I am spending the week in Tokyo. What an amazing city this is! I plan to
write parts of this as they take place. As I write this, I am through the
first half of the week. I spent the first day learning the ropes (mostly
the trains) with the help of Chiaki (who has been mentioned several times in
these journals and is Mr. Wocher's assistant). Today I earned my wings, so
to speak, and was on my own and had to get to various locations in Tokyo on
my own. This freedom also meant that I could explore a little on my own.
More on this later.
A little background...Tokyo is home to 12 million people. That is a pretty
big transition from Kamogawa City, a town of just over 30,000. This paltry
population enables Kamogawa to (barely) to append the title "shi," or city,
to its name. Couple this transition with the fact that an Iowa boy is in
Japan and you have a pretty scary situation. Conversely, there are the
stories you hear about people leaving their cameras and other belongings on
trains and being able to recover them. This journey to Tokyo was certain to
be the most challenging part of my stay so far.
7/4/00 - Tuesday - Independence Day in the USA, just Tuesday in Japan
Of course, an early morning departure for a strange city should leave one
with a sleepless night. That was certainly the case for me. Alas, stress
contributed little to my sleeplessness. Kameda had some special guests in
town from Canada, where instead of going OUT and ABOUT, they go OOT and
ABOOT. Neat. The guests were the president of Translogic, Mr. Collings,
and his son, John. Translogic sold Kameda their air shooter system,
enabling them to fire blood samples and other goodies across the Kameda
campus. John is 19 and is starting college in Canada (Queen's College, I
think) this fall. He will be working at Kameda for a few weeks to get some
international experience. Mr. Wocher suggested that the four of us go out
to his favorite Italian restaurant. When we arrived at the restaurant,
Kids, the really neat aspect of the restaurant presented itself - Mr. Wocher
is a close friend of the chef. I walked in carrying a mysterious black bag
that Mr. Wocher entrusted to me. This turned out to hold some wine that we
were to drink with dinner. The chef greeted us at the door and sampled a
sip of the wine before slipping away into the kitchen. As conversation was
exchanged and wine was consumed, food began to appear. Plate after plate of
the best Italian food was brought out and consumed. All of it was BEYOND
excellent. Funny that such great Italian food should be hiding in rural
Japan... The bottles of wine disappeared before long and were replaced with
a considerably stronger Italian wine. I took a shine to this beverage and
consumed several glasses of it in a period of less than 30 minutes, assuring
that the effects of the alcohol would be present. Oddly, I was feeling very
well by the time we were back. I watched the news and went to sleep. At
2:30, I woke up and could not fall asleep again. I find that when I drink
here, I can sleep for a few hours and then wake up, as if it's morning. A
physician friend here assured me that is normal, but it fails to please me.
After several sleepless hours, I surrendered and rose from bed.
The train to Tokyo from Kamogawa left at 7:38 AM. Chiaki picked me up
outside of my dwelling and accompanied me to the train station. The train
left on time, transporting a group composed chiefly of business travelers.
A large contingent of school-aged children wearing assorted school uniforms
resembling sailor suits populated the train station, awaiting their rides to
school. I found the prospect of a lengthy train ride to school interesting.
I now know how lucky I was to live mere blocks from Cedar Falls High School,
back in the early-mid 1990s.
The first place I toured was Pfizer. Mr. David Larkin was my tour guide
there. He was retired from IBM and was now Chief Information Officer of
Pfizer Japan. We exchanged some ideas about information technology in
Japan. We also talked extensively about the difficulty of getting drugs
approved here. Pfizer only has had two drugs approved here in the last five
years. One of them was Viagra, which was the most rapidly approved drug in
Japanese history. Interestingly, Japan requires all clinical trials to be
performed on Japanese people before the drug is approved. International
data are not used. Viagra was the first drug to be approved without
domestic clinical trials. I also spoke with two other western men who
worked for Pfizer. They did some explaining of the Japanese drug market and
the role of technology in marketing drugs. Drugs in Japan are much more
expensive than the same products in the US. They showed me some data,
showing that drugs in Japan were actually cheaper than in the US, but their
argument seemed rather thin to me.
