"Castration", the HIV Scandal

and the Japanese Bureaucracy

MASAO MIYAMOTO, M.D.

PAPER PRESENTED AT

MASSACHUSETTS INSTITUTE OF TECHNOLOGY

APRIL 10TH, 1996

Cambridge Massachusetts

[From the Annals of Anthro Culture: http://www.nancho.net/anthcult/castrhiv.html]

Bracketed notes by WilliamBanzai7

Good evening ladies and gentlemen.

I am delighted to be able to speak about the Japanese bureaucracy and the system
of Japan here at MIT tonight. I find that Japan, the bureaucracy in particular,
faces many problems. One could say that Japan's protectionism, led by the
bureaucrats, leads to trade disputes with other industrialized nations. Furthermore,
this protectionism does not benefit the Japanese people. If both Japanese and
Americans recognize the grave problems of the Japanese system, it would mean
further pressure on the system from both within and without, leading to a greater
insistence on deregulation and downsizing. This change in Japanese society will
not only benefit the Japanese, but will also benefit Americans as well as the world
economy.

In tonight's speech I will focus on the HIV scandal and the goal of the Japanese
educational system, which I hope will shed some light on the bureaucracy and its
protectionism.

I feel some nostalgia for the Boston/Cambridge area as 22 years ago, when I first
arrived in America, I lived in Waterbury, Connecticut. Since this town was so small,
on weekends I often drove to the Boston area. I distinctly remember the wonderful
taste of the seafood in Boston. In Waterbury I started my residency in internal
medicine at a hospital that was affiliated with Yale Medical School. Although
Waterbury was a small town, everything to me was new so I had to struggle with a
now environment. But I have a strong lingering impression that people were eager
to help me become familiar with the community.

After living in America for over 10 years, I went back to Japan and joined the
Ministry of Health and Welfare. 10 years is along time and this caused me a certain
uneasiness since a lot had changed in the intervening period. What perplexed me
was the attitude of my colleagues who expected me to know all of the changes
that had taken place. Instead of trying to help me become familiar with what was
essentially a now environment, I was baptized by bullying or "ijime".

When you compare my first year in America with the first year after I returned to
Japan, I am convinced that coming back to Japan was far more stressful. Since I
am Japanese it should have been easier, but this was not the case.

[WB7: This is a very well known social phenomena in Japan, the stigma of those
who return home. You are treated as a nail that has to be hammered down.]

Americans were kind to me, but upon returning to Japan I found that bringing back
foreign ways, for example, clarity in speech or an individual style of dress, was
rejected. Many Japanese who have been abroad try to erase any acquired foreign
habits because of their fear of ostracism through "ijime". I resisted this pressure to
conform.

In fact, I more or less preferred to be isolated from my colleagues, because by

being ostracized I no longer had to dine or sing together with them at a karaoke
bar, which meant my evenings were my own, to spend as I wanted. However, I
was not happy with the way the Japanese bureaucracy functioned, and this is
why I wrote a book called "Straitjacket Society," which is a clinical analysis of the
psychology of the Japanese bureaucracy and society.

[WB7: The English version of the book is out of print but was a best seller in Japan
and is considered a must read for those who want to understand the iron triangle of
business, politics and beureacrats. It is available used on Amazon.]

I have no regrets about writing this book. In fact, through writing this book my world
has expanded. For me to give a speech in front of you today is a good example.
Being able to give speeches about the bureaucracy reminds me of the opening
remarks of a famous cardiology professor whose lecture I went to hear when I lived
in Waterbury. He said to the audience, "I am very happy to talk to you about heart
disease. Since Americans have become very concerned about heart disease, I
receive more and more requests to speak. Not only physicians, but other health
professionals, and even the man on the street are interested in what I have to say.
But if I were a specialist in a rare disease with only 10 cases in the world, I do not
think I would have an opportunity to speak to you today, nor would many people
come to hear me speak. But since I chose such an ordinary subject, I have been
asked to lecture around the world. The choice of field can certainly expand one's
world.

I could not agree with him more. If I were a researcher on snails, I do not think I
would have been invited to speak to you today. But the Japanese bureaucracy is
like a snail. It seems to me that people around the world wonder why the pace of
change is so slow, and how Japan's economy became so successful. I think I can
provide a partial answer to this question in today's speech.

The bureaucracy is proud of having a history of over 1,000 years, and in the last
400 years this bureaucratic system has become so entrenched in society that it
may take far longer than 20 years to downsize the system if they continue at the
same pace. What this means is that I will continue to have the opportunity to speak
about the bureaucracy.

As many of you may be aware, over the last four months the Ministry of Health and
Welfare has come under fire over the scandal of HIV-tainted blood being used to
treat hemophiliacs. Because of their negligence, 400 people have already died and
over 3,000 people have been infected with the HIV-virus. On March 29 the ministry
acknowledged their negligence and agreed to pay compensation to the victims.
This is a positive first step in investigating this tragedy. For those of you not aware
of the background of this scandal, let me give you a brief summary.

