Health and Global Policy Institute (HGPI) has held a series of special discussions on the theme of “Wisdom and Philosophy for Interpreting Modern Society” featuring guest speakers invited by HGPI CEO and Board Member Mr. Ryoji Noritake. For the second event in this special forum series, entitled “Comprehending Healthcare in Terms of Human History – How Did People Perceive Healthcare?” we welcomed Mr. Ryunosuke Fukai, historian and CEO of COTEN INC. Together with everyone who participated, we deepened our understanding of healthcare through the lens of anthropology.
To begin the discussion, Mr. Fukai gave a keynote lecture titled “The History of Medicine,” which examined the series of changes and developments in the presence of healthcare throughout human history with a focus on Europe.

 

 

<Key points of “The History of Medicine”>

• Authority is necessary to engage in medical practice, and religion held that authority from ancient times to the Middle Ages.
• Although the foundation of medicine dates back to ancient times, the science of medicine entered a period of rapid development starting in the Renaissance.
• Until the modern era, most of the body’s inner workings were a mystery, and those who practiced medicine were of low social standing. Dissection was necessary for revealing the body’s inner workings, but those who practiced medicine required authority before they could practice dissection. It took most of history to escape this dilemma.

■Ancient Egypt – The close connections between medicine and religion
Approximately 4,500 years ago, in ancient Egypt, people felt that they were living alongside spiritual entities like gods and spirits. People believed that illness was caused by malicious spirits and there was a close connection between medicinal practice and religion. To drive away disease, prayers were conducted as a form of medical practice. At the same time, ancient Egypt had one of the most highly-developed cultures in the world of that era, and ancient Egyptians had opportunities to gain perspectives on medicine through the mummification process. Records of their discoveries still survive.

When medicine had not yet developed, medical practice required the backing of authority. That authority was religion itself, so religion and medicine were closely related. This also meant that the human body was sacrosanct and that attempting to reveal its inner workings through dissection was a religious taboo. We will go into greater detail on the topic later, but it took several centuries for medicine to break free of religion and overcome this taboo.

■From ancient Greece and Rome to Medieval Europe – Advances in scientific thought and civilization followed by regression
Developments in medicine were also seen in ancient Greece approximately 2,500 years ago. Hippocrates, the most well-known physician of ancient Greece, believed that disease was not a punishment inflicted by the gods. He began making clinical observations and records and established analysis methods similar to modern medical practices. He also spread ethical viewpoints concerning the role of the physician as a profession, which later became known as the Hippocratic Oath. That Oath has been passed down through the ages and still exists in modern medical education in Japan. However, dissection was absolutely forbidden at the time and was not practiced.

The systematic medical knowledge established by Hippocrates was passed down and inherited by the people of ancient Rome. There, a man named Galen was able to infer the inner workings of the human body even though dissection was still forbidden at the time. He did so by observing the wounds of gladiators or by dissecting animals such as pigs and dogs and worked to systematize that knowledge. This was a revolutionary undertaking for the period and his findings provided a foundation for medicine for the following 1,400 years.

The relatively stable systems of governance in ancient Greece and Rome allowed for these foundational developments in medicine to gradually advance. However, the Roman Empire collapsed and medieval Europe entered a period of bloodshed. It was during this time that the science of medicine regressed. Christianity rose to authority. This was a significant factor in re-popularizing the belief that illness is caused by malicious spirits.

However, the foundations of medicine built by Hippocrates and Galen were not forgotten; they were passed on in the Islamic and Asian countries, which had highly-developed cultures for the era. There, that knowledge was combined with knowledge built up in oriental medicine over its long history and was further developed, particularly in the Middle East.

■From the Renaissance to the modern era – The fall of religious authority and the dawn of dissection
Around the 13th century, the Mongolian empire covered the world, creating the largest empire in the history of mankind. This led to increased traffic of people and goods but also encouraged the spread of infectious diseases. The Black Death spread throughout Europe, killing approximately one-third to half of the population at the time, or an estimated 20 to 50 million people. Although indirect, this caused the authority of Christianity to wane, leading to religious reform and the Renaissance. With the arrival of the Renaissance, dissection began to be practiced in earnest.

Shortly before the arrival of the Renaissance, the first school of medicine was established at the University of Bologna in Italy, where dissection began to be practiced. One of the men who learned medicine there named Andreas Vesalius created detailed records that were published as Anatomical Engravings in 1714, 160 years after his death. The science of medicine advanced rapidly thereafter, with achievements like the discoveries of William Harvey concerning the cardiovascular system, the discovery of viruses, and the development of antibiotics.