I also visited Colby Group International and the Tokyo Kameda Offices. The
former is a consulting group for Japanese healthcare. They work on
accreditation of laboratories. They are moving into accrediting infection
control. They have a tough job, since the Japan Medical Association is
rather Hitler-esque. They are diametrically opposed to patient interests
and argue against many ideas westerners view as simple courtesies. The
Tokyo Kameda offices were focused on computer development. They had a
prototype database product they demonstrated for me. It related to disease
management and hospital statistics. They can examine a particular disease
group and drill down to microcosmic levels to see details of the diagnoses.
It would make a great research tool and the staff was very enthusiastic
about it. I look forward to seeing a completed product, but fear it will
run very slowly when finished. I questioned the speed of the product and
they said they will keep adding servers to assure its performance. That
seems to be an expensive solution, but it will work...
Through the course of the day, I was lugging a large bag with my clothing
and laptop. This was quite heavy, but it didn't really bother me until late
in the day. The fatigue of carrying the bag, coupled with my lack of sleep
was beginning to wear on me. Chiaki, after a crash course on train
navigation, helped me to find my hotel. A strong rain was beginning to
fall. Fortunately, we found the Grand Central Hotel quickly. I paid the
bill in advance and went up to my room. I was getting situated in my room
when the phone rang. Chiaki was afraid to leave for the train station, due
to thunder and lightning. These are rare events in Japan. I agreed to meet
her downstairs for a quick dinner. There was a nice little Italian
restaurant in the hotel. They served some very good food, mostly small
pizzas and pasta rolls. During the meal, I explained to Chiaki that these
kinds of storms were common in Iowa and were nothing to worry about. By the
time we were done eating, the storm had passed. She went on her way. I
found out on the 10 o'clock news that the rainfall exceeded 82.5 mm per hour
and was the largest rainfall ever recorded in Tokyo. The streets were
flooded and the trains were delayed. So much for my judgment.
7/5/00 - Wednesday
After reluctantly leaving my key at the desk of the hotel (customary in
Japan and surprising to me), I walked down to Kanda station. Kanda is the
neighborhood train station.
[I wrote the following section in quotes in Tokyo Station]
"I bought a ticket and attempted to find a sign to tell me where the train
[to Tokyo Station] was. None was visible. I was left with several gates to
choose from and picked one at random. I picked the correct choice and was
almost immediately whisked to Tokyo Station. The train was crowded, but not
terribly so. A CAMBUS on a rainy day is worse. The ride took place at 7:30
AM, so I may have already hit an off-peak time.
"Due to a complete lack of confidence in my navigation abilities, I left far
in advance of my rendezvous at 9:15 AM. The travel on the train and through
Tokyo station went much more smoothly than I ever expected. I ended up at
my destination at 8:00 AM, a famous meeting place called Gin-no-suzu sitting
area. With the extra time, I was able to enjoy both the tiniest bottle of
Coke I could have conceived of and the activities around me.
"Most people at this hour appeared to be in a sleep-like state. On the
trains I rode yesterday and today, people slept in a wide variety of ways,
including standing up. I guess some people need to get to bed earlier.
"There was also an attractive woman [in the sitting area] holding a white
flag emblazoned with the red logo of a travel agent. She smiled constantly
and instantly took up conversation with anyone within three feet of her. I
chose to avoid this zone, since her level of enthusiasm is ruinous to me at
this point of the morning. Time passed and her radiant smile faded to a
mere grin. One of her little sheep must not have made it to Tokyo Station.
In any case, it was time for her and her group to move on. The travel agent
turned from smiling-friend-of-the-world-mode to smiling-drill-sergeant-mode.
She barked out some indecipherable Japanese, prompting the gathering of a
group of elderly Japanese people into two neat lines. She talked to them in
rapid Japanese with her original glowing smile. The whole scene reminded me
of a preschool. I half expected her to attach her aged flock to the child
tethers that are increasingly popular in Iowa City whenever an adult is
responsible for more than one child. The travel agent continued to fire out
her Japanese phrases, prompting me to translate some:
'Don't mess with me or you'll be sleeping with the fishes.'
