Prescription of kampo drugs in the Japanese health care insurance program

Analysis of drug-induced interstitial lung disease caused by herbal medicine using the Japanese Adverse Drug Event Report database

BACKGROUND

Drug-induced interstitial lung disease (DIILD) is a severe adverse event leading to morbidity and mortality. This study evaluated the adverse event indicators of DIILD and time-to-onset profiles following the daily intake of herbal drugs (Scutellariae radix ["ogon" in Japanese], Bupleuri radix ["saiko" in Japanese], and Pinelliae tuber ["hange" in Japanese]) using the Japanese Adverse Drug Event Report database. DIILD was defined in accordance with the Medical Dictionary for Regulatory Activities.

METHODS

The Japanese Adverse Drug Event Report database contained 830,079 reports published between April 2004 and April 2023. The association between herbal medicines and DILLD was evaluated using the pharmacovigilance index as the reporting odds ratio (ROR), logistic regression models, propensity score-matching techniques, and Weibull shape parameters.

RESULTS

The adjusted RORs using multivariate logistic regression models for Scutellariae radix (daily intake), Pinelliae tuber (daily intake), sex (male), age (≥ 60 years), Scutellariae radix (daily intake)*age (≥ 60 years), and Scutellariae radix (daily intake)* Pinelliae tuber (daily intake) were 1.47 (1.36 - 1.59), 1.05 (1.01 - 1.10), 1.45 (1.34 - 1.57), 1.92 (1.74 - 2.11), 3.35 (3.12 - 3.60), and 1.49 (1.46 - 1.53), respectively. DIILD onset profiles were evaluated using the Weibull shape parameter. A logistic plot of daily intake and onset of DIILD was drawn. ROR signals were detected in 32 of 54 herbal medicines, including Scutellariae radix, Bupleuri radix, and Pinelliae tuber. The median duration (days) (interquartile range) to DIILD onset was 36.0 (27.0-63.0) for Saikokaryukotsuboreito, 35.0 (21.0-55.0) for Saireito, and 31.0 (13.5-67.5) for Shosaikoto. The Weibull shape parameter beta (95% confidence interval) values for Saikokaryukotsuboreito, Saireito, and Shosaikoto were 1.36 (1.08-1.67), 1.36 (1.20-1.52), and 1.31 (0.98-1.68), respectively.

CONCLUSIONS

DIILD demonstrated a dose-dependent to crude drugs. Clinicians should strive for the early detection of DIILD and avoid the inadvertent administration of herbal medicines.

Machine Learning-based Models for Outpatient Prescription of Kampo Formulations: An Analysis of a Health Insurance Claims Database

BACKGROUND

Despite the widespread practice of Japanese traditional Kampo medicine, the characteristics of patients receiving various Kampo formulations have not been documented in detail. We applied a machine learning model to a health insurance claims database to identify the factors associated with the use of Kampo formulations.

METHODS

A 10% sample of enrollees of the JMDC Claims Database in 2018 and 2019 was used to create the training and testing sets, respectively. Logistic regression analyses with lasso regularization were performed in the training set to construct models with prescriptions of 10 commonly used Kampo formulations in 1 year as the dependent variable and data of the preceding year as independent variables. Models were applied to the testing set to calculate the C-statistics. Additionally, the performance of simplified scores using 10 or 5 variables were evaluated.

RESULTS

There were 338,924 and 399,174 enrollees in the training and testing sets, respectively. The commonly prescribed Kampo formulations included kakkonto, bakumondoto, and shoseityuto. Based on the lasso models, the C-statistics ranged from 0.643 (maoto) to 0.888 (tokishakuyakusan). The models identified both the common determinants of different Kampo formulations and the specific characteristics associated with particular Kampo formulations. The simplified scores were slightly inferior to full models.

CONCLUSION

Lasso regression models showed good performance for explaining various Kampo prescriptions from claims data. The models identified the characteristics associated with Kampo formulation use.

How Should the Worldwide Knowledge of Traditional Cancer Healing Be Integrated with Herbs and Mushrooms into Modern Molecular Pharmacology?

