Nancho Advisory: Dr. Masao Miyamoto has become an official Japanese nightmare or at least a nightmare for Official Japan. As a defrocked bureaucrat, stinging government gadfly and now best-selling author, he has fashioned a boisterous new career, internationally exposing the corruption, misfeasance and bullying totalitarian mentality in Japan's once sacrosanct bureaucracies. As a respected Western-trained psychiatrist and Establishment insider "gone bad", Miyamoto explains in telling detail how the Japanese system works to psychologically "castrate" both both the general public and the members of the Great Bodies that rule them.
In a wide range of essays, articles and speeches, he not only describes how and why this emasculation is carried out in Japan, he also skillfully correlates the consequences with local political events and social phenomena. In short, Dr. Miyamoto continues to make major contributions to the study of corporate anthroculture, and when the history is finally written, will doubtless be recognized as a true pioneer in the field.
EXCERPT: In order to maintain the status quo, you have to educate people, and this is where "castration" comes into play. The Japanese bureaucracy wants the people to be as obedient as sheep. Not to complain. Not to challenge the system. Not to resist their superiors. For individuals to enslave themselves to the system. If one is educated to embrace these values, then Japan as a system can maintain harmony... However, in order to imprint these values, you need a special technique, which is to halt the growth of identity...
Good evening ladies and gentlemen. I am delighted to be able to speak about the Japanese bureaucracy and the system of Japan here at MIT tonight. I find that Japan, the bureaucracy in particular, faces many problems. One could say that Japan's protectionism, led by the bureaucrats, leads to trade disputes with other industrialized nations. Furthermore, this protectionism does not benefit the Japanese people. If both Japanese and Americans recognize the grave problems of the Japanese system, it would mean further pressure on the system from both within and without, leading to a greater insistence on deregulation and downsizing. This change in Japanese society will not only benefit the Japanese, but will also benefit Americans as well as the world economy.
In tonight's speech I will focus on the HIV scandal and the goal of the Japanese educational system, which I hope will shed some light on the bureaucracy and its protectionism.
I feel some nostalgia for the Boston/Cambridge area as 22 years ago, when I first arrived in America, I lived in Waterbury, Connecticut. Since this town was so small, on weekends I often drove to the Boston area. I distinctly remember the wonderful taste of the seafood in Boston. In Waterbury I started my residency in internal medicine at a hospital that was affiliated with Yale Medical School. Although Waterbury was a small town, everything to me was new so I had to struggle with a now environment. But I have a strong lingering impression that people were eager to help me become familiar with the community.
After living in America for over 10 years, I went back to Japan and joined the Ministry of Health and Welfare. 10 years is along time and this caused me a certain uneasiness since a lot had changed in the intervening period. What perplexed me was the attitude of my colleagues who expected me to know all of the changes that had taken place. Instead of trying to help me become familiar with what was essentially a now environment, I was baptized by bullying or "ijime".
When you compare my first year in America with the first year after I returned to Japan, I am convinced that coming back to Japan was far more stressful. Since I am Japanese it should have been easier, but this was not the case.
Americans were kind to me, but upon returning to Japan I found that bringing back foreign ways, for example, clarity in speech or an individual style of dress, was rejected. Many Japanese who have been abroad try to erase any acquired foreign habits because of their fear of ostracism through "ijime". I resisted this pressure to conform.
In fact, I more or less preferred to be isolated from my colleagues, because by being ostracized I no longer had to dine or sing together with them at a karaoke bar, which meant my evenings were my own, to spend as I wanted. However, I was not happy with the way the Japanese bureaucracy functioned, and this is why I wrote a book called "Straitjacket Society," which is a clinical analysis of the psychology of the Japanese bureaucracy and society.
I have no regrets about writing this book. In fact, through writing this book my world has expanded. For me to give a speech in front of you today is a good example. Being able to give speeches about the bureaucracy reminds me of the opening remarks of a famous cardiology professor whose lecture I went to hear when I lived in Waterbury. He said to the audience, "I am very happy to talk to you about heart disease. Since Americans have become very concerned about heart disease, I receive more and more requests to speak. Not only physicians, but other health professionals, and even the man on the street are interested in what I have to say. But if I were a specialist in a rare disease with only 1 0 cases in the world, I do not think I would have an opportunity to speak to you today, nor would many people come to hear me speak. But since I chose such an ordinary subject, I have been asked to lecture around the world. The choice of field can certainly expand one's world.
I could not agree with him more. If I were a researcher on snails, I do not think I would have been invited to speak to you today. But the Japanese bureaucracy is like a snail. It seems to me that people around the world wonder why the pace of change is so slow, and how Japan's economy became so successful. I think I can provide a partial answer to this question in today's speech. The bureaucracy is proud of having a history of over 1,000 years, and in the last 400 years this bureaucratic system has become so entrenched in society that it may take far longer than 20 years to downsize the system if they continue at the same pace. What this means is that I will continue to have the opportunity to speak about the bureaucracy.