'The reason I'm curt with you is because time is a factor. I think fast
and I talk fast and I need you to act fast if you want to get out of this.'
(A few of you should know the origin of this quote).
"A pigeon just walked by me. I have no idea how it got here. There are no
windows or doors anywhere near here. This is my first double-take of the
[End Tokyo Station writings]
Dr. Takayanagi met me at the meeting place a little while after I stopped
writing. She is an MD, PhD who was a pediatric surgeon and is now an
Associate Professor of Health Services Management at Nippon Medical School.
She is very pleasant and has a warm, memorable smile. She hurriedly led me
through the station to a train to our destination across town. I visited
with two researchers at the Institute of Health Services Management. They
discussed the development of health insurance in Japan. Much of it was
material I had encountered before, but they put some interesting historical
perspectives on it. They believe that policy adjustments made in 1938
anticipated involvement in World War II. I kept asking why and they avoided
the question. I kept prying and they explained that the insurance
introduced in that period covered women more so they could produce more
children (soldiers) for wars. That puts an interesting spin on health
policy in this country that I hadn't had before. The second presentation
was by an economist. He showed the improvement of the healthcare system
over time and presented some empirical evidence regarding equality in
healthcare throughout Japan and the world. Over time, Japan's prefectures
(states) have become more similar in the levels of infant mortality and life
expectancy. In the earlier part of the twentieth century, certain
prefectures had much poorer health indicators than others. Interesting...
Dr. Takayanagi then took me to lunch. We dined at a place that catered to
the college crowd. They served noodle pancakes called modan-yaki. These are dough layers
enveloping noodles and sauce. They were very tasty and fairly inexpensive
at 500 yen ($5.00). Following that, she needed coffee. We went to a coffee
shop and had some excellent coffee. Even though she would not let me reach
for my wallet at any point, telling me to go outside while she paid for
things, she wanted to know my guess of the price of the coffee. I guessed
two dollars. It turned out to be five per cup. The shop had a series of
cups hanging up that cost up to $100 each. You pay for the atmosphere at
this establishment. It was a neat shop and a good cup of coffee, though I
don't think I would pay $5 for a cup of coffee in Iowa.
After coffee, we took the train to Dr. Takayanagi's university. I toured
the emergency room/trauma center. This facility is the premier trauma unit
in Japan. However, they see less than one gunshot wound per year and very
few stabbings. They see a few more cases of HIV than Kameda, though the
number seems small in relation to the size of Tokyo (1 a month or so). They
also showed off their computer and telecommunications system. These were
both very innovative, assuring me than the Tokyo area was well-prepared for
a disaster. Nippon Medical School's ER handled many of the major traumas in
the cult sarin gas attack in 1994.
To cap the business day I went with Dr. Takayanagi to a French restaurant.
She had to interview a healthcare executive about amenities in Japanese
hospitals, an area of strong interest for her. She invited me along to give
views of American healthcare in comparison to Japan. The interview lasted
about an hour and a half. Everyone seemed extremely pleased with my
answers. I was relieved. The interview was followed by a four course
French meal. All of it was excellent. A cut of beef served was so tender
that my fork cut through it with almost no effort. The service was also
excellent. Several waiters exchanged plates and refilled glasses. What a
Alas, that did not cap the day completely for me. I set out for Akihabara,
a neighborhood of Tokyo composed almost exclusively of electronics stores.
This place is better than I ever would have expected. There are rows of
stores containing rows of toys. If you like computers, mini discs, CDs,
DVDs, CBs, TVs, VCRs, video cameras, and any other electronic product, you
will find things that will blow your mind in Akihabara. I took it easy,
purchasing some headphones, a power converter, and a laptop case for less
than $35. I have a feeling I will be back there before I leave town. It
was incredible and exemplifies every reason a geek would need to live in
I also should mention the service at the hotel. They are extremely polite,
even to a peon, like me. They always addressed me as Mr. Davis. My room
was cleaned daily and every single supply was replenished. This Japanese
hotel gets high marks from me in almost every category.