[WB7: Sadly Dr Miyamoto passed away in 1999. But his message has reached its
critical moment in Fukushima.]

In March of 1983 the Centers for Disease Control in Atlanta issued a warning in
the U.S. that blood products might be tainted with the HIV virus. Soon afterwards
the F.D.A. approved the use of heated blood products. As a matter of course, this
information would have been reported to the Ministry of Health and Welfare by the
Japanese embassy in Washington, D.C.
In June Travenol Japan (the former name of Baxter Ltd.) sent a report to the
Ministry of Health and Welfare (MHW) that Travenol America, because of findings
connecting unheated blood products to HIV, had recalled their products in America.
In the same month, the Ministry of Health and Welfare established an AIDS study
group headed by Dr. Abe, an expert on hemophilia. The file containing notes of a
conference hold on July 4, long thought to be non-existent, magically appeared
at the ministry in February 1996, after Mr. Kan, the new minister of Health and
Welfare, appointed an in-house investigative body to look into HIV-related issues.

[WB7: yes that is the same kan who is the current PM.]

This file revealed three important facts.

● One: imports of heated blood products were urgently being considered.
● Two: unheated blood products of non-American origin would continue to be
imported.
● Three: the use of heated blood products from America would cause some
damage to Japanese pharmaceutical companies, but this should be ignored.

In essence, the MHW was aware and had adequately grasped the danger
surrounding AIDS. However, a week after the conference on July 4, the AIDS
study group held another conference and decided that imported heated blood
products would be subject to lengthy clinical trials, and unheated blood products
from America would not be banned.

What this means is that there was a 180 degree change in their assessment.

In the latter part of July 1983 one of Dr. Abe's hemophiliac patients died of an
AIDS-like disease. He consulted on this case with two physicians from the CDC,
and they both diagnosed the cause of death as AIDS, but this was not recorded as
the first AIDS death in Japan.

In February 1984 clinical testing of heated blood products began in Japan.

In March, a subcommittee of the AIDS study group recommended the use of
heated blood products and the AIDS study group was dissolved, with no sense of
impending crisis.

In September 1984 Dr. Abe confirmed that 23 of his 48 patients with hemophilia
had been infected with HIV, but this information was not made public. In December
1984 the ministry confirmed that 47 out of 183 hemophiliacs tested positive for
HIV.

Again this was not made public. In March 1985 the ministry identified a male
homosexual, who was living in the U.S. and had returned to Japan temporarily, as
the first AIDS patient in Japan.

Given this chronology, for the ministry to reveal that the first AIDS patient in Japan
was a homosexual living in America seems to be an attempt to manipulate the
public into believing that AIDS is a disease prominent outside of Japan, that Japan
is immune to HIV.

Behind this manipulation is the protectionism of the Japanese pharmaceutical

industry, namely to give Green Cross, the largest Japanese maker of blood
products, sufficient time to develop heated blood products so that the Japanese
market would not be inundated with imported blood from America.

In July 1985 the ministry approved the sale of heated blood products. However,
despite knowing that unheated blood products could lead to the spread of HIV,
they did not order companies to recall unheated blood products.

In May 1989 HIV infected hemophiliacs filed a lawsuit against the government and
pharmaceutical companies. During this lawsuit the ministry has maintained that
they could find none of the files of the AIDS study group.

[WB7: Hmm, I over the weekend that they couldn’t find the TEPCO presentation
on Tsunami preparedness. Sound familiar?]

In October 1995 the court proposed a compromise settlement, which indicated

that the government was at fault. In January 1996 Green Cross was found to have
continued selling unheated blood products until 1988, after heated blood products
were approved in 1985. This sale of unheated blood products affected not only
hemophiliacs, but people who underwent surgery and were treated with these
products to stop bleeding.

In January 1996 Mr. Kan was appointed Minister of Health and Welfare and
he formed an in-house investigation team. On February 9, 1996 nine files of
documents related to the HIV case, long claimed to be non-existent, were found.

[WB7: Well, at least Mr Kan knows about dredging through the muck to get to the
truth. One can only hope he retains that ability.]
This is when the HIV scandal started to cause an uproar. On March 29, 1996 a
compromise settlement was signed by both sides. On April 3 the vice-minister
informed Mr. Kan that seven more files had been found. The files had been found
in January, but were only disclosed after the settlement. So far only two of the
seven files have been made public. These two files make it very clear that the
ministry had been collecting information from around the world related to HIV-
tainted blood products and AIDS, and were therefore certainly aware of the
dangers. These files make clear that Dr. Abe, the head of the AIDS study group,
manipulated the time frame so that Japanese and American pharmaceutical
companies finished their clinical trials at the same time. This meant that approval
was granted at the same time. If the clinical trial period had not been manipulated,
since American pharmaceutical companies had a head start, early approval
for American companies would have been inevitable, which meant that they
could overwhelm the Japanese market with their heated blood products. Dr.
Abe's manipulation of the clinical trial period suggests that he wanted to protect
Japanese pharmaceutical companies so that they could enter the market at the
same time.