As many of you may be aware, over the last four months the Ministry of Health and Welfare has come under fire over the scandal of HIV-tainted blood being used to treat hemophiliacs. Because of their negligence, 400 people have already died and over 3,000 people have been infected with the HIV-virus. On March 29 the ministry acknowledged their negligence and agreed to pay compensation to the victims. This is a positive first step in investigating this tragedy. For those of you not aware of the background of this scandal, let me give you a brief summary.
In March of 1983 the Centers for Disease Control in Atlanta issued a warning in the U.S. that blood products might be tainted with the HIV virus. Soon afterwards the F.D.A. approved the use of heated blood products. As a matter of course, this information would have been reported to the Ministry of Health and Welfare by the Japanese embassy in Washington, D.C.
In June Travenol Japan (the former name of Baxter Ltd.) sent a report to the Ministry of Health and Welfare (MHW) that Travenol America, because of findings connecting unheated blood products to HIV, had recalled their products in America. In the same month, the Ministry of Health and Welfare established an AIDS study group headed by Dr. Abe, an expert on hemophilia. The file containing notes of a conference hold on July 4, long thought to be non-existent, magically appeared at the ministry in February 1996, after Mr. Kan, the new minister of Health and Welfare, appointed an in-house investigative body to look into HIV-related issues. This file revealed three important facts.
- One: imports of heated blood products were urgently being considered.
- Two: unheated blood products of non-American origin would continue to be imported.
- Three: the use of heated blood products from America would cause some damage to Japanese pharmaceutical companies, but this should be ignored.
In essence, the MHW was aware and had adequately grasped the danger surrounding AIDS. However, a week after the conference on July 4, the AIDS study group held another conference and decided that imported heated blood products would be subject to lengthy clinical trials, and unheated blood products from America would not be banned. What this means is that there was a 180 degree change in their assessment.
In the latter part of July 1983 one of Dr. Abe's hemophiliac patients died of an AIDS-like disease. He consulted on this case with two physicians from the CDC, and they both diagnosed the cause of death as AIDS, but this was not recorded as the first AIDS death in Japan.
In February 1984 clinical testing of heated blood products began in Japan. In March, a subcommittee of the AIDS study group recommended the use of heated blood products and the AIDS study group was dissolved, with no sense of impending crisis.
In September 1984 Dr. Abe confirmed that 23 of his 48 patients with hemophilia had been infected with HIV, but this information was not made public. In December 1984 the ministry confirmed that 47 out of 183 hemophiliacs tested positive for HIV. Again this was not made public. In March 1985 the ministry identified a male homosexual, who was living in the U.S. and had returned to Japan temporarily, as the first AIDS patient in Japan.
Given this chronology, for the ministry to reveal that the first AIDS patient in Japan was a homosexual living in America seems to be an attempt to manipulate the public into believing that AIDS is a disease prominent outside of Japan, that Japan is immune to HIV. Behind this manipulation is the protectionism of the Japanese pharmaceutical industry, namely to give Green Cross, the largest Japanese maker of blood products, sufficient time to develop heated blood products so that the Japanese market would not big inundated with imported blood from America.
In July 1985 the ministry approved the sale of heated blood products. However, despite .knowing that unheated blood products could lead to the spread of HIV, they did not order companies to recall unheated blood products. In May 1989 HIV infected hemophiliacs filed a lawsuit against the government and pharmaceutical companies. During this lawsuit the ministry has maintained that they could find none of the files of the AIDS study group. In October 1995 the court proposed a compromise settlement, which indicated that the government was at fault. In January 1996 Green Cross was found to have continued selling unheated blood products until 1988, after heated blood products were approved in 1985. This sale of unheated blood products affected not only hemophiliacs, but people who underwent surgery and were treated with these products to stop bleeding.
In January 1996 Mr. Kan was appointed Minister of Health and Welfare and he formed an in-house investigation team. On February 9, 1996 nine files of documents related to the HIV case, long claimed to be non-existent, were found. This is when the HIV scandal started to cause an uproar. On March 29, 1996 a compromise settlement was signed by both sides. On April 3 the vice-minister informed Mr. Kan that seven more files had been found. The files had been found in January, but were only disclosed after the settlement. So far only two of the seven files have been made public. These two files make it very clear that the ministry had been collecting information from around the world related to HIV-tainted blood products and AIDS, and were therefore certainly aware of the dangers. These files make clear that Dr. Abe, the head of the AIDS study group, manipulated the time frame so that Japanese and American pharmaceutical companies finished their clinical trials at the same time. This meant that approval was granted at the same time. If the clinical trial period had not been manipulated, since American pharmaceutical companies had a head start, early approval for American companies would have been inevitable, which meant that they could overwhelm the Japanese market with their heated blood products. Dr. Abe's manipulation of the clinical trial period suggests that he wanted to protect Japanese pharmaceutical companies so that they could enter the market at the same time.
After going over this information, I have come to see ton problems with the MHW's bureaucratic structure.
I think these problems are a condensation of the Japanese bureaucracy, and they are all interrelated. In today's presentation I would like to connect the HIV scandal with the social psychology of Japanese society.
- The harmony of the ministry or the group is more important than reality.
