What is the optimum way of using medication ? Clues to this question are hidden in medical information databases (hereinafter referred to as “DBs”), comprising of huge amounts of data such as medication histories and therapeutic records. With data of actual use such as symptoms, medication history and prognosis of patients, we can see what happens when patients are given the drugs, information that is unavailable at the clinical trial stage. I am integrating the data, analyzing trends, and using the information to pursue a new form of medicine in which drugs are developed not only from the viewpoint of the development stage but also from the point of actual usage by patients.
In the practice of medicine, data is accumulated on patients and treatments in forms such as electronic health records, medical fee receipts, disease diagnoses (such as cancer or hepatitis), treatment outcome research, and other test records. An enormous amount of data is stored at medical institutes, national institutes, insurance companies and pharmaceutical companies, but the data has seen little use in research in Japan. In recent times, expectations of a new kind of knowledge from data mining these kinds of data collected during actual medical treatment have arisen. This type of knowledge such as understanding the differences in the effects of a drug by age and/or condition of the patient, differences in prescriptions by hospital department and physicians, and the actual effects of a drug in practice are distinct from that available for clinical trials where specific conditions are imposed on subjects and prescriptions.
In Europe, North America, and Asia (Taiwan and South Korea), large-scale medical information DBs are already in use for evaluating and monitoring the safety of pharmaceutical products and for epidemiologic studies. In Japan, construction of such DBs is progressing, but their use is just starting. The DBs are expected to be increasingly used for epidemiologic studies and for evaluation of pharmaceutical products based on nation-wide results of actual use in medical practice.
I have investigated how widely the actual state of medical practice is reflected in the prescribing of drugs and conducted studies to find problems related to pharmacological treatment by using several medical information DBs. Currently I’m focusing on two major medical issues in Japan.
The first issue is inappropriate prescription of drugs for elderly patients. In Japan, medical expenses are on the rise accompanying rapid aging of the population. Control of medical expenses for elderly persons is an important topic also from the viewpoint of stabilizing the finances of the medical insurance system. Elderly persons are more prone to be afflicted by diseases and adverse events than the younger population, and many senior citizens take more than one kind of medicine. Therefore, pharmacological treatment for the elderly requires special attention. Outside Japan, lists have been published about drugs that require careful consideration when prescribing for an elderly person. On the other in hand in Japan, such a general-purpose list has not been prepared, and little consideration has been given to the prescription of such drugs. I am studying the aforementioned existing lists and the list of pharmaceutical products that was recently published in Japan. In this study, the national receipt database (NDB) of Japan is used and compared with the national database of Taiwan. Understanding of the actual state of prescriptions to elderly persons would lead to appropriate use of drug prescriptions and curb the increase of medical expenses.
As the second theme, I’m working on the problem of mental disorders in breast cancer patients. Breast cancer is the most common cancer in women and affects one in 12 women in Japan. Because breast cancer is also associated with sexuality, many patients suffer from mental disorders which are known to have negative effects such as reducing the survival rate, lowering the quality of life, and increasing medical expenses. However, no study has reported a large-scale survey on mental disorders and treatment in breast cancer patients in Japan. I’m investigating the percentage of breast cancer patients who have developed a mental disorder, the actual treatment, factors that affect development and treatment, effects of the disorder on recurrence of cancer, and the economical effects of the disorder on breast cancer treatment by using a nationwide receipt DB. The survey on the prevalence and treatment of mental disorders in breast cancer patients is expected to promote resolution of disparities in available cancer treatment and reduce medical expenses by improving the results of breast cancer treatments.
As described above, there were almost no nationwide medical information databases in Japan available to researchers, and the use of existing DBs has been scarce. Therefore, there are many problems to be solved such as proposing methods for using DBs, accumulation of knowledge based on international cooperation, cultivation of personnel who can handle the data, and translating study results to actual medical practice.
The revision of Pharmaceutical Affairs Law in 2009 legalized selling certain types of pharmaceutical products at stores where there is no pharmacist. Consumers can easily buy drugs at drug stores, etc. It is therefore necessary to construct a new system to fully understand the actual state of medicine use where diverse situations can arise and to return the knowledge to the public as medical wisdom. Although study results are still to be produced, my research will facilitate applying knowledge acquired by using medical information DBs to actual medical practice in order to help as many people as possible. It may be possible to understand the questions and difficulties of ordinary people in their daily use of medication by analyzing medical information DBs. I believe that by listening to their voices, research that better reflects the actual situation can be performed, and the knowledge gained from the results can be returned to the public. I cannot conduct research or return knowledge alone. In order to pursue highly significant studies, I would to like to cooperate with those who are interested in medical information DBs or involved in medical practice.