[WB7: Ok readers, here is where the golden nuggets start.]

After going over this information, I have come to see ten problems with the MHW's
bureaucratic structure.

1. The harmony of the ministry or the group is more important than reality.
[WB7: This explains why you are not seeing the Ministries hammer TEPCO
publicly]
2. The major task of the ministry or the bureaucracy is the protection of
industry, not the protection of people. [WB7: No need to panic folks.]
3. The concept of continuity, which is an important dogma within the
bureaucracy, clashes with crisis management. [WB7: Which explains the
apparent lack thereof despite the best efforts of the PM.]
4. The seniority system minimizes criticism of one's superiors, obscuring the
existence of problems. [WB7: Paging President Shimizu]
5. No leadership is exercised in the decision-making process, and the people
are made to pay for the bureaucrats' mistakes. [WB7: Are you scared yet?]
6. The system of "amakudari" (bureaucrats joining related industries in
their field upon retirement) fosters the status quo and maintains the pre-
existing regulations. In other words 'amakudari' functions as a watchdog for
regulations. [WB7: Government Sachs Japanese style]
 7. The lack of a Freedom of Information Act in Japan. [WB7: I am not certain if
this is still the case. Have to check]
8. Individual rights are not respected. [WB7: This is the well known stereotype
of the Japanese sheeple.]
9. Clinical trials for new drugs are a form of non-tariff trade barrier. [WB7: Not
particularly germaine to the Fukushima situation, or is it?]
10. Japanese are very special. [WB7: The Japanese way or the highway.]

I think these problems are a condensation of the Japanese bureaucracy, and they
are all interrelated.

In today's presentation I would like to connect the HIV scandal with the social
psychology of Japanese society.

[WB7: Social Psychology of the Japanese Society. Pay close attention ZH readers,
he hits it right on the head.]

When I entered the ministry I recognized that in Japan individuals should not
assert their rights. The rights of the individual are acknowledged by the group.
Even if these rights are acknowledged, you are not supposed to exercise them in
front of the group.

[WB7: Group think obviously stifles crisis management.]

The system of Japan is special in the sense that once you belong to the
bureaucracy, you have to embrace the myth that the system is immortal. In order
to. maintain this myth, it becomes important that everyone believes the group is
perfect.

Furthermore, the concept of tradition has been reinforced, however, tradition

itself is not a problem. The problem arises when tradition equals the status quo.
Many bureaucrats think that the Japanese bureaucracy has reached the level of
perfection, to the point that the bureaucracy could be called a Japanese tradition.

Therefore, major change does not have to take place.

[WB7: This all explains the resistance to changing and modernizing the regulatory
requirements.]

There is another dogma of the Japanese bureaucracy which is continuity. Upon

entering the ministry I was told by many of my superiors that continuity is the most
important concept for the bureaucrats. Why is continuity so important? It prevents
significant change and values the status quo, . Given these values, the Japanese
bureaucracy as an organization has been built in such a way that it becomes
almost impossible to restructure.

The status quo in the Japanese bureaucracy is labeled as precedence and one
should always respect precedents that have been set.

In the case of the HIV scandal, in 1983 some officials of the ministry thought that it
might be important to change the policy and import heated blood products in order
to prevent the spread of the AIDS among hemophiliacs, but there was opposition
to this because it would establish a precedent of approving drugs for sale without
clinical testing.

The concept of precedence is more important that human life.

[WB7: My emphasis. Read that again.]

In Japan, in order to market a new drug, regardless of the country of origin, it is

mandatory that the drug undergo clinical trials in Japan as a regulatory measure.
In the case of heated blood products, the ministry could have used its power to
wave clinical testing and call for emergency imports.

When precedence becomes a tradition, it overrides any emergency.

[WB7: Again, my emphasis.]

From 1987, 1 worked at the Defense Agency for two years, and I was in charge of
the health problems of the entire Japanese army. At one conference I emphasized
that the HIV virus could be a big problem and that the armed forces should be
aware of its dangers.

The then air force colonel, who was also a physician, said to me, "Dr. Miyamoto,
is what you said the opinion of the Ministry of Health and Welfare, or is it your own
personal opinion?'

I answered, 'it is my own opinion.'

