5th Asia Cancer Forum
What Should We do to Raise Awarenesson the Issue of Cancer
in the Global Health Agenda?
Organized in Collaboration with 20th APCC
Medical Platform Asia
NPO Health Medicalcare Promotion
Date: November 12 (Thu.), 2009,12:00-15:00
Location: Tsukuba International Congress Center

Contextual Intelligence
Collective IntelligenceContinuous Intelligence

Asia
CancerForum

Asia Cancer Forum

What Should We do to Raise Awareness on theIssue of Cancer in the Global Health Agenda?
The Asia Cancer Forum has been engaging with the global healthcommunity to share information about the current challenges forcancer in developing countries and to discuss future trends.
Discussions also focus on how we can enhance communicationand cooperate in improving the global health status.
It is our intention to position our agenda as an item to be
included within the next Millennium Development Goals (MDGs)of the United Nations.
The starting point of the debates within the Asia Cancer Forumis the concept of human security. Based on the concept of humansecurity, we are discussing the following questions: What should
we do to achieve this goal? And, further, what items should be
added to the revised MDGs?

Human
Security

Science

CANCER

Diplomacy

Contextual
Intelligence

CultureEconomyContinuousIntelligence

CollectiveIntelligence

http://www.asiacancerforum.org/

! ! ! ! ! ! ! ! !

!

Preface
Asia Cancer Forum
Norie Kawahara

Progress in science bestows upon people the promise of limitless possibilities and themeans to live longer. Humankind has devoted much time and effort in the fight against
disease.
Of all diseases cancer causes the longest suffering and impediment to people's lives,
and the final brave fight against the disease, or the shock of being confronted with itcreates a negative image among patients and their families.
Cancer is not merely a biological phenomenon, it also has anthropological aspects.
It is strongly colored by the cultural impact of various interlinked lives. The cultural
diversity in Asia may be an obstacle to overcoming cancer, but this cultural diversity isalso a tremendously powerful force for seeking to live longer. It is our responsibility tocarefully bring together the various societies in Asia and seek to address the various
different views and perceptions regarding cancer in the region.
Cancer is a disease that is still thought of as a scourge of industrialized nations, but its
incidence is in fact increasing most rapidly in the developing world, including India andChina, which makes it all the more urgent for Asia to decide how to face and overcome
cancer.
In the near future the international community is likely to face an unjust situation inwhich some people with the same disease will be cured while others will suffer and die.
It is this grave reality that we must address.
As we address this issue we must recognize that this is more than a humanitarian
movement. The issue is inextricably linked with the evolution of life science itself.
Science is utilizing humankind as a research resource and must bear the responsibility
for such treachery. Life science must transcend national boundaries and become part of
the “intelligence” bestowed equally upon all human beings.
! Asia Cancer Forum in preparation for the APCC, has been convened 4 times sinceJune 2008. Through our deliberations on the agenda item “What can we do to raiseawareness about the issue of cancer in the global health agenda?” we arrived at the“Concept Notes” for this meeting, with the help of comments from Dr. Akaza of Japan,
Dr. X. S. Hao of China, Dr. Harold Varmus of the United States and Dr. Alwan ofWHO. The Asia Cancer Information Network, part of the Asia High-Tech Network
initiated in 2004, is the precursor of the Asia Cancer Forum. The starting point was a
proposal I made in an article for “Nature” in 2002*.
! Progress in large-scale human genome research has dramatically increased theamount and content of personal data used in many areas of biomedical research. Life
science exists within a collaborative environment involving medicine, research andindustry. Personal data, data derived from human sources, are collected with the guiding
principle of sharing the “collective assets of humankind”, and the realization that theseresources are the joint property of the world community constitutes the very essence of
science.
*Tsuboi, E., Kawahara, N., Mitsuishi, T., Oshima, A., Yonemoto, S. NATURE 417, 2002; 689

Mission

The Universal Declaration of Human Rights states that everyone has the right to share inscientific advancement and its benefits equally. Based on that spirit enshrined in the Declaration,with the aim of overcoming the common challenge of cancer that is faced by humanity as awhole, and linking it to human life in the Asian region, we have attempted to bring together
several types of "intelligence", which we have subsumed as the "3Cs."• Collective Intelligence• Contextual Intelligence• Continuous Intelligence
The relationship between these three forms of modern intelligence and the activities of thisforum are described below.
Contextual intelligence is an intuitive skill that helps a leader align tactics with objectives tocreate smart strategies in new situations. Contextual intelligence consists partly of analytic
capabilities and partly of tacit knowledge built up from experience, which tends to be expressedin rules of thumb.
This is a concept expounded by Joseph Nye in his book The Powers to Lead, and this kind of
intelligence requires a top-down approach. In terms of policy challenges it leads to questions
about what kind of agenda-setting should be employed.
Collective intelligence is a shared or group intelligence that emerges from the collaboration andcompetition of many individuals.
George Pór, defined the collective intelligence phenomenon as "the capacity of humancommunities to evolve towards higher order complexity and harmony, through such innovation
mechanisms as differentiation and integration, competition and collaboration."
This is a type of intelligence that supports a bottom-up approach. In the context of the Asia
Cancer Forum our attempt to create a common base for information collection by providing
information on such topics as cancer prevention educational activities for children and women’s
self-respect issues and cancer, is a part of such a bottom-up approach.
Continuous Intelligence is a new approach that derives immediate insights from fast changing,“live” data, and determines the immediate actions front-line personnel can take to proactively
solve problems, or reduce risk. This is an expression taken from IT terminology and it denotes atype of intelligence that seeks to create driving force to link the two prior noted intelligences(contextual and collective) towards the future, without losing or disconnecting the main aspectsof these two kinds of intelligence. The Asia Cancer Forum has used these scientific metaphors
to create a concept note on this issue, as seen below.

