【3】日本医学会会長門脇孝氏発言問題｜日本アレルギー学会問題

皆さま、こんにちは。
前回は、2024年6月28日に行われた日本専門医機構の社員総会で、日本医学会会長の門脇先生と、日本医師会長の松本先生が、「どうしてこの場でこんなことを言わないといけないの？」という内容を言及したことを記事にしました。（関連記事日本専門医機構2024/06/28社員総会にて日本医学会会長と日本医師会長が不穏な発言）
今回も、日本専門医機構2024/06/28社員総会における、門脇先生の発言について、法的な問題を検討してみたいと思います。

これらの問題については、シリーズで深堀していきたいと思いますので、どうぞよろしくお願いいたします。
関連記事：2024日本専門医機構社員総会での日本医学会会長門脇孝氏発言問題を検討【1】
2024日本専門医機構社員総会での日本医学会会長門脇孝氏発言問題を検討【2】

日本専門医機構社員総会で行われた門脇孝日本医学会会長の問題発言をおさらい

全文については、
日本専門医機構2024/06/28社員総会にて日本医学会会長と日本医師会長が不穏な発言
をご覧ください。

門脇孝氏の発言の問題点をピックアップ

今回の記事では、以下の部分についての問題点を考えてみたいと思います。

これは、私の推測ですが、おそらく、「日本アレルギー学会」のことを言っているのだと思っています。（多分間違っていないと思います）
以下のアレルギー学会のコメントを見てください。

要するに、アレルギー学会では、2022年1月から、アレルギー学会が認定するいわゆる学会専門医から、日本専門医機構の認定する「機構専門医」になるべく努力されていたのですが。それがつぶれてしまったということなのです。

それでは、原因はどういうところにあったのでしょうか？
今日は、知られざる日本専門医機構のプログラム認定の問題点について、お伝えしていきたいと思います。

日本アレルギー学会をプログラム認定するにあたり何が問題だったのか

アレルギーを引き起こす疾患はいろいろあって、大人もいれば小児もいる、結膜炎もあれば鼻炎もある、ということで、内科・小児科・皮膚科・耳鼻咽喉科・眼科を基本領域とすることをアレルギー学会は目指しています。

日本専門医機構の専門医の基本領域とは？

日本専門医機構の専門医の基本領域は、医師が特定の専門分野で高度な知識と技術を習得し、医療の質向上を目指すために定められています。現在、19の基本領域が設定されており、内科、小児科、精神科、外科、整形外科、産婦人科などが含まれます。これらの領域での研修と試験を経て専門医が認定され、地域医療に貢献することが期待されます。基本領域は、高度専門医療への基盤であり、研修を終えた医師はさらにサブスペシャリティ領域に進むことも可能です。日本専門医機構は医療のニーズや社会の要請に応じて基本領域を設定しています。

アレルギー学会専門医のようなサブスペシャルティ専門医は、基本領域専門医を取得しないと取ることができない

日本専門医機構では、サブスペシャルティ専門医（特定分野の専門医）を取得するためには、まず基本領域専門医を取得することが必要です。基本領域専門医として、内科や外科などの基礎的な診療能力を身につけ、その後に特定分野でさらなる専門性を深めた医師がサブスペシャルティ専門医として認定される仕組みになっています。基本領域専門医の資格が、サブスペシャルティ領域への進学の前提条件となっています。このような専門医制度を一般的に「二階建て」と呼んでいます。

日本の専門医制度が二階建てになった歴史

日本の専門医制度が「二階建て」になった背景は、専門医の質向上と医療提供体制の整備にあります。この制度は、基本領域専門医とサブスペシャルティ専門医という二階層に分かれています。以下にその歴史を簡潔に述べます。

1. 戦後の専門医制度の誕生

日本では、戦後の医療制度の整備に伴い、各専門学会が独自に専門医を認定する制度が徐々に形成されていきました。これにより、医師が特定分野での高度な知識と技術を身につけるための基盤が作られましたが、制度は一貫性に欠け、認定基準も各学会ごとに異なっていました。

2. 専門医制度の統一と透明化の動き（2000年代）

2000年代に入り、専門医の質を保証し、国民にわかりやすい形で専門医を提供する必要性が高まりました。特に、学会ごとにバラバラだった認定基準を統一し、透明性と一貫性を持たせるための動きが本格化しました。これにより、専門医制度を国家レベルで統一するための議論が進められました。