Traditional herbal medicine (THM) is a “core” from which modern medicine has evolved over time. Besides this, one third of people worldwide have no access to modern medicine and rely only on traditional medicine. To date, drugs of plant origin, or their derivates (paclitaxel, vinblastine, vincristine, vinorelbine, etoposide, camptothecin, topotecan, irinotecan, and omacetaxine), are very important in the therapy of malignancies and they are included in most chemotherapeutic regimes. To date, 391,000 plant and 14,000 mushroom species exist. Their medical and biochemical capabilities have not been studied in detail. In this review, we systematized the information about plants and mushrooms, as well as their active compounds with antitumor properties. Plants and mushrooms are divided based on the regions where they are used in ethnomedicine to treat malignancies. The majority of their active compounds with antineoplastic properties and mechanisms of action are described. Furthermore, on the basis of the available information, we divided them into two priority groups for research and for their potential of use in antitumor therapy. As there are many prerequisites and some examples how THM helps and strengthens modern medicine, finally, we discuss the positive points of THM and the management required to transform and integrate THM into the modern medicine practice.

A Japanese Herbal Formula, Daikenchuto, Alleviates Experimental Colitis by Reshaping Microbial Profiles and Enhancing Group 3 Innate Lymphoid Cells

Daikenchuto (DKT) is one of the most widely used Japanese herbal formulae for various gastrointestinal disorders. It consists of Zanthoxylum Fructus (Japanese pepper), Zingiberis Siccatum Rhizoma (processed ginger), Ginseng radix, and maltose powder. However, the use of DKT in clinical settings is still controversial due to the limited molecular evidence and largely unknown therapeutic effects. Here, we investigated the anti-inflammatory actions of DKT in the dextran sodium sulfate (DSS)-induced colitis model in mice. We observed that DKT remarkably attenuated the severity of experimental colitis while maintaining the members of the symbiotic microbiota such as family Lactobacillaceae and increasing levels of propionate, an immunomodulatory microbial metabolite, in the colon. DKT also protected colonic epithelial integrity by upregulating the fucosyltransferase gene Fut2 and the antimicrobial peptide gene Reg3g. More remarkably, DKT restored the reduced colonic group 3 innate lymphoid cells (ILC3s), mainly RORγt^high-ILC3s, in DSS-induced colitis. We further demonstrated that ILC3-deficient mice showed increased mortality during experimental colitis, suggesting that ILC3s play a protective function on colonic inflammation. These findings demonstrate that DKT possesses anti-inflammatory activity, partly via ILC3 function, to maintain the colonic microenvironment. Our study also provides insights into the molecular basis of herbal medicine effects, promotes more profound mechanistic studies towards herbal formulae and contributes to future drug development.

Application of objective structured clinical examination (OSCE) for the evaluation of Kampo medicine training

BACKGROUND

The purpose of this study was to develop an objective, content-valid, and reliable assessment method for Kampo medicine using an objective structured clinical examination (OSCE) for the assessment of clinical competence in Kampo medicine.

METHODS

We developed a blueprint followed by a list of 47 assessment items and three task scenarios related to clinical competence in Kampo medicine. An eight-member test committee checked the relevance of the assessment items on a Likert scale. We calculated a content validity index and content validity ratio, and used the Angoff method to set the passing threshold. We trained a total of nine simulated patients with three assigned to each scenario. We conducted an OSCE for 11 candidates with varying medical abilities, and conducted three stations per person, which were evaluated by one evaluator in one room by direct observation. We used video recordings to test the inter-rater reliability of the three raters. We used the test results to verify the reliability of the assessment chart.

RESULTS

The inter-rater reliability (intraclass correlation coefficient [2,1]) was 0.973. The reliability of the assessment chart for each scenario (Cronbach's α) was 0.86, 0.89, and 0.85 for Scenarios 1, 2, and 3, respectively. The reliability of the assessment chart for the whole OSCE (Cronbach's α) was 0.90.