– Concept Note –What should we do to raise awareness!
on the issue of cancer in the global health agenda?
Key words: Health equity/MDGs/Human security/Collective intelligence
Cancer is Pandemic!
Japan, 2009---------------------------------------------------------------------------------------------------------1. Background and overview
Although infectious diseases remain a significant issue, changes in population
demographics brought about by successes in tackling infectious diseases are creatingother issues. Developing countries, including China and India, account for more thanhalf of the global population, and as longevity increases in the developing world, so too
do incidences and deaths from cancer, causing a new and serious situation.
Cancer, however, has not acquired an appropriate position in global health agendas.
International health, which differentiates domestic and international issues, has become
a global agenda, placing domestic health issues in the global context. The era of global
health has brought further complexity to disease treatments, incorporating new elements
into the field of health, including socio-economic concerns and political conflicts
among others. This complexity means that the “fight against cancer” may not yet be asuitable issue for worldwide collaboration.
Cancer is not yet on the agenda in global health. There is still no suitable mechanism forcollecting information and analyzing it in order to gain a global picture about cancer.
Many questions exist that require our attention. How have we finalized global heath
agendas in the past? What have been the supporting mechanisms and philosophies thatform the basis for decision-making processes? What will be the future agenda? How cancancer be developed as a global agenda item and what can we do to ensure thishappens?
The Asia Cancer Forum has been engaging with the global health community to share
information about the current challenges for cancer in developing countries and discuss
future trends. Discussions also focus on how we can improve communication andcooperate in improving the global health status.
We are resolved to propose our agenda as an item in the next Millennium Development
Goals (MDGs) of the United Nations. What should we do to achieve this goal? Whatshould be the agendas to be added to the revised MDGs? These questions need to be
discussed in the forum.
2. Objectives
Cancer has become a challenge not only for industrialized countries but also fordeveloping countries. However, the perception of cancer as an “individual’s” disease
has inhibited discussion on cancer due to perceived issues relating to fairness andjustice.
“Our goal changes from treatment at whatever cost to care and respect for the integrity
and dignity of the person.” To achieve this goal we seek to combine basic ideas andpolitical agendas as a means of strengthening the next step towards the construction of a
proposal.
3. Expected outcomes
1) Currently what position do cancer issues hold in the global health community?
From the outset we believe that experts should share a basic understanding about
this issue, focus on top down mechanisms, and aim the outcome of our discussions
towards achievement of the stated objectives.
2) How can we cooperate to prevent developing countries following the trend ofincreasing cancer incidence that has been the case in industrialized countries? Weshould ensure that economic development is not sacrificed and that the knowledge
and experiences of industrialized countries are transferred and shared effectively.
To achieve this goal, we should construct mechanisms to collect medical
information over a long period and a wide range of issues. Databases should beshared to strengthen the health care system for the next generation.
Another question is how can we tie a bottom up approach, including transforming
the awareness of citizens on cancer incidence and cancer information sharing, into a
top down policy at the state and global level?
3) We will seek the opinions of various experts and widen the scope of our discussion
to incorporate the following:
Information Technology
Pharmaceutical Industries
International Organizations

4) The outputs of this meeting are also intended for presentation:
ECOSOC
WHOWORLD BANKUICCWorld Medical Association
The Seattle Science Foundation
4. Organization of the agenda
The forum will start with a video presentation by Dr. Alwan of the WHO and theprogram consists of three sections covering a total of three hours. In each section there
will be two invited presenters, followed by question and answer sessions.
Various issues will be address, including those mentioned above: top down and bottom
up issues, specific action plan, and what should be incorporated in future agendas. !

AGENDAW ha t s h ould w e d o to rais e a war e nesson the iss u e of ca nc er i n th e gl obal h eal th ag e nda?
3C

I ntell ig e nc e
Contextual Intelligence
Collective IntelligenceContinuous Intelligence

12:00

Opening remarks
Tetuichiro Muto
Hideyuki Akaza
Norie Kawahara

12:10

President, NPO Health and Medical care Promotion
President, APCC
Organizer, Asia Cancer Forum

Global Challenges in Cancer Control.

Video Letter

Ala Alwan
WHO Assistant Director-General - Noncommunicable Diseases and Mental
Health”

Session 1: What will shape the global health agenda?
Contextual Intelligence
From the view point of top down

12:25

The Challenges in The Global Health.
Keizo Takemi, Senior Fellow
Japan Center for International Exchange Professor, Tokai University
Special Advisor, Sasakawa Health Memorial Foundation

12:40

Cancer as a Global Health Ag enda.
Hajime Inoue, Executive Advisor,
Department of Health and Welfare, Chiba Prefecture,

12:50 How could the issue of cancer be justified as a global
health agenda?
Hiroyoshi Endo, Professor
Department of International Affairs and Tropical Medicine,Tokyo Women’s Medical University

Discussion

13:15

Research platform to formulate
strategies in Asian-region.

cancerprevention

Manami Inoue, Section Head
Epidemiology and Prevention Division, Research Center for Cancer
Prevention and Screening, National Cancer Center

Session 2: Where are we really?
What activity can we do against Health Equity?
-Collective Intelligence –From the view point of bottom up

13:30 On dispatch as expert adviser i n Thailand
Eitaka Thuboi, Former President of World Medical Association
Asian Network of Childhood Cancers Tu mor Banks:
Aiming for Better Cure of the Sick Children
Akira Nakagawara, Director
Chiba Cancer Center,
Role of Traditional Medicine for Cancer Patients.
Kenji Watanabe, Associate Professor, Center for Kampo Medicine,
Keio University School of Medicine

Discussion

Session 3: What should be incorporat ed in future agendas?
-Continuous Intelligence-

14:05 Health information in my hand.
Mamoru Iwabuchi, Associate Professor, RCAST, the University of Tokyo

14:10 Cancer: from Personal to Societal.
Tohru Masui, Chief, Division of Bioresources Research,
National Institute of Biomedical Innovation

Special Comments
David Hill
Australia President, UICC/Cancer Council Victoria
Tomoyuki Kitagawa
Chiarn, UICC Japan
Jae Kyung Roh
Yonsei University,Korea