His response was, 'As a bureaucrat, the most important thing is continuity. What
you're saying is that once you become infected with HIV there is no treatment,
and since the mortality rate is extremely high, extra precautions should be taken.
It is my understanding that AIDS is a disease limited to homosexuals. Since the
Ministry of Health and Welfare's opinion is 180 degrees different from yours, your
statement will only provoke anxiety among armed services personnel.'

[WB7: Notice the “avoidance of anxiety as a justification for marginalizing the

truth.]

He further said, "As a bureaucrat, one should not make a drastic change in
approach, because of the importance of continuity, which you may not be aware
of since you only recently returned from America. If you want to make a drastic
change you must have an order given from the MHW." I was shocked to hear his
remarks because in my mind people in the armed forces should be trained to
deal with crisis.

[WB7: My emphasis added.]

As you may recognize by now, the concept of continuity and the placing of
importance on precedent have severe implications for crisis management.

AIDS is a big problem for all countries. When it first became recognized as a
problem, it should have been a matter of crisis management, but the lack of a
crisis management mentality in the Japanese bureaucracy is revealed in the
decisions made by the MHW in 1983.

[WB7: Now he looks at inculcation by the Japanese educational system you

always hear about.]

In order to maintain the status quo, you have to educate people, and this is where
today's title of "castration" comes into play. The Japanese bureaucracy wants the
people to be as obedient as sheep. Not to complain. Not to challenge the system.
Not to resist their superiors.

[WB7: This is a siginificant factor in the public stoicism which you are seeing. But
that is also affected by cultural mores.]

For individuals to enslave themselves to the system. If one is educated to

embrace these values, then Japan as a system can maintain harmony. From the
bureaucrats' point of view, from the point of view of those who control Japan Inc.,
this is ideal.

However, in order to imprint these values, you need a special technique, which is
to halt the growth of identity integration.

Identity integration are words used in psychoanalysis. In general terms let me

explain what they mean. Identity integration means that you will be able to
develop the capacity to distance yourself from the parental figure and become
independent. You could say that identity integration is similar to the concept
of independency. To have your identity integrated means that you become an
independent individual. All of us live in the worlds of both fantasy and reality,
but most of us are able to make a distinction between the two. What identity
integration does is to place a clear boundary between these two worlds. If
these boundaries are clear one has the capacity to control one's impulses,
and at the same time to deal with stranger and separation anxiety. Therefore,
identity integration is a sine qua non to function without difficulty in everyday life,
particularly when yes and no are clearly stated.

Just as a child matures to become an adult, identity integration follows a similar

path.

What the Japanese bureaucracy's educational goal does to people is to halt

identity integration at the level of adolescence, a period when people still need
some dependency. This is why I say that the goal of Japanese education is
psychological castration. Unfortunately the bureaucrats are also puppets of
the bureaucracy, and their identity integration is the same as other people's.
Therefore, they do not know that they hinder identity integration.

How did this sophisticated way of controlling people enter into the educational
goals of the bureaucracy? The responsibility goes back to the Edo or Tokugawa
government that Initiated this approach. Perhaps Japanese bureaucrats got a hint
from bonsai, the Japanese art of stunting the growth of trees, because in Japan
creative ability and innovation have been trimmed. Bonsai can be viewed as a
form of "castration".

[WB7: I love this Bonsai analogy!]

The HIV scandal arose within these dynamics of Japan as a system, and
because of the Japanese educational goal. As you are aware, my specialty is
psychoanalysis. When I was going through my residency I learned the technique
of the psychoanalytic diagnostic interview. What this interview technique does is to
confront the contradictions the patient presents. By engaging in this technique, one
can come up with quite an accurate diagnosis.

Thanks to learning this technique, I was able to apply it to the HIV scandal and
thoroughly understand the issues.

When I went over all the documents and comments released by the MHW I found
a contradiction. On one hand, what the MHW emphasizes is that what is most
important is the safety of the people. But on the other hand, according to the file of
July 1983, the MHW was well aware that unheated blood products stood a good
chance of being contaminated by HIV. If you go along with the MHW's official
stance, it would not be surprising if there was an immediate ban on imports of
unheated blood products and they ordered the emergency import of heated blood
products.

But instead the MHW reversed its original decision and decided against
emergency imports of heated blood products from the U.S. and a ban on unheated
blood products. The ministry decided to go through the regular procedure of
clinical trials, which takes a long time. This allowed Japanese pharmaceutical
companies to develop and market their own heated blood products, keeping
American products out of the Japanese market. I should emphasize that it was
only in 1985 that the ministry approved heated blood products, and that they did
not order the recall of unheated blood products tainted by HIV until 1988.

What this contradiction means is that the bureaucracy is not concerned about
the safety of the people. What are they concerned about? The evidence clearly
indicates that the MHW is concerned about protecting the pharmaceutical industry.

[WB7: OK, there is is. Start looking for inexplicable contradictions about safety
and radiation exposure. About the level of radio active contamination and the
proposed actions. etc.]

