大学の部 優勝
檜井 満夫（広島大学）

Expectations of Future Medicine

 When I was in elementary school, I wanted to become a doctor. To achieve my dream I studied hard, and in 2015 I entered Hiroshima University School of Medicine. In the constantly evolving field of medicine, I realized that there is always more to learn. We're looking for better ways to heal, and there are many expectations in the future. Before I introduce them, I want to tell two stories I experienced in college.  The first story is during summer vacation of my first year at college. I participated in a hands-on learning program and visited Mitsugi General Hospital in Onomichi, Hiroshima. During the program, I learned about the functions of the hospital and how it contributed to the community. Mitsugi General Hospital had a collaborative system called "regional comprehensive medical care", a system that contiguously serves everyday-health support. It quickly corresponds to the changing needs of the patient in aspects of medical treatment and care. I didn't understand what this meant at first, but my questions were resolved in the evening. I visited an elderly woman's home near the hospital with a nursing care staff for home healthcare. The nursing care staff communicated with the patient warmly, made a simple health checkup, and asked her if she had any trouble in daily life. Through this program, I realized that many medical staffs, not just inside the hospital but outside as well, were involved in taking care of a patient.
 The second story goes back a year ago. During spring break, my college held a lecture at our campus, welcoming Nobel prize winners, Sir John Gurdon and Dr. Shinya Yamanaka. It was such a valuable experience listening to their speeches, and I was especially impressed at the iPS cells that Dr. Yamanaka lectured. By just introducing 4 reprogramming factors, an adult cell can be converted to a pluripotent stem cell. This means that you can create any cell composing your body, such as neuron cells, cornea, and heart muscle from only your blood cells, which you can get simply by taking blood samples. Dr. Yamanaka explained that iPS cells hold a great promise in the field of regenerative medicine. Clinical application and medicine development using iPS cells might bring forth a treatment for incurable diseases, such as Parkinson's disease and spinal cord injury. I was amazed that day, and imagined how dramatically medicine will change in the next few decades.
 Again, there is always more to learn in medicine. From these two experiences, I learned that there are two types of medicine; highly advanced medicine and regional medicine. It is my conclusion that we need to establish a medical system in every region focusing on both of these fields. In other words, we need a hospital-centered medical care in the urban area and community-oriented medical care in the suburbs. I believe that this system will be necessary to correspond to many problems.
 One of the most serious problems Japan is facing today is the ultra-aging society. It is estimated that the aging rate will be 33.4% by 2060, which means that one of three people will be the age 65 or older. The older we become, the higher the risk of us getting cancer. The number of medical staffs is chronically lacking, so we need to think up of a more optimistic and efficient health-care system. This isn't a problem that is going to happen in the future; it is happening right now.
 Highly advanced medicine can lead to treatments for diseases that don't have a fundamental cure yet. I think this will be important especially in curing cancer. iPS cells can make this happen. I read an article that a Japanese team led by Riken had carried out the world's first surgery transplanting retina cells created from donor iPS cells. iPS cells can widen our field of transplant for cancer treatment, and this can save many lives of people who suffer from cancer.
 Regional medicine is also going to be important from now on. It is necessary to develop a team-based medicine, an organic cooperation of medical and nursing care professionals. I saw Mitsugi General Hospital already taking this into action. My idea is to introduce cloud computing to the medical field. Like we use our smartphones, medical staffs can get information of the patient whenever they need it if they store files in the cloud. In this way, the information of the patient can be shared smoothly and safely. It is estimated that in 2024, the market scale for cloud service in medical fields will be ten times bigger than it is now. It is important that specialists in the fields of public health, medical care, nursing care, and welfare work on establishing a collaborative system suitable for the local characteristics of each region by making the best use of their own specialties.
 In the end, I want you to know that the center of the team-based medicine isn't the doctor; it is the patient. The patient has to actively participate and get involved with the care-supporting society, and we need to increase this public awareness. The most important thing for a patient to do is to understand the condition of his own body. If the patient has correct knowledge of his own diseases or injuries, he can think of a treatment together with the doctor, and better chances he receives the most appropriate treatment possible. As Lucius Annaeus Seneca said, "The wish for healing has always been half of health"