingrained in society, and the reason you have stated is most certainly one of the causes.

          The thing about when people start conflating racism and Japanese culture is that inevitably, someone will point out that culture is a good thing, to be protected, etc. Racism was also an ingrained part of culture in the southern U.S. and as such continues to be a place where it lingers on. If we treat racism as just a part of Japanese culture, not as a negative social phenomenon that appears worldwide and also happens to be present in Japan as well, we also start to pave the way for Japanese exceptionalism, don’t we?

          I’m not trying to suggest racism hasn’t been ingrained in society. It most definitely has. However, it is not the grand sum total, nor is it inseparable from, Japanese culture. And of course, the more we take action and raise our voices, the more we can help to shut it down and flush it out.

          Reply
          • Jim Di Griz says:

            Thank you, but I can’t agree with you; Japanese racism IS inseparable from Japanese culture.

            70 years after Japan’s ‘great’ experiment with Nihonjinron Japanese superiority ended with two atomic bombings, the deaths and suffering of tens of millions of Japanese, the Japanese are simply unable to divorce themselves from the ideology that caused it.

            Japanese society has never moved from shock, to denial, to grief, and then to acceptance that they lost the war because their ideology was wrong- their culture was wrong.

            The inability to accept that fact and move on (like Germany), but rather to seek to ‘explain’ the ideologies failure in a manner that doesn’t deny the ideology’s validity is why it has all come to this; Japan is stuck at 8/15/45. It has chosen to fail to comprehend what happened and why.

            So yeah, maybe that’s the only ‘unique’ and ‘special’ thing about Japan.

          • Jim Di Griz says:

            Also, I would agree that ‘culture’ is generally a good thing, whilst I would also disagree with any ideas of ‘preserving culture’ since culture is, and ought to be, a living and changing thing.

            Therefore culture should not be ‘protected’ and any attempt to do so results in an ersatz facsimile of the way some people think culture was. It ceases to have any connection to everyday realities. And this is what HAS happened in Japan, which has a history of attempting to ossify its culture at some imaginary ‘peak’ which results in a stilted, disconnected, irrelevant practice that fails to resonate with people.

            The failure to understand this is what then leads the self-appointed guardians of Japanese culture to blame it all on ‘western influences’.

            And therefore, we have right-wingers like Nippon Kaigi blaming the failure of their own attempts to preserve culture on ‘non-Japanese’ ideas; like human rights for women, children and NJ.

            It is the Japanese racists themselves who conflate culture and racism, because that’s all the culture they are left with when you take away ‘western concepts’.

          • Anonymous says:

            When the majority of individuals and legislators and judges in America felt it was OK for businesses to legally commit race-based-entry-denial, at THAT time one could have (and one should have) honestly stated, “American culture has institutionally legal Embedded Racism.”

            Then, in 1964 American culture outlawed and begin using the courts to penalize race-based-entry-denial (and ALL sorts of discrimination done by companies), and the majority of people in America now agree with that Civil Rights Law being needed to penalize discrimination by businesses, so that old “rude” sentence about “American culture having institutionally legal Embedded Racism” can no longer be honestly said.

            Currently, the majority of individuals and legislators and judges in Japan feel it is OK for businesses to legally commit race-based-entry-denial, so: at THIS time one can (and one should) honestly state, “Japanese culture has institutionally legal Embedded Racism.”

            Don’t like to hear a country’s culture being (gasp) criticized?

            Well, to avoid such “rude” criticism, Japan’s culture must immediately outlaw and begin using the courts to penalize race-based-entry-denial.

            Japan’s government legally contracted with the United Nations when it signed the Committee on the Elimination of Racial Discrimination Treaty in 1995: a Supreme Law Treaty which Japan’s culture remains blatantly in violation of today in 2017.

            C’mon Japan culture, hurry up: push your legislators to obey the United Nations Supreme Law by outlawing and penalizing businesses committing race-based-entry-denial, so that humanity can no longer criticize institutional legal Embedded Racism being an aspect of Japanese culture in 2017.