Let's go back to the clinical testing, which I view as a form of trade barrier. This
barrier sheds light on the bureaucrats' view that the Japanese are special. In order
to market drugs in Japan, even drugs developed in America and approved by the
F.D.A., you have to undergo years of clinical trials. By comparing the quality of
medical care and research, there is no doubt that the U.S. is superior, so there is
no reason for clinical trials.
But the MHW officials explain the importance of doing clinical testing in Japan
(which can be almost exactly the same procedure) by saying, "The Japanese are
different, therefore new drugs have to undergo our own testing." But MHW officials
seem to have forgotten that America is a multi-racial society. This is why I say
clinical testing is a hidden trade barrier.

What is hidden behind the word "specialness' is the protection of the

pharmaceutical industry.

[WB7: This may explain resistance to following external parameters of safety in

design and operation.]

This mentality of "Japanese as special' was vividly witnessed after the earthquake
in Kobe last year. Five physicians from the U.S. came to Japan for emergency
assistance, -but they were told by the MHW that they could not treat the victims
because they were not licensed to practice in Japan. In addition, after the
earthquake Americare donated a large amount of Tylenol, but the MHW said that
the pain-killing effect of Tylenol was too strong for the Japanese. Again, because
of the distorted mentality of the Japanese bureaucracy, the Tylenol was rejected
and people had to suffer.

The bureaucracy's mentality that the Japanese are special is not confined to the
MHW. In 1987, when there was pressure from the American government to open
the Japanese beef market, a group of American politicians invited their Japanese
counterparts to a luncheon of American beef. At that luncheon, Mr. Hata, a former
prime minister and head of the delegation representing the Ministry of Agriculture,
stated that it would be difficult to increase the consumption of beef in Japan
because of Buddhist restrictions and because Japanese intestines are longer.

Senator Phil Gramm of Texas [WB7: Senator Derivative Hustler] said that opening
the market would prove whether long intestines or Buddhist teaching were
preventing increased consumption of beef. Japan has since opened its market for
beef, and consumption has quadrupled. Mr. Hata is also known for his statement
saying that because snow is different in Japan, foreign skis have to be restricted.
The reasoning behind these restrictions on medical qualifications, Tylenol, beef
and snow are so unscientific as to be laughable.

The most important task of the Japanese bureaucracy is to maintain the system,
and specialness is a way to accomplish this.
The bureaucrats' thinking that the Japanese are special has been transferred to an
educational goal. What specialness does is to create psychological barriers, which
makes it difficult to have an independent life, particularly one outside of Japan. The
specialness that the bureaucrats are reinforcing is an illusion, and if you embrace
this illusion it is not easy to develop identity integration. In order to mature identity
integration, it is essential to develop the strength to face reality, and this strength
will allow the maturation of identity integration. In other words, to embrace the
illusion of of specialness will stunt the growth of identity integration. In essence
one will be castrated. The educational system has castrated most Japanese, and
as a result they feel insecure and try to seek protection. To keep people feeling
insecure is a wonderful way for the Japanese bureaucracy to maintain its power.

Psychological castration transformed into daily life means that people do not
express frustration, resign from their desires, avoid confrontation in human
interchange and continue to be dependent on the bureaucracy.

[WB7: Now do you understand passive public behaviori n Japan?]

Now let's return to the AIDS scandal and the issue of 'amakudari'. That Japanese
bureaucrats view themselves as special is clear from the meaning of the
word, 'amakudari," which means "descent from heaven". They are clearly in a
heavenly world because they do not have to take responsibility, and upon retiring
from the ministry, through "amakudari," they are guaranteed a large income
without much work.

[WB7: God’s work Lloyd ;-)]

Green Cross, a pharmaceutical company known for its blood products, has
suffered heavy criticism for having continued to sell unheated blood products
until 1988, which caused the widespread dissemination of the AIDS virus among
hemophiliacs. Many bureaucrats from the MHW went to this company upon
retirement from the ministry as "amakudari'. For example, the president of this
company was a former director general of Pharmaceutical Affairs.

Why does industry accept these bureaucrats? This is because if the company
makes a mistake they expect the ex-bureaucrats to take care of the problem.

[WB7: Or as in the US ithe ex-company people go to the Ministry, right Hank?]

Japanese business is unlike American business in that it functions through
narcissistic identification" not rational decision-making. Narcissistic identification
means that group members have to hold the feeling that they are all the same.
Given that ex-bureaucrats are working together with younger bureaucrats in the
ministry creates the necessary narcissistic feeling of unitedness. The seniority
system forces you to develop narcissistic identification.

