A public health crisis caused by a foreign military deployment in a small island

Urasoe city (photo, my current hometown) is provided water to drink by the Chatan water supply system, which is considered as contaminated by PFAS (a cancer-causing toxic substance).

US military bases have been constructed and developed by internally displacing local people in the crowded 1,207-square km tiny island of Okinawa, a southwestern island of Japan over the last 75 years. The military bases have been continuously polluting its air, water and land by toxic chemicals and are producing extremely noxious noise pollution. 

Recently it has also found that local water supply systems are highly contaminated by PFAS (Per- and Polyfluoroalkyl Substances) which cause cancer and is considered as a leakage from the base (1). Likewise, groundwater near three military air bases in Georgia, US, is also contaminated with these same chemicals (2, 3).

While local Okinawan people have been suffering from this pollution, there have been numerous aircraft accidents related to military drills over the island and its nearby seashore. Seventy percent of all US military bases in Japan are concentrated in this crowded island. To add insult to injury, Japanese central government currently tries to construct a new military base despite the strong opposition from local people and their governor. 

Military troops of foreign country is uncontrollable or beyond the control of the host country. Okinawa was once an independent country known as a Ryukyu Kingdom until Japan forcefully annexed it in 1879 as the 47th Prefecture of Japan, 140 years ago.

The military colonization by Japanese and the environmental toxic contamination by the US Base and adverse health effects among Okinawa people is unjust, unethical and undemocratic. Health professionals of Okinawa, Japan and the US should act against public health crisis and prevent the construction of new military bases. Okinawa public health matters as well as individual health. 

Yasuharu Tokuda, M.D., M.P.H.

Muribushi Okinawa for Teaching Hospitals, Okinawa

References:

1: Okinawa Prefecture. Detection of Organofluorine Compounds in the Corporate Bureau. access date: Feb 1, 2019. Accessed at: 

https://www.eb.pref.okinawa.jp/sp/opeb/309/619

2: Meris Lutz. The Atlanta Journal Constitution. Contaminated groundwater, a toxic legacy of Georgia’s air bases. Jan 03, 2019. Accessed at:https://www.ajc.com/news/local/contaminated-groundwater-toxic-legacy-georgia-air-bases/sKLbYPA7ucd7ojDr5NvtFI/

3: Harvard Chan School news. Groundwater contamination near Georgia air bases worries experts, residents. Jan 11, 2019.

Accessed at:

https://www.hsph.harvard.edu/news/hsph-in-the-news/groundwater-contamination-georgia-air-bases/?utm_medium=email&utm_campaign=Update_01.11.2019

Constructing New US Military Base as a Health Threat to Okinawan People

Dr Tokuda (left) and Dr Barnett (right)

Constructing New US Military Base as a Health Threat to Okinawan People

Yasuharu Tokuda, MD, MPH; Peter B. Barnett, MD, MPH

Abstract

Okinawa, a group of small islands between Japan and Taiwan, has been the site of wars conducted by foreign armies for hundreds of years. Since World War II Okinawa has been the focus of the American military presence in Japan. The people of Okinawa experience a number of adverse health and environmental effects from the US military bases. These health and environmental effects include aircraft noise, asbestos exposure, and pollution of sea, land and air along with disrupted biodiversity. Other adverse health consequences have been identified as severe hearing loss, sleep disturbance, poor quality of life, and increased cancer risk in local Okinawan people, and impaired learning among Okinawan school children. Recently the central government of Japan approved construction work on a new US military base despite strong opposition by local Okinawan people. Healthcare professionals are in a position to better assess and understand the seriousness of the adverse health and environmental effects of the proposed and existing military bases. However, no medical professional societies in Japan or the US have provided comments about this issue. Healthcare professionals have a responsibility to educate citizens and politicians concerning the adverse health and environmental effects of military bases, and to advocate for a more peaceful world.