CONCLUSIONS

We developed a content-valid new OSCE assessment method for Kampo medicine and obtained high inter-rater and test reliabilities. Our findings suggest that this is one of the most reliable evaluation methods for assessing clinical competence in Kampo medicine.

Prescription of Kampo Formulations for Pre-natal and Post-partum Women in Japan: Data From an Administrative Health Database

Introduction: Traditional Japanese (Kampo) medicines are often prescribed for women in Japan before, during, and after pregnancy. However, detailed information on the actual frequency of use and safety of Kampo preparations during pregnancy is lacking. Aim: To investigate the frequency of prescription of Kampo medicines for pregnant women in Japan. Methods: Information on Kampo medicines prescribed during outpatient care and hospitalization of selected mothers from January 2005 to August 2016 were extracted from the Japan Medical Data Center (Tokyo, Japan), which is a large claims database. Results: Of the 33,941 subscribers identified from the database, 16,294 (48%) received at least one prescription of a Kampo medicine. Kakkonto was the formula most prescribed during the study period, followed by shoseiryuto and tokishakuyakusan. In the 180 days before pregnancy, the most prescribed medicine was tokishakuyakusan, followed by kakkonto and shoseiryuto. Shoseiryuto, tokishakuyakusan, and kakkonnto were the formulae most prescribed during pregnancy. The most prescribed medicines during the 180 days postpartum were kakkonto, shoseiryuto, and saireito. Conclusions: Information in the Japanese insurance system shows that Kampo medicines are often prescribed during pregnancy. Most of these prescriptions are generally used for the treatment of common cold. Tokishakuyakusan in particular is usually used in the treatment of various symptoms of pregnancy. Further research is needed to clarify the relationship between the use of Kampo medicines during pregnancy and adverse events in infants in Japan.

Development of Kampo（traditional Japanese medicine）e-learning program: evaluation of the flipped classroom for medical students

In May 2019, the World Health Assembly, in an unprecedented move, endorsed the inclusion of traditional medicine in the International Classification of Diseases, 11th Revision. In Japan, traditional medicine (known as Kampo) is regulated by the government and prescribed by over 90% of physicians along with modern medicine under the national health insurance system. Although Kampo education must be included in Japan's core medical curricula, there are significant challenges to implementation. In the educational context, the flipped classroom teaching method has received considerable attention in recent years. This study developed a Kampo e-learning program and verified the effectiveness of a flipped classroom using Kampo e-learning. The Kampo e-learning Committee determined three courses and assigned an administrator for each. The administrators appointed lecturers who developed Kampo e-learning lessons. Physicians, pharmacists, medical students, and pharmacy students were asked to participate in the e-learning program, and their comments and suggestions were collected after program completion. The flipped classroom was evaluated by implementing Kampo e-learning in the Kampo session with fourth-year students at Keio University School of Medicine in Japan. Seven courses were created, including four based on volunteer suggestions. The 'Systematic Kampo Curricula' featured 88 lessons developed by 54 Kampo specialists. Out of 118 fourth-year medical students who participated in the flipped classroom, 113 registered for the Kampo e-learning program, 100 attended the session, and 88 answered the post-session questionnaire. Among the students who answered the questionnaire, 86.4% were satisfied with the flipped classroom, 79.5% replied that the program made them understand Kampo and 80.7% stated that it should be adopted. The flipped classroom using Kampo e-learning program was shown to be attractive in one medical school. Further expanded study is necessary in the near future to reveal the usefulness of the flipped classroom of Kampo learning.

Medicine in motion: Opportunities, challenges and data analytics-based solutions for traditional medicine integration into western medical practice

ETHNOPHARMACOLOGICAL RELEVANCE

Traditional pharmacopeias have been developed by multiple cultures and evaluated for efficacy and safety through both historical/empirical iteration and more recently through controlled studies using Western scientific paradigms and an increasing emphasis on data science methodologies for network pharmacology. Traditional medicines represent likely sources of relatively inexpensive drugs for symptomatic management as well as potential libraries of new therapeutic approaches. Leveraging this potential requires hard evidence for efficacy that separates science from pseudoscience.