3. 日本専門医機構の設立と二階建て制度の導入（2014年）

2014年に設立された日本専門医機構は、専門医制度の統一と透明化を図るための機関として設立されました。これにより、専門医制度は「基本領域」と「サブスペシャルティ領域」の二階建て構造となりました。
基本領域専門医: 医療の基本を担う19の専門分野（例：内科、外科、小児科など）での専門医を取得する段階。
サブスペシャルティ専門医: 基本領域専門医取得後に、さらに特定分野の専門性を深めたサブスペシャリティ領域での専門医を取得する段階。
この二階建て制度により、医師はまず基礎的な専門領域で認定を受け、その後にさらに高度な専門分野での研鑽を積むことが可能になりました。

まとめ

二階建て専門医制度の導入により、日本の医療はより一貫性と透明性を持ち、国民に信頼される医療提供体制が構築されました。これにより、医師の育成も体系的に行われるようになり、質の高い医療を提供できる体制が強化されました。

サブスペシャルティ領域検討委員会

サブスペシャルティ領域検討委員会が、日本専門医機構においてサブスペシャルティ領域の認定やその関連事項を話し合うために設置されています。この委員会は、サブスペシャルティ領域の整備や新たな領域の認定プロセス、運営方針に関する検討を行います。
日本専門医機構の2024年6月改選した第6期からは以下の委員となっています。
委員長名 滝田　順子
副委員長 鈴木　　昌
委　　員 池田　徳彦　　市川　智彦　　今村　英仁　　楫　　　靖　　梶波　康二　　名越　澄子　　松本　陽子　　渡辺　雅彦　　
担当理事 江口　英利

改選前まで、宮崎俊一理事がサブスペシャルティ領域検討委員会（以下、サブスぺ委員会と表記）に入っていました。
宮崎氏は、日本内科学会から日本専門医機構に理事に出ています。
日本内科学会では、「内科学会の利益を代弁してもらうために専門医機構に理事を出している」と明言しております。これは前の事務局長から直接聞きました。

日本内科学会が「内科学会の利益を代弁してもらうために専門医機構に理事を出している」と述べている問題点

日本内科学会が「内科学会の利益を代弁してもらうために専門医機構に理事を出している」と述べていることには、いくつかの問題点があります。これは特に専門医機構の中立性や透明性に関わる重要な懸念を引き起こします。

専門医機構においては、すべての医療分野において公平で中立な判断が求められます。特定の学会が自らの利益を守るために理事を送り込むという姿勢は、機構の信頼性、中立性、公平性に対する懸念を引き起こす可能性があります。このような行動は、専門医制度の透明性を高め、国民の信頼を得るという目的に逆行するものであり、再検討が必要です。

宮崎俊一理事の問題点

宮崎俊一氏は現在、富田林病院に院長として勤務しており、循環器内科の医師として活動しています。その前は確か、近畿大学の教授だったように思います。

宮崎氏は内科学会から理事に出ていて、現在の専門医機構理事長の渡辺氏とともに、長いこと内科学会で専門医制度を担当してきた人です。
アレルギー学会に関して、「内科以外をベースにアレルギー専門医になることは認めない」と何度も明言していたそうです。これに関しては複数の確かな方々から証言を頂いておりますので、間違いないと思っております。

この宮崎氏の問題はそれにとどまらず。サブスぺ委員会の委員長は、滝田順子氏なのですが。サブスぺ委員会で決めた内容は、一旦、運営委員会を経て理事会に出されます。第5期までは、理事でない人は理事会に出席できなかったので、滝田委員長は理事会に出ることができず、サブスぺ委員会で取りまとめた内容は、理事である宮崎氏が理事会で答弁する形になっていました。
ところが、宮崎氏は、サブスぺ委員会の時は決議内容に同意したにもかかわらず、理事会に提出する段になって、「自分はこの内容に承服できない」といって勝手に引っ込めてしまう、というありえない状況を繰り返していたそうです。

ここはわたしの推測ですが、アレルギー学会を「内科・小児科・皮膚科・耳鼻咽喉科・眼科を基本領域」とする決議をサブスぺ委員会が何度しても、宮崎氏が理事会で議題を出すときに自分の考えに反するから取り下げてしまうことが起こっていたのではないでしょうか。

これを事実と仮定して、以下を議論します。
宮崎俊一氏の問題点として指摘される点は、特に専門医制度における意思決定の過程での行動です。

以上のように、宮崎俊一氏の行動は、内科中心主義や専門医機構における透明性の欠如といった問題を引き起こしており、特定の学会の利益を優先するかのような行動が疑問視されています。このような行動は、日本専門医機構の中立性や専門医制度全体の信頼性に悪影響を与える可能性があり、改善が求められます。

日本専門医機構渡辺理事長と、日本内科学会選出の宮崎理事が長年内科学会専門医制度を担当して特別懇意にしていることの問題点

日本専門医機構において、宮崎俊一理事と渡辺理事長が懇意な関係にあることが問題視される理由は、組織の透明性や公正な運営が損なわれる可能性があるためです。

まとめ
宮崎理事と渡辺理事長が懇意な関係であることは、専門医機構の公正性、透明性、利益相反のリスクなど、多くの問題を引き起こす可能性があります。組織運営においては、個人的な関係が影響しないよう、厳格なルールやプロセスが必要です。