- The major task of the ministry or the bureaucracy is the protection of industry, not the protection of people.
- The concept of continuity, which is an important dogma within the bureaucracy, clashes with crisis management.
- The seniority system minimizes criticism of one's superiors, obscuring the existence of problems.
- No leadership is exercised in the decision-making process, and the people are made to pay for the bureaucrats' mistakes.
- The system of "amakudari" (bureaucrats joining related industries in their field upon retirement) fosters the status quo and maintains the pre-existing regulations. In other words 'amakudari' functions as a watchdog for regulations.
- The lack of a Freedom of Information Act in Japan.
- Individual rights are not respected.
- Clinical trials for new drugs are a form of non-tariff trade barrier.
- Japanese are very special.
When I entered the ministry I recognized that in Japan individuals should not assert their rights. The rights of the individual are acknowledged by the group. Even if these rights are acknowledged, you are not supposed to exercise them in front of the group.
The system of Japan is special in the sense that once you belong to the bureaucracy, you have to embrace the myth that the system is immortal. In order to. maintain this myth, it becomes important that everyone believes the group is perfect. Furthermore, the concept of tradition has been reinforced, however, tradition itself is not a problem. The problem arises when tradition equals the status quo. Many bureaucrats think that the Japanese bureaucracy has reached the level of perfection, to the point that the bureaucracy could be called a Japanese tradition. Therefore, major change does not have to take place.
There is another dogma of the Japanese bureaucracy which is continuity. Upon entering the ministry I was told by many of my superiors that continuity is the most important concept for the bureaucrats. Why is continuity so important? It prevents significant change and values the status quo, . Given these values, the Japanese bureaucracy as an organization has been built in such a way that it becomes almost impossible to restructure.
The status quo in the Japanese bureaucracy is labeled as precedence and one should always respect precedents that have been set. In the case of the HIV scandal, in 1983 some officials of the ministry thought that it might be important to change the policy and import heated blood products in order to prevent the spread of the AIDS among hemophiliacs, but there was opposition to this because it would establish a precedent of approving drugs for sale without clinical testing. The concept of precedence is more important that human life.
In Japan, in order to market a new drug, regardless of the country of origin, it is mandatory that the drug undergo clinical trials in Japan as a regulatory measure. In the case of heated blood products, the ministry could have used its power to wave clinical testing and call for emergency imports. When precedence becomes a tradition, it overrides any emergency.
From 1987, 1 worked at the Defense Agency for two years, and I was in charge of the health problems of the entire Japanese army. At one conference I emphasized that the HIV virus could be a big problem and that the armed forces should be aware of its dangers. The then air force colonel, who was also a physician, said to me, "Dr. Miyamoto, is what you said the opinion of the Ministry of Health and Welfare, or is it your own personal opinion?' I answered, 'it is my own opinion.' His response was, 'As a bureaucrat, the most important thing is continuity. What you're saying is that once you become infected with HIV there is no treatment, and since the mortality rate is extremely high, extra precautions should be taken. It is my understanding that AIDS is a disease limited to homosexuals. Since the Ministry of Health and Welfare's opinion is 1 80 degrees different from yours, your statement will only provoke anxiety among armed services personnel.' He further said, "As a bureaucrat, one should not make a drastic change in approach, because of the importance of continuity, which you may not be aware of since you only recently returned from America. If you want to make a drastic change you must have an order given from the MHW." I was shocked to hear his remarks because in my mind people in the armed forces should be trained to deal with crisis.
As you may recognize by now, the concept of continuity and the placing of importance on precedent have severe implications for crisis management. AIDS is a big problem for all countries. When it first became recognized as a problem, it should have been a matter of crisis management, but the lack of a crisis management mentality in the Japanese bureaucracy is revealed in the decisions made by the MHW in 1983.
In order to maintain the status quo, you have to educate people, and this is where today's title of "castration" comes into play. The Japanese bureaucracy wants the people to be as obedient as sheep. Not to complain. Not to challenge the system. Not to resist their superiors. For individuals to enslave themselves to the system. If one is educated to embrace these values, then Japan as a system can maintain harmony. From the bureaucrats' point of view, from the point of view of those who control Japan Inc., this is ideal. However, in order to imprint these values, you need a special technique, which is to halt the growth of identity integration.
Identity integration are words used in psychoanalysis. In general terms let me explain what they mean. Identity integration means that you will be able to develop the capacity to distance yourself from the parental figure and become independent. You could say that identity integration is similar to the concept of independency. To have your identity integrated means that you become an independent individual. All of us live in the worlds of both fantasy and reality, but most of us are able to make a distinction between the two. What identity integration does is to place a clear boundary between these two worlds. If these boundaries are clear one has the capacity to control one's impulses, and at the same time to deal with stranger and separation anxiety. Therefore, identity integration is a sine qua non to function without difficulty in everyday life, particularly when yes and no are clearly stated. Just as a child matures to become an adult, identity integration follows a similar path.