The Challenges of Cancer Prevention in China.
Xi Shan Hao

President, Chinese Anti-Cancer Association

Expanding Need of Cancer Medicine i n Asia.
Hideyuki Akaza

President, APCC

14:55 Closing Remark
Masanori Nishiyama
Norie Kawahara

President, Medical Platform Asia
Organizer, Asia Cancer Forum1. Health as foreign policy
agendaTsukuba International Congress Center (Epochal Tsukuba)
November 12, 2009

Asia Cancer Forum

Senior Fellow, Japan Center for Int’l Exchange
Professor, Tokai University
Special Advisor, Sasakawa Health Memorial
Foundation

Keizo Takemi

Challenges in Global Health

3

1

2

Health has become global agenda: ‘global health’Globalization has increased the speed and threats oftransmission of pandemics% global responses are required (shift of the concept of‘international health’ to ‘global health’)

Expansion of scope of impacts of health issues:

4

Globalization has expanded domain of health issues toinclude social determinants such as social, cultural,environmental, political, and economic factors within which
health and disease occur%multi-sectoral responses are required

Expansion of domain of health issues:

Globalization and Health$" Challenges for Japan

process as an example#" Japan’s health diplomacy: Toyako G8!
" Health as foreign policy agenda

Contents

Realist approach: emerging pandemics and conflicts between property rights
and public health
Theoretical approach: emerging new theories such as social determinants ofhealth, cross-sectoral approach
Legalistic approach: health as a human right
Moral approach: human dignity and human security

&

&

&

– Multilateral diplomacy– Civil society networking– Bilateral diplomacy

Multi-sectoral approach is inevitable: “Participatory
Diplomacy”
Diplomacy”
WG on “Challenges in global health and Japan’
Japan’scontributions”
contributions” at the track 2 level– Collaboration among relevant ministries (foreign affairs,
health, finance, and education)– Public-private partnership– International Advisory Board and Task Force on Global
Action for Health System
New dimensions of foreign policy

7

5

UK (IHP+), USA (PEPFAR), Canada (The Catalytic Initiative to Save a Million
Lives)
Foreign Policy and Global Health Initiative: Brazil, France, Indonesia, Norway,
Senegal, South Africa, and Thailand
High-Level Taskforce on Innovative International Financing for Health Systems
Strengthening: UK

Innovative decision making at
the Toyako G8 Summit and beyond

&

&

&

Other initiatives:

Role of human security in decision making for diplomacy& Okinawa Infectious Disease Initiative (2000)& Toyako Framework for Action on Global Health (2008)

Japan’s approach to health diplomacy: human security

&

&

&

&

Global health has become a diplomatic issue

Global Health as Foreign
PolicyJapan Center for International Exchange (JCIE) !"Director and WG secretariat
Japanese Organization for International Cooperation in Family Planning (JOICFP)
Health Policy Institute, JapanThe Nippon Foundation
Universities: Tokyo Univ., Osaka Univ., Waseda Univ., Jichi Medical Univ.
International Medical Center of Japan
National Institute of Public HealthJapan International Cooperation Agency (JICA)

&

&

&

&

#UN agencies are invited as observers

Ministry of Foreign Affairs
Ministry of Health, Labour and Welfare
Ministry of Finance
Ministry of Education, Culture, Sports, Science, and Technology

Ministries&

Governmental agency

&

&

&

Experts

&

&

&

&

WG members
NGO representatives

WG Chair: Prof. Keizo TAKEMIWorking group on“Challenges in Global Health & Japan’s Contributions”

6

Toyako G8 process as an example

2. Japan’s health diplomacy :World Population 65+ yrs, 2000

3. Challenges for Japan11

9average life expectancies%men (79.29 years), women(86.05 years)

World Population 65+ yrs, 2030:
Aging society&

Advanced aging society& Expertise on chronic diseases&

Experience of achieving universal health care
& Achieving longevity:

Japan’s Advantages

1210Deaths (millions)

2005

2010

2015

2020

2025

2030

Malaria&

Identify Japan’s comparative advantages incontributing to global health encourage cooperationin tackling global and regional health challenges– Collaboration among relevant ministries (foreign affairs, health,finance, and education)– Public-private partnership– Partnership with health-related international organizations andkey local organizations around the world

Maintain momentum for putting global health at theforefront of foreign policy agendas& Keep and enhance participatory approach to health atthe domestic and global levels&

15

Updated from Mathers and Loncar, PLoS Medicine, 2006

Challenges for Japan

2000

0

Perinatal

2

HIV/AIDS
TB

Road traffic
accidents

Acute respiratory
infections

6

4

StrokeIschaemic HD

Cancers

8

10

12Global projections for selected causes
2004 to 2030

Growing Number of Cases ofNon-communicable Diseases as
Causes of Deaths

2

4
6
8
Death rate per 1000 adults aged 15–59 years

Promote evidence-based global health policy–
policy–The
Lancet Japan Series& Enhance bilateral and multilateral cooperation for
global health–health–e.g. establishing a consortium ofinterdisciplinary centers of health innovation in SubSaharan Africa& Promote implementation of human security
approaches to global health–health–workshop series

Japan Center for International Exchange)&

10!"#$%&'()*"+,*(-#$.&/("0(123&,3&(4556(78.,9&'((!&*&%9&.(02:#$&3(,/.(9,+*&3;(<=>

0

Maternal and nutritional conditions

Other infectious and parasitic diseases

HIVAIDS

Injuries

Other noncommunicable diseases

Cancers

Cardiovascular diseases

Launching of Program on Global
Health and Human Security (within the

AfricaEuropeSouth East Asia

Eastern Mediterranean

AmericasWestern PacificHigh income

Adult Mortality Rates by Major Cause
Group and Region, 2004

16

12

I look forward to discussingthese ideas with you.