宮崎氏問題が引き起こしたこと

専門医機構事務局は、こういう状態であるので、「一旦は内科のサブスぺとしてスタートし、時機を見て小児科・皮膚科・耳鼻咽喉科・眼科を基本領域として追加する」という二段構えの作戦をとったほうが良いのではないか、という提案を事務局折衝として行ったようです。
そして、この時点で、アレルギー学会の理事長がカンカンになり、各方面に激しい抗議をしたようです。
理事長というのは、事務局に対して抗議したりしないと推測されるので、関係する学会の理事長たちに直接抗議したのでしょう。
事務局に聞いたとしても、宮崎氏がこんなことを言っているので、苦肉の策として、などということを言っても聞く耳なかったかもしれません。
以上述べてきた内容が、門脇氏が2024年6月に日本専門医機構社員総会で、「事務局の責任者が各学会に保証のない話を持ちかけ、疑念を招いたという報告も複数受けています。」と発言した内容と推認されます。

アレルギー学会の件に関しては

わたしはだいぶ前から存じておりまして、ネットで書きたいなと思わなくもなかったのですが。専門医機構や関係学会の自浄作用を期待して、書かずに来ました。でも、ここにきて、専門医機構の中で、起こっていることを皆さんに知ってもらったほうがいいと思うことがいろいろありますので、公表することにしたのです。
専門医機構におけるアレルギー学会の問題は、長年にわたって透明性や公正性に対する疑問を投げかけてきました。私は、この問題を以前から認識しており、ネットでの公開をためらいながらも、関係者たちの自浄作用に期待してきました。しかし、ここにきて、専門医機構の中で実際に起こっていることが非常に深刻であり、これ以上の黙認は多くの人々にとって不利益をもたらすと感じています。

具体的には、内科中心主義の横行、アレルギー学会に対する不公平な扱い、そしてサブスペシャルティに関する議論が理事会でどのように扱われているかなど、内部での偏った意思決定プロセスが問題です。特に、決議の撤回や変更に関して、事前に合意した事項が最終的に覆されるという事例は、機構の透明性と公正性に対する信頼を大きく揺るがしています。

私が今回公表を決意したのは、関係者が自らの行動を振り返り、必要な改革を行うためのきっかけを提供するためです。専門医制度は、日本の医療の未来を左右する重要な制度であり、すべての専門分野が平等に評価され、公正に扱われるべきです。公表することにより、外部からの監視と圧力を促し、内部改革が進むことを期待しています。

門脇氏の問題発言に戻りましょう

「事務局の責任者が各学会に保証のない話を持ちかけ、疑念を招いたという報告も複数受けています。」というのが門脇氏氏の発言ですが。
事務局折衝とは、組織や団体の事務局が、他の組織、政府機関、関連する部署などとの間で行う調整や交渉を指します。事務局折衝の目的は、意見のすり合わせや合意形成、手続きの確認、課題の解決などを効率的に進めるためです。

要するに、事務局折衝は、組織間の調整を円滑に行うために必要なプロセスです。

そもそも、事務局折衝というのは、理事会で決まる前のことに対して、どういう風にしたらまとまるのかなどを話し合う段階です。
保証のある話しか持っていけないのであれば、理事会で全部やればよろしいと思います。

この点からも、門脇氏の発言は、全く意味が不明ですし、そもそも、この事態を引き起こしたのは、日本内科学会の内科中心主義ともいえる横暴さなのです。
日本内科学会理事長だった門脇氏が、日本医学会会長になって、専門医機構社員総会でこんな発言をする。

この事例における問題点は複数あり、特に事務局折衝の役割や意義を誤解している可能性と、組織間での適切なコミュニケーションが行われていない点が挙げられます。

まとめ
この事例では、事務局折衝の役割を誤解し、保証のない話が疑念を招く結果となった点や、門脇氏自身の発言に矛盾が生じている点が問題となっています。また、日本内科学会の内科中心主義が他の専門分野に与える影響も無視できず、全体的な公平性と透明性が損なわれる可能性があります。

これはわたしの感想ですが、門脇孝先生っていったいナニサマなんでしょうね？？？

門脇氏の発言のほかの問題点については

順次書いていこうと思います。
この問題は、日本の医学のアカデミアの最高峰であるはずの、日本医学会連合会長が関係しているので、前回同様、英語をつけておきます。
もうね。世界中の人に見てもらったほうがいいんですよ。
どうせ日本人なんてガイアツでしか変われないのですから。
内容に問題がある、英文が間違っている、情報提供などありましたら、ぜひ、コメント欄からお知らせください！