            But oh, wait, Japanese culture is NOT pushing legislators to outlaw and penalize the “No Gaijin Races Allowed” action, because… Japanese culture itself (since even before the Meiji Era and continuing unrepentant into present day 2017) STILL APPROVES of the “No Gaijin Races Allowed” action.

      • Anonymous says:

        From the start of the Meiji era continuing into the present day 2017:

        A) The current majority culture of Japan encourages Embedded Racism.

        B) The culture of Japan encourages Embedded Racism.

        C) Japan’s culture encourages Embedded Racism.

        D) Japanese culture encourages Embedded Racism.

        E) Wajin Culture encourages Embedded Racism.

        I understand HJ, you want only Debito’s new “Wajin” term to be used from now on.

        The current majority culture of Japan defines “Japanese (Nihon-jin)” as “The Japanese Race.”

        The current majority culture of Japan defines “Outsiders (Gaijin)” as “Any Non-Japanese Race, even if they have citizenship of Japan, even if they are 50% Japanese Race ‘haa-fu’, even if they are 75% Japanese Race ‘kwoo-taa’, to be ‘Japanese’ one must be ‘pure Japanese race.”

        We don’t like those current realities, but we talk about them.

        I hear you saying, “Let’s refuse to call the current majority culture of Japan ‘Japanese culture’, let’s from now on only call the current majority culture of Japan ‘Wajin culture.'”

        I think some folks have decided that the proper approach to this problem is, “The ‘Yayoi-Jomon Race’ majority currently holding power do NOT have genetic markers slightly differentiating this relatively ‘sakoku’-ed group from the Korean and Chinese races in Korea and China, and the Korean and Chinese races don’t have genetic markers slightly differentiating themselves either, all Asians are Asians and there are no racial differences between any Asians. There are racial differences between redheads and blondes, with genetic markers through mutations, but let’s just say that all Asians are one race! We can not tell, through double-blind DNA testing, an Ainu from a Ryuukyuu. Asians are just one big un-differentiable group which we should call Asians. So stop saying the term, “Japanese race”. First (not firstly by the way, harumph) one should no longer even use the term race, one should run away from that word and use the politically correct term ethnicity instead. And secondly, we should no longer use the term Japanese ethnicity. Wajin is the only term we should use from now on, when describing the majority power holders in Japan… who visually appear to be part of the majority race in Japan, but oops, Wajin is NOT a race!”

        I think the proper approach to this problem is to boldly state, “Japanese culture itself currently encourages Embedded Racism. Japanese culture refused to allow a white Japanese citizen (Debito) into a bathhouse, Japanese culture refused to allow a half-white-race half-Japanese-race Japanese citizen into a bathhouse (one of Debito’s children), but allowed in the other child who “appeared to be Japanese race”. Japan has an American written Constitution which outlaws GOVERNMENT workers from committing such race-based-entry-denial, but in 2017 Japan has NO Civil Rights Law outlawing BUSINESS workers from committing such race-based-entry-denial. Thus, since Japanese culture refuses to legislate such much needed Civil Rights Law, Japanese culture encourages Embedded Racism.”

        If Japanese culture someday STOPS encouraging Embedded Racism, then finally we will be able to say:

        It’s 2099, and Japanese culture no longer encourages Embedded Racism. Finally, everybody who is a Japanese citizen is Japanese. The word Gaijin is no longer used. And all humans within Japan are guaranteed by law equal protection from race-based-entry-denial, and from all such racial discrimination.

        Reply
      • Anonymous says:

        To add to and summarize the post I wrote a few hours ago:

        When we Debito commenters complain about actions of Japanese Culture, we are complaining about ACTIONS of the current majority CULTURE in JAPAN.

        The current majority culture in Japan defines “a Japanese person” as “a person with Japan race genetics.”

        We want the the majority culture in Japan to begin defining “a Japanese person” as “a person with Japan CITIZENSHIP.”