Text

In 2015, in order to strengthen the US and Japan defense alliance, and as a replacement of the Futenma airbase located on the main Okinawa island, “the most dangerous base in the world”(1), the Japanese central government approved construction work on a new US airbase in the Henoko bay area of Okinawa island. No other Japanese prefectures have accepted new US military base since they have concerns about the increased risk of adverse health effects of a military base, as well as the increased crime rate in communities where bases are located. Nonetheless, the US government wants to expand its bases in Okinawa and the central Japanese government is willing to supply more land in Okinawa. Local Okinawan people strongly oppose the construction of a new US base and the governor of Okinawa has declared that the central government's decision "tramples on the will of the Okinawan people."(2) There are two major reasons by Okinawan people for opposing the new US military base: further adverse environmental and health effects on Okinawa and Okinawan people and the longstanding antiwar philosophy in Okinawa.

The people of Okinawa have already experienced a number of adverse health and environmental effects from existing military bases. Aircraft noise has long been a huge public health problem in Okinawa. Local residents living near military bases have developed severe hearing loss, sleep disturbance, impaired learning among school children, and poor quality of life.(3) Use of asbestos in the US military buildings has led to numerous cases of lung cancer and malignant mesothelioma among local workers.(4)

Military bases have caused serious air pollution, including carbon monoxide, nitrogen oxides, hydrocarbons, and sulfur dioxide. Further, the island’s sea, land and air have been contaminated by the high concentrations of polychlorinated biphenyls (PCBs), including Agent Orange dioxin (retrograde shipments from postwar Vietnam) and dichlorodiphenyl trichloroethane (DDT), arsenic, depleted uranium, and nerve gas that have been leaked from US military storage.(5-7) It is expected that there will be ongoing environmental damage and adverse health effects produced by a new military base, as well as the other already existing military bases. Other dangers include aircraft accidents and damage to the fragile agricultural and fishing environments upon which the Okinawan people depend.

Fortunately, several American communities have taken the initiative of supporting the Okinawan position. On December 21, 2015, the city council of Cambridge, Massachusetts, passed a resolution opposing the construction of the new base in Henoko, following the resolution by the Berkeley, California city council in September, 2015 which opposed the new base and pledged solidarity with Okinawa.(8) The city council of Honolulu, Hawaii also proposed a resolution opposing the base construction in January 2016. These thoughtful councils of the US communities believe that it is their responsibility to support Okinawan people because the construction is mandated by Japanese government in defiance of local opinion, and the construction is likely to cause further ill-effects to local people.

Another reason for opposing the new Henoko base is the prevalent antiwar philosophy among the Okinawan people. Many years ago Okinawa was an independent chain of islands, and has been the object of centuries of foreign military occupation, by China, Japan, and the US. Okinawa was the site of harsh battles between US and Japan near the end of World War II (WWII) which killed almost 100,000 Okinawan civilians. Since WWII, the central government of Japan continues to force Okinawa to host 75% (more than 30 bases) of all U.S. military installations in Japan, occupying 20% of the main island of Okinawa.

Healthcare professionals are in the position to accurately assess and communicate the seriousness of the adverse health and environmental effects of constructing yet another military base in Okinawa. However, no medical societies in Japan or the US have so far provided comment about this issue. Healthcare professionals of Japan and US have the social and medical responsibility to educate the citizens and politicians of both governments to protect the Okinawan people from the ill effects of military bases, and to advocate for promoting a more peaceful and just world.

This article has been published in the Journal Environmental Justice at:

https://www.liebertpub.com/doi/abs/10.1089/env.2016.0029?journalCode=env

References

1.           The Guam daily post: The two most dangerous bases in the world. 2015/11/4 [accessed on 2016/1/6].

2.           NBC News World: Okinawa Relocation of U.S. Military Base Triggers Protests 2015/10/29 [accessed on 2015/12/25]. Available from: http://www.nbcnews.com/news/world/okinawa-relocation-u-s-military-base-triggers-protests-n453486

3.           Department of Culture and Environmental Affairs of Okinawa Prefectural Government: A Report on the Aircraft Noise as Public Health Problem in Okinawa 1999 [accessed on 2015/12/25]. Available from: http://www.pref.okinawa.jp/site/kankyo/hozen/taiki/noise/aircraft_as_health.html

