Funding for research in hepatology
Authors: Masao Omata
Journal: Hepatology (2004)

Japan has a general population of 120 million distributed among four islands with a total area similar to that of California. The number of annual deaths just exceeded 1 million per year, and liver disease–related deaths accounted for 5% (50,000) of this group. Health and Welfare statistics in 2001 reported that 34,311 people died of primary neoplastic diseases of the liver, almost a 5-fold increase in the last 25 years. The statistics in 2001 also reported that the number of people dying of causes other than neoplastic diseases, including cirrhosis and fulminant hepatic failure, was 15,848; this figure was basically unchanged or slightly decreased in the last 25 years. The number of deaths due to primary neoplasm in the liver exceeded that of nonneoplastic liver diseases approximately 15 years ago. The reason for this increase is explained by hepatocellular carcinoma's arising from hepatitis C virus infection. Currently, 80% of hepatocellular carcinoma is the result of hepatitis C virus infection, and only 10% is due to hepatitis B virus infection. Approximately 40% of those who had C-viral hepatocellular carcinoma had a history of blood transfusion, often in the 1950s and 1960s. These are some unique features of liver diseases in Japan. A mandate exists to increase the effort to reduce the prevalence of disease, C-viral hepatocellular carcinoma in particular. There are two major resources of funding for research. One is the Ministry of Health, Labour and Welfare, and the other is the Ministry of Education, Culture, Sports, Science and Technology. The Ministry of Health, Labour and Welfare has supported a collaborative group designated as "The Study for Intractable Liver Disease" since 1978. It had been the major study group in Japan for a long time. The main topic for this group had been the study of hepatitis A, B, and non-A non-B, but recently the focus has switched to autoimmune liver diseases and fulminant hepatic failure. The funding for this group has been in the range of $300,000 to $600,000 (U.S. dollars) a year. During the last five years, the Organization for Pharmaceutical Safety and Research, affiliated with the Ministry, has supplied grants of similar amounts for several study groups involved in basic studies of hepatitis viruses. In 2001, the Ministry embarked upon a new hepatitis and hepatocellular carcinoma project, called "Immediate Action Program for Hepatitis and Related Disorders." The total budget of this initiative was $58 million (6.4 billion yen) in fiscal year 2003. Of this amount, $6.7 million (740 million yen) was allocated to clinical and basic research for hepatitis B, C, and E, cirrhosis, and hepatocellular carcinoma, including 24 study groups. The remaining $51.3 million (5.6 billion yen) was for nationwide screening of hepatitis B and C in the general population and for education. This initiative included the screening of healthy individuals for presence of hepatitis B and C viruses. People older than 60 can have the test for the hepatitis viruses at no cost. Through this initiative we should be able to detect asymptomatic healthy individuals who carry the viruses. It is estimated that 1.5 million to 2 million people are carriers. The total budget of the Ministry for biomedical research grants in 2003 was approximately $1,110 million (122 billion yen). Therefore, 5.2% of the Ministry's biomedical science grant was allocated to screening, and basic and clinical research in hepatitis viruses. The total budget of the Ministry of Education, Culture, Sports, Science and Technology for biomedical research in 2003 was $1,600 million (176 billion yen). However, the application for the grants from this Ministry is basically on an individual basis. It supports 31,000 projects. So it is somewhat difficult to estimate how much money is being spent on research for liver diseases. Overall, funding for virus-related liver disease research and education in Japan is still much smaller than that of the National Institutes of Health ($378 million in fiscal year of 2003). Japan has a very good public insurance coverage of medical expenses for liver transplantation, including C-viral transplantation. We believe that this fact, combined with medical-technical expertise, contributes to the long life expectancy in Japan (78 years for men, 85 years for women). Regarding the virus-related, C-viral disease, in particular, we might have experienced the onset of the epidemic 10 to 20 years earlier than did the United States and other western countries. At this time, we experience the increase of liver disease seen throughout the world: diseases related to metabolic disorders.