What the Japanese bureaucracy's educational goal does to people is to halt identity integration at the level of adolescence, a period when people still need some dependency. This is why I say that the goal of Japanese education is psychological castration. Unfortunately the bureaucrats are also puppets of the bureaucracy, and their identity integration is the same as other people's. Therefore, they do not know that they hinder identity integration.
How did this sophisticated way of controlling people enter into the educational goals of the bureaucracy? The responsibility goes back to the Edo or Tokugawa government that Initiated this approach. Perhaps Japanese bureaucrats got a hint from bonsai, the Japanese art of stunting the growth of trees, because in Japan creative ability and innovation have been trimmed. Bonsai can be viewed as a form of "castration".
The HIV scandal arose within these dynamics of Japan as a system, and because of the Japanese educational goal. As you are aware, my specialty is psychoanalysis. When I was going through my residency I learned the technique of the psychoanalytic diagnostic interview. What this interview technique does is to confront the contradictions the patient presents. By engaging in this technique, one can come up with quite an accurate diagnosis. Thanks to learning this technique, I was able to apply it to the HIV scandal and thoroughly understand the issues.
When I went over all the documents and comments released by the MHW I found a contradiction. On one hand, what the MHW emphasizes is that what is most important is the safety of the people. But on the other hand, according to the file of July 1983, the MHW was well aware that unheated blood products stood a good chance of being contaminated by HIV. If you go along with the MHW's official stance, it would not be surprising if there was an immediate ban on imports of unheated blood products and they ordered the emergency import of heated blood products.
But instead the MHW reversed its original decision and decided against emergency imports of heated blood products from the U.S. and a ban on unheated blood products. The ministry decided to go through the regular procedure of clinical trials, which takes a long time. This allowed Japanese pharmaceutical companies to develop and market their own heated blood products, keeping American products out of the Japanese market. I should emphasize that it was only in 1985 that the ministry approved heated blood products, and that they did not order the recall of unheated blood products tainted by HIV until 1988.
What this contradiction means is that the bureaucracy is not concerned about the safety of the people. What are they concerned about? The evidence clearly indicates that the MHW is concerned about protecting the pharmaceutical industry.
Let's go back to the clinical testing, which I view as a form of trade barrier. This barrier sheds light on the bureaucrats' view that the Japanese are special. In order to market drugs in Japan, even drugs developed in America and approved by the F.D.A., you have to undergo years of clinical trials. By comparing the quality of medical care and research, there is no doubt that the U.S. is superior, so there is no reason for clinical trials. But the MHW officials explain the importance of doing clinical testing in Japan (which can be almost exactly the same procedure) by saying, "The Japanese are different, therefore new drugs have to undergo our own testing." But MHW officials seem to have forgotten that America is a multi-racial society. This is why I say clinical testing is a hidden trade barrier. What is hidden behind the word "specialness' is the protection of the pharmaceutical industry.
This mentality of "Japanese as special' was vividly witnessed after the earthquake in Kobe last year. Five physicians from the U.S. came to Japan for emergency assistance, -but they were told by the MHW that they could not treat the victims because they were not licensed to practice in Japan. In addition, after the earthquake Americare donated a large amount of Tylenol, but the MHW said that the pain-killing effect of Tylenol was too strong for the Japanese. Again, because of the distorted mentality of the Japanese bureaucracy, the Tylenol was rejected and people had to suffer.
The bureaucracy's mentality that the Japanese are special is not confined to the MHW. In 1987, when there was pressure from the American government to open the Japanese beef market, a group of American politicians invited their Japanese counterparts to a luncheon of American beef. At that luncheon, Mr. Hata, a former prime minister and head of the delegation representing the Ministry of Agriculture, stated that it would be difficult to increase the consumption of beef in Japan because of Buddhist restrictions and because Japanese intestines are longer.
Senator Phil Gramm of Texas said that opening the market would prove whether long intestines or Buddhist teaching were preventing increased consumption of beef. Japan has since opened its market for beef, and consumption has quadrupled. Mr. Hata is also known for his statement saying that because snow is different in Japan, foreign skis have to be restricted. The reasoning behind these restrictions on medical qualifications, Tylenol, beef and snow are so unscientific as to be laughable.
The most important task of the Japanese bureaucracy is to maintain the system, and specialness is a way to accomplish this. The bureaucrats' thinking that the Japanese are special has been transferred to an educational goal. What specialness does is to create psychological barriers, which makes it difficult to have an independent life, particularly one outside of Japan. The specialness that the bureaucrats are reinforcing is an illusion, and if you embrace this illusion it is not easy to develop identity integration. In order to mature identity integration, it is essential to develop the strength to face reality, and this strength will allow the maturation of identity integration. In other words, to embrace the illusion of of specialness will stunt the growth of identity integration. In essence one will be castrated. The educational system has castrated most Japanese, and as a result they feel insecure and try to seek protection. To keep people feeling insecure is a wonderful way for the Japanese bureaucracy to maintain its power. Psychological castration transformed into daily life means that people do not express frustration, resign from their desires, avoid confrontation in human interchange and continue to be dependent on the bureaucracy.