4.           The Japan Times: Japanese coinfirmed with asbestos injuries from working at U.S. bases 2014/1/8 [accessed on 2015/12/25]. Available from: http://www.japantimes.co.jp/news/2014/01/08/national/28-japanese-confirmed-with-asbestos-injuries-from-working-at-u-s-bases/#.VnyG7fmLSM8

5.           The Japan Update: Urasoe habu have high concentrations of PCB and DDT 2015/9/8 [accessed on 2015/12/25]. Available from: http://www.japanupdate.com/2015/09/urasoe-habu-have-high-concentrations-of-pcb-and-ddt/

6.           Mitchell J. FOIA Documents Reveal Agent Orange Dioxin, Toxic Dumps, Fish Kills on Okinawa Base. Two Veterans Win Compensation, Many More Denied. The Asia-Pacific Journal. 2015;13 (39).

7.           The Japan Times: Okinawa: the junk heap of the Pacific 2013/11/11 [accessed on 2015/12/25]. Available from: http://www.japantimes.co.jp/community/2013/11/11/issues/okinawa-the-junk-heap-of-the-pacific/#.VnyTsPmLSM8

8.           Peace & Planet: Cambridge City Council Debating Resolution of Solidarity for Okinawa 2015/12/11 [accessed on 2016/01/07]. Available from: http://www.peaceandplanet.org/cambridge-city-council-debating-resolution-of-solidarity-for-okinawa/

Japanese language blogs by Dr Yasuharu Tokuda

For people: https://blog.goo.ne.jp/yasuharutokuda-g

For doctors: https://blog.goo.ne.jp/yasuharutokuda

Twitter by Dr Yasuharu Tokuda

https://twitter.com/yasuharutokuda?lang=ja

A walk down a memory lane: India’s transformation from poverty to peace and prosperity

Taj Mahal: An icon of India

In the cold winter night in NYC, circa 1983, I was cruising in a crowded street of Broadway, Manhattan. It was snowing moderately and I was surprised to see a  lot of people standing in the line waiting for a theater to open. 

It’s normal to see New Yorkers and visitors from out of town to fall in line to secure a nice seat for a theater or a movie. I was curious to find out what was showing. I drove slowly to the front door of the theater and to my big surprised it was Gandhi the movie.  

At that very moment, my mind started to navigate to many areas related to Gandhi, including his great contemporary  Dr. Rizal of the Philippines. Both Gandhi and Rizal became greatest men in Asian history.

Ten years prior to the movie, (circa 1973)  I read the biography of Mohandas Gandhi (1869-1948). At that time, the name Gandhi was not yet a household name in North America, although Gandhi received the title “Mahatma” (great soul) in his native country. 

In just a span of two decades from 1983 (start of the movie) to 2003, there was a moderate improvement in Indian economy. In fact, the economy of India was burgeoning. For the meantime, Indian immigrant workers prior to the Gandhi the movie, were discriminated in North America at workplace, or in other places of social gatherings. The Americans complained about the trivial things like the way Indians dressed and the way men wear their turbans, etc. Asians were also discriminated in North America during that period. And both Indians and Asians had a higher tolerance for discrimination. In the 21st Century, racial discrimination is still exist in the US.

In 1983, India was also one of poorest countries in Asia with GDP (PPP) of $742.

I  sincerely believed that Gandhi, the movie could inspire the Americans  and help change the negative stereo-type image of Indian immigrants in North America and in other countries in the world.   

Most importantly, the movie could create a major change - a paradigm shift from poverty to prosperity of India in just short span of time.

Prior to the movie, very few knew about India’s great contributionto our present civilization. India’s Sanskrit language is compatible to our present computer system. Aside from this, peace, the art of meditation and self-realization are also valuable contribution of India to the world. 

Pioneer Indians in the US

In the late 1800s, Indian pioneer Swami Vivekananda (1863-1902) went to the US and gave impressive speeches. Americans received Swami Vivekananda with open arms. He influenced many people including the richest man in the US at that time, John D.  Rockefeller and convinced him to share his fortune by donating money to charities. The Rockefeller Foundation is now one of the biggest charity giving foundations in the world. And the US is considered the most giving country in the world. Swami Vivekananda’s famous saying: “Service to humanity is service to God”.