Hello everyone.
In the previous article, we reported on the content of the comments made by Dr. Kadowaki, President of the Japan Medical Association, and Dr. Matsumoto, President of the Japan Medical Association, at the Japan Medical Specialty Organization’s general meeting of employees on June 28th, 2024, which included the words “Why do I have to say this here? (Related article: Japan Medical Specialty Board 2024/06/28 General Meeting: Unrestful Remarks by the President of the Japan Medical Association and the President of the Japan Medical Association)
This time, we would like to examine the legal issues surrounding the remarks made by Dr. Kadowaki at the Japan Medical Specialty Board 2024/06/28 General Meeting.
We will be looking into these issues in a series of articles, so please look forward to them.
Related articles: Examining the issues surrounding the comments made by Japan Medical Association President Takashi Kadowaki at the 2024 Japan Medical Specialty Board General Meeting [1]
Examining the issues surrounding the comments made by Japan Medical Association President Takashi Kadowaki at the 2024 Japan Medical Specialty Board General Meeting [2]
Reviewing the controversial comments made by Japan Medical Association President Takashi Kadowaki at the Japan Medical Specialty Board General Meeting
For the full text, please see
Japan Medical Specialty Organization 2024/06/28 General Meeting: Unrestful Remarks by the President of the Japan Medical Association and the President of the Japan Medical Association
.
Issues with the Remarks of Takashi Kadowaki
In this article, we would like to consider the issues with the following parts.
We have also received multiple reports that the person in charge of the secretariat approached each academic society with a proposal that was not guaranteed, and this led to suspicion.
This is just my guess, but I think he is probably referring to the Japanese Society of Allergology (I think I’m probably not wrong).
Please see the following comment from the Japanese Society of Allergology.
Update date: March 11, 2022
March 11, 2022
To whom it may concern
Japanese Society of Allergology
President: Motohiro Ebisawa
Special Committee for Countermeasures for the New Specialist System
Chairman: Minoru Niimi
Apologies to doctors who were thinking of aiming to become a provisionally certified specialist in allergy by the Japan Medical Specialty Board
The Japanese Society of Allergology, under the guidance of the Japan Medical Specialty Board, has been preparing to launch the “Japan Medical Specialty Board-certified Allergist System (provisional)” in April 2022, with internal medicine, pediatrics, dermatology, otolaryngology, and ophthalmology as the basic fields, and to transition to the official “Japan Medical Specialty Board-certified Allergist System” in 2023, with the Special Committee for the New Specialist System taking the lead. As of the fall of 2021, the organization had accepted the provisional start of the organization-accredited allergy specialist system in April 2022, so we began accepting applications for group facilities (programs) based on the new system in January 2022.
However, the result of the review of the development standards by the JAAAC that we received at the end of February was that the review of the development standards for JAAAC-certified allergy specialists would be “put on hold”. The content of the review was that the development standards would have to be fundamentally reconsidered again, such as “reviewing the basic fields (should be limited to internal medicine) with the aim of starting in April 2023” or “aiming for JAAAC-approved and academic society-approved specialists”.
Due to the unexpected response from the organization that turned the world upside down, there was no longer any guarantee that the organization-approved allergy specialist system with five basic fields would be approved in April 2023, so it was no longer possible to start the organization-approved allergy specialist system (provisional) from April this year.
As the Japanese Society of Allergology, we would like to offer our sincere apologies for the great inconvenience caused to those doctors who were aiming to become a JSO-certified allergist (provisional).
We have already sent a letter of inquiry to the Japanese Society of Internal Medicine, which oversees the internal medicine subspecialty area, and we will also be making an immediate inquiry to the JSO, and we will continue to work persistently to realize a JSO-certified allergist system based on the five basic areas. We look forward to your continued cooperation.
Source:Apology to doctors who were aiming to become provisionally certified allergy specialists by the JSO
In short, the Japanese Society of Allergology had been working to have its so-called specialist doctors certified by the society become “JSO-certified specialists” certified by the Japan Medical Specialty Board from January 2022. However, this plan has now been scrapped.
So, what were the causes of this?
Today, I would like to talk about the problems with the program accreditation of the Japan Medical Specialty Board, which are not well known.
What were the problems with the program accreditation of the Japanese Society of Allergology?
There are various diseases that cause allergies, and there are adults and children, conjunctivitis and rhinitis, so the Japanese Society of Allergology aims to have internal medicine, pediatrics, dermatology, otolaryngology, and ophthalmology as its basic fields.
What are the basic fields of specialty for the Japan Medical Specialty Board?
The basic fields of specialty for the Japan Medical Specialty Board have been established to ensure that doctors acquire advanced knowledge and skills in specific fields of specialization and to improve the quality of medical care. Currently, there are 19 basic fields of specialty, including internal medicine, pediatrics, psychiatry, surgery, orthopedics, and obstetrics and gynecology. After undergoing training and examinations in these fields, specialists are certified and expected to contribute to community healthcare. The basic fields are the foundation for advanced, specialized medical care, and doctors who have completed their training can also go on to further subspecialty fields. The Japan Medical Specialty Board sets the basic fields in response to medical needs and social demands.
Subspecialty specialists, such as allergists, cannot become certified unless they have first become certified in a basic field.
In order to become a subspecialty specialist (a specialist in a specific field), you must first become a basic specialist. The system is set up so that doctors who have acquired basic clinical skills in fields such as internal medicine and surgery as basic specialists, and who have then further deepened their expertise in a specific field, are certified as subspecialty specialists. The qualification of a basic specialist is a prerequisite for studying in a subspecialty field. This type of specialist system is generally referred to as a “two-tiered” system.
The history of the two-tiered specialist system in Japan
The background to the introduction of the two-tiered specialist system in Japan is to improve the quality of specialists and to improve the medical care provision system. This system is divided into two tiers: basic area specialists and subspecialty specialists. The history of this system is outlined below.
1. The birth of the post-war specialist system
In Japan, as the post-war medical system was being developed, each specialist academic society gradually formed its own system for certifying specialists. This created a foundation for doctors to acquire advanced knowledge and skills in specific fields, but the system lacked consistency, and the certification criteria differed between each academic society.
2. Movement towards unification and transparency of the specialist system (2000s)
As we entered the 2000s, there was a growing need to guarantee the quality of specialists and provide them in a way that was easy for the public to understand. In particular, there was a full-scale movement to unify the certification standards that had been different for each academic society, and to make the system more transparent and consistent. As a result, discussions were held to unify the specialist system at a national level.
3. Establishment of the Japan Medical Specialty Board and introduction of the two-tier system (2014)
The Japan Medical Specialty Board was established in 2014 as an organization to unify and make the specialist system more transparent. As a result, the specialist system became a two-tier structure of “basic areas” and “subspecialty areas”.
Basic Field Specialist: The stage of acquiring a specialist qualification in one of the 19 basic medical fields (e.g. internal medicine, surgery, pediatrics, etc.).
Subspecialty Specialist: The stage of acquiring a specialist qualification in a subspecialty field, which is a more specific field of expertise than the basic field.
This two-tiered system means that doctors can first be certified in a basic specialist field, and then go on to further their studies in a more advanced specialist field.
Summary
The introduction of the two-tiered specialist system has made Japanese healthcare more consistent and transparent, and has created a healthcare provision system that the public can trust. This has also led to the systematic training of doctors, and has strengthened the system for providing high-quality healthcare.
Subspecialty Field Review Committee
The Subspecialty Field Review Committee has been established within the Japan Medical Specialty Board to discuss matters related to the accreditation of subspecialty fields. This committee examines the development of subspecialty fields, the accreditation process for new fields, and operational policies.
The following members have been appointed to the Japan Medical Specialty Board from the 6th term, which was elected in June 2024.
Chairperson: Junko Takita
Vice-Chairperson: Masashi Suzuki
Committee Members: Norihiko Ikeda, Tomohiko Ichikawa, Hidehito Imamura, Yasushi Kaji, Koji Kajinami, Sumiko Nagoshi, Yoko Matsumoto, Masahiko Watanabe
Director in Charge: Hidetoshi Eguchi
Until the last election, Director Shunichi Miyazaki was a member of the Subspecialty Committee (hereafter referred to as the “Subspecialty Committee”).
Mr. Miyazaki is a director of the Japan Medical Specialty Organization (JSMO) from the Japanese Society of Internal Medicine (JSIM).
The JSIM has stated that it has appointed a director to the JSMO in order to represent the interests of the JSIM. I heard this directly from the previous JSIM Secretary General.
The problem with the statement that the Japanese Society of Internal Medicine “has a director on the board of the Japan Medical Specialty Board to represent the interests of the internal medicine association
There are several problems with the statement that the Japanese Society of Internal Medicine ‘has a director on the board of the Japan Medical Specialty Board to represent the interests of the internal medicine association’. This raises important concerns, particularly regarding the neutrality and transparency of the Japan Medical Specialty Board.
Problems
1. Loss of neutrality and public interest of the Japan Medical Specialty Board
The Japan Medical Specialty Board was established with the aim of improving the quality of medical care for the whole nation and ensuring fair and transparent certification of specialists, rather than for the benefit of specific academic societies or organizations. However, the intention of specific academic societies to send their own representatives to the board to represent their own interests could undermine the neutrality of the board. This could lead to decisions being made in favor of specific academic societies and their affiliates, and other fields and academic societies could be treated unfairly.
2. Risk of conflict of interest
The fact that the Japanese Society of Internal Medicine is sending a director to the Japan Medical Specialty Board to protect its own interests raises the issue of conflict of interest. As the Japan Medical Specialty Board is responsible for certifying specialists in all medical fields using fair standards, the increased influence of specific academic societies risks undermining the credibility and fairness of the board.
3. Lack of transparency
The explicit statement that the organization exists “to represent the interests of the medical profession” could lead to a lack of trust in the transparency of internal discussions and decision-making. The decisions of the organization need to be based on fair processes and widely accepted by society, but if the influence of specific interest groups becomes too strong, it could invite criticism of a lack of transparency.
4. Impact on other academic societies and specialist fields
If other academic societies, like the Japanese Society of Internal Medicine, also start sending their own representatives to the board of directors of the medical specialist organization in order to protect their own interests, the organization as a whole could become a place for the interests of each academic society to be coordinated. This could potentially lead to a deviation from the original purpose of the organization, which is to certify medical specialists in order to provide fair, high-quality medical care to the entire nation.

