医療改革提言 競争力高めて成長の原動力に

The Yomiuri Shimbun May 9, 2013
Enhance Japan's medical care competitiveness to boost growth
医療改革提言　競争力高めて成長の原動力に（5月8日付・読売社説）

　◆最先端技術を早く役立てたい

Japan's medical care is in a precarious situation. It is winning in the technology field, but losing when it comes to business.
　日本の医療は、技術で勝って、ビジネスで負ける深刻な状況だ。

Although the nation has superb technologies, it lags when it comes to the practical use of drugs and medical equipment.
　優れた技術を持ちながら、医薬品や医療機器の実用化で後れをとっている。

These concerns were behind The Yomiuri Shimbun's decision to propose reform plans that would make Japan's medical care more competitive internationally and boost the country's economic growth.
　読売新聞が、医療の国際競争力を高め、日本の成長に弾みをつけるための改革案を提言した背景には、こうした危機感がある。

Fostering the medical care industry is one pillar of a growth strategy that the government will compile in June. We urge the government to map out concrete and effective policies.
　医療関連産業の育成は、政府が６月にまとめる成長戦略の柱の一つだ。具体的かつ実効性のある政策を打ち出してもらいたい。

The core of The Yomiuri Shimbun's five-point proposal is to strengthen medical care as an industry and harness it as an engine for economic growth.
　提言の核心は、医療を産業として強化し、経済成長のエンジンとして活用するところにある。

Excess of imports hits 3 tril. yen
　◆輸入超過は３兆円にも

Japan's rapidly graying population has increased demand for medical and nursing care, and imports of drugs and medical equipment are growing. On the other hand, exports of drugs and medical equipment remain anemic, with imports exceeding exports by about 3 trillion yen in 2011. A colossal amount of Japan's wealth is being sucked overseas. Sitting idly by is not an option.
　急速な高齢化で医療・介護の需要が伸び、医薬品や医療機器の輸入額が増えている。一方で、輸出は振るわず、２０１１年は約３兆円の輸入超過だった。巨額の富が国外に流出している。手をこまねいていてはならない。

As exemplified by Kyoto University Prof. Shinya Yamanaka, who won the 2012 Nobel Prize in Physiology or Medicine for his research on induced pluripotent stem (iPS) cells, Japan is a world leader in the field of basic research. However, the country straggles in the application of technology and relies heavily on foreign products.
　山中伸弥・京大教授のｉＰＳ細胞（人工多能性幹細胞）研究がノーベル生理学・医学賞を受賞したように、日本は基礎研究の分野で世界をリードしている。だが、応用では立ち遅れ、外国製品に頼っているのが実情だ。

An episode involving a surgical robot named "da Vinci" epitomizes Japan's current situation.
　「ダビンチ」と呼ばれる手術ロボットを巡るエピソードは、日本の現状を象徴している。

Manufactured in the United States, the computer-controlled da Vinci moves more delicately than a doctor's hands and fingers. By operating the robot instead of directly holding a scalpel, the surgeon can perform more accurate surgery. The da Vinci surgical system is being used in hospitals around the world.
　コンピューター制御のダビンチは米国製で、医師の手や指より繊細な動きをする。外科医はメスの代わりにロボットを操作し、より精密な手術が可能になった。今や世界中の病院で使われている。

But as a matter of fact, a Japanese researcher studying artificial organs made a drawing that looked identical to the da Vinci robot in the 1970s. Unfortunately, the researcher's idea never came into practical use and was forgotten. The drawing was discovered among the researcher's possessions in 2011.
　実は、ダビンチとそっくりな図面を、日本の人工臓器の研究者が１９７０年代に描いていた。残念なことに、実用化されることなく、その構想は埋もれ、一昨年、研究者の遺品から見つかった。

The reason such a valuable and outstanding idea did not get off the drawing board is because various obstacles clog the system for commercializing such devices. These obstacles must be cleared so Japan's medical care industry can grow.
　せっかくの卓越したアイデアが実を結ばないのは、製品化へ制度上の様々な障害があるからだ。それを克服し、日本の医療関連産業を成長させる必要がある。

Cooperation necessary
　◆必要な産学官の連携

The Yomiuri Shimbun proposed excellent research results be used through collaboration between the medical and engineering fields. The government plays an important role in encouraging companies with technological expertise to enter the medical care market and in strengthening cooperation between business and academic circles.
　読売新聞は「医工連携」によって優れた研究成果を生かすよう提言した。技術力を持つ企業に参入を促し、産学連携を強めるため、政府が果たす役割は重要だ。

The time and cost required for clinical trials to ensure the safety of drugs and medical equipment in Japan are far longer and greater than in foreign countries. This saps corporate enthusiasm for developing medical products.
　海外に比べ、日本では医薬品や医療機器の効果、安全性を調べる治験に時間と費用がかかりすぎ、企業の開発意欲をそいでいる。