MATERIALS AND METHODS

We performed a review of non-Western medical systems and developed case studies that illustrate the epistemological and practical translative barriers that hamper their transition to integration with Western approaches. We developed a new data analytics approach, in silico convergence analysis, to deconvolve modes of action, and potentially predict desirable components of TM-derived formulations based on computational consensus analysis across cultures and medical systems.

RESULTS

Abstraction, simplification and altered dose and delivery modalities were identified as factors that influence actual and perceived efficacy once a medicine is moved from a non-Western to Western setting. Case studies on these factors highlighted issues with translation between non-Western and Western epistemologies, including those where epistemological and medicinal systems drive markets that can be epicenters for zoonoses such as the novel Coronavirus. The proposed novel data science approach demonstrated the ability to identify and predict desirable medicinal components for a test indication, pain.

CONCLUSIONS

Relegation of traditional therapies to the relatively unregulated nutraceutical industry may lead healthcare providers and patients to underestimate the therapeutic potential of these medicines. We suggest three areas of emphasis for this field: First, vertical integration and embedding of traditional medicines into healthcare systems would subject them to appropriate regulation and evidence-based practice, as viable integrative implementation mode. Second, we offer a new Bradford-Hill-like framework for setting research priorities and evaluating efficacy, with the goal of rescuing potentially valuable therapies from the nutraceutical market and discrediting those that are pseudoscience. Third, data analytics pipelines offer new capacity to generate new types of TMS-inspired medicines that are rationally-designed based on integrated knowledge across cultures, and also provide an evaluative framework against which to test claims of fidelity and efficacy to TMS made for nutraceuticals.

Traditional medicine for the treatment of common cold in Korean adults: A nationwide population-based study

BACKGROUND

Traditional medicines (TMs) have been used to treat common cold in Asia, but no studies have been conducted to examine the trend of use for several years. The objective of this study was to analyze the prescription patterns of TMs for common cold using national claims data accrued over 7 years in Korea. This will contribute to the scientific evidence enhancing the understanding of TM use for the treatment of common cold.

METHODS

This study analyzed national claims data from the Health Insurance Review and Assessment Service database. We extracted data for diagnosis of common cold (Korean Standard Classification of Diseases: J00, Acute nasopharyngitis) and prescriptions of TMs for adults who visited all types of oriental medical institutions during 2010-2016. We estimated the prescription patterns of TMs by sex, age group, and year.

RESULTS

We extracted 3,014,428 prescriptions. The total number of prescriptions increased by 125.1% in 2016 compared to that in 2010. For all ages and periods, the number of prescriptions in women was higher than that in men. The age range with the most prescriptions was 70-79 years. The seven most prescribed TMs for common cold were Socheongnyongtang, Samso-eum, Yeongyopaedoksan, Insampaedoksan, Gumigohwaltang, Galgeuntang, and Hyeonggae-yeongyotang.

CONCLUSION

This was the first study to analyze the prescription patterns of TMs for common cold using National Health Insurance data in Korea. This study provides scientific evidences on the disease burden and the utilization pattern of TMs for common cold to support decision making on initiatives such as allocation and management of health resources.

Outpatient Prescriptions of Kampo Formulations in Japan

Objective Kampo is a traditional Japanese medicine using formulae of natural agents. Although Kampo is widely practiced, information regarding the current prescriptions of Kampo formulations is lacking. The aim of the study was to describe the outpatient use of Kampo formulations in the current Japanese health insurance system. Methods From the JMDC Claims Database, we identified subscribers with outpatient prescriptions of Kampo extract formulations between April 2017 and March 2018. Prescription records were summarized at the individual level to describe the pattern of each formula's use, such as the frequency of prescription and the number of days within a year that were covered by the prescriptions. We also examined whether or not Kampo formulations were prescribed in combination with other drugs. Results Of the 4.5 million subscribers, 13.5% received prescriptions of Kampo extracts within 1 year, and 54% of Kampo users were women. The most commonly prescribed Kampo formulae included kakkonto, shoseiryuto, and maoto, which were used for the short term covering a median of 5 to 7 days. There were also several formulae that were prescribed for longer periods. The median numbers of days covered by kamishoyosan and keishibukuryogan were 60 and 56, respectively. Kampo formulations were used in combination with Western drugs in 85% of prescriptions. Conclusion Kampo formulations are commonly prescribed under the Japanese insurance system and are frequently used in combination with Western drugs. The pattern of prescriptions varied across different formulae.

