Medical writing in Japan
Medical writing in Japan has faced barriers in English-language publication, education and editorial support, alongside changing demands for internationally usable regulatory documents.
English-language publication and recognition
In a 2014 account, medical-English educator J. Patrick Barron described encountering Japanese clinical research whose international recognition was limited by language. After arriving in Japan in 1969, he became English teacher to lung-cancer surgeon Yoshihiro Hayata, whose wartime education had used German medical texts while English was prohibited and who could not speak, read or write English. Following Hayata to conferences challenged Barron’s earlier assumption that academic medical research was confined to the West.
Barron recalled that Hayata had performed two early lung-lobar transplantations by the mid-1960s and stopped because immunosuppressants were unavailable, with no English publication record Barron could find. Hayata later wrote about the rejection mechanism, and Barron translated the manuscript. After six months, the US journal said it had not received the submission; a resubmission was promptly rejected for allegedly poor English. Barron, who grew up in Britain and completed high school and an English-literature degree in the US, challenged that judgment and asked for the errors; he received no reply, but the paper was published almost verbatim.
Increased international contact during the 1970s was associated in his account with greater acceptance of informed consent and prospective randomised trials, and recognition of the need for regulatory-writing education and bodies such as AMWA.
Medical English and publication-ethics education
When Barron began teaching in 1980, he found no national medical-English teaching standard and judged the teaching weak, with many teachers unwilling to cover medical content. He sought interest in a society developing national texts and standards by sending a questionnaire to more than four hundred medical-school English teachers; about 10% responded and only four, including him, wanted to form a group. He later joined the Japanese Society for Medical English Education, founded around 1990, and helped establish a national English-for-medical-purposes examination.
By 2014 he still saw no joint official text or national approach to language and medical communication, almost no undergraduate or graduate teaching of publication ethics, and no coherent medical-writing education or mentoring. Some fellow educators described Japan as a “medical education Galapagos”. His proposed incentive was to put about one-third of national medical-licensing examination questions in English, covering medicine and ethics, including publishing ethics, to encourage basic competence among graduates.
Clinician workload and support
Barron regarded unpublished clinical material across the Far East as a moral problem arising from academic systems that did not support individual efforts. He described Japanese clinicians as expected to combine patient care, teaching, research and writing results in English despite its different grammar and writing system, a burden he considered inhumane. Training for medical secretaries appeared to be developing in the early to mid-1980s, but computers then encouraged senior staff to expect juniors to do their own secretarial work. In 2014 he still saw a serious shortage of in-hospital clerical assistance and writing or editing advice, with many senior staff unaware of the financial benefits of competent writing and editorial support.
Journal conflict-of-interest management
In 2014, as a conflict-of-interest subcommittee member of the Japan Association of Medical Societies, Barron surveyed societies publishing medical journals and received responses from all 118 journal offices approached. More than half did not require editorial-board members to disclose their own conflicts, few proactively educated committee members or reviewers, and most did not use Committee on Publication Ethics flowcharts. Bilingual medical-writing educational material and Japanese translations of the flowcharts were nevertheless available through the free ronbun.jp site with which he was involved.
He considered the absence of board disclosures untenable and described journal offices as aware of conflicts’ importance, especially over the preceding decade, but unsure how to manage them. He advocated comprehensive conflict-of-interest education and a nationwide policy-education programme.
International educational collaboration
Barron proposed regular AMWA chapter meetings in Japan in 2014, potentially twice yearly using the rail network, with on-site workshops, self-study modules, guidance for technical communicators and consulting expertise. Many Asian freelances could not afford the estimated US$3,000–5,000 to attend an AMWA conference across the Pacific. He expected a joint AMWA effort with the Japanese Society for Medical English Education and Japanese Medical Communicators Association to have more impact than a single domestic body, drawing on his view that Japan responded to external pressure. He predicted that better medical communication would ultimately help patients through faster drug and device development and better healthcare.
Writing reports for international applications
In 2019, Japan-only local studies were becoming less common in global companies, and English was accepted for clinical study reports in Module 5 of Japanese new-drug applications. Companies typically chose English for Japanese study reports to avoid preparing a second language version if the reports were used in other countries’ or regions’ marketing applications. Using native English writers was suggested as productive because reports were generally prepared in English. Opportunities for Japanese writers to prepare clinical study reports were decreasing, and their interest in reports and the changing preparation environment appeared to be declining. Japanese pharmaceutical companies seeking international expansion nevertheless needed writers able to prepare reports for global applications and disclosure.