The Japan Medical Specialty Board is required to make fair and neutral judgments in all medical fields. The attitude of certain academic societies sending their own board members to protect their own interests could cause concerns about the reliability, neutrality and fairness of the organization. Such behavior runs counter to the aim of increasing the transparency of the specialist system and gaining the trust of the public, and needs to be reconsidered.
The problem with Director Shunichi Miyazaki
Shunichi Miyazaki is currently working as the director of the Tondabayashi Hospital, and is active as a cardiologist. Before that, I believe he was a professor at Kinki University.
Miyazaki is a director of the Japanese Society of Internal Medicine, and together with the current president of the Japan Medical Specialty Board, Watanabe, he has been in charge of the specialist system at the Japanese Society of Internal Medicine for a long time.
With regard to the Japanese Society of Allergology, he is said to have repeatedly declared that “becoming an allergy specialist based on a field other than internal medicine is not acceptable”. We have received testimony from several reliable sources regarding this, so we believe it to be true.
The problem with Mr. Miyazaki does not end there. The chairperson of the subcommittee is Junko Takita. The content decided by the sub-committee is first passed through the steering committee and then to the board of directors. Until the 5th term, people who were not board members were not allowed to attend the board of directors meetings, so committee chairperson Takita was unable to attend the board of directors meetings, and the content compiled by the sub-committee was answered by board member Miyazaki at the board of directors meetings.
However, Mr. Miyazaki would repeatedly withdraw the content of the resolution on his own, saying that he could not accept it, even though he had agreed to it when it was discussed at the subcommittee meeting.
This is just my speculation, but I think that no matter how many times the sub-specialty committee passed a resolution designating the Japanese Society of Allergology as having “internal medicine, pediatrics, dermatology, otolaryngology, and ophthalmology as its basic fields”, Mr. Miyazaki would withdraw it when he brought it up at the board meeting because it went against his own ideas.
Assuming this to be true, let’s discuss the following.
The issues pointed out with regard to Dr. Shunichi Miyazaki are particularly related to his actions during the decision-making process for the specialist medical system.
We will now summarize the main issues
1. His attitude towards the Japanese Society of Allergology and his focus on internal medicine
Dr. Miyazaki is a representative of the Japanese Society of Internal Medicine and serves as a director of the Japan Medical Specialty Board. It is said that he repeatedly made statements such as “I do not recognize becoming an allergy specialist based on anything other than internal medicine”. This could lead to the opinions of other basic fields (pediatrics, dermatology, otolaryngology, ophthalmology) in the allergy society being disregarded, and questions could arise about the fairness of the specialist system. Decisions that are biased towards specific societies or fields risk undermining the transparency of the system as a whole.
2. Inappropriate behavior by the subspecialty committee
At the subspecialty committee, the chairperson, Junko Takita, summarized the content of the resolutions, but as she was unable to attend the board meeting, the director, Miyazaki, gave the response at the board meeting. The problem is that Miyazaki agreed with the committee’s resolutions, but at the stage of submitting them to the board meeting, he repeatedly withdrew the agenda, saying that he could not accept them. This is an action that creates a contradiction in the committee’s decision-making process and undermines the trust of other committee members and the academic society.
3. Lack of transparency and accountability
Mr. Miyazaki’s action of withdrawing the subspecialty committee’s resolution at the board of directors meeting demonstrates a lack of transparency and accountability. If the content of the decisions made by the committee is not properly communicated to the board of directors, the transparency of the management of the subspecialty area and the specialist physician system will be undermined, and the decision-making process will not be satisfactory to other stakeholders.
4. Allegations of conflict of interest
Mr. Miyazaki’s actions could lead to the agenda of the Japanese Society of Allergology being biased towards a medical perspective, and the entire Japan Medical Specialty Board being influenced by specific academic societies and fields. This is an action that goes against the basic principle that fair judgments should be made in the specialty physician system.