Now let's return to the AIDS scandal and the issue of 'amakudari'. That Japanese bureaucrats view themselves as special is clear from the meaning of the word, 'amakudari," which means "descent from heaven". They are clearly in a heavenly world because they do not have to take responsibility, and upon retiring from the ministry, through "amakudari," they are guaranteed a large income without much work.
Green Cross, a pharmaceutical company known for its blood products, has suffered heavy criticism for having continued to sell unheated blood products until 1988, which caused the widespread dissemination of the AIDS virus among hemophiliacs. Many bureaucrats from the MHW went to this company upon retirement from the ministry as "amakudari'. For example, the president of this company was a former director general of Pharmaceutical Affairs.
Why does industry accept these bureaucrats? This is because if the company makes a mistake they expect the ex-bureaucrats to take care of the problem. Japanese business is unlike American business in that it functions through narcissistic identification" not rational decision-making. Narcissistic identification means that group members have to hold the feeling that they are all the same. Given that ex-bureaucrats are working together with younger bureaucrats in the ministry creates the necessary narcissistic feeling of unitedness. The seniority system forces you to develop narcissistic identification.
Having these relationships, if the company has a problem, particularly trouble with the bureaucracy, if the ex-bureaucrats -bow and say to their younger colleagues in the ministry, 'Please take care of it,' the bureaucrats will comply because they are taught not to destroy their narcissistic identification. In Japan narcissistic identification is called harmony, and it is the strongest code of the group.
In the case of Green Cross, if the ministry decided that unheated blood products should be destroyed, and heated blood products should be imported without clinical trials, the damage caused to Green Cross would be vast. In order to prevent even the smallest possible damage to your company, since the group places the utmost importance on perfection, employing former bureaucrats is a way to take care of any problems that may arise, because of their connections in different ministries. Since the president of Green Cross is a former director general of Pharmaceutical Affairs, his influence is quite large and one phone call to his successor at the ministry would be enough to take care of any problem.
Nobody knows whether this former director general, the president of Green Cross has made this phone call. There is no proof. However, it was quite clear that the change in the ministry's direction in July of 1 983 certainly benefited Green Cross, and at the same time it maintained the harmony of the MHW. Harmony here means that the organization's size and jurisdiction has not decreased and that the status quo has been maintained. Everyone was happy, except for the hemophiliacs who started to fall ill.
In 1989 a group of hemophiliacs initiated a lawsuit against the MHW and five pharmaceutical companies. In court, the MHW was asked to reveal internal files of the AIDS study group. The MHW continuously stated that they had no record or recollection of such files. After seven years of investigation, when Mr. Kan became the Minister of Health and Welfare in January of 1996, when he formed an in-house body to investigate this disaster, the missing files suddenly appeared, as if Mr. Kan waved a magic wand. Ministry officials said they "discovered" the files, refusing to admit that the files had been hidden. The bureaucrats are trained not to take responsibility, and the use of the word "discovered" is a typical way that they avoid taking responsibility.
The question is why did these files remain hidden for seven years, files containing information on changes in official policy on unheated blood products? At this point no Japanese believes that these files were 'discovered'. People believe they were hidden.
This subject is the most important of all those I have mentioned today, and so different from western society. The Japanese bureaucracy places greater value on maintaining group harmony than on discovering the truth of the matter or facing. reality. In fact, in order to maintain group harmony, there is nothing unethical about lying in Parliament or in court. As I have already pointed out, the Japanese bureaucracy maintains its cohesiveness or harmony through narcissistic identification. Anything that disturbs the narcissistic identification or produces a crack in the mirroring process will be considered bad.
The missing files disclose that the MHW was aware that unheated blood products were contaminated by HIV. If this information had been disclosed, the ministry would have had to take responsibility for its negligence. For the ministry to take responsibility would mean that someone inside the system would have to become responsible.
The basic principle of the Japanese bureaucracy is that neither the people nor the system take responsibility. If this kind of tragedy, which is clearly a criminal act, is revealed, the people involved and the system would both be indicted. , What this means from a psychoanalytic point of view is that a huge crack would appear in the mirror of narcissistic identification. In the end, the ministry will not be able to avoid a change in their internal structure. They will no longer be able to maintain the status quo or tradition.
What puzzles me is why such important files were not shredded. I believe many people in the MHW knew about the existence of these files. Given the contents of these files, if someone reveals their existence, he would bring himself into the spotlight. For most bureaucrats, to go up the ladder is the most important goal in their life. In order to achieve this, to take care of their given duties without making any blunders is the preferred course of action. If you cause a problem, and you come under fire, promotion will be closed to you. Therefore, in order to protect themselves, 'see not, hear not and speak not' is the modus vivendi of the Japanese bureaucracy.
Given this bureaucratic mentality, ignoring the existence of these internal files is why they did not go into the shredder. Of course the bureaucrats probably thought that once they belonged to the bureaucracy, no one would reveal anything to outsiders, so there was no reason to put the files into the shredder.