Another notable person who was inspired by Swami Vivekananda was 

Paramahansa Yogananda (1893-1952) who went to the US in 1920s. Yogananda invigorated many Americans through his book  and lectures,  including Steve Jobs, the greatest entrepreneur, who introduced the greatest smart phone. Steve was a man of wisdom who understood the art of living and dying. When his health started to deteriorate, he made the list of friends who would be invited to attend his memorial service. And all his invited friends who would attend the memorial would receive a gift placed inside a very light wooden box. It was a huge surprised for me to find out what was inside the wooden box. It was a book, an autobiography of Yogananda 

What is amazing is that  I read the book half a century ago. What a marvelous coincidence!

Steve Jobs 

passed away on Oct 5, 2011. 

The gesture was the greatest last act that can’t be altered. It was a magnanimous tribute and respect for Indian Teacher.

Yogananda also inspired Gandhi in his search for justice, equality and unity.

Few years later, you don’t hear anymore about discrimination of Indian immigrants.  

Some of the India-born workers are now great leaders, CEOs in business industries in the USA in 2018.  Let me just mentioned five of them. All five are CEOs; four males and one female; and one CEO still wears his turban.

India-born CEOs

Here are five CEOs:

Sundar Pichai, CEO of Google with 85,000 employees; Satya Nadella, CEO of Microsoft with 131,000 employees; Indra Nooji, (female) CEO of PepsiCo with 263,000 employees; Ajaypal Singh Banga, CEO of MasterCard with 13,400 employees; and Shantanu Narayan, CEO of Adobe Systems with 18,000 employees. The combined total number of employees of five CEOs is more than half a million. These five CEOs, I repeat, were India-born and started as foreign workers in the USA. They became CEOs recently through hard work, wisdom and dedication.

Absolutely there is no room for discrimination.

It was a sweet example of exoneration!

The Director and the Movie

Sir Richard Attenborough of UK, who directed Gandhi the movie had a hard time in securing a budget to fund the movie. The Movie won eight Academy Awards including ‘Best Picture’ and ‘Best Actor’. Gandhi: The Movie depicted the extraordinary life of Mahatma Gandhi, thus, served as a rallying point of Indians and transformed their country from poverty to peace and prosperity . 

Eventually, India entered the ‘Golden Age’ of  economy in around 2003 with the GDP (PPP) of US$2,394. And in 2017, the GDP (PPP) of India was $9,585.

India is now ranked #3 top economy in the world based on GDP, (PPP).  Indians though hard work, self-discipline, perseverance, wisdom and creativity achieved economic power and political stability and peace.

What an amazing, ginormous achievement!

References:

1. Data on GDP, (PPP) from IMF. 

2. Alyson Shontell. “The last gift Steve Jobs gave to families and friends was a book about self realization”

3. Autobiography of a yogi

4. Borestein, Erica. Disquietng Gifts: Humanitarianism in New Delhi. Stanford University Press.

Alcohol and health

Small amount of sake is considered “medicine”

How many glasses of this Chatan craft beer are good for health?

Sake, alcoholic drink made from rice, produces a special “appetite” for food, especially in the autumn. At dinner, Japanese usually increase their appetite when sake is served. Good combination of alcohol drink is beer and edamame (green pea); wine and meat dish; awamori (Okinawa rice alcohol) and champloo (mixed fried vegetables) are served in a small plate with small quantity of food. This makes drinkers in good shape (weight). Recently in Japan, the popularity of craft beer is rising. Sango (coral) beer or Chatan beer are popular in Okinawa, and Nest beer is in Ibaraki Prefecture, located northeast of Tokyo.

Sake is believed to be the source of hundred medicines. Red wine, on the other hand, is regarded as a source of health for people around the Mediterranean countries such as France. In addition to antioxidant contained in wine called polyphenols, wine is said to have another substance called resveratrol. Its function may inhibit or slow aging. However, the effect of resveratrol has not yet been confirmed in clinical trials.