[An analysis of the ingredients in decoctions and extracts of Kampo medicines: Amounts of baicalin and baicalein in Kampo medicines containing Scutellariae Radix]

AIM

Kampo medicines containing Scutellariae Radix (the root of Scutellaria baicalensis Georgi; SR) sometimes cause serious adverse effects, including interstitial pneumonia and liver dysfunction. Baicalin (BL) is the major active component of SR and is presumed to be responsible for the adverse effects. We analyzed the amounts of BL in Kampo medicines to better understand how they can be used safely.

METHODS

We determined the amounts of BL in 28 Kampo decoctions containing SR (recommended daily dose: 1.5-4 g/day) and corresponding Kampo extract products by high-performance liquid chromatography.

RESULTS

The amounts of BL in the Kampo decoctions were 1.7-4.0-fold higher than those of the corresponding Kampo extract products. Inter-product variations in the amounts of BL in Shosaikoto, Otsujito, Daisaikoto, Saibokuto, Orengedokuto, and Saireito Kampo extracts from various companies were also examined. Significant differences in the amounts of BL were observed for Shosaikoto, Otsujito, Daisaikoto, and Saibokuto extract products (up to 2.6, 1.6, 1.5, and 1.3-fold differences, respectively), whereas no significant differences were observed for Orengedokuto and Saireito extract products.

CONCLUSIONS

Because the Kampo decoctions containing SR that we examined contained 1.7-4.0 times as much BL as the corresponding Kampo extract products, medical doctors and pharmacists should be aware that Kampo decoctions containing SR might cause more severe side effects than corresponding Kampo extract products. Furthermore, we recommend that the amounts of BL and its aglycone, baicalein (BA), in Kampo extract products be made known to practitioners and patients.

Kampo for the Treatment of Pain in Japan: A Review

Kampo, a branch of traditional Japanese herbal medicine, has been the backbone of Japanese medicine for more than 1500 years. The health insurance system in Japan allows patients to access both Western and Kampo medical care at the same time in the same medical institution. Kampo has been used for the treatment of not only acute but also chronic pain in Japan. In this review, we will elaborate on the short history of Kampo, its basic concepts, and use for the treatment of pain.

Jakyakgamcho-tang in the relief of delayed-onset muscle soreness in healthy adults: study protocol for a randomized, double-blind, placebo-controlled, crossover design clinical trial

Background

Muscle soreness after exercise, called delayed-onset muscle soreness (DOMS), may cause significant changes in muscle function and may increase the risk of sports injuries. Therefore, various therapeutic strategies have been studied to help recovery after exercise. Jakyakgamcho-tang (JGT) is a widely prescribed herbal medicine to treat muscle pain and cramps in traditional Eastern medicine. The aim of this study is to evaluate the effect of JGT for reducing pain and improving muscle damage after exercise.

Methods

This study is a randomized, double-blind, placebo-controlled, crossover design clinical trial. A total of 30 healthy male adults will be recruited. Subjects who voluntarily wish to participate in this study will be hospitalized for 4 days. On the first day, the subjects will perform a standardized treadmill exercise for 1 h to induce DOMS. After the exercise, the subjects will take either JGT or a placebo for 3 days. After a more than 1 week wash-out period, the subjects will repeat the same process with the other drug. Pain intensity, calf circumference, and pain threshold will be measured as outcome measures. Blood tests and blood pressure will be measured as safety assessments. In addition, blood tests for muscle damage and inflammation markers, such as creatine kinase, interleukin-6, and C-reactive protein, will be analyzed.