        So I don’t think complaining about “Japanese culture” is a problem.

        I also don’t even think saying that “a Japanese race exists” is wrong.

        I simply think that Japanese culture legally allowing businesses to state “Japanese Race Only, Gaijin Races not Allowed” is the problem.

        Reply
        • I understand HJ, you want only Debito’s new “Wajin” term to be used from now on.

          This is a strawman argument. Wajin is not a new word that Dr. Arudō invented. It already had a history of use in Japanese social studies to properly differentiate the Yamato majority from Japanese ethnic minorities. It is the correct term to refer to that specific majority group, and using the word “Japanese” to refer to Wajin and their privilege is at best inaccurate, and really moreso a dismal dismissal of the very ethnic minorities whose voices and rights we are seeking to protect. Even apologists have pointed out how hypocritical it is to use the blanket term “Japanese” to discuss Wajin racism, then turn around and point out Dr. Arudō, who is Japanese himself, as a champion of human rights. Are Japanese (all of them) the problem, or not?

          Furthermore, I criticized your misuse of terms and supplied a legitimate argument as to why we should all be using correct terminology to discuss the ethnic groups in place in Japan. Your contrite response attempts to dismiss this as some mere personal preference that I have expressed, saying “you want us to…” If I’m wrong–if your position is that using the correct terms is not important–where is your counterargument?

          I hear you saying, “Let’s refuse to call the current majority culture of Japan ‘Japanese culture’, let’s from now on only call the current majority culture of Japan ‘Wajin culture.’”

          I never made such a claim, and I challenge you to copy and paste where I did. I criticized your inaccurate use of the expression “Japanese ethnicity,” and in doing so myself used the expression “Japanese culture,” which very much does exist, and is an amalgamation of influences from other cultures.

          When we Debito commenters complain about actions of Japanese Culture, we are complaining about ACTIONS of the current majority CULTURE in JAPAN.

          The culture is made up of many constituent factors and is a fluid, changing entity, right? The culture does not act; the people do. Yes, there is a strong tendency to encourage bigotry underlying in the culture. And we are right to criticize that. But the perpetrators of the bigotry are generally members of the majority ethnic group–Wajin.

          The current majority culture in Japan defines “a Japanese person” as “a person with Japan race genetics.”

          We want the the majority culture in Japan to begin defining “a Japanese person” as “a person with Japan CITIZENSHIP.”

          Replace “majority culture” with “majority ethnic group,” add the qualifier “generally,” and I agree with you. The majority ethnic group highly influences the culture, to be sure, but let’s be clear that they are the source–the culture does not autonomously generate bigotry.

          And yes, historical influences have brought us to the current state. But culture is constantly changing and fluid. Let’s educate the majority, refuse to be silenced by them, and make our mark on the culture. The culture encompasses all of us. The Wajin ethnic group does not.

          So I don’t think complaining about “Japanese culture” is a problem.

          I also don’t even think saying that “a Japanese race exists” is wrong.

          I agree that it’s fine to complain about the culture, so long as we’re A) acknowledging that racist members of the majority ethnic group are the ones who have made it that way; and B) we’re complaining from the position of “Let’s proactively do something to make changes.”

          On the other hand, endorsing the notion that a “Japanese race exists” is to simply legitimize the exclusionary, fictitious worldview of the racists belonging to the ethnic majority (again, not all Wajin are racists). Yes, I understand those racists believe the “Japanese race” exists. That doesn’t mean we have to use their factually inaccurate terms when discussing the reality of social problems here.

          Again, I have the same goals and interests in mind–ending race-based entry denial, ending the use of the racial epithet “gaijin,” and the enactment of legislation that protects the human rights of all persons, citizen or not, Wajin or not. Let’s be clear and accurate though, when we talk about this, about what is the source of the problem, and what needs to change. And, of course, finally, let’s take action to make changes.

          Reply
          • Anonymous says:

            @HJ

            I was wrong about something, sorry about that, thank you for the correction.