A lot of liquor consumption is considered poison to the body

Drinking too much is not recommended. It is medically and socially prohibited specially among the minors. Long-term heavy drinking destroys liver, pancreas, brain, and nerves. There are many diseases associated with alcohol intake: cirrhosis of liver, chronic pancreatitis, cerebral atrophy, neuropathy and other diseases. There is a risk of carcinogenesis (cancer-forming) in long-term alcohol drinkers. These cancer by locations are found in the colon, female breast, mouth, pharynx, larynx, liver, esophagus, stomach, pancreas, lung, and gallbladder. All are cancer related to alcohol consumption.

Also, binge drinking on a single day is dangerous. Acute alcoholism may result in aspiration pneumonia, which may lead to respiratory arrest due to suppression of respiratory centers. It is dangerous to drink a lot at university clubs and parties to welcome new members that involves dangerous alcohol. We strongly suggest to the students to stop this harmful tradition. Although drunk driving is self-destructive, there is also a risk of killing others, so it is social menace.

Even if you are not driving, there is a risk of traumatic death such as injuries due to falls and injuries due to falling from train station, going back home hit in the railroad track, or fighting with other customs with heavy drinking. In Japan, there are still many people who smoke while drinking. If you drink alcohol often with people who smoke, it is an exposure to secondhand smoke.

Estimated amount of health drinking

So how much do you drink alcohol? First, there is no need to forcibly make a person drink if he cannot or do not drink. Originally, people who do not have enzyme called acetaldehyde (toxic by-product of alcohol) cannot drink alcohol basically. Also, Oriental people whose face is flushed red with a little alcohol intake are known to be at high risk of esophageal cancer.

As a measure of alcohol consumption, the standard estimate based on the amount of pure alcohol (ethanol) ingested is used. Using this amount of ethanol (grams), it is recommended to use standard unit of 1 drink in each country, 10 grams = 1 drink in Japan. Australia and New Zealand also use the same grams as Japan, but in America 14 grams = 1 drink.

In traditional guidelines, it was recommended that up to 1 drink per day for women and 1 to 2 drinks for men. One drink is 250 mL for beer or Happo Shu (a kind of beer) (5%), 180 mL for Chu-Hai (sake mixed with soda) (7%), 50 mL for Shochu (sake made from potato or wheat) (25%), 80 mL (0.5 cups) for Japanese sake (15%), Whiskey, or Gin etc. (40%), or 30 mL for wine (12%).

Healthy drinking amount different for men and women

Previous epidemiological studies on alcohol consumption and disease showed a J-shaped curve. In other words, light drinking is better than zero drinking amount, but the health outcomes are good, but if it is more than the amount of indicated above, the risk of drinking, risk of drinking will be higher, and higher than those with zero drinking.

In addition to heart diseases such as heart failure, cerebrovascular disorders, diabetes, etc., the risk of total mortality is also J-shaped. However, the important thing when evaluating alcohol consumption and health risks is the effect of smoking. Drinking people have higher rate of smoking than non-drinkers, and it is difficult to evaluate epidemiological results, as risk of cancer increases considerably due to smoking.

Recently, research in the United States focusing on the risk of "cancer" was announced. The results showed that in non-smoking men, the risk of cancer does not increase in the case of mild drinking up to 2 drinks a day. Women, on the other hand, show that even if mild drinking up to 1 drink a day, the risk of breast cancer increases. As an advice based on this latest result, women with a family history of breast cancer are at high risk of breast cancer, so we recommend that those women better refrain from drinking alcohol.

References

Cao Y, Willett WC, Rimm EB, Stampfer MJ, Giovannucci EL. Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studies. BMJ. 2015 Aug 18; 351: h4238: https://www.bmj.com/content/351/bmj.h4238

Do not smoke cigarettes

My uncle and tobacco

Tobacco is the number one enemy of public health in Okinawa.

I often hear the question "Why did you enter medical school and became a doctor?” Let me just answer this question with a narrative. When I was in the first grade in elementary school, I felt like I wanted to be a doctor. At the age of 6, I suffered from acute rheumatic fever, and had an inflammation of the heart, and valvular disease. When I visited a clinic, the doctor told me: "I can hear noises (murmurs) from the heart, but I cannot see them".