For advanced modern medicine to exist, we not only require a high level of knowledge with a scientific basis in medical science and ethical viewpoints and education on those topics, we also need organizations that can license individuals who meet certain standards. However, over most of the long history that was required to reach this point, many of the inner workings of the human body were unknown, and those who practiced medicine were of low social standing. Meanwhile, there was a dilemma in which it was considered taboo to dissect human bodies to reveal the body’s inner workings when that practice was only permitted to those in positions of authority. From this historical context, we can understand why medicine developed rapidly after the 17th century, when that dilemma was solved.

■Special discussion
Mr. Noritake:
In the discussion on medical science and authority, it is important to consider the state of modern medicine from a historical standpoint. Medicine is still an authoritarian field. While it is necessary for people to undergo strict training and education to become established as professional healthcare providers, it can lead to the creation of a hierarchy in which it is difficult for people to voice their opinions in face of their authority.
Meanwhile, the number of people with non-communicable diseases (NCDs) such as diabetes or diseases is increasing. These are considered chronic diseases. In addition to receiving diagnoses or care from healthcare providers, perspectives on how to manage everyday living or conduct self-management grow important for patients and other parties most affected when responding to such diseases. Within the authoritarian healthcare system, we must empower patients and other people receiving healthcare and think about how to engage them in communication on a fair and level playing field.

Mr. Fukai:
In order to escape from the exceedingly powerful authority of religion, it was necessary to make healthcare itself an authority, and doing that required a significant amount of energy. In order to conduct dissections, which was considered taboo, it was necessary for healthcare providers to take up authority. I think that energy of recoil has carried forward to create the authoritarianism seen in medicine today. While people with chronic diseases are increasing in number, developments in fields like medical anthropology lead me to feel that medicine has arrived at its next stage. There was a time when health workers were ridiculed for only being interested in treating their patients’ illnesses and not being interested in treating the patients themselves. 

Mr. Noritake:
Earlier, you gave us an overview of the history of healthcare from ancient times to the modern era. One of the major issues facing us today is Coronavirus Disease 2019 (COVID-19). Mr. Fukai, please share your thoughts on COVID-19.

Mr. Fukai:
I would like to point out some of the similarities and differences to the Black Death from a historical perspective. Everyone living in modern society knows about viruses, but during the Black Death, people were still unaware of the existence of viruses or bacteria, and one-third to half of the population was killed. All people could do in the face of the plague was feel fear. Some felt it was a punishment from the gods and formed conspiracy theories. One such theory led to the persecution of Jewish people. In the current era of COVID-19, while it isn’t going so far as persecution, there may be groups or individuals who are having painful experiences right now. People should learn from history on that point and fix their behavior.

Mr. Noritake:
Natural disasters or the spread of infectious diseases make vulnerable people even more vulnerable, starting with the poor. We should be considerate towards what are known as social determinants and make efforts to prevent issues like widening health gaps due to infectious diseases.

Now, we have some questions from the floor. Within this information society, the internet is overflowing with information on healthcare. The information gap that once existed between healthcare providers and their patients may be shrinking. What are your thoughts concerning the role of healthcare professionals in an era like this?

Mr. Fukai:
We must consider that role together with advances in AI. Once a portion of medical examinations or diagnoses are handled by machines, I believe that the value provided by healthcare providers will change. As their roles as technical professionals start to shrink, I think it will grow more important for them to work more closely with people on an emotional level. I think the same change will affect long-term care in addition to healthcare.

Mr. Noritake:
In that vein, the roles of general practitioners and hospitalists (general practitioners at hospitals who focus on hospitalized patients) are gathering attention in Japan and abroad. Even in a family doctor system, I think it will become necessary to develop human resources who can provide comprehensive medical examinations to people in communities.

Furthermore, we are seeing many hospitals are starting to contain worship facilities in the U.S. and other places, which gives us a visual example of coexistence between religion and healthcare. Similarly, if we look back on history in Japan, we can find many cases in which temples served as social welfare or medical facilities.

Mr. Fukai:
I think we are approaching an era in which the fields of medicine, care for the mind such as through religion, and long-term care will become more integrated. Currently, healthcare providers are approaching people receiving healthcare from separate positions, but from the perspective of people receiving healthcare, there are many situations in which they would prefer it if those fields were united.

Mr. Noritake:
In the fields of medical anthropology and medical sociology, Ivan Illich published Medical Nemesis in the 1970s. In that book, he discusses the concept of “iatrogenic disease” and raises the alarm about our daily lives growing more reliant on healthcare and hospitalization as we identify more and more diseases in the modern era. I think that line of thinking has hints for us today and that we have room to reexamine that topic in the era of COVID-19.