Discussion

This will be the first trial to assess the effect of JGT on exercise-induced muscle soreness. Our findings will provide valuable data to determine the clinical effects of JGT on DOMS.

Trial registration

Clinical Research Information Sevice, KCT0003457. Registered on 29 January 2019.

Japanese government research grants for Kampo medicine: aAn overview of 10 years (1997-2017)

Background

Japan has its own traditional medicine called Kampo medicine, but it is relatively unknown in compared to Traditional Chinese Medicine. Therefore, this study examined the current status of the research related to Kampo medicine supported by Japanese government research grants (JGRG).

Methods

Three databases were searched on October 2019: National Institute of Public Health, Grant-in-Aid for Scientific Research and Japan Agency for Medical Research and Development. The search keywords were Kampo medicine, acupuncture, integrative medicine, oriental medicine, and traditional medicine. The final research that satisfied the inclusion criteria were selected and analyzed.

Results

After a comprehensive search of the three database and removing any duplication research, 2246 JGRG (985 new proposal) that met the inclusion criteria were selected. The number and amount of JGRG have been increasing steadily. The basic research conducted by academic research institutes was mainstream, and the proportion of development research of new Kampo medical technology was low. Most J-research was non-clinical research and 21 % were clinical research. The largest research institute was the Toyama University and there were many non-clinical, cancer, and Juzentaihoto research. On the other hand, government grants were funded relatively evenly without bias to specific fields or institutions.

Conclusions

After analyzing the Japanese government research grants from 1973 to 2017, research on Kampo medicine, which barely had any interest previously, was revived in the 2000s. In particular, it increased sharply in the 2010s, and the research fields were relatively diverse.

Factors affecting the provision of analgesia during childbirth, Japan

Japan’s universal health-care system means that it is a very safe country in which to give birth. Perinatal outcomes in Japan are excellent, with low infant mortality and neonatal mortality. However, childbirth remains a challenge for many Japanese women, who are faced with a scarcity of places to give birth, limited availability of analgesia and social norms that favour natural birth. The number of birth facilities in Japan continues to decrease as fewer children are born. The numbers of qualified medical staff remain inadequate, with a continuing lack of female physicians, perpetuated by a pervasive negative gender bias. Recruitment efforts are underway, but few doctors want to specialize in obstetrics or gynaecology. Furthermore, around half of female obstetricians and gynaecologists in Japan’s male-dominated medical system stop practising when they have their own children. The difficulty of obtaining analgesia during labour is another problem. Although low uptake of labour pain relief in Japan is said to be due to cultural influences, the root of the problem is a lack of qualified anaesthesiologists and the inflexibility of a system that will not allow other staff to be trained to administer labour analgesia. Problems with labour anaesthesia have been linked to 14 maternal deaths since 2010. Japanese policy-makers need to act to renovate the nation’s obstetric facilities, reorganize regional perinatal care systems, train more obstetricians and anaesthesiologists, promote task-shifting and better integrate biomedical and traditional, non-medical care for pregnant women.

Women between Religion and Spirituality: Observing Religious Experience in Everyday Japanese Life

A large majority of Japanese people describe themselves as mushūkyō, ‘non-religious’, even though they participate in several religious-related cultural practices that socialize them to accept spiritual attitudes without the mediation of organized religion. This phenomenon fits well into the ‘spiritual but not religious’ formula of the contemporary Northern European and North American sociological debate, in which the ‘religion’ and ‘spiritual’ categories denote interdependent, although not always reciprocated, domains. Drawing upon two sets of qualitative data on women belonging to five religious organizations (Shinnyoen, Risshō kōseikai, the Roman Catholic Church in Japan, Sōga Gakkai, and God Light Association (GLA)), in this study, I argue that the religion–spirituality distinction not only fails to capture the empirical reality of contemporary Japanese religions, it also does not take into account new modalities of religious and spiritual experiences of people with such affiliations. Their experiences are expressed through the socio-cultural milieu and the language of religion and spirituality available to them in contiguous and complementary ways. In this respect, the aim of this article is to discuss such aspects of Japanese women’s religious and spiritual experiences that have often eluded scholars writing on Japanese religiosity in order to broaden the focus of reflection to include the mushūkyō aspect and the presumed religion–spirituality mismatch.

