Small but Steady Steps in Stroke Medicine in Japan

Abstract

December 14, 1702, was an unforgettable day for many Japanese, when 47 samurais from Ako Domain launched a raid on their foe's residence in the snowy night of Edo (the former name of Tokyo) and avenged their deceased master, who was illogically forced to commit suicide by self‐disembowelment on a sword, after waiting and planning for a year and a half persevering through all sorts of hardships. They have been repeatedly praised by Bunraku (puppet play) and Kabuki plays, novels, and movies. On the same day 316 years later (December 14, 2018), a Stroke and Cardiovascular Disease Control Act was proclaimed by the Japanese government to vanquish these national maladies.1 Eight basic policies on stroke and cardiovascular diseases are listed in the new law: (1) promotion of education to the general population and prevention by national and local governments; (2) development of a system for transportation using an ambulance and others and acceptance of emergent patients; (3) development of medical institutes where specialized medical care for stroke and cardiovascular diseases can be offered; (4) maintenance and improvement of participation in social activities and other quality of life for patients with subsequent complications; (5) development of a system for collaboration among agencies involved in health, medical care, and welfare, such as hospital ambulance services, social welfare services, and others; (6) human resource development for health, medical support, and welfare; (7) development of a system for collection and provision of information; and (8) promotion of research. The Japan Stroke Association, a stroke support organization, and other organizations prepared the draft for the basic law on stroke in 2009 and appealed to the government for its enactment but without success. The bill was then expanded to include cardiovascular disease in general and was then finally approved. The Japan Stroke Society, an academic organization, has joined with the Japanese Circulation Society for the 5‐year strategy for stroke and cardiovascular diseases (Stop CVD Project) since 2016 in anticipation of the basic law. Although stroke has long been called the Japanese national disease, the government was relatively slow to act to take measures for stroke care compared with cancer care. The new Act is a steady step forward for tomorrow's stroke medicine in Japan.