The wish not to make any blunders prevails in the bureaucracy, and this stems from a desire to be blameless and to play it safe. This mentality echoes throughout Japanese society. This is because of the goal of Japanese education, which is to castrate people psychologically. In order not to make any blunders requires that you do not address any problems that arise and that you close your eyes to them. This means that narcissistic mirroring will be preserved, which in Japan's collectivistic environment is a form of self-protection. People who have been psychologically castrated have a tendency to get hurt easily, therefore they seek self-protection.
One of the major problems with castrating people is that they do not know what to do when faced with a crisis. According to the Japanese collective mentality, maintaining harmony is the highest ethics, and in order to maintain harmony there is nothing wrong with lying or destroying evidence. But evidence was not destroyed, and this is the result of the psychological castration that was introduced by the bureaucracy.
What an irony that through their educational goal, the psychological castration of people, the goal of which is to maintain group harmony, people within the ministry were not able to make the decisions that would maintain the harmony of the group. What this means is that the educational goal of psychological castration backfired. Everyone who goes through this educational process will be strangled.
The question is why did previously missing files at the MHW start to appear after Mr. Kan became Minister of Health and Welfare in January, and why did previous ministers not address this issue? To answer the latter part of this question, politically appointed ministers do not have any control over the system. Castrated, they are puppets of the bureaucrats, and this reveals their lack of leadership.
To answer the first part of the question one has to recognize that there is a power struggle within the MHW. Mr. Kan appointed a vice minister to head the in-house investigative team for-AIDS. The MHW is divided into three major groups: career bureaucrats, who pass a difficult civil service exam and are guaranteed an elite career; non-career bureaucrats, who can go only halfway up the ladder, which is the majority of all bureaucrats; and the physicians' group. There is an on-going power struggle between these groups.
When I worked at the ministry, I belonged to the physicians' group. Non-career bureaucrats tend to side with the elite bureaucrats, and there is always antagonism between these two groups and the physicians' group. The reason for this antagonism is that the physicians hold medical degrees, and they always have the option of leaving the ministry and opening a private practice, whereas the career and non-career bureaucrats can only stay where they are. The physicians' group has more freedom, and apparently the inability to obtain freedom creates envy. The career bureaucrats criticize the physicians for what they perceive to be a lack of loyalty.
The world in which the bureaucrats live is similar to the world of the yakuza, the Japanese Mafia. The utmost goal of both is to increase their territory, because increasing their influence leads to promotion. In the case of the bureaucracy, or the MHW, the bureaucrats search for other people's faults, and use this to deflate their influence. This behavior may be quite common, but since the Japanese bureaucracy does not value the merit system, this behavior becomes particularly effective in maintaining power. If you can get the other groups' posts to be yours, your territory will increase along with your vested rights, and it will be considered as a great achievement.
After being dismissed from the ministry last year, I continued to keep in touch with my friends there. According to them, because the head of the investigating team, a vice minister, is an elite bureaucrat, most likely the career bureaucrats tried to use this incident as a way to increase their influence by attacking the physicians' group. This is why Dr. Gunji, a former director of the biological and antibiotics division, now the office of blood products management, was the first to be criticized. Don't misunderstand me. I'm not trying to protect Dr. Gunji. I think he is responsible for the HIV scandal, but what becomes ironic is that attacking the physicians' group only spreads the fire to the career bureaucrats.
The more you attack the physicians' group, the question arises as to why the ministry, knowing the danger of unheated blood products, did not ban their import. As I mentioned before, after the ministry recognized the danger of contracting HIV from unheated blood products, heated blood products went on sale in Japan in 1985. Since the ministry had complete authority over the decision, why did they not ban the sale of unheated blood products at that time? When you look into the decision-making process of the Japanese bureaucracy, it is not one director who makes the decisions, but a group of people. Since consensus is the only way to come up with a decision in the bureaucracy, when there is an important decision to be made, many people are involved in the final decision. What this means is that the director general of pharmaceutical affairs was involved in this decision-making process, and even a vice minister could have been involved as well. Both of these are not from the physicians' group but are career bureaucrats.
I would now like to focus on the issue of seniority. The seniority system, predominant throughout Japanese society, prevents people from expressing themselves freely, just like in the military. This system had a strong influence on the HIV scandal. I am sure there are many people who are involved in this scandal, but there are at least four people who became the focus of media attention. Dr. Gunji, the former director of the biological and antibiotics division, Dr. Abe, the head of the AIDS study group and dean of Taikyo Medical College, Mr. Mochinaga, the then director general of Pharmaceutical Affairs and now a member of Parliament, and Mr. Matsushita, then president of Green Cross and a former-director general of Pharmaceutical Affairs. His position at Green Cross was the result of "amakudari'.
When I entered the ministry, the first paper I was given was a list of physicians with their medical school and their year of graduation. I noticed that many physicians carried around a miniaturized copy of this list in their agendas, in order to check the seniority and ranking of other physicians. Within the ministry, twice a year, graduates from the same medical school got together in order to maintain and strengthen their cohesiveness and reinforce seniority. Another twice yearly meeting to reinforce group solidarity brings together graduates from the same year but different medical schools.
