Editors: Norio Fujiki, M.D. & Darryl R.J. Macer, Ph.D.
Director, Department of Public Health Administration, The Institute of Public Health, Ministry of Health and Welfare, JAPAN
When we think of the "Science and Technology Administration" in the context of this symposium, and location of this session, we can first point to the problems in reflecting the fruits of scientific technology as methods useful to social welfare in administrative measures. At the same time, we have to consider and overcome the problem of bioethics and social acceptance.
Furthermore, from the point of view of administration, the problem is in developing and perfecting administrative measures from the fruits of scientific technology, and presenting these choices in a way that meets the criteria of bioethics and social acceptance. As there is no established procedure, we must carefully consider each measure, case by case. Current topics in health and welfare administration include securing research funding for the incorporation of scientific technology into new administrative measures and the expectation of research that conforms to bioethics and social acceptability.
In this paper, we touch on research promotion by the Health Science Research Funds, and incorporation of these results into new administrative measures. Then, we discuss the current status of bioethics and social acceptability from the perspective of public administration.
2. Research Promotion by the Health and Welfare Administration
From its early days, the importance of research activities has been well understood by the health and welfare administration. In the 1951 fiscal year (26th year of Showa), the Grant System for Health Science Research was established to promote scientifically administrative measures for public health and welfare, and to support researchers who were studying problems in advancing the level of technology. Thereafter, a new large scale grant system for subjects that were important to health and welfare administration but difficult to solve within a short period of time, was established as part of the Grant System of the Health Science Research. We now have 28 programs under this system. Recently, gene therapy has received attention as one area of highly advanced medical treatment. Furthermore, we have actively and purposefully established many new grant systems injecting funds into long-standing problems, such as dementia, diabetes, and rheumatism, to promote research and survey for possible new administrative measures in these areas. The Ministry of Health and Welfare defines the term "Health Science" as a generic concept of science and technology to fulfil public need for health services, welfare, and environmental health and promote its quality of life, and as a frontier and multidisciplinary science having a high regard for humanity.
"Research into Treatment of Specific Diseases", established in the 1972 fiscal year (47th of Showa), is a program that includes financial support for research and treatment of intractable diseases. There are 43 research teams involved in this program. Research, epidemiological surveys, and the development of therapeutic procedures for specific diseases have been carried out. "Research into Mental and Physical Disabilities", established in the 1971 fiscal year (46th of Showa), is a grant system for promoting research on the pathogenesis, prevention, early diagnosis, treatments, and care of mental and physical disabilities. We also have the Grant for Cancer Research, Grants for Cardiovascular Disease, Grants for Mental and Neurological Disorder, Trust Fund for Research in International Medical Aid, Grant for Pediatric Medical Treatment systems, etc.
3. The Development of Science and Technology, and the Administration
It is commonly said that research activities undertaken for the Ministry of Health and Welfare should be goal-oriented or application-based. This means that grants are directed not toward fundamental research that directly promotes scientific and technological development, but rather toward specific subjects that are important for the health and welfare administration. Grants should contribute guidance to research activities where solutions would be possible were current findings applied to the problem. Therefore, research themes are often proposed by the ministry beforehand, then a research group is nominated, and the research is carried out by that team. Even in themes open to the general research community, the theme is publicized in advance and researchers apply for funding under the scheme. Thus, the ideal form of research project in health and welfare is that the result of the research can be incorporated into new administrative measures. We can point to successful examples of this, such as the Health Examination for 1.5 year old Children, the Examination for Inborn Errors of Metabolism, Genetic Counseling, NICU, and the Examination for Neuroblastoma.
We can also present many examples where surveying the current understanding of research and clinical medicine has led to establishment of treatment guidelines and criteria. For example, the criteria for contracture of the quadriceps muscle of the thigh, the criteria and guidelines on retinopathy in premature infants, and the criteria for cerebral death are widely utilized. These criteria and guidelines as well as many others are accepted as de facto standards.
Recently, there have been increasing numbers of research projects that do not meet the classical characteristics of research projects mentioned above, such as the 10 Years of Strategic Cancer Research Program aimed at uncovering the basis of cancer and the Science of Aging Program aimed at revealing the physiological mechanism of aging.
This change has coincided with the advocation of "Health Science" by the Ministry of Health and Welfare. The aim of research may be wider than the classical purposes that were object-oriented and application-based, and has spread to include making the fruits of science and technology useful to improvements in public health and welfare, as well as quality of life.
4. Incorporation in New Administrative Measure
Modern nations are sometimes called "welfare states". The central dogma of the term "welfare state" is that the state to accept guaranteeing "quality of life" as a national responsibility. As goes without saying, in Article 25, the Constitution of Japan states that all people shall have the right to maintain a minimum standard of wholesome and cultured living. Japan is on its way to becoming a welfare state. Because of this, support for health science is being maintained and we are trying to incorporate the fruits of research in to new administrative measures.
Therefore, we would like to review the formation of new government policy from the administrative point of view.
Firstly, it is important to recognize changes in the circumstances surrounding a certain issue, and determine whether a new policy is necessary. Needless to say, new developments in scientific technology can be taken as such an important change in the surrounding circumstances. As can be seen from the promotion of research mentioned above, the government itself advocates changing the circumstances, and the results of the research require objective judgments on the need for new technology.
Secondly, it is also important to judge the need for new administrative measures. Estimation of the needs of the new administration is also necessary. Sometimes the need for a new administrative measure may appear in demands on the government by public expectations, while others, for whatever reasons, may not, and lie latent. Also, the needs differ between special interest groups and/or individuals and may sometimes conflict with one another. In any case a careful investigation of the bioethical problems and social acceptability should be done at this stage. If the need satisfies these criteria, or is judged to involve problems that can be overcome relatively easily, we propose the new policy to the public. The policy is presented in terms of actual enforcement, embodied in some procedural plan. Conversely, if there is a serious problem in bioethics, and the policy will have difficulty in achieving social acceptability, introduction of the policy should be handled very carefully.
In modern nations, especially welfare-oriented states, the administration has come to be required to respond precisely to the demands and expectations of subject groups. However, the demands and expectations of one interest group have increasingly come to contradict those of other groups. This dilemma that confronts administrations can be understood as a problem of responsible administration. In the traditional view, responsibility arises when the government controls people by enforcing a system. In the modern view, responsibility is a matter of the autonomic responsibility of the government. This means that the administrator should overcome the dilemma of conflicting interests according to his or her inner conscience, belief and sense of values. That is, the enthusiasm, insight, and sense of responsibility of the administrator becomes the key to solving the problem.
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