17

Cancer as a Global Health Agenda
Hajime Inoue
Executive Advisor, Department of Health and Welfare, Chiba Prefecture

In view of rapid population aging, cancer incidence has increased rapidly amongdeveloped countries in the past several decades. During this period, increased cancer
mortality and morbidity have received public attention, which has facilitated research
into cancer prevention and treatment, and has strengthened social support in theseindustrialized societies.
Alternatively, despite the fact that more than 70% of cancer mortality currently occurs
among middle and low-income countries, neither the appropriate attention nor theadequate allocation of resources has been made in these countries. While demographic
and epidemiological transition rapidly transforms the major disease burden from
infectious diseases to non-communicable disorders, global health communities havefailed to adjust their focus, which was set by Millennium Development Goals (MDG) in
2000.
Adequate attention and resource reallocation relative to the emerging health challenges
within developing countries - cancer and other non-communicable disorders - requires
the recognition of cancer as a global health agenda. As we approach the MDG goal yearof 2015, discussion will transpire regarding the establishment of a renewed global
health agenda in the next five years. To prepare for this discussion as a cancer society,there is a need to gather and analyze epidemiological evidence so that cancer indeveloping countries receives due attention among wider health community in its future
global health agenda setting.

How could the issue of cancer be justified as a global health agenda?
Hiroyoshi Endo
Professor, Department of International Affairs and Tropical Medicine,Tokyo Women's Medical University

Chronic diseases that are the major cause of mortality in the world have been increasing
in recent years, and according to World Health Organization (WHO) statistics for 2007,
cancer now accounts for 13% of the total deaths caused by such diseases. In addition,
chronic diseases, including cancer, are increasing in the developing world, creating what
has been termed a “double burden.” There is no refuting the fact, therefore, that whether
it be the industrialized or developing worlds, chronic diseases and cancer are becoming
a grave issue for human health in the 21st century.
However, faced with only epidemiological facts and figures detailing high mortality andhigh morbidity, the question arises as to whether cancer will be included as part ofglobal-scale measures, including in the developing world, that must be implemented aspart of a global health agenda. It is not just the scale of the issue as part of the global
health agenda, but also a question of availability, including means of resolution, thehuman, physical and financial resources to implement these means, as well as methodsof evaluation and commitment by those involved. What is required now is serious
consideration of what justification exists for raising the issue of cancer alongside and incomparison with mother and child health and infectious diseases, which have formed
the global health agenda to date.
Based on our long experience in dealing with measures against infectious diseases, wenow seek to elucidate the differences in measures to tackle cancer and those to deal with
infectious diseases, and consider what justification is required for the inclusion of
measures to tackle cancer in the Millennium Development Goals (MDGs), in a similarmanner to infectious diseases.
While it is true that there are differences between individual infectious diseases andvarious types of cancer, in general a number of commonalities also exist: (1) They strike
indiscriminately (although the genetic influence on cancer incidence is larger), (2) there
are means of diagnosis and treatment available (although cancer requires specialist
technology, which comes at a high price), (3) they have a significant social andeconomic impact in addition to medical concerns (although the personal impact ofcancer is larger), and (4) they are preventable through individual actions (although thedegree to which cancer can be prevented is limited and behavior modification is noteasy).
On the other hand the differences between infectious diseases and cancer can be listed
thus: (1) time frame for treatment (infectious diseases can be dealt with in the short term,
whereas cancer treatment is long term, counted usually in units of years), (2) target fortreatment (collective treatment for infectious diseases and individual treatment forcancer), (3) resources for diagnosis and treatment (overwhelming lack of resources forcancer treatment in the developing world), and (4) potential for full recovery (cancer hasa high rate of reoccurrence, etc.).
Although it is not necessary to resolve all these issues, is it not now necessary to createeven to a certain extent a forward-looking vision that would serve as a justification for
the inclusion of cancer in the global health agenda?

Research platform to formulate cancer prevention strategies in Asian-region
Manami Inoue
Epidemiology and Prevention Division,
Research Center for Cancer Prevention and Screening, National Cancer Center
5-1-1 Tsukiji Chuo-ku Tokyo 104-0045 Japan

To obtain concrete estimation of the impact of cancer as a nation, it is inevitable toconduct monitoring of disease statistics and systematic review of the epidemiologic
studies and meta-analysis and estimation of population attributable fraction of majorrisk factors in the target population. In Asia, however, this kind of work has been
limited. Insufficient evidence has prevented the most Asian populations fromconducting such evaluation on a national basis. Likewise, Asian populations sharesimilar ethnic and environmental background, and evaluation by pooled ormeta-analysis among Asian populations also contributes to the estimation of impact ofmajor risk factors and cancers in Asian region.
In Asian region, disease monitoring systems such as population-based cancer registries
have been improved and increased number of epidemiological evidence from individual
studies has become available in the past decade. However, current research funding
usually available for cancer research in Asia is oriented to topic-specific research (i.e.
association between smoking and lung cancer, etc.) and is usually domestic, not for
creation and maintenance of cross-country network platform, namely, a cornerstone forformulating cancer prevention strategies in Asia. This type of platform is inevitable forcross-country communication and collaborative research, and eventually the estimationof the impact of major risk factors and cancers in Asia, and international organizationand international fund are expected to play a role.