7/6/00 - Thursday
I spent this entire day at a conference about evidence-based infection
control. Most of the content was in Japanese, and therefore of limited
utility to me. I did get to meet some interesting Americans who were giving
talks. One was from the CDC and specialized in vancomycin resistant
infections. The other was an MD who was trained as a computer programmer.
He was there to train Japanese researchers on the use of a database program
for finding health data. Most of the talks were indecipherable, but I was
able to pick up a few things. I was able to confirm some of my thoughts
about infection control, so I walked away from the conference with some new
Ms. Morimoto, an employee of the education department of Kameda, was also
present at the conference. She offered to take me to dinner with a friend
of hers that lives in Tokyo. At the conclusion of the conference, we
departed for a train station where we would meet her friend, a Japanese girl
in her mid-twenties that spoke English. We ended up eating at a Japanese
barbacue. They cook everything right in front of you. It was interesting
to watch and I found myself mesmorized by the cooking. In Japan, it is
customary to order new dishes as you go along, rather than ordering most of
the food at the beginning, as in American restaurants. We were there about
an hour and a half and saw several kinds of food go by. Interesting stuff.
After the late dinner, I headed back to the hotel to get some much needed
7/7/00 - Friday
This morning was to be a little less busy than others. My first meeting was
at 9:00. I had to make it to a neighborhood called Yotsuya. I boarded the
train. I knew I was on the correct line, but was uncertain if I was heading
the correct direction. After a couple of long runs of the train, I decided
to get off. I was pretty sure I was going the wrong way. As I got off the
train, a sign indicated that I not only was going the right way, I was also
at the right station. Dumb luck served me well again.
Due to my good fortune, I had plenty of time before my appointment at Baxter
Pharmaceuticals. I walked slowly to the office and consumed a bottle of
Pepsi before arriving. The building Baxter owned was much smaller and
intimate than the high-rises that housed the other places I visited. I
received a pretty thorough explanation of Baxter's operations from the Japan
President, Bob Hurley. A particularly interesting part of Baxter's
operations was the release of heated blood products to prevent the spread of
AIDS in 1983. This process was approved in the US in 1983, after just 6
months of testing. Similar testing in Germany took 11 months. In Japan, a
government official decided that a Japanese company by the name of Green
Cross should develop the heated blood product. Baxter was not allowed to
market their product. Several years passed. Ultimately, over 1700 people
died of AIDS as a result of the absence of a heated blood product. Baxter
was wrapped up in the controversy and ended up with a large group of
protesters outside their offices. Mr. Hurley had a bodyguard for several
weeks. The company eventually issued an apology, a significant act in
Japan. It's frightening to think how many people were affected by the
bureaucratic decision to develop a heated blook product within Japanese
industry, rather than allowing an outsider to market theirs...
I also spoke with Frank Vaughn, the President of Health Industry
Manufacturers Association. Their office is located in Baxter's building.
We discussed a variety of issues about healthcare in Japan. Most of it was
focused on the role of medical instruments. In addition, we discussed a lot
of general economics in application to Japanese healthcare. I ended the
morning at Baxter with a brief discussion with Chad Ruston. He is 29 and
has worked at Baxter Japan for much of his career. He went to Indiana
University, a fellow Big 10 man. We discussed life in Japan and Tokyo, in
particular. We shared a lot of ideas and observations. It proved useful
and piqued my interest in returning to Tokyo again before I leave Japan.
After I was finished at Baxter, I hurried to the train station My objective
was to meet Mr. Motoyoshi, the head of the pharmacy of Kameda, at the
Shinagawa station. This station was a good way across Tokyo. I was
expecting to be picked up at 2:30 for my next appointment. I got there a
little before 1:00. This left me with much spare time. I looked for a
place to lock my bags up. None was to be found. I had to lag a large bag
and my laptop anywhere I went. I ended up eating a quick lunch and spending
the rest of the time standing around, waiting, since there were no benches.