During this critical time, we received a message from my cousin who has been working in Kyoto and asked me to come to hospital in Kyoto. Right away, my father and I decided to go to Kyoto. We visited a hospital in Kyoto and met with the doctor for the first time. The doctor did follow the standard procedure like my chief complaint, history of the present illness, physical examination and auscultation using stethoscope, etc. When everything has been examined, the doctor finally made his diagnosis and ready to reveal his findings. My father and I anxiously waited for that few seconds. And suddenly we heard powerful words from my doctor: “this is no big deal anymore”.

That was the biggest assurance the doctor gave us about my present health condition. Upon hearing the doctor, my father immediate got relieved from uncertainty of my health condition. Because of this remarkable impression the doctor gave me as a first-grade elementary school student, I thought "a doctor was amazing". At that time, I started gradually longing and hoping to become a doctor in the future.

After few years, I entered junior high school and decided to consult with my uncle (the father of my cousin who asked me several years ago to go to Kyoto hospital) about entrance exam to medical school. My uncle was active in the community and was a chairperson of local education. His advice was very helpful for my future medical entrance examination. With hard work in school and great advice, (thanks to my uncle) I was able to pass successfully the entrance examination and admitted to medical school.

Aside from being an active person in the community, my uncle enjoyed tobacco/cigarette (smoking) since he was young. Through many years of smoking, my uncle, who gave me a guidance in preparing for entrance exam in medicine, developed emphysema (chronic obstructive pulmonary disease) due to smoking. It was a sad news to the entire family members and relatives.

For the meantime, I graduated from medical school and became a doctor. During my clinical practice at a hospital in Okinawa, my uncle was hospitalized with acute exacerbation of emphysema of the lungs. Due to complication of emphysema, he died in the hospital. I got so frustrated and felt so sad and sorry for my uncle. He could have lived a longer and healthier life if he did not smoke. My father also smoked during that period. He stopped smoking when he saw my uncle’s condition and finally died in the hospital due to smoking.

Smoking and its consequences in the world 

The smoking rate in Japan and European countries has declined over the past 60 years. On the other hand, the sad reality is that smoking rates are rising in 40 countries. Tobacco smoking has been recognized for many years without doubt: it causes sickness and death by the millions of people in the world. Smoking is the single biggest cause of death. And yet the prevalence of cigarette smoking has not decreased dramatically. Why?

The first factor is that the government actions are still insufficient in preventing smoking. Educating the general public and smokers intensively and extensively about the toxicity of smoking is not effective. Raising cigarette taxes; no smoking in public places; and supporting the people who would like to quit smoking are proven effective.

Although WHO recommends cigarette tax of 3/4 (75%) of the retail price or more, the tax rate of tobacco in Japan is about 65%, but it is still relatively higher compared to low tax rate among developed countries, resulting in low tobacco prices.

The Review Committee of the Ministry of Health, Labor and Welfare reports that "It is important to lower smoking rate (no. of smokers) by raising the tobacco price and tobacco tax now; and that we need to continue making efforts to realize that."

The second factor is the pressure from the tobacco company. The American movie entitled: "Insider" (directed by Michael Mann, and starring Al Pacino and Russell Crowe, shown in 1999) depicting anti-social pressure and misleading campaign by tobacco company was a real story. For example, cigarette companies do business by misrepresentation and deceit. The companies usually use brand strategy such as "light", "slim",’ "mint", but the harm to health is the same.

The third factor is the difficulty to change the behavior of smokers. In addition to public education, promotion of smoking cessation among the outpatient is important. Understanding that smoking is a disease called nicotine addiction is a prerequisite. All smokers must recognize that addiction is a disease. In public places, it is important to introduce a complete non-smoking rule.

Most domestic airports, cafes and restaurants have introduced smoking designated areas in Japan. Non-smoking rule is more important to introduce in public places like in Western countries.

In conclusion, it is a top priority to support smoking cessation, due to the extremely high morbidity and mortality caused by tobacco. More than 6 million people in the world die each year; and it is estimated that 8 million people in the world population will die every year by 2030, unless the smoking rate remains as it is. Many of the mortality would come from people in developing countries. The world needs to unite and create a movement that could focus on smoking cessation. China with its biggest number of smokers (1/3) of the population started a powerful non-smoking campaign.

