Rural Medical Education Design in Minami-Hiyama / 医学教育

We are engaged in community medical education using Minami-Hiyama (14,000km<SUP>2</SUP>, population 23,000, aging rate 41.6%) in southern Hokkaido as a resource. The “rural(region)” concept has become more diverse in recent years, and a highly designed physician training program for rural doctors has become necessary. Therefore, we are attempting to design a rural medical education program based on the concept of “difference.” These “differences” can occur not only between urban and rural areas but also between different cultures. We hope that by connecting Minami-Hiyama and Sapporo with a telemedicine/education system, “differences” will be created and students who experience these differences will have a deeper understanding of rural medicine.

History of Japanese and Western Medical Professionalism Developed in the Context of Social Structure / 医学教育

Introduction: Currently, there is confusion about what constitutes medical professionalism in Japan.　Method: We compared the histories of the development professionalism in western countries and Japan based on the stage theory of economic development and a literature review. Using the information we gathered, we discuss the reasons why the confusion occurred.　Result: In most of western countries, medical professionalism was affected by the industrial revolution and Protestantism. As Weber noted, for Protestants, working industriously and using the gift of one’s talent to earn much money was consistent with the teachings of God. Thus, reward was an important proof of their faith. Meanwhile, the Japanese social system and professionalism were developed independently from the industrial revolution. Since Japan was less influenced by the industrial revolution, knowledge was not subdivided. This resulted in undeveloped specialist jobs and the continuation of classical education based on Buddhism and Confucianism. Japanese professionalism, which included sacrificial altruism, differed from western professionalism, particularly with regard to the concept of reward.　Discussion: Due to globalization, Japanese society now has two types of professionalism: one from western ideals and another from classical Japanese ideals. Because these two types of professionalism conflict on certain points, such as the concept of reward, there is confusion about what constitutes Japanese professionalism.

Usefulness of Adalimumab for Treating a Case of Intestinal Behcet's Disease With Trisomy 8 Myelodysplastic Syndrome

Behcet's disease (BD) is a systemic vasculitis, while myelodysplastic syndrome (MDS) is a heterogeneous group of clonal hematologic disorders characterized by ineffective hematopoiesis. Some studies suggest a relationship between MDS and BD, especially intestinal BD, and trisomy 8 seems to play an important role in both diseases. There are several reports on patients with BD comorbid with MDS involving trisomy 8 that frequently have intestinal lesions refractory to conventional medical therapies. Tumor necrosis factor (TNF)-alpha is strongly involved in the pathophysiology of several autoimmune diseases such as rheumatoid arthritis, inflammatory bowel disease, and BD. In addition, TNF-alpha plays an important role in the pathophysiology of MDS by inhibiting normal hematopoiesis and inducing the programmed cell death of normal total bone marrow cells and normal CD34+ cells. Recent clinical reports demonstrate the favorable effect of TNF-alpha antagonists in patients with refractory intestinal BD and in those with MDS. We present the case of a patient with intestinal BD and MDS involving trisomy 8 who was successfully treated with adalimumab.