            I had wrongly assumed that you were rallying against the term “ethnicity” itself.

            My wrong assumption about your stance is partially a result of hearing folks take the good-intentioned-yet-incorrect stance of
            A. “Ethnicities don’t exist” (the “just a mental construct physical DNA haplogroups don’t exist” stance)
            or
            B) “Ethnicities exist but all Asians are just one ethnicity” (the “China’s majority, Korean’s majority, Japan’s majority, absolutely zero haplogroup/locus/allele differences between them” stance)

            So now I realize you do indeed admit that ethnicities exist in general and that Japan’s majority ethnicity in particular exists.

            You simply do not want us to make the mistake of limiting the definition of “the Japanese ethnicity” to being just “Japan’s majority ethnicity”.

            You suggest that we no longer fall into Japan’s culture’s wrong linguistic trap of shortening “Japan’s majority ethnicity” into “the Japanese ethnicity”.

            Your point about the importance of adding the word MAJORITY in front of ethnicity makes sense: since the real thing we are against is the action of the majority of “the MAJORITY ethnicity in Japan” refusing to outlaw the discrimination against the minority ethnicities in Japan.

            And yes, we can shorten “the majority ethnicity in Japan” to “Wajin” (thanks for the correction that it is not just a term invented by Debito) yet since MOST people around the world currently don’t know the term “Wajin” I’m going to use the phrase “the majority ethnicity in Japan” from now on.

            Yes, I have been guilty of shortening “the majority ethnicity in Japan” to “the Japanese ethnicity” many times while complaining about them doing the exact same thing, so from now on I will add that essential MAJORITY qualifier when mentioning ethnicity.

            Still, we will continue to criticize “the JAPANESE CITIZENS”, which of course can be logically shortened to “the JAPANESE”, who continue to refuse to outlaw and penalize racial discrimination such as race-based-entry-denial.

            I look forward to someday (perhaps within this century?) being able to stop criticizing the Japanese for having LEGAL discrimination against minority ethnicities in Japan.

            The Americans allowed legal ethnicity discrimination until 1964.

            The Japanese continue to allow legal ethnicity discrimination in 2017.

  • You have to separate medical, social and moral issues. Medical drugs are tested on various human populations from different ethnicities. Traditionally in Japan (but this has changed recently), drug approval required the drug to be tested on “ethnically Japanese” patients, and did not accept global trials (which included testing on different ethnic groups, including East-Asian).
    On a political level, of course it is inacceptable to make any difference between citizens. On a medical level, it is obvious that ethnicity needs to be taken into account. One can wonder why the Japanese medical establishment clings to the “Japanese ethnicity” tale though, since for all that matters, the majority of Japanese people are simply East-Asians (there is no specific “Japanese” medical characteristics).
    Another question raised by the article is the question of low daily dosage for medicine. In my opinion, this is related to the overall philosophical foundations of the medical profession as well as Japanese culture (alleviating pain for example has definitely lower priority here than in Western medicine).
    Most of those issues could be resolved easily if evidence-based medicine was systematized including on the regulatory level, instead of relying on tradition.

    Reply
    • Jim Di Griz says:

      You said, ‘On a medical level, it is obvious that ethnicity needs to be taken into account.’

      This is absolute racist hogwash, and I can only presume that you are speaking from ignorance, rather than deliberately seeking to apologize for Japanese institutional racism.

      The only factors that should be taken into account when determining dosages are age, body mass, pre-existing conditions and medical history, gender (i.e. pregnant ladies). Ethnicity makes no difference whatsoever in itself.

      Reply
      • Jim, calm down. I am just saying that some human subgroups have different medical susceptibilities and that is taken into account during drug design, therapy or in preventive medicine.
        For example, heart failure is mostly due to ischemic disease in non-Black populations, while it is due to hypertension in Black populations. Ashkenazi women have higher risk of breast cancer due to high rates of BRCA mutation.
        Population differences may be due to genetic or non-genetic differences (environmental, lifestyle, etc.). It might be negligible or important depending on the disease.
        I was not trying to justify any racism whatsoever. Concerning usual medicine or over-the-counter medicine, there is usually indeed small or no difference.