Kampo Therapies and the Use of Herbal Medicines in the Dentistry in Japan

Dental caries and periodontal disease are two major diseases in the dentistry. As the society is aging, their pathological meaning has been changing. An increasing number of patients are displaying symptoms of systemic disease and so we need to pay more attention to immunologic aggression in our medical treatment. For this reason, we focused on natural products. Kampo consists of natural herbs-roots and barks-and has more than 3000 years of history. It was originated in China as traditional medicine and introduced to Japan. Over the years, Kampo medicine in Japan has been formulated in a way to suit Japan's natural features and ethnic characteristics. Based on this traditional Japanese Kampo medicine, we have manufactured a Kampo gargle and Mastic Gel dentifrice. In order to practically utilize the effectiveness of mastic, we have developed a dentifrice (product name: IMPLA CARE) and treated implant periodontitis and severe periodontitis.

The actual conditions of traditional Japanese Kampo education in all the pharmacy schools in Japan: a questionnaire survey after the enforcement of the new national 2015 core curriculum

Background

To investigate the present status of Kampo education, which has still not been elucidated, after the introduction of the new core national curriculum of 2015 into nationwide pharmacy education, in all 74 pharmacy schools in Japan.

Methods

A postal questionnaire survey was conducted from August 2015 to January 2016. The completed questionnaires were returned by mail. Web-based syllabi were also investigated to ascertain the detailed lecture curricula in each school. Descriptive analyses were conducted without statistics.

Results

A total of 74 questionnaires were collected (response rate, 100%). In 2015, the numbers of clinical Kampo classes as required subjects during the 6 years of regular pharmacy school education ranged from 0 to 36 (median, 13; mean, 11.8 ± 7.6). Of the 74 schools, 49 schools (66%) provided Kampo education from a clinical standpoint. Pharmacists employed in pharmacies and physicians taught most of these classes. The major problems to be solved first are: selecting and retaining teachers to teach clinical Kampo medicine (43 of 74 schools, 58%), preparing standard textbooks (37 schools, 50%), and improving the environment for practical Kampo training (30 schools, 41%).

Conclusions

Curricula for teaching Kampo medicine significantly differ at each of the 74 Japanese pharmacy schools. In addition to selecting teachers who can adequately teach clinical Kampo medicine, improving training environments, and nationwide standardization of the curricula and textbooks are critical.

Electronic supplementary material

The online version of this article (10.1186/s12906-018-2368-5) contains supplementary material, which is available to authorized users.

The association between the use of biomedical services and the holistic use of traditional East Asian medicine: a national survey of outpatients in South Korea

OBJECTIVES

The holistic use of a system of complementary and alternative medicine (CAM) is potentially linked to its treatment outcomes. This paper examines how the use of biomedicine is associated with the holistic use of CAM, focusing on traditional East Asian medicine (EM) that is uniquely integrated in the medical system in South Korea.

DESIGN/SETTINGS

A representative national sample of EM outpatients in South Korea.

PARTICIPANTS

3861 survey respondents.

METHODS

By using the 2011 Korean National Survey of EM patients, ordered logistic regression models specify the relationship between EM outpatients' use of biomedicine and their holistic use of EM modalities.

RESULTS

Among EM outpatients who used at least one EM modality in the past 3 months, people who used two (33.3%) or three (29.4%) modalities together are the two highest proportions, followed by users of four (18.1%), five (7.2%), six (2.1%) and seven (0.6%) modalities. The odds for EM users to use EM holistically are 17% greater among EM users who used biomedicine as well, compared with EM users who did not use biomedicine.