For example, South Korea has huge hospitals with more than 2,000 beds, allowing each hospital to comfortably secure enough patients for its own clinical trials. Japan, on the other hand, has smaller hospitals, most of which are not equipped to carry out such trials.
　例えば、韓国には２０００床を超える巨大病院があり、治験に参加する患者を１施設だけで容易に確保できる。これに対し、日本の病院は規模が小さく、治験の環境が整った施設はほとんどない。

A cluster of research institutions, hospitals and corporations have been set up in a special zone in Kobe designated by the government to develop advanced drugs and other medical products. However, current regulations restrict the number of beds at each hospital, so it is impossible to construct large hospitals there. It is imperative that the government quickly ease these regulations so a core hospital can be built to conduct clinical trials.
　新薬開発などを目指し、政府が認定した神戸市の「先端医療産業特区」には研究所や病院、企業が集まるが、病床数は制限され、大規模病院を建設できない。政府は規制を緩和し、治験の中核病院を整備することが急務だ。

Safety screening of medical equipment does not require as much data as that of new drugs, which must be backed up by a huge volume of research figures. Despite this, the time required for a medical device to win government approval after being developed is about two years longer than in the United States.
　医療機器の場合、安全性の審査に医薬品ほど膨大なデータを必要としない。それにもかかわらず、開発から承認までの期間が、日本は米国より約２年も長い。

We think it would be worthwhile to let a private institution, rather than regulatory authorities, screen and approve the use of new medical equipment, as is the case in Europe.
　承認審査は、規制当局ではなく、欧州のように民間の認証機関に任せることも検討すべきだ。

The government should expand the scope of tax cuts for investments geared to research and development in this field, paving the way for venture companies to enter the business.
　ベンチャー企業などが参入しやすくなるように、研究開発の投資減税の拡充も求められる。

Also, there must be an institution that directs Japan's medical technology development.
　医療技術開発の司令塔も欠かせない。

A good model for Japan is the U.S. National Institutes of Health (NIH), which orchestrates medical research and development in the United States. We welcome the government's move toward establishing a Japanese version of the NIH.
　米国で医療研究開発を統括している国立衛生研究所（ＮＩＨ）の機能は、大いに参考になるのではないか。政府が「日本版ＮＩＨ」の設立へ動き出したことは評価できよう。

Above all else, Japanese medical researchers will need to change their perspectives for boosting the medical industry.
　医学研究者に何よりも求められるのは、医療の産業化へ向けた発想の転換である。

Japanese universities tend to give more weight to basic medical research. We believe, however, they should give higher appraisal to clinical research results, which are useful to actual treatment.
　日本の大学では、基礎研究を偏重する風潮が根強い。実際の治療に役立つ臨床研究の成果こそ高く評価されてしかるべきだ。

Expand mixed treatment
　◆混合診療を拡充せよ

Under Japan's universal medical insurance system, anybody with a medical insurance card can receive treatment at any institution. The Yomiuri Shimbun's five-point proposal calls for maintaining this system so people can be assured that they can still get medical treatment.
　日本の医療は、保険証があれば、どの医療機関にもかかれる国民皆保険制度だ。国民が安心して医療を受けられるよう、読売新聞の提言では制度の堅持を求めた。

But financial constraints will make it difficult to cover all new medical technology under the medical insurance system. It is necessary to expand the scope of so-called mixed treatment, in which medical tests and drugs are administered--and covered by public insurance--and advanced treatments, which are not covered by insurance, are provided.
　ただ、新しい医療技術をすべて保険で賄うのは、財源の制約から難しい。公的医療保険で認められた検査や投薬とともに、保険が適用されない治療を併用する混合診療を拡充する必要がある。

At present, this mix is allowed for about 100 kinds of treatment designated by the Health, Labor and Welfare Ministry, such as a heavy ion radiotherapy, a form of high-precision radiation therapy.
　現在、混合診療は、高度放射線療法の重粒子線治療など、厚生労働省が指定した約１００種類の治療法にしか認められていない。

The unregulated expansion of allowable mixed treatments must be avoided. But if the procedures involve such state-of-the-art treatment as regenerative medicines that have been confirmed safe, we think they should be approved.
　混合診療の野放図な拡大は避けねばならないが、安全性が確認された再生医療などの先端的医療であれば認めるべきだ。

Building a robust medical industry and maintaining the medical insurance system will certainly serve the best interests of patients.
　強い医療産業を育て、医療保険制度もしっかり守っていく。それが患者の利益につながる。

(From The Yomiuri Shimbun, May 8, 2013)
（2013年5月8日01時21分 読売新聞）