Asian Network of Childhood Cancers Tumor Banks:
Aiming for Better Cure of the Sick Children
Akira Nakagawara, MD, PhD
Chiba Cancer Center, Chiba 260-8717, Japan

During the last 40 years, the cure rate of childhood cancers has dramatically increased
from 20% to more than 70% in the developed countries. However, it seems to be still
very poor in many developing countries including those in Asia and Africa. In children,the mortality of cancer is the second following that of the accidents in developed
countries, while we do not know what the status is in developing countries. Though theincidence of childhood cancers is less than 1% that of adult cancers, we estimate that
more than 200,000 children a year newly suffer from cancer in Asian countries. Thus,
the childhood cancer is not rare but one of the most important diseases to be cured.
Therefore, it is urgent to establish the international network of childhood cancers tosave the patients from cancer especially in developing countries including Asia.
In 2008, at the meeting of the Advances in Neruoblatoma Research (ANR2008) held
in Chiba, Japan, the Steering Committee and the Advisory Board members of the ANR
Association decided to take an action to start to establish the international tumor bank ofneuroblastoma, one of the most common but still very poor prognostic pediatric solid
tumors. The goal of this project is to make the tumor banks of pediatric solid tumors in
the main cities in each Asian country to provide the internationally standardized
pathological and molecular diagnoses to the doctors and hospitals treating the patientsin local area. So far, we are successful to make the Asian network linking the key
stations in Taiwan, China (5 cities), Korea, India (3 cities), Bangladesh, Thailand,
Vietnam and Japan. This project will be expanded to other Asian countries as well as
Africa in the near future and further connected to the similar systems in United Statesand Europe.
We are currently trying to link this project with the International Society of PediatricOncology (SIOP) and hopefully the UICC to collaborate together to fight againstchildhood cancers in the whole world.

Role of traditional medicine for cancer patients
Kenji Watanabe, MD, PhD, FACP
Center for Kampo Medicine, Keio University School of Medicine

For a long period of human history, traditional medicine has taken care of all kinds ofdiseases of mankind, including cancer, even though, the main target of traditional
medical treatment has been infectious diseases.
The main reason why cancer is featured in modern days, is the prolongation of thelongevity. This is true not only in developed countries but also developing countries.
In Asian countries, cancer is a big problem. For the wealthy people, all kinds of thetreatment are available. On the other hand, for almost all the people, access to themodern treatment is limited.
Traditional medicine in East Asia, originated from ancient China includes traditional
Chinese medicine in China, traditional Korean medicine in Korea and Kampo medicine
in Japan.
In Japan, more than 70% of physicians use Kampo medicine in daily clinic withhigh-tech medicine. Most of the diseases are good indications of Kampo medicine
including cancer.
Of course, herbal drugs or acupuncture is not comparable to chemotherapy or irradiation
to diminish cancer. However, these chemotherapy or irradiation is sometimes too strongfor elder people and more natural course is comfortable. For those patients, traditional
medicine is useful to relieve pain or agony.
In 1997, NIH approved that acupuncture is useful to control a pain of cancer patients.
This effect appears via endorphin in the brain. Also acupuncture stimulates the immune
system. Herbal medicine is also used for the variety purposes of cancer treatment, i.e.,prevention of the cancer recurrence or metastasis, or pain control in the palliative care.
In conclusion, for the people modern therapy can be chosen, that is the best andtraditional medicine may be supplemental therapy. Also traditional medicine is useful asa primary care for the people to whom modern medicine is not available.

Health information in my hand
Mamoru Iwabuchi,
Associate Professor, RCAST, the University of Tokyo

Today's information technology (IT), particularly mainstreaming technology, such as
mobile phones and the Internet, can be used as a basic infrastructure to disseminate
information. This could be true even in developing coutries or their rural areas, wherea mobile phone can be shared among people. The objectives of our project is toprovide important and useful information about the prevention of canser. The
prototype using mobile phones will be discussed in the presentation.

Cancer: from Personal to Societal
Tohru Masui
National Institute of Biomedical Innovation
7-6-8 Saito-Asagai, Ibaraki-shi, Osaka 567-0085, Japan

Though communicable diseases are still the major concern in global health, longevity oflife and significant but not full wellbeing of population in the world have framed cancer
up a global health agenda. Society should be responsible for the life of a person andpopulation, though it never happened consistently or satisfactory. Now cost oftreatments and care of cancer patients limits our imagination and dream on quality oflife of the global population. The cost could widen feeling of inequality and strengthen
envy on economic status. This could deeply spoil self respect and integrity of people
and countries.
In this context we are asked to change our policy on our health. We, now, should seek
consistent and coherent policy on our life. This issue is closely relating to rapid aging of
population in the world, developed and developing countries.
“Our goal changes from treatment at whatever cost to care and respect for the integrity
and dignity of the person.”This is an essential remark on our concerns. We may have to change key words fromunlimited to limited. One question is how we could allocate our limited resources on ourlife in the world. This is a global issue and is different from the sense of importance ofcommunicable diseases as a global health agenda. What we are facing in this global
health agenda becomes a focus of our health policy. In this Asia Cancer Forum I would
like to incubate our shared question.

$1.03
$1.1
$0.8

$0.6

Thailand

Malaysia

Hong Kong

Singapore$0.66$132.1$1.3$13

Source: Business Monitor International Q1 2008 Reports*Note: Europe including pharmaceutical market France, Germany, Italy, Spain and U.K. is about $123 billion

Vietnam$100.7$2.16

Philippines

TaiwanIndonesia

$3
$2

$63
$30
$18
$5.3
$4
$4

$58.5
$12
$16
$4.3
$1.7
$2.6

China
Korea

Japan

$116.3Market Size 2008e(billion)

As of Dec 01, 2007

Market Size 2007
(billion)

Asian Pharma. Market : 20% of Global Market

1

Department of Urology, University of Tsukuba

Hideyuki Akaza, MD.

Asian Cancer Forum
November 12, 2009
During 20th APCC in Tsukuba

Expanding Need of Cancer
Medicine in Asia
North America
337 Millions

4

sites
Source: www.clinicaltrialmagnifier.com! Asia Contributes 5.9% of all global clinical trial

Western Europe! Emerging regions : Continents except North America andregions

protocols: the largest among the emerging! Asia Contributes 18.1% of all global clinical trial

2

Latin America
576 Millions

Source: CIA Factbook (https://www.cia.gov/library/publications/the-world-factbook/geos/xx.html)

Oceania34 Millions

4,075 Millions

Asia

World Population

Clinical Trials Conducted in Asia

2

Africa955 Millions

Europe800 Millions

60% of theAsia, the Most Densely Populated Continent

7!

Sample Testing/Submission!

Thailand: Material Transfer Agreement signed between site and lab

Source: !"# $%&'

Korea: agreement of subject compensation should be provided

templates

Hong Kong: specific indemnity agreements, some sites have specific contract!