Having these relationships, if the company has a problem, particularly trouble with
the bureaucracy, if the ex-bureaucrats -bow and say to their younger colleagues
in the ministry, 'Please take care of it,' the bureaucrats will comply because they
are taught not to destroy their narcissistic identification. In Japan narcissistic
identification is called harmony, and it is the strongest code of the group.

In the case of Green Cross, if the ministry decided that unheated blood products
should be destroyed, and heated blood products should be imported without
clinical trials, the damage caused to Green Cross would be vast. In order to
prevent even the smallest possible damage to your company, since the group
places the utmost importance on perfection, employing former bureaucrats is a
way to take care of any problems that may arise, because of their connections in
different ministries. Since the president of Green Cross is a former director general
of Pharmaceutical Affairs, his influence is quite large and one phone call to his
successor at the ministry would be enough to take care of any problem.

Nobody knows whether this former director general, the president of Green Cross
has made this phone call. There is no proof. However, it was quite clear that
the change in the ministry's direction in July of 1 983 certainly benefited Green
Cross, and at the same time it maintained the harmony of the MHW. Harmony
here means that the organization's size and jurisdiction has not decreased and
that the status quo has been maintained. Everyone was happy, except for the
hemophiliacs who started to fall ill.

In 1989 a group of hemophiliacs initiated a lawsuit against the MHW and five
pharmaceutical companies. In court, the MHW was asked to reveal internal files
of the AIDS study group. The MHW continuously stated that they had no record or
recollection of such files. After seven years of investigation, when Mr. Kan became
the Minister of Health and Welfare in January of 1996, when he formed an in-
house body to investigate this disaster, the missing files suddenly appeared, as
if Mr. Kan waved a magic wand. Ministry officials said they "discovered" the files,
refusing to admit that the files had been hidden. The bureaucrats are trained not to
take responsibility, and the use of the word "discovered" is a typical way that they
avoid taking responsibility.

The question is why did these files remain hidden for seven years, files containing
information on changes in official policy on unheated blood products? At this point
no Japanese believes that these files were 'discovered'. People believe they were
hidden.

This subject is the most important of all those I have mentioned today, and
so different from western society. The Japanese bureaucracy places greater
value on maintaining group harmony than on discovering the truth of the matter
or facing. reality. In fact, in order to maintain group harmony, there is nothing
unethical about lying in Parliament or in court. As I have already pointed out, the
Japanese bureaucracy maintains its cohesiveness or harmony through narcissistic
identification. Anything that disturbs the narcissistic identification or produces a
crack in the mirroring process will be considered bad.

The missing files disclose that the MHW was aware that unheated blood products
were contaminated by HIV. If this information had been disclosed, the ministry
would have had to take responsibility for its negligence. For the ministry to take
responsibility would mean that someone inside the system would have to become
responsible.

The basic principle of the Japanese bureaucracy is that neither the people nor the
system take responsibility. If this kind of tragedy, which is clearly a criminal act, is
revealed, the people involved and the system would both be indicted. , What this
means from a psychoanalytic point of view is that a huge crack would appear in
the mirror of narcissistic identification. In the end, the ministry will not be able to
avoid a change in their internal structure. They will no longer be able to maintain
the status quo or tradition.

[WB7: Well it certainly seems that the elite have managed to engineer this type of
evasion of accountability in the US as well.]

What puzzles me is why such important files were not shredded. I believe many
people in the MHW knew about the existence of these files. Given the contents
of these files, if someone reveals their existence, he would bring himself into the
spotlight. For most bureaucrats, to go up the ladder is the most important goal in
their life. In order to achieve this, to take care of their given duties without making
any blunders is the preferred course of action. If you cause a problem, and you
come under fire, promotion will be closed to you. Therefore, in order to protect
themselves, 'see not, hear not and speak not' is the modus vivendi of the
Japanese bureaucracy.

Given this bureaucratic mentality, ignoring the existence of these internal files is
why they did not go into the shredder. Of course the bureaucrats probably thought
that once they belonged to the bureaucracy, no one would reveal anything to
outsiders, so there was no reason to put the files into the shredder.

The wish not to make any blunders prevails in the bureaucracy, and this
stems from a desire to be blameless and to play it safe. This mentality
echoes throughout Japanese society. This is because of the goal of
Japanese education, which is to castrate people psychologically. In order
not to make any blunders requires that you do not address any problems
that arise and that you close your eyes to them. This means that narcissistic
mirroring will be preserved, which in Japan's collectivistic environment is a form of
self-protection. People who have been psychologically castrated have a tendency
to get hurt easily, therefore they seek self-protection.

One of the major problems with castrating people is that they do not know
what to do when faced with a crisis.

[WB7: All of my emphasis.]

According to the Japanese collective mentality, maintaining harmony is the highest

ethics, and in order to maintain harmony there is nothing wrong with lying or
destroying evidence. But evidence was not destroyed, and this is the result of the
psychological castration that was introduced by the bureaucracy.