As we have seen, the actions of Dr. Shunichi Miyazaki have given rise to problems such as a focus on internal medicine and a lack of transparency in the organization of specialist physicians, and his actions, which appear to prioritize the interests of specific academic societies, are being called into question. Such actions have the potential to have a negative impact on the neutrality of the Japan Medical Specialty Board and the credibility of the specialist physician system as a whole, and improvements are required.
The problem with the close relationship between the President of the Japan Medical Specialty Board, Dr. Watanabe, and Dr. Miyazaki, a board member elected by the Japanese Society of Internal Medicine, who has been in charge of the Japanese Society of Internal Medicine’s specialist system for many years
The reason why the close relationship between Dr. Miyazaki and Dr. Watanabe is considered a problem is because it could undermine the transparency and fair operation of the organization.
Specific problems
1. Lack of fair decision-making
The board of directors is the place where important decisions regarding the operation of the specialist system are made. If the directors have a close personal relationship with each other, there is a risk that decisions will lack objectivity and fairness, and that particular intentions and opinions will be prioritized. If the President Watanabe and Director Miyazaki have a strong personal relationship, there is a risk that the opinions of other directors and committee members will not be fully reflected, and that discussions will be biased.
2. Lack of transparency
The JSME is required to operate in a fair and transparent manner. However, if there is a special relationship between board members, the internal decision-making and discussion processes may become difficult to see from the outside, and transparency may be impaired. A situation in which a particular board member has too much influence could also affect the credibility of the organization as a whole.
3. Concerns about conflicts of interest
If there are close relationships between board members, there is a risk of a conflict of interest arising, as personal interests and intentions may take precedence. For example, if the interests of a particular academic society or specialist field are given preferential treatment, there is a concern that the balance with other fields and academic societies will be lost, and the fairness of the system as a whole will be undermined.
4. Increase in dissatisfaction and distrust within the organization
If a particular board member has too much influence within the board, there is a possibility that the dissatisfaction and distrust of other board members and related parties will increase. This could lead to a decline in morale and internal conflict throughout the organization, and could have a negative impact on the operation of the specialist medical system.