Dr. Gunji and Dr. Abe are both graduates of Tokyo University Medical College, and Dr. Abe is 20 years senior to Dr. Gunji. So Dr. Abe telling Dr. Gunji that he's an expert in hemophilia and that he's taking a certain direction, Dr. Gunji, not being a specialist in the field, would offer no opposition. Dr. Gunji, upon retiring from the ministry, became a tenured professor at Tokyo University Medical College, another 'amakudari' position. If he were to have had a major fight with Dr. Abe over the marketing of heated blood products, it would be questionable whether or not he would have received the post at Tokyo University Medical College, the most prestigious medical school in Japan.
In the same vein, Mr. Matsushita was senior to Mr. Mochinaga at the Ministry of Health and Welfare. Both graduated from Tokyo University and are elite career bureaucrats. According to a weekly magazine, Dr. Abe and the founder of Green Cross, Dr. Naito, were good friends. Dr. Abe held great respect for Dr. Naito, his senior. Dr. Naito was in the Japanese Imperial Army, Dr. Abe was in the Japanese Imperial Navy, and both were on the career track. Their military career was another bond or narcissistic identification between them. This bond is very important because in the pre-war period the military was the most respected career. Defeat distorted the bond of narcissistic identification, and helped to strengthen it. So now you can start to see the intricate web of human ties and the dynamics of the seniority system. Once these dynamics are revealed, many people will start to wonder to what extent the former director generals are implicated in this scandal.
Mr. Kan, the present minister, has achieved something that no other minister in Japanese history has, which is to take a role of leadership. He places more importance on reality than on group harmony. He has been praised by almost all Japanese for the actions he has taken in this scandal, but his reputation suffers among the bureaucrats. Up until now ministers have been special guests of the bureaucrats, put on a pedestal and ignored, but Mr. Kan has declined special guest status and asserted his own political point of view, which has made him their enemy.
When I speak to my former colleagues, I can sense their underlying hostility. What Mr. Kan has done is to reveal information to the public. Unfortunately, in Japan we do not have a Freedom of Information Act. Why don't we have a Freedom of Information Act? The reason is very simple. The bureaucrats would like to maintain their power.
One of my superiors said to me after I first joined the ministry, "Do you know why we bureaucrats have such power over the people and politicians? It is because we control all information. We determine what information to give out and to whom, in such a way that it benefits the bureaucracy. Basically what he said is that people do not have any right to have access to information.
Mr. Tada, the vice minister of the MHW, upon Mr. Kan's request to investigate the AIDS scandal, commented to the press that, 'The ministry's decision to reveal information at this time because so many people want to know, is an exception.' What this means is that if only some people want to know, the ministry would not reveal any information. Japanese bureaucrats forget that they live at the taxpayers' expense, but since individual rights are not recognized by the bureaucracy, Mr. Tada's comment would not arouse any uproar. It turns out that Mr. Tada's remark is an endorsement of my superior's comment 1 0 years ago.
The proof that the ministry is unwilling to reveal information, and that information is not for the people, became very clear a week ago when 27 more files connected to this scandal were found in mid-February, but kept hidden from Mr. Kan. Their existence was only revealed after the court settlement in late March when the government agreed to pay damages to HIV-infected hemophiliacs. Mr. Kan was apparently very angry and he verbally reprimanded the vice minister. Disappointed in the way the investigation is being conducted, Mr. Kan mentioned the possibility of bringing in a third party to uncover the truth. With this internal investigation it became clear that the in-house body was only concerned with maintaining harmony and protecting the organization.
I agree with Mr. Kan's idea of bringing in a third party to investigate this matter, because given the dynamics of the Japanese bureaucracy, to form an in-house investigation is like asking a convict to be his own jailer.
Everything I touched on today boils down to one issue, and that is the rights of individuals. The Japanese government, for over 400 years has prevented the concept of individual rights from entering Japan. It is about time for the Japanese bureaucracy to accept that bureaucracy is for the people, not that the people are for the bureaucracy; for people to learn that individual rights are more important than group harmony; to end the educational goal of castration and replace it with the development of independent thinking so that the people can become free of governmental control.
Thank you very much.
Chronology of the spread of the HIV virus
through unheated blood products in Japan
- 1979: Unheated blood products to treat hemophilia are first imported from the U.S.
- September 1979: The Pharmaceutical Affairs Law is revised to require that the Health and Welfare Minister ensures drug safety.
- June 1981: The U.S. Centers for Disease Control and Prevention reports that five homosexual men have pneumocystis carinii pneumonia (a characteristic symptom of AIDS).
- July 1982: The CDC reports that three hemophiliacs in the U.S. caught PCP and that two died from the infection.
- September 1982: The CDC originates the term Acquired Immunodeficiency Syndrome.
- February 1983: The Health and Welfare Ministry approves coverage of home infusion of unheated blood products under the national health insurance system. This leads to wide use of such products in Japan.
- March 1983: The CDC reports that AIDS seems to have spread among hemophiliacs through unheated blood products. The U.S. Food and Drug Administration approves a heat-treated blood product developed by Travenol Co., now Baxter World Trade Co.