!

Taiwan: most sites’ indemnity statement difficult to be revised!

ICF/Commitment letter/Contract: Specific templates

Taiwan, Korea, Thailand! Lab Kits/Devices Importation Permit required for

Taiwan: not for human embryonic germ cell, including cell line!

Source: !"# $%&'!

! Trial Specimen Export

Implementation Status of ICH-GCP!

Critical Points: Regulatory Differences5

Geographic Shift of Studies to Asiawith qualified medical infra-structure! Cost effective environment! Good quality of data

potential

6

Label (if given to patients)• Other Asian countries : ICF,

• Taiwan : Synopsis, ICF

Synopsis, ICF• Thailand : Part of protocol,

protocol, CMC, ICF, Label

Investigator Brochure• Korea : Summary of IB,! A significant emerging bio-pharmaceutical market

Protocoltranslations required for! A large patient population!!

COA (Certificate of Analysis)
Information ofplacebo/comparator

Certificate of insurance

!!

!!

!!

!!

Indemnity letters
Published full article!!

!!

Label for investigational
drugs

Local applicant’s license

GMP certificate

!!

!!
!!
!!

!!
!!
!!

Investigators’ CV

Informed Consent Form

Case Report Form

!!

!!
!!
!!
!!

!!
!!
!!
!!

Protocol Synopsis! English! Vernacular

!!

!!
!!
!!

!!

!!
!!

!!

!!
!!
!!

!!
!!
!!
!!

!!

!!

!!

!!

!!
!!
!!

!!
!!
!!
!!

Source: !"# $%&'

!!
!!

!!

!!
!!

!!
!!

!!
!!
!!

!!
!!
!!
!!

!!

!!
!!
!!

!!
!!
!!
!!

Taiwan Korea China Singapore Malaysia Thailand

A great deal of

In Asia;
Required Documents

Critical Points: Language Differences

Growing Opportunity for Clinical Trials

11

assigned panel members

12!

What is the role of academic site?
What is the role of industry (pharmacy)?
! What is the role of journalism?
! What is the role of the government?
!

3. Sort out the evidences and recommendation by

over the world.
! In Asia-Pacific, it is time to set our endeavor incancer health science.
! What should we and can we do for from Japan?

! Cancer health science is rapidly expanding all

Summary

2. Select and provide relevant solution

1. Specify and collect the problems! Procedure:!

Raise the problems! Find the way to solve! Objective:

Objective and Procedure of
Asian Statement on NCCN guideline

www.nccn.org/international/pdf/Synopsis_1st_NCCN_Asia_Symposium_Repo
rt_KS%20_2.pdf

Since 2006, NCCN has been in close collaboration with Chinese oncology experts
headed by Dr. Yan Sun in developing the!China edition of the NCCN Guidelines.
This project achieved huge success in China, and!is under rapid expansion. In
making full use of the present opportunity for summit!discussion, this symposium
especially incorporated panel meetings of NCCN experts and!Chinese experts to
update the China versions of available NCCN Guidelines as well as!develop new
NCCN Guidelines. Experts from China paid high!attention to the!development of
NCCN Guidelines that are especially tailored to China’s situation. Their!intense
research on relevant clinical evidence before the meeting and lucid presentation!of
their viewpoint and findings during the discussion gained wide recognition fromNCCN Panel Members. The resulting updated China editions of NCCN Clinical
Practice Guidelines in Oncology™, created through the joint efforts of Chineseexperts and NCCN experts, shall be instrumental in pushing forward thestandardization of clinical oncology practice in China.

1st NCCN Asia Scientific Symposium
Report

!

15

3.5

1.3

3.2

EuropeEast Europe

Africa0

2.5

Latin America

Oceania

1.8

0

57.1

38.7

49.3

56.1

54.3

51.8

58.3

42.9

58.1

49.3

40.4

43.2

46.4

41.7

No Action
(%)

7

31

150

287

81

2711

36

Number ofInspection

Source:www.clinicaltrialmagnifier.com

Official Action Voluntary Action(%)(%)

North America

Asia

respectively.

while North America and Europe prompted action in 1.8% and 3.5%,

No Asian Country prompted ‘Official Action Indicated’,Results of FDA Inspections

Back-ups

15

14

Protocol‘www.clinicaltrials.gov’ in terms of

Ranking by the
number of
protocols ofclinical trials
registeredeach Year in2009 (up to
2005
2006
2007
2008
July/20)
1 USA
USA
USA
USA
USA
2 Germany
Germany
Germany
Germany
Germany
3 Canada
CanadaCanadaCanadaCanadaFranceUK
UK
France4 France
5 UK
UKFranceFrance
UK
Spain
Spain
Spain
Spain
6 Spain
7 Italy
Italy
Italy
Italy
Italy
Belgium
Belgium
Belgium
Belgium
8 Netherlands
Netherlands
Australia
Netherlands
Japan
9 Australia
PolandPolandAustralia
Netherlands
10 Belgium
Australia
Netherlands
PolandSweden11 Poland
12 Sweden
RussiaRussiaSwedenKorea
13 Denmark
Czech Republic Sweden
RussiaPolandCzech Republic Austria
Australia
14 Czech Republic Sweden
Austria
Austria
Korea
India
15 Switzerland
Denmark
Korea
Czech Republic Russia
16 Russia
IsraelHungaryJapan
Brazil17 Finland
18 Austria
MexicoJapan
BrazilAustria
BrazilIsraelDenmark
China
19 South Africa
20 Hungary
Hungary
India
India
IsraelArgentina
Argentina
Hungary
Czech Republic
21 Mexico
22 Brazil
Switzerland
MexicoIsraelDenmark
NorwaySouth
AfricaDenmark
MexicoSwitzerland
23
Korea
BrazilRomania
Hungary
24 Argentina
India
Switzerland
Finland
Mexico25 JapanJapan
TaiwanArgentina
Taiwan26 Israel
Finland
China
TaiwanArgentina
27 Taiwan
28 Korea
China
South Africa
South Africa
FinlandRomania
Finland
Switzerland
Norway29 Greece
30 India
TaiwanRomania
China
Slovakia

Steady Growth of Asian Countries(Protocols)correspondence

Data security is crucial for Japanese science

R ule s th a t ar e b a s e d s olely o n v olu nt ary g uid elin e s will n o t g ain th e tru st of th e p u blic.