        Reply
        • Jim Di Griz says:

          Er, yeah, I’ll just ‘calm down’ when confronted by racism shall I? Way to blame the victim there.

          You said; ‘heart failure is mostly due to ischemic disease in non-Black populations, while it is due to hypertension in Black populations.’

          Yeah, so people with hypertension get one medicine, and people with ischemic disease get a different medicine for different illnesses. That’s got nothing to do with ethnicity. Everything to do with illness.

          You said; ‘Ashkenazi women have higher risk of breast cancer due to high rates of BRCA mutation.’

          Yeah? So? That ethnic group has a higher risk of developing an illness. If they develop the illness, do they receive a special medicine developed solely for their ethnic group, or do they get prescribed the same breast cancer treatment as any other female sufferer would?

          Stop apologizing for racism.

          Reply
      • Loverilakkuma says:

        I agree with your last statement. Attributing race/ethnicity to medicinal research always poses the risk for creating biological assumptions underlying hereditary bias. I heard that such assumptions are prevalent in health and medicine, and science community–especially, those engaging in the studies of genetics– is vulnerable to reduction of logic to biological determinism, which is held accountable for false representation of gene/environment study to the general public. Joe’s critique shows us the absurdity of consensus on appropriate dosage with its narrow scope. Yes, dosage level needs to be reconsidered for drastic change by offering NJ adults access to local medical service across the nation. But it’s also kind of scary to have blind faith in their practice that seems to be innocuous, as some medical professionals at hospital could send a wrong message by exploiting their ignorance or hubris of racial superiority for Wajin in their practice.

        Reply
    • Loverilakkuma says:

      Well, I would argue that medical practice is exactly the sphere in which experts use and abuse their power of studies for producing racialized norms of gene-environment relation. Here’s a starter:

      Condit, Celeste M., et al. “Exploration of the impact of messages about genes and race on lay attitudes.” Clinical genetics 66.5 (2004): 402-408.

      http://s3.amazonaws.com/academia.edu.documents/27478563/13research.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1495088418&Signature=0HGT5%2Fc11YYefxt1msQYFoyEYYw%3D&response-content-disposition=inline%3B%20filename%3DExploration_of_the_impact_of_messages_ab.pdf

      Reply
  • Patrick O'Brien says:

    What a timely topic. I need to go to the dentist again, yet after ten years of non-stop visits, I find I’m just too apprehensive about the whole thing.

    Why?

    Well, it’s the sheer pain.

    From childhood onward, I’d always been a trooper and gone through my dental treatments in America with good cheer. Honestly, I don’t remember any instances of real pain.

    As I entered my 40s in Japan, however, I needed root canals, the first of which was done at Hokudai. The dentist was great. Having studied in America for a few years, he was even good at cracking jokes during treatment.

    As he prepared for my first root canal, I overheard him saying to his students (in clear Japanese), “Gaijin need three times the dosage of Japanese.” That actually made me feel much better, and the procedure was fine.

    After that, not wanting to travel to Hokudai and hour each way, I began to go to local dentists. Well, the pain was intense. It got to the point that any drilling at all just made me extremely anxious — especially when inevitably a nerve was hit. I kept thinking, “In this day and age, why do we need to endure this?”

    I have yet another molar that has cracked in half like the others. Early treatment would help, but I dread the thought of multiple visits of drilling, dealing with a “cap” that usually falls off, returning for more painful drilling, etc.

    I know I should do it now since I’m paying out of pocket for relatively cheap insurance here, but the thought of such pain keeps me home.

    I can appreciate why an individual dentist might not be aware of this issue, or why they wouldn’t want to risk censure on account of one (gaijin) patient. Thus, it seems an industry-wide approach is needed.

    Reply

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