What an irony that through their educational goal, the psychological castration of
people, the goal of which is to maintain group harmony, people within the ministry
were not able to make the decisions that would maintain the harmony of the group.
What this means is that the educational goal of psychological castration backfired.
Everyone who goes through this educational process will be strangled.

The question is why did previously missing files at the MHW start to appear after
Mr. Kan became Minister of Health and Welfare in January, and why did previous
ministers not address this issue? To answer the latter part of this question,
politically appointed ministers do not have any control over the system. Castrated,
they are puppets of the bureaucrats, and this reveals their lack of leadership.
To answer the first part of the question one has to recognize that there is a power
struggle within the MHW. Mr. Kan appointed a vice minister to head the in-house
investigative team for-AIDS. The MHW is divided into three major groups: career
bureaucrats, who pass a difficult civil service exam and are guaranteed an elite
career; non-career bureaucrats, who can go only halfway up the ladder, which is
the majority of all bureaucrats; and the physicians' group. There is an on-going
power struggle between these groups.

When I worked at the ministry, I belonged to the physicians' group. Non-

career bureaucrats tend to side with the elite bureaucrats, and there is always
antagonism between these two groups and the physicians' group. The reason
for this antagonism is that the physicians hold medical degrees, and they always
have the option of leaving the ministry and opening a private practice, whereas the
career and non-career bureaucrats can only stay where they are. The physicians'
group has more freedom, and apparently the inability to obtain freedom creates
envy. The career bureaucrats criticize the physicians for what they perceive to be
a lack of loyalty.

The world in which the bureaucrats live is similar to the world of the yakuza,
the Japanese Mafia. The utmost goal of both is to increase their territory,
because increasing their influence leads to promotion. In the case of the
bureaucracy, or the MHW, the bureaucrats search for other people's faults,
and use this to deflate their influence. This behavior may be quite common,
but since the Japanese bureaucracy does not value the merit system, this
behavior becomes particularly effective in maintaining power. If you can get
the other groups' posts to be yours, your territory will increase along with
your vested rights, and it will be considered as a great achievement.

[WB7: Those are amazing observations. Not a very happy situation when the
building is on fire.]

After being dismissed from the ministry last year, I continued to keep in touch
with my friends there. According to them, because the head of the investigating
team, a vice minister, is an elite bureaucrat, most likely the career bureaucrats
tried to use this incident as a way to increase their influence by attacking the
physicians' group. This is why Dr. Gunji, a former director of the biological and
antibiotics division, now the office of blood products management, was the first to
be criticized. Don't misunderstand me. I'm not trying to protect Dr. Gunji. I think he
is responsible for the HIV scandal, but what becomes ironic is that attacking the
physicians' group only spreads the fire to the career bureaucrats.

The more you attack the physicians' group, the question arises as to why the
ministry, knowing the danger of unheated blood products, did not ban their import.
As I mentioned before, after the ministry recognized the danger of contracting HIV
from unheated blood products, heated blood products went on sale in Japan in
1985. Since the ministry had complete authority over the decision, why did they
not ban the sale of unheated blood products at that time? When you look into the
decision-making process of the Japanese bureaucracy, it is not one director who
makes the decisions, but a group of people. Since consensus is the only way to
come up with a decision in the bureaucracy, when there is an important decision to
be made, many people are involved in the final decision. What this means is that
the director general of pharmaceutical affairs was involved in this decision-making
process, and even a vice minister could have been involved as well. Both of these
are not from the physicians' group but are career bureaucrats.

I would now like to focus on the issue of seniority. The seniority system,
predominant throughout Japanese society, prevents people from expressing
themselves freely, just like in the military. This system had a strong influence
on the HIV scandal. I am sure there are many people who are involved in this
scandal, but there are at least four people who became the focus of media
attention. Dr. Gunji, the former director of the biological and antibiotics division, Dr.
Abe, the head of the AIDS study group and dean of Taikyo Medical College, Mr.
Mochinaga, the then director general of Pharmaceutical Affairs and now a member
of Parliament, and Mr. Matsushita, then president of Green Cross and a former-
director general of Pharmaceutical Affairs. His position at Green Cross was the
result of "amakudari'.

When I entered the ministry, the first paper I was given was a list of physicians
with their medical school and their year of graduation. I noticed that many
physicians carried around a miniaturized copy of this list in their agendas, in order
to check the seniority and ranking of other physicians. Within the ministry, twice
a year, graduates from the same medical school got together in order to maintain
and strengthen their cohesiveness and reinforce seniority. Another twice yearly
meeting to reinforce group solidarity brings together graduates from the same year
but different medical schools.