Summary
The close relationship between Director Miyazaki and President Watanabe has the potential to cause a number of problems, including a lack of fairness and transparency in the organization, and the risk of conflicts of interest. In order to ensure that personal relationships do not affect the organization’s operations, strict rules and processes are necessary.
What the Miyazaki issue has caused
As the situation was like this, the secretariat of the board of specialists seemed to have suggested that it would be better to take a two-step approach, starting off as a sub-specialty of internal medicine and then adding paediatrics, dermatology, otolaryngology and ophthalmology as basic fields at the right time.
At this point, the president of the Japanese Society of Allergology became very angry and made a strong protest to various quarters.
It is assumed that the president of the society would not make a protest to the secretariat, so he must have made a direct protest to the presidents of the societies involved.
Even if they had asked the secretariat, they may not have listened to any excuses about it being a last resort, etc., because of what Mr. Miyazaki had said.
The above content is thought to be what Mr. Kadowaki said at the Japan Medical Specialty Board General Meeting in June 2024, “We have received multiple reports that the person in charge of the secretariat approached each medical society with a story that was not guaranteed, and that this led to suspicion.
As for the issue of the Japanese Society of Allergology,
I have known about it for quite some time, and I have thought about writing about it online. I have refrained from doing so in the hope that the Japan Medical Specialty Board and the relevant academic societies would be able to purify themselves, but now I have decided to go public because there are various things that I think it would be better for everyone to know about what is happening within the Japan Medical Specialty Board.
The problems with the Japanese Society of Allergology within the Japan Medical Specialty Board have been casting doubt on transparency and fairness for many years. I have been aware of these issues for some time, and while I hesitated to go public on the internet, I had hoped that the people involved would be able to clean up their act. However, I now feel that the situation within the Japan Medical Specialty Board is extremely serious, and that further tacit approval of the situation will be detrimental to many people.
Specifically, the problem is the biased decision-making process within the organization, such as the prevalence of internal medicine-centeredness, unfair treatment of the Japanese Society of Allergology, and how discussions about subspecialties are handled at board meetings. In particular, the cases where previously agreed-upon matters are overturned in the end, such as the withdrawal or modification of resolutions, have shaken the trust in the transparency and fairness of the organization.
The reason I have decided to make this public is to provide an opportunity for those involved to reflect on their own actions and make the necessary reforms. The specialist medical system is an important system that will determine the future of Japanese healthcare, and all specialist fields should be evaluated and treated fairly. By making this public, I hope to encourage external monitoring and pressure, and to promote internal reform.
Let’s return to Mr. Kadowaki’s controversial comments
“We have received multiple reports that the person in charge of the secretariat approached each academic society with a proposal that was not guaranteed, and that this led to suspicion.”
Secretariat negotiations refer to the coordination and negotiations that the secretariats of organizations and groups carry out with other organizations, government agencies, related departments, etc. The purpose of secretariat negotiations is to efficiently advance the alignment of opinions, consensus building, confirmation of procedures, and resolution of issues.
Specifically, they are carried out for the following purposes
Adjusting policies and rules: Based on the policies and rules of each organization, matters that need to be adjusted are discussed to form a common understanding and agreement.
Adjusting interests: When the interests and requests of each party involved differ, the aim is to find the best solution through negotiations.
Resolving issues: When complex problems or conflicts of opinion arise, the secretariat acts as an intermediary to resolve the issues.
Smooth progress of work: The secretariat makes detailed adjustments regarding procedures and progress, and coordinates matters so that projects and plans proceed smoothly.
In short, secretariat negotiations are a necessary process for ensuring smooth coordination between organizations.
To begin with, secretariat negotiations are a stage where discussions take place regarding how to bring together matters that have not yet been decided by the board of directors.
If you can only bring up issues that have been guaranteed, then it would be better to do everything at the board meeting.
From this point of view, Mr. Kadowaki’s comments are completely meaningless, and to begin with, the reason for this situation is the arrogance of the Japanese Society of Internal Medicine, which could be described as being centered on internal medicine.
Mr. Kadowaki, who was the President of the Japanese Society of Internal Medicine, became the President of the Japan Medical Association and made this comment at the General Assembly of the Japan Medical Specialty Board.
There are multiple issues with this case, particularly the possibility that the role and significance of secretariat negotiations were misunderstood, and the fact that there was no appropriate communication between the organizations.
1. The problem of making proposals without guarantees
The comment made by Mr. Kadowaki, “to approach them with a proposal that has no guarantee”, could damage the relationship of trust between organizations. The secretariat is responsible for negotiating with other organizations to reach agreements and make adjustments while protecting the interests of the organization and academic society, so it should conduct negotiations responsibly. If it is only possible to bring up topics with guarantees, then there is no need for secretariat