Mr. Fukai:
And it is exactly for that reason that we have arrived at an era which requires us to hold discussions from positions of equality. We must hold ethical and cool-headed discussions throughout society that not only consider the medical perspective. After all, limiting discussions to specific points of view is the same as when people of the past were condemned for attempting to conduct dissections. First, we must create an environment in which we can hold fair discussions. Furthermore, this is not a war; it is important that society come together in a cooperative spirit rather than go on the offensive.

Mr. Noritake:
I’d love for HGPI to continue providing opportunities like that. I’d like to take a few more questions from the floor. Here’s a question about scientific concepts that were denied by Christianity but were accepted within Islamic countries, even though those two religions worship the same god.

Mr. Fukai:
Islamic society at the time was relatively stable. In addition, I think Islam is actually a highly receptive religion, relatively speaking. There are examples of other religions coexisting within Islamic nations. Also – and this applies to Mohammed’s ancestors too – I believe they had a deep understanding of commerce, and in that sense, I think it may have been easier for them to accept scientific viewpoints.

Mr. Noritake:
I’d like to ask Mr. Fukai about how he became interested in history and why he started a company focusing on the theme of history.

Mr. Fukai:
My company is building a database of world history. When creating a database of world history, I think it is necessary to gather people and funding, so we are working to increase the popularity of COTEN Radio and to gather people. By providing easy-to-understand discussions on history from positions of equality through COTEN Radio, we want to help people develop an interest in history and understand the significance of making a historical database.

One of the truths revealed by studying history is that people change in some ways but not in other ways. Studying history also deepens your understanding of culture and social structures. In order to arrive at that understanding, one must read countless history books. However, if we had a database, past knowledge could be combined and referred to like each item was the subject of a case study.

For example, we could research historical leaders who were killed by their followers to check on what tendencies they had, and we might even be able to conduct a quantitative element analysis on them. We would like to contribute to improving society by accumulating the experiences of humanity in that manner.

Mr. Noritake:
It is an extremely interesting effort and we are rooting for you. Now, HGPI Chairman Dr. Kiyoshi Kurokawa will also join us.

Dr. Kurokawa:
It was an important discussion. Moreover, we must redefine the assumption that diseases can be cured. The era in which we must discuss end-of-life planning has now arrived and, as a super-aged, long-lived society, Japan has a major role to play in that effort. What will be important in the future will be having an independent civil society that can make their own choices towards their preferred lifestyles and deaths. I think it will become necessary for society to allow people to have early discussions with their families on their preferred ways of living and dying.

Although it was mentioned in the discussion earlier, during times like this, I think the presence of family doctors, starting with home doctors, will grow even more important. We need healthcare providers that can provide options to patients and their family members while understanding their religion, values, or way of living. I believe the roles of healthcare providers who can help ensure people’s happiness in their final moments will grow more important.

In that sense as well, it will become the age of wisdom rather than the age of knowledge. We will require wisdom, not knowledge. Wisdom barely changes over the course of human history. Gathering wisdom is important, and the efforts of COTEN Radio are exactly that – efforts to gather wisdom. I would like to continue supporting those efforts.

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■Profile
Mr. Ryunosuke Fukai
Mr. Ryunosuke Fukai is from Izumo City, Shimane Prefecture. After graduating from the School of Letters, Faculty of Human Science at Kyushu University, he joined the semiconductor domain at Toshiba Corporation, where he was assigned to the Corporate Planning Team. He then joined the Board of Directors at Reevo Inc., where he gained experience in a variety of fields including business planning, funding, recruitment, and service development. In 2015, he joined WELMO INC. as CSO. There, he grew the organization from 2 employees to 60 employees. He has been involved in their management as an external director since October 2017. In February 2016, he established COTEN INC., which operates in the history field.
https://coten.co.jp/team/fukai/

Mr. Ryoji Noritake
Mr. Ryoji Noritake is a graduate of Keio University’s Faculty of Policy Management and he holds an MSc in Medical Anthropology from the University of Amsterdam, the Netherlands. During his time at an international NGO, he worked to establish healthcare facilities for disaster prevention in developing countries and areas struck by disaster, mainly in the Asia-Pacific region. He has worked with organizations such as governments of developing nations, private enterprises, other international NGOs, and armed forces to provide healthcare assessment from the perspective of medical anthropology. Through his fieldwork in various countries, he has unified multi-sectoral stakeholders including those from the fields of engineering and design in projects for overcoming challenges facing healthcare. He is currently a Visiting Scholar at the National Graduate Institute for Policy Studies and a member of Tokyo Metropolitan Government’s Policy Discussion Roundtable for a Super Ageing Society. He is also a member of Salzburg Global Seminar’s Advisory Council and is an Advisory Board Member of Elsevier Atlas.

 

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[Event Report] Special discussion forum: Wisdom and philosophy for interpreting modern society by examining the intersection of culture, countries, individuals, and ideologies (May 28, 2019)>