Mr. Motoyoshi arrived a little after 2:40. He accompanied me to Sankyo
Pharmaceuticals, a Japanese company. They haven't had a new drug approved
in 10 years, though they have several products in the pipeline. Most of
their efforts are focused on buying and selling products of other companies.
In spite of the low output of new products, Sankyo had a very impressive
facility. They had a research campus with over 1000 employees, including
400 PhDs. The facilities were very modern and were built in the last
several years. Their animal care facility was most impressive. It was very
clean and lacked the stench of Med Labs at The University of Iowa. The
people I spoke with were very friendly and answered my questions fully. I
was impressed. My expectations were low coming in. I assumed that they
would ignore my questions and give a bare-bones tour, since I am a
foreigner. This was certainly not the case. They gave me a thorough tour
and greatly improved my perspective of the pharmaceutical industry in Japan.
After this was over, a quick dinner was consumed and a final train was
boarded to return to Kamogawa. There was much concern about the train trip
back, since at the same time, a typhoon was making its way north. This
ultimately did not cause problems. After a two hour train ride, I arrived
in Kamogawa. It was raining heavily by this time, but Chiaki was there to
give me a ride back to my dwelling.
The typhoon hit in the early hours of the morning. It dropped a large
amount of rain, but did not real damage. The ocean was very active for the
remainder of the day. The weather had turned back to the heat and humidty
typical of Japan by early afternoon.
Things have started to come full circle here in Japan. The new student
working here in the maintenance area, Jon Collings, has been here for almost
a week now. He assisted me with a key problem, setting the air conditioning
in my apartment properly. He received much assistance I was not privvy to
upon my own arrival. In exchange for the air conditioning assistance, I
showed him the wonder of shopping at the massive Jusco department store.
Taking the slower approach of a teacher, I found many things in the store
that I had not found before. I found this was also the case when I gave him
a tour of the Kameda Clinic last week. It has been interesting to be on the
other end of the tours and teaching experiences here.
I have also been finding some interesting quirks in the last few days. On
the way back from Tokyo, I chose to unwind by reading an English language
magazine called Tokyo Classified. The magazine had many interesting
articles in it, but was largely composed of advertising. Of course, there
was a large personals section. A few of them bear repeating (punctuation is
as written, do not read these if you are easily offended):
MEN LOOKING FOR WOMEN:
"ADVENTUROUS LADY! I am seeking sex-friend for pleasure as I am too strong
for my wife and girlfriend. I am safe and convenient in bed. I already
have a family and will never be serious about you"
"Aeshiteru. Well-endowed Caucasian man, 28, servicing financially secure
women, 18-45, in the Tokyo area. I have a hard ass and sexy dark features
not to mention a good sense of humor."
"American lover, 36, handsome, passionate, clean, wants Japanese sex friend
to enjoy a variety of sexual pleasures in the arms of a good, experienced
man. Must be able to endure hours of intense sexual activity."
"Are you an exhibitionist? Avid photographer seeks Japanese lady to satisfy
each others carnal desires. Safe but dirty satisfaction guaranteed."
"C, C++, Visual C, JAVA, Perl, bilingual programmer with strong DB and
networking skills seeks dominatrix friend."
"Cheerful man, good job and quite lonely, seeks fat, cheerful and not so
choosy Japanese lady who does not care much about my outside appearance, but
my character. I need a kind lady to help me out of my loneliness. Lots of
love and happiness guaranteed for the willing lady. Serious only."
"Male seeks sex friends. Just sex."
"Seeking female, 20-50, as long as you're thin, don't have rotten teeth and
are pretty. I know a great love hotel in Shinjuku, I'll pay for the room
and give you a full back massage that you'll love. Don't worry, nothing
will happen that you don't want to."
There were several pages of these ads. I thought these were the best,
excepting an ad a little too graphic to send out.
I am officially half-way done with my internship. So far, so good.