My own proposal is to ban smoking in all public places. Government bureaucrats in the world must also start non-smoking rule during work, inside and outside their buildings. Smoking ban could prevent millions of sickness and save millions of lives.

By the way, the first-grade elementary school boy was Dr Yasuharu Tokuda.

Attention to Fish Bones!

Fish dishes and me

 Eating fish carelessly may lead to a serious 

disease requiring a surgery.

I (Dr. Tokuda) like fish dishes, especially sashimi. And among variety of assortment of sashimi, I like tuna and salmon, a lot. My father is a former fisherman. In Okinawa, fishermen are called ‘Uminchu’ (meaning people of the sea). As a child, I used to eat fish frequently.

However, there are two fish dishes I don’t like. These are one whole fish either broiled or grilled with all its meat and bone. The reason I dislike whole fish when I was young, is to go back to my elementary school days.

One night, the very first catch of my father was our meal for that supper. When I was eating my supper, suddenly, my throat hurt. I spurted out the fish meat from my mouth, and a small fish bone came out.

Since then I have been able to improve the skill of eating a whole fish dish by completely removing fish bone with chopsticks. Since fish dishes served every day in my family, it was considerably a good training for me.

I learned my lesson because I felt intuitively that in every child's heart knows that "I will get harm seriously if I swallow the fish bone, even if I make a mistake accidentally. This is some sort of a protective mechanism inherent in every child.

Fish bones and me

Several years later, I looked up the textbook on fish bones during my medical student 's years at the University of the Ryukyus, and I could no longer find a concrete answer to the question of: “What will happen if I swallow the bones of the fish?"

However, during my residency at Okinawa Chubu Hospital, I was responsible for medical treatment in the Emergency Room. Coincidentally, I came across, once again the "fish bone" I experienced in my elementary school years, and this time a patient at the hospital.

I was in a doctor’s consultation room with a patient with a chief complaint: "My throat hurts suddenly when I was eating fish." I knew right away the diagnosis: fish bone stuck in the throat. The senior resident who had several cases of fish bone showed me how to take out a fish bone stuck in patient’s throat with a use of small scissors-like instrument called "Kansi". The fish bone was taken out and glad to see the patient on the road to recovery and will get well soon without complications.

After that, I was in charge of a male patient with an abscess in the abdominal cavity. The etiology (cause) of abscess was unknown at that moment. The patient complaint of abdominal pain; and had fever. Ultrasound and CT scan examinations were ordered. The initial impression/suspicion before surgical operation, there was a foreign body in the abscess area. Sure enough, the "fish bone" was found during laparotomy surgery. The diagnosis was "fish bone abscess"; length of the fish bone was of several centimeters and was removed together with the abscess. The patient fully recovered after surgical and medical treatment. 

This case was presented at the Medical Society of Okinawa Prefecture around 1990. The presentation was like patterned after Clinical Pathological Conference (CPC). The case which I presented at a formal conference was entitled: “Fish osseous abscess".

Pierced abscess by fish bone

To swallow fish bone is dangerous to the body. 

The first reported case of abdominal disorder due to fish bone in the world was in 1842, with the fish bone penetrating the stomach stuck in the vein of the viscera, resulting in severe phlebitis.

Many of the fishbone diseases reported later are from Asia. The bones of the fish caught in the vicinity of Asia are small and it is "easy to swallow". In the 1980s, Queen Mary Hospital in Hong Kong reported 117 cases of fish bone disease.

"Swallowed" fish bones penetrate like piercing various organs and tissues in the body. When penetrating at the pharynx, cervical abscess or thyroid abscess occurs, and when penetrating through the esophagus, it causes mediastinitis. Penetration through the stomach and duodenum leads to liver abscess and phlebitis of internal organs. The bone of fish

accompanying bacteria in the oral cavity creates pus from the bacteria.

Diagnosis, treatment, and prevention of fish bone abscess diseases

Fish bones do not appear in simple radiographs (x-ray). It is therefore, the diagnosis is surprisingly difficult. Recently, it became possible to diagnose with CT with angle changing part by constructing CT image in three dimensions, which brings about the advancement of diagnosis.