Sir — The Japanese parliament is currently
discussing new data-protection legislation,
the first to be introduced in Japan, which
will provide scientists with a broad
exemption from the proposed rules.
This exemption has not been widely
discussed, and few citizens are even awareof the issue. Although the biomedical
research community and pharmaceuticalindustry initially indicated tacit consent,
concerns are now being voiced.
We believe the bill does not constitute anadequate regulatory framework for privacy
protection in biomedical research. Several
ministries, agencies and scientific societies
have, in the past, drafted guidelines that haveincreased awareness of ethical issues, suchas informed-consent procedures and review
by research ethics committees. Yet the scopeof the existing guidelines is restricted andthere is considerable confusion about how
the rules would be applied. We fear that dataprotection based solely on voluntary
guidelines is insufficient to win public trust.
Progress in large-scale human genome
research has dramatically increased theamount and content of personal data usedin many areas of biomedical research.
Large online databases linking personal

information with genomic and clinicaldata are now feasible. For example,
BioBank UK (see Nature 417, 9; 2002) isseen by many observers as an important
step forward for clinical-genomics researchin Britain. But its success will depend on
the participation of UK citizens. Suchsupport is unlikely without a well-conceived
scientific strategy and, equally important,a convincing legal and regulatory
framework for privacy protection.
Assembling large-scale cohorts forgenome research remains very difficult
in Japan; we believe a more widespreadsharing of resources is now inevitable. Yet
without a coherent, transparent approachto data security and data protection, theJapanese public is unlikely to support
efforts to build large databases containing
medical information and lifestyle details
linked with genetic samples, because of
distrust and the perception that Japan’s
medical and scientific community is
unable to govern itself.
An inadequate data-protection regime
could harm progress in clinical genetics
and other biomedical sciences in Japan formany years. The result could well be thatJapanese scientists and enterprises go

elsewhere — already, Japanese companies
are choosing Singapore and even Mongolia
for new clinical-genomics researchfacilities. The Japan Association of
Bioindustries Executives, a grouprepresenting the chief executives of Japan’smajor biotechnology companies, has justreleased a statement (www.jba.or.jp/jabex)
urging the government to strengthen
genetic privacy protection.
We believe that large databases
containing both genetic and medical
information are inevitable for the future ofbiomedical research. But without adequate
data protection or public trust, suchdatabases are unlikely to be set up in Japan.
For biomedical research to progress inJapan we, as members of its scientific andmedical community, believe it is time forJapanese scientists to engage in aconstructive public debate on this issue.

Collaboration can work if
inequality is recognized

important is to use scientific interactions
creatively, to promote true reconciliation.

Sir — Your News report “Sciencecollaboration stymied by relentless Middle
East conflict” (Nature 417, 209–210; 2002)
mentioned my support for Palestinian–
Israeli cooperation. I would like to expand
on my views. The Palestinian–Israeli
conflict is neither a scientific issue nor apersonal conflict but a struggle between
two peoples over the same land. Therefore
neither scientific collaboration in itself
nor the personal relationships developed
therein can advance the cause of peace
unless conflict-related issues are also
addressed and resolved.
Israelis have a strong army, resources,
freedom and control over the land;
Palestinians have none of these. One is
occupier and the other is occupied. Thisinequality underlies any interaction
between Palestinians and Israelis, including
scientific cooperation, and should be theframework for any constructive dialogue.
Unfortunately, this imbalance is often
replicated in the collaboration and becomesa cause of frustration and disengagementon the part of the Palestinian partner.
It requires courage and commitment towiden the partnership beyond the realmof science, to rise above the current
polarization and high emotional pitch in
our respective societies, to place universal
humanitarian values above nationalism andto take a clear stand for justice and peace. Yet
it is possible, as demonstrated by individual
academics as well as organizations such as
Médicins sans Frontières, Physicians for
Human Rights and the Alliance of Middle
Eastern Scientists and Physicians. An
example of such a stand is a recent
statement by 300 Israeli faculty members,
which can be seen at www.seruv.org.il/
UniversitySupportEng.asp.
The international scientific community
should become more actively engaged.
Foreign collaborators and funding agencies
can request a commitment to basic humanrights and equality, and to the principle ofequal academic freedom and access to
education for Palestinians and Israelis.
Israeli scientists and institutions should
express solidarity with Palestinian universities under siege and use their politicalclout to assist them. All partners should
insist on a return to negotiations based on
UN resolutions and international law.
A boycott of Israeli science would be
relatively easy but, in the long run, counterproductive. Much more challenging and

NATURE | VOL 417 | 13 JUNE 2002 | www.nature.com/nature© 2002 Nature Publishing Group

Eitaka Tsuboi
President, Japan Medical Association, World
Medical Association, 28-16, Honkomagome
2-chome, Bunkyo-ku, Tokyo 113-8621, Japan
Other signatories to this letter:
Norie Kawahara (freelance journalist)
Tadahiro Mitsuishi (attorney-at-law)
Akira Oshima President, Japan Association of Cancer Registries
Shohei Yonemoto Director, Center of Life Science and Society

Yehuda Tzfati
Alliance of Middle Eastern Scientists and Physiciansand Department of Genetics, The Hebrew
University of Jerusalem, Jerusalem 91904, Israel