- June 1983: Travenol reports to the Health and Welfare Ministry that it is recalling from the market a certain number of lots of contaminated unheated blood products. the ministry sets up an AIDS study group headed by Takeshi Abe, an expert on hemophilia and a professor at Teikyo University
- July 1983: A document dated July 4, found at the ministry in February 1996, states that urgent imports of heated blood products are being considered.
- A document dated July 11, also found in February 1996, states that the measure should not be taken. Green Cross Corp. distributes letters of "safety assurance of unheated blood products" to patients. A hemophiliac treated at Teikyo University Hospital dies of AIDS but is not recognized by the ministry as an AIDS victim.
- September 1983: A subcommittee on blood products is formed as an affiliate of the AIDS study group to consider how to handle blood products. A nationwide group of hemophiliacs asks the ministry to allow access to heated blood products.
- November 1983: Cutter Japan Ltd. (now Bayer Yakuhin Ltd.) reports to the ministry that it is recalling two lots of contaminated blood products. The ministry Issues a guideline to drug makers on clinical testing of heated blood products.
- February 1984: Clinical testing of heated blood products begins In Japan.
- March 1984: The subcommittee recommends continued use of unheated blood products. The AIDS study group Is dissolved.
- September 1984: Abe confirms that 23 out of his 48 patients with hemophilia have been infected with HIV. This is not made public.
- December 1984: The ministry confirms that 47 out of 163 tested hemophiliacs have been infected with HIV. This is not made public.
- March 1985: The ministry Identifies a male homosexual who had lived in the U.S. and is temporarily back in Japan as "the first AIDS case in Japan."
- May 1985: The ministry admits publicly for the first time that two hemophiliacs have died of AIDS, including one who died in July 1983.
- July 1985: The ministry approves heated blood products. It does not order drug makers to recall unheated blood products.
- December 1988: The AIDS Prevention Law Is enacted, requiring doctors to report to prefectural governments all AIDS and HIV cases, excluding cases related to blood products.
- May 1989: HIV-infected hemophiliacs in Osaka file a lawsuit against the government and five drug makers.
- October 1989: A Tokyo group of hemophiliacs files a similar suit.
- April 4, 1994: The hemophiliacs and their attorneys file an accusation of attempted murder at the Tokyo District Prosecutor's office against Abe, now vice president of Teikyo University.
- March 27, 1995: Hearings on the Tokyo H IV suit are concluded.
- July 26,1995: The Osaka hearings conclude.
- Oct 6,1995: The Tokyo and Osaka district courts propose a compromise settlement.
- Oct 11, 1995: Health and Welfare Minister Churyo Modi expresses the ministry's intention to offer an apology to the plaintiffs and to accept the compromise plan, but will. refuse to admit its legal responsibility for failing to prevent the spread of HIV.
- Jan. 5, 1996: Green Cross is found to have continued distributing unheated blood products after heated products had been approved in July 1985.
- Jan. 11, 1996: Naoto Kan takes office as health minister.
- Jan. 23, 1996: Kan instructs officials to form an in-house body to investigate the disaster.
- Jan. 25, 1996: The Tokyo plaintiffs file a complaint at the Tokyo District Prosecutor's Office against Atsuaki Gunii, former chief of the ministry's biologics and antibiotics division, for perjury.
- Feb. 9, 1996: Nine files of documents related to the case, long claimed by officials not to exist, are "discovered" at the ministry.
- Feb. 15, 1996: The mother of a deceased hemophiliac files an accusation of murder against Abe
- Feb. 16, 1996: Kan admits the ministry's legal responsibility for failing to prevent the disaster and apologizes to the plaintiffs in the two HIV suits.
- Feb. 21, 1996: Kan makes public the "Gunii File, " one of the nine "discovered" files.
- Feb. 23, 1996: The ministry conducts an on-site inspection of Green Cross.
- Feb. 26, 1996: Abe resigns as vice president of Teikyo University.
- Feb. 27, 1996: Green Cross is found to have made a false report to the ministry in 1985 on its withdrawal of unheated blood products.
- Feb. 28, 1996: The ministry's in-house investigation team releases Its interim report.
- March 1, 1996: The Lower House's health affairs committee holds intensive deliberations on the scandal.
- : The ministry inspects drug maker Nippon Zoki Pharmaceutical Co.
- March 6, 1996: It is learned that Baxter had asked the district courts to resume court hearings in light of "new facts discovered" in the ministry.
- March 7, 1996: The Tokyo and Osaka district courts recommended a second compromise plan.
- March 12, 1996: The Tokyo District Public Prosecutor's Office forms a special squad to look into the case.
- March 14, 1996: Four of the five drug makers in the scandal officially announce they will accept the compromise. The fifth, Nippon Zoki, suggests its intention to accept it.
- March 16, 1996: The government formally announces its acceptance of the compromise
- March 19, 1996: The ministry's in-house investigation team releases a second report. Nippon Zoki officially announces ft is accepting the compromise.
- March 20, 1996: The plaintiffs in both the Tokyo and Osaka suits decide to accept the compromise.
- March 29, 1996: The plaintiffs and defendants sign the court-mediated compromise.
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