Dr. Gunji and Dr. Abe are both graduates of Tokyo University Medical College, and
Dr. Abe is 20 years senior to Dr. Gunji. So Dr. Abe telling Dr. Gunji that he's an
expert in hemophilia and that he's taking a certain direction, Dr. Gunji, not being
a specialist in the field, would offer no opposition. Dr. Gunji, upon retiring from
the ministry, became a tenured professor at Tokyo University Medical College,
another 'amakudari' position. If he were to have had a major fight with Dr. Abe over
the marketing of heated blood products, it would be questionable whether or not
he would have received the post at Tokyo University Medical College, the most
prestigious medical school in Japan.

In the same vein, Mr. Matsushita was senior to Mr. Mochinaga at the Ministry
of Health and Welfare. Both graduated from Tokyo University and are elite
career bureaucrats. According to a weekly magazine, Dr. Abe and the founder
of Green Cross, Dr. Naito, were good friends. Dr. Abe held great respect for
Dr. Naito, his senior. Dr. Naito was in the Japanese Imperial Army, Dr. Abe
was in the Japanese Imperial Navy, and both were on the career track. Their
military career was another bond or narcissistic identification between them. This
bond is very important because in the pre-war period the military was the most
respected career. Defeat distorted the bond of narcissistic identification, and
helped to strengthen it. So now you can start to see the intricate web of human
ties and the dynamics of the seniority system. Once these dynamics are revealed,
many people will start to wonder to what extent the former director generals are
implicated in this scandal.

Mr. Kan, the present minister, has achieved something that no other minister
in Japanese history has, which is to take a role of leadership. He places
more importance on reality than on group harmony. He has been praised
by almost all Japanese for the actions he has taken in this scandal, but his
reputation suffers among the bureaucrats. Up until now ministers have been
special guests of the bureaucrats, put on a pedestal and ignored, but Mr.
Kan has declined special guest status and asserted his own political point of
view, which has made him their enemy.

[WB7: This is something I have not heard from anyone in the MSM.]

When I speak to my former colleagues, I can sense their underlying hostility. What
Mr. Kan has done is to reveal information to the public. Unfortunately, in Japan
we do not have a Freedom of Information Act. Why don't we have a Freedom of
Information Act? The reason is very simple. The bureaucrats would like to maintain
their power.

One of my superiors said to me after I first joined the ministry, "Do you know why
we bureaucrats have such power over the people and politicians? It is because we
control all information. We determine what information to give out and to whom, in
such a way that it benefits the bureaucracy. Basically what he said is that people
do not have any right to have access to information.

Mr. Tada, the vice minister of the MHW, upon Mr. Kan's request to investigate
the AIDS scandal, commented to the press that, 'The ministry's decision to reveal
information at this time because so many people want to know, is an exception.'
What this means is that if only some people want to know, the ministry would not
reveal any information. Japanese bureaucrats forget that they live at the taxpayers'
expense, but since individual rights are not recognized by the bureaucracy, Mr.
Tada's comment would not arouse any uproar. It turns out that Mr. Tada's remark
is an endorsement of my superior's comment 1 0 years ago.

The proof that the ministry is unwilling to reveal information, and that information is
not for the people, became very clear a week ago when 27 more files connected
to this scandal were found in mid-February, but kept hidden from Mr. Kan. Their
existence was only revealed after the court settlement in late March when the
government agreed to pay damages to HIV-infected hemophiliacs. Mr. Kan was
apparently very angry and he verbally reprimanded the vice minister. Disappointed
in the way the investigation is being conducted, Mr. Kan mentioned the possibility
of bringing in a third party to uncover the truth. With this internal investigation
it became clear that the in-house body was only concerned with maintaining
harmony and protecting the organization.

I agree with Mr. Kan's idea of bringing in a third party to investigate this matter,
because given the dynamics of the Japanese bureaucracy, to form an in-house
investigation is like asking a convict to be his own jailer.

Everything I touched on today boils down to one issue, and that is the rights
of individuals. The Japanese government, for over 400 years has prevented
the concept of individual rights from entering Japan. It is about time for the
Japanese bureaucracy to accept that bureaucracy is for the people, not that
the people are for the bureaucracy; for people to learn that individual rights
are more important than group harmony; to end the educational goal of
castration and replace it with the development of independent thinking so
that the people can become free of governmental control.

[WB7: It is my humble opinion, that this last point is the bull in the china room.
Much has changed since this speech was given. There is a huge swath of young
Japanese society feels no obligation to the so called “social contract.” They are
on the internet, the want a “wonderfful life” and they will interpret the Fukushima
catastrophe as the folly of older generations and a system in dire need of reform.
Mr Buffet and Government Sachs have every reason to downplay this because
of all the uncertainty involved. But the is a genrational fault line in Japan long
overdue for a tectonic shift.]

Thank you very much.

[WB7: I am prepared to stick my neck out and say if you have read this speech
carefully, you are much better informed than 99% of the MSM talking heads]