Scientific links support
an unjust peace process
Sir — Cooperation between Israeli andPalestinian academics since the 1993 Oslopeace agreement (see Nature 417, 209–210;
2002) has been primarily donor-led —that is, imposed or strongly encouraged via
the carrot of money in a money-starved
environment, with the underlying
assumption that such cooperation would
assist the peace process.
This push for “Israeli–Palestinianscientific cooperation”, as if science weredivorced from society, was regarded bymany Palestinian academics as suspect.
Most Palestinians opposed a basicallyunjust and non-sustainable peace process,as recent events in the area clearly confirm.
Palestinian academics have been paying
the very heavy price of occupation formany years, both personally and in the689

Document 1
On dispatch as expert adviser in Thailand
Eitaka Tsuboi
Director, Tsuboi Cancer Center Hospital
Former President of World Medical Association

In 1968, at the request of the government of Thailand I traveled to Thailand as part of aJapanese expert team, for the establishment of the National Cancer Institute (NCI) of
Thailand. The NCI in those days was on a small scale with only a clinical test laboratory
and x-ray room being completed, among other minor facilities. Japan had provided theNCI with an x-ray television fluoroscope and a wide range of equipment for clinicaltesting, and in December of 1968 the King of Thailand visited the center to formallyreceive the equipment on behalf of the Thai government from the Japanese government.
The King of Thailand attended the ceremony and the representative of Japan on thisoccasion was then President of the National Cancer Center (NCC) of Japan, Professor
Masaru Kuru. The King of Thailand expressed his gratitude to the Japanese government
for its cooperation in the establishment of the NCI. At that ceremony various displays
were provided concerning new cancer examination methods being implemented at the
NCC, including the peripheral tumor scrape method I have developed for the early
diagnosis of lung cancer, and President Kuru provided an explanation to the King about
these displays. At this point it was possible for experts dispatched from Japan to provide
specific education concerning diagnosis techniques and examination methods and theNCI began to gradually grow and develop as a result. Thai doctors from various
departments who had undergone study and training programs at the NCC also returned
to Thailand at this time together with the Japanese expert team and with these doctors
working as our counterparts we were able to implement operations smoothly at the NCI.
As the work of the NCC expert team that had been dispatched to Thailand at the time ofthe opening of the NCI gradually began to bring forth results, the original team returned
to Japan from the National Cancer Center of Japan to be replaced by a new team.
The Ministry of Health White Paper of 1969 notes the following:
In May 1968 a survey team was dispatched from the National Cancer Center of Japan toThailand for the establishment of the National Cancer Institute of Thailand. In
November of the same year an expert team of seven persons was dispatched together
with the provision of diagnosis equipment. On December 5, an opening ceremony for
the NCI was held in the presence of the King of Thailand. In addition a further eight
experts have been dispatched and are providing technical guidance and working toenhance the content of work at the NCI.

Document 2
Research into temporary prevention of lung cancer
With particular emphasis on the production of anti-smoking pamphlets targeting juniorhigh school students and evaluation of their educational effectPreventing young people taking up smoking as a primary prevention method to halt theincrease in lung cancer is thought to be both realistic and effective. The “Research intoPrimary Prevention of Lung Cancer” implemented based on this concept is introduced
in an anti-smoking pamphlet that was produced with the aim of providing anti-smoking
education to junior high school students on a national scale as a form of awarenessraising education.

Calling upon the wisdom of Asia and sending it to the world
Yoshiki 'Paul' Otake
Founder, Executive Advisor,
Aflac JapanI am delighted that the fifth Asia Cancer Forum will be held here in Japan. I wish to
express my thanks for the hard work of all those people actively involved in the frontline of cancer treatment throughout Asia. I would have liked to participate in the forum
and discuss the issues with everyone but unfortunately I am unable to attend. I hope thatyour proposals and lively discussions make for a very successful forum.
The hope and the mission of Norie Kawahara, founder of the Asia Cancer
Forum, was the controlling of cancer patient numbers in the Asia region where asignificant increase is expected to be seen in the coming years. It was her passion thatsees us now already holding our fifth forum since the first one in June of last year.
As the first person in Japan to introduce cancer insurance, I wanted to be ofsome assistance to the forum and therefore I am sending this message to you.
Aflac was founded in Japan 35 years ago with the idea of saving cancer patients andtheir family from financial disaster. Since 1981, cancer has been the main cause of deathin Japan and in 2004 accounted for a total of 320,000 out of 1,029,000 deaths.
Approximately one in three people dies of cancer. It is expected that, by 2015, one in
two people will die of cancer and that the 3,000,000 existing cancer patients will
increase rapidly to 5,400,000, referred to as “the 2015 issues” for cancer.
Even developed countries such as Japan are currently struggling with this mostserious issue of cancer. The Basic Plan to Promote Cancer Control Programs wasapproved by Cabinet in 2007 by way of addressing the issue, and a 20% reduction ofcancer deaths by 2016 has become a national objective.
Aflac Japan will lend their support to the fight against cancer and the education
program conducted by the government and local public organizations based on the plan
as a community service of the highest priority. It has been my wish since I set up Aflac
Japan and I am truly delighted that it has finally become a reality.
The area in which Japan can take the lead for all Asian countries is that of disseminationof accurate information about cancer, its treatment, prevention and diagnosis. Looking
back over the kinds of approaches that Japan with its Basic Plan to Promote Cancer
Control Programs has taken thus far, ideas to address the mismatch of policy on the one
hand and the day-to-day issues for medical care workers, facilities, technology andpatients on the other will connect us to better cancer treatment and better control ofcancer.
I am truly delighted to give my support using the knowledge, information andworldwide network I have gained through managing a cancer insurance company andfrom the personal experience of being a cancer patient, in order to make the fightagainst cancer a global issue. I am certain this forum will prove to be a very fruitfulexperience and I look forward to its findings being used in future contributions to
medical treatment in Japan.
I thank you for your guidance and encouragement for the development of thisforum in the future.
I hope we all continue to work together to call upon the wisdom of Japan andof Asia with our proposals and information, to lead the world in the fight against cancer.
My wish is to save even one person but preferably many people from the tragedy that iscancer.

Yoshiki P. Otake
Founder & Executive Advisor
Aflac Japan