articles from Japan follow the recommendations of the excellent article by Gordon H. Guyatt et al. in that they use opinions and scientific measures for quality of life along with scientific opinions of morbidity and mortality.
I, and many physicians, would rather discuss values of therapy in the old manner of patient benefit and patient risk ratios rather than the new cost benefit ratios of managed care, but it is the quality benefit ratio that we all wish for our patients. Many disease states from various forms of cancer, cardiovascular disorders, surgical techniques, arthritis, endocrine disorders such as diabetes, neurological disorders such as seizures, asthma, infections--especially HIV, behavioral problems, and other areas are undergoing quality of life investigations. Each study is expected to help improve patient care and quality of life for the patient of today and the future.
Naoko T. Mijaji has reported how Japan has closely monitored the role of women, especially in the context of motherhood. Care of the nation's children has been exceptional and world recognition has been achieved and deserved. Women are especially respected for their role in childbearing and child care, but attention is needed in the negative social role of being a working mother or being childless. Marriages are now occurring later in life with fewer children. The impact of this lower fertility rate on the future needs of Japan's children and the aged is important. The current rate in fertility will not support the increasing numbers of the aged of the 21 st century.
An interesting article by Robert Levine in 1992 discusses the difference in how quality of life is perceived in the cultures of Japan and the United States; and Levine simply states that although the Japanese are financially more progressive than Americans, the Americans are more satisfied in quality of life issues such as sex, age and perception of brighter futures expected by the year 2,000. He stated that Japan has a higher cost