CONCLUSIONS

The healthcare community should recognise that CAM use likely becomes holistic as people use biomedicine concomitantly, when the practice rights over a CAM system are comprehensively and exclusively entitled to a group of CAM professionals who are independent from practitioners of biomedicine.

The education of traditional Japanese (Kampo) medicine: surveys of training hospitals and residents

Background

Japanese physicians prescribe Kampo medicine, but Kampo education is not standardized. We surveyed training hospitals and residents to identify problems and suggest solutions to promote Kampo education during and after residency.

Methods

This was a double questionnaire survey of 1011 training hospitals in Japan and 93 Tokai University School of Medicine graduates of 2011.

Results

There were 816 effective responses (81%) from the training hospitals. Most instructors (84%) thought physicians should have Kampo clinical skills; 67% thought positively about introducing Kampo education into clinical training; 23% of the hospitals provided Kampo education; 70% of instructors at hospitals without Kampo education indicated the lack of Kampo instructors, 16% lack of time, and 7% no necessity for Kampo education; hospitals permitted Kampo education through voluntary study (42%), lectures sponsored by Kampo manufacturers (35%), and study sessions with other hospitals (32%); independent study sessions (10%); smaller hospitals were less active in Kampo education than larger ones. The survey of residents had 72 effective responses (77%): 91% were interested in Kampo medicine; 96% thought it worth learning; 31% could learn it during residency; 52% were not satisfied with the training, 83% wanted to learn it; 73% thought it should be introduced into the curricula; 93% prescribed Kampo medicine, and residents who learned it prescribed it more; 48% were reluctant to prescribe it after residency; 89% thought Western and Kampo medicine should be integrated.

Conclusions

Instructors knew Kampo education was needed, but little of it was taught, especially in small hospitals, because of the lack of Kampo instructors. Residents recognized the need for Kampo medicine and were motivated to learn it. Kampo medicine was mostly prescribed because instructors suggested it. Because of the limited opportunities to learn Kampo medicine, it should be taught during residency. In small hospitals, cooperation with other hospitals could be a solution to teach Kampo medicine.

Electronic supplementary material

The online version of this article (doi:10.1186/s12906-017-1634-2) contains supplementary material, which is available to authorized users.

The influence of social context on the treatment outcomes of complementary and alternative medicine: the case of acupuncture and herbal medicine in Japan and the U.S

Background

Complementary and alternative medicine (CAM), such as acupuncture and herbal medicine, is popular in many countries. Yet, treatment outcomes of CAM are found to vary significantly between medical trials in different social environments. This paper addresses how the social organization of medicine affects medical treatment outcomes. In particular, it examines the extent to which two popular complementary and alternative medicine (CAM) interventions (acupuncture and herbal medicine) are coordinated with biomedicine and how coordination characteristics are related to the treatment outcomes of the two CAM interventions.

Methods

This paper conducts an archival analysis of the institutional settings of the CAM interventions in Japan and the U.S. It also conducts a systematic content analysis of the treatment outcomes in 246 acupuncture reports and 528 herbal medicine reports that are conducted in Japan or the U.S. and registered in the Cochrane Library’s Central Register of Controlled Trials (CENTRAL), and 716 acupuncture reports and 3,485 herbal medicine reports that are from Japan or the U.S. and listed in MEDLINE. It examines the association between the treatment outcomes of the two interventions and the geographical location of the reports; it also explores how the institutional settings of the interventions are related to the treatment outcomes.

Results

Japanese herbal medicine is integrated into the national medical system the most and American herbal medicine the least; American acupuncture and Japanese acupuncture fall in the middle. Treatment outcomes are the most favorable for Japanese herbal medicine and the least favorable for American herbal medicine. The outcomes of American acupuncture and Japanese acupuncture fall in the middle.

Conclusions

The co-utilization of CAM with biomedicine can produce difficulties due to tensions between CAM and biomedicine. These difficulties and subsequent CAM treatment outcomes vary, depending on how CAM is institutionalized in relation to biomedicine in the national medical system. Coordinated CAM interventions are more likely to be effective and synergic with biomedicine, when compared to uncoordinated ones.