2. Misunderstanding of the role of secretariat negotiations
Secretariat negotiations are a coordination process that takes place before the final decision is made at the board meeting, and is the stage at which the specific details are worked out. Saying at this stage that “we can only talk about things that are guaranteed” shows that you misunderstand the true significance of secretariat negotiations. Negotiations are a flexible coordination process, not a final decision, so it should be understood that there is a possibility that there will be talks without guarantees. Mr. Kadowaki’s comments suggest that he may not have properly understood this coordination process.
3. The arrogance of internal medicine-centeredness and the problem of leadership
The internal medicine-centeredness of the Japanese Society of Internal Medicine has been pointed out due to the fact that Mr. Kadowaki was the President of the Japanese Society of Internal Medicine. This could lead to unequal treatment of other academic societies and specialist fields, and raise questions about the fairness of the specialist physician system. If Mr. Kadowaki makes this statement as the President of the Japan Medical Association, it could be interpreted as an action that represents the interests of a specific academic society or specialist field, and there is a risk that the fairness of his leadership could be undermined.
4. Inconsistency of the statement and unclear responsibility
While Mr. Kadowaki points out that he was “offered a story with no guarantees”, he also criticizes the cause of the situation as being the internal medicine-centered approach of the Japanese Society of Internal Medicine. By pointing out the problems with the organization he was involved in, his comments lack consistency and the responsibility for the situation is unclear. This is another reason why the meaning of his comments is considered unclear.

Summary
In this case, the problem is that Mr. Kadowaki misunderstood the role of the secretariat’s negotiations, and his comments about things that were not guaranteed led to suspicion, and there were also contradictions in his own comments. In addition, the impact of the Japanese Society of Internal Medicine’s internal medicine-centric approach on other specialist fields cannot be ignored, and there is a possibility that overall fairness and transparency will be undermined.
This is just my impression, but I wonder who Dr. Takashi Kadowaki really is?
I will write about the other problems with Dr. Kadowaki’s comments
in due course.
As this issue involves the president of the Japan Medical Association, which is supposed to be the highest peak of Japanese medical academia, I will again include English translation.
It’s better if people from all over the world can see it.
After all, Japanese people can only change if they are given a good kick.
If you have any problems with the content, or if you find any mistakes in the English, or if you have any information to provide, please let us know in the comments section!