Treatment is surgery. In the future, we may expect laparoscopic surgery. With antibiotics alone, abscess due to "foreign body" cannot be cured.

The most important thing is prevention. As fish cuisine comes out as I do it, standing up, and look carefully like you are in a three-dimension level, and remove the dangerous bones. For elderly people with cataracts and hyperopia, weak eyes, etc. it is better to avoid a “fishy" fish dishes. I would like you to follow my favorite sashimi system, mentioned in the beginning of this article. Because fish dishes are healthy and tasty.

Reference

Gharib SD, Berger DL, Choy G, Huck AE. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 21-2015. A 37-Year-Old American Man Living in Vietnam, with Fever and Bacteremia. N Engl J Med. 2015 Jul 9; 373(2): 174-83

Spicy food and health

What is spice?

Okinawa Soba (Okinawan noodle and soup) 

is delicious and healthier with spices

 (red pepper, chili source, & red ginger).

People who often eat spicy foods live longer. This finding is based on the research result announced from China. It is said that the possibility of living longer and higher more than 10% of the average life expectancy. 

By the way, spicy dishes in China almost contain chili. If so, it means that chili is good for your health. Well, the problem with this opinion is whether we should take chili every day or not.

Spicy is an adjective from a noun, spice. There are various spices in the world. Pepper, ginger, nutmeg etc. are also spices. Humankind has been using spices since the ancient times. 

Spices are important ingredients for making cooked dishes more palatable and tastier. Spices are also served as preservative by delaying food spoilage and as disinfection due to its antibacterial property. In general, spices are used as seasoning, and many more. However, spices effect of preservation and sterilization are actually mild.

For example, Okinawa soba (noodle) a classic menu served in the cafeteria and small eateries in Okinawa. When you reach the table at the cafeteria, you will notice the spices on the table such as, the Shichimi red pepper, Awamori Chili Sauce (Ko-Re-Gu-Su), and red ginger. We like to eat these "spices" with buckwheat Okinawa soba. This is how to eat Okinawa soba. Okinawa soba is a menu that uses spices well.

Spicy food is good for health

There are many spicy menus at American restaurants. Specifically, there is a famous menu called "chicken wing," which has a large amount of spices for deep-fried chicken. By the way, we love it myself. However, it does not have a good image of healthy diet.

Mexican food "Chile" seems like a healthy menu. It is because the ingredients mixed with chili peppers (legumes). Since “chicken wing” was originally "fried birds", and it is difficult to regard it as a healthy menu no matter how much chili is mixed.

Spicy foods and capsaicin

Various studies on spices and health effects have been conducted. It has been said long time ago that there are fewer incidence of cancers in areas with a high intake of spices. Bioactive substances, such as capsaicin contained in spice, have the function of burning fat. Upon ingesting capsaicin, the substance physiologically active, substance P near the pharynx (oropharynx) increases. This substance P also improves the swallowing function, and some studies succeeded in using spices to prevent aspiration pneumonia.

It also can improve digestion and absorption functions. In addition, spice has antibacterial action and a good effect on intestinal bacteria, reduce the risk of diseases such as diabetes, cardiovascular disease, cancer, and cirrhosis of the liver.

In this way, the good effect of spice has been pointed out in the beginning of this article. The result of the Chinese research that we introduced at the beginning of this article is shown here:

About 20 thousand (subjects) people followed-up for an average period of seven years. The mortality rate of those who had spicy food more than six times a week had a 14% lower in total death rate compared with people who ingested less than once a week. The cause of death from cancer, ischemic heart disease, respiratory illness had declined. This good health benefit was found to be even bigger, especially for non-drinkers.

Based on this result, what will happen to our health advice? We recommend that a rich diet incorporating spices as part of the dishes as well. However, since the original ingredients are important, use spices for vegetables and fish dishes. In addition, it should be used for meat dishes too. We frequently eat Okinawa soba at restaurants in Okinawa. Of course, it is also spicy.

Yasuharu Tokuda, MD, MPH & David Itokazu, MD