感染症から人々の暮らしを守る
Q:先生は、いつ頃、どんなきっかけで医学の道を目指すようになったのですか。
祖父、父と2代続けて薬剤師でした。だから、小さなころから医学の世界には馴染みがありました。両親からは、せっかく進むのならば、薬剤師ではなく医者になれといわれてきました。
ただ、自分自身は社会科が大好きで、すでに小学校4年生の時には小学5年生・6年生の社会科の参考書を全て読んでいました。他方で算数も好きな科目でした。そういうわけで、高校生になった時には経済学部も面白いかなと思いましたが、医学は必ずしも理科系とは割り切れないものがあり、高校3年で必死になって不得意科目の物理と化学を勉強し、医学部に進学しました。
Q:医師免許を取得されてから、府立医大に勤務されていたそうですね。
府立医大在学中に、公衆衛生学の初代教授となっておられた恩師との出会いがあり、その先生が元々消化器内科の先生で、中でも胃カメラの大家でした。そういうわけで、府立医大を1978年に卒業し、府立医大附属病院での研修医の道は選ばないで、公衆衛生学教室に所属して、滋賀や大阪の病院で4年間内科医、主に消化器内科医として勤務しました。たまたま、卒後4年目に勤務した病院が大阪鉄道病院という民営化する前の国鉄の時代の病院で国鉄職員とその家族しか受診しないもので、かなり暇な時間があって、このままでは医療の世界からおいていかれると不安に思い、卒後5年目からは母校の府立医大大学院でさらに勉強することにしました。その時に、まだ日本の中であまり普及していなかった疫学という学問について学ぶ機会を得て、当時がんの疫学の第一人者であった名古屋大学の先生のところに1年間通い、基礎をみっちりと学びました。
その後86年に府立医大の助手となってからは、33年間在籍していました。府立医大の面白いところは、京都府の大学ですので京都府の行政職を兼務できるところです。私は在籍していた33年間のうち京都府園部保健所長、京都府中丹東保健所長、京都府山城南保健所長、京都府健康福祉部保健医療対策監として4回、合計約7年間京都府の行政職も担当していました。
実は、この時の経験が自分の研究に大いに生きています。また、地域の行政担当者と一緒に仕事をする中で、いかに優秀な公務員がいるのかということがわかりました。
Q:先生の研究内容についてご教示ください。
私の専門は、1982年に京都府立医科大学大学院社会医学系専攻に入って以降、消化器疾患の疫学研究です。学位論文も、「A case-control study of diet and some factors in colorectal cancer in Kyoto, Japan.」という大腸がんの発生要因に関する疫学研究でした。勃興期の便潜血検査による大腸がん検診の実務と評価を1982年から25年間程実施すると同時にバリウム検査による胃がん検診に対してピロリ菌抗体価と萎縮性胃炎のペプシノゲン検査を用いた血清学的スクリーニングも1994年から開始しました。
1998年に府立医大の脳血管疾患系老化研究センター社会医学・人文科学部門の初代教授に就任してからは脳卒中や認知症等の動脈効果と関連する疾病の疫学研究にも従事してきました。その他には、ピロリ菌だけでなく腸管出血性大腸菌O157：H7の発生要因の研究等の感染症の疫学研究にも取り組んできました。国内では、JACC studyという1986～1988年にベースライン調査を行った生活習慣病とライフスタイルに関する全国45地域約11万人の共同コホート研究のうち約１万人を京都府内の4町で担当したり、J－MICC studyという生活習慣病の発生要因における遺伝子・環境相互作用を評価する全国13地域約10万人の共同コホート研究のうち約6,500人を京都府全域で担当したりしてきました。
Q:現在の研究内容を将来、どのような形で社会に還元していきたいとお考えでしょうか。
もともと小学生の時から理科よりも社会の方が好きだったこともあり、医学部卒業後当初は内科医、中でも消化器内科医をしていましたが、社会医学系の大学院に進学してからは、社会医学の教育・研究を専らとしてきたのは必然であったと理解しています。
疫学研究は基本的には実施機関にそのデータが所属するという性格がありますので、本学に赴任する直前の2019年3月に京都府立医科大学を定年退職する際にすべてのデータを京都府立医科大学の共同研究者に託しました。ただ、退職時に京都府立医科大学の名誉教授の称号付与をいただいていますので現在も引き続きＪ－ＭＩＣＣ studyの資料を用いた文科省の科学研究費による基盤研究も実施しています。疫学研究は一人では決して実施することはできず、多くの共同研究者と一緒にすることで成り立つものですので、体力と知力の及ぶ限り、引き続きＪ－ＭＩＣＣ studyとは関わり研究を続行したく考えています。文科省の科学研究費は税金を投入したものですので少しでも成果を増やして国民・府民に還元し、生活習慣病予防の推進に寄与したいと考えています。
Q:先生は、本学の感染症対策委員長として、昨年来大学全体の防疫や学生への指導の先頭に立っていただいています。ただ、今回のコロナウイルスの撲滅は簡単なことでないように思えます。
コロナ禍は、まだ1、2年続くでしょう。100年前のスペイン風邪、これはインフルエンザなのですが、その時代は世界中が大きな被害を受けましたが、その後予防接種や特効薬が開発されて、毎年限定的な死者は出るものの、パンデミックは抑えられてきています。コロナも恐らく将来的には特効薬もできてインフルエンザのようなものになってくるかもしれません。
ただ、我々の生活は、簡単にはコロナ前の2019年の状況には戻らないと思っています。振り返って見ると、いかに我々が飛沫を飛ばしてきたか、手洗いも不十分だったか。恐らく今後、清潔ということに対する意識が相当高まり、こうした環境衛生をしっかり取り組んでいく業界や企業が生き残り、そうでないところは淘汰されていくことになるでしょう。今コロナ疲れということが言われますが、ここで立ち止まってはいけないのです。衛生環境に留意するこうした状態が新しい通常状態（ニューノーマル）になっていくのだろうと思います。
Q:本学学生へのメッセージをお願いします。
本学の学生は、看護であれば保健師、看護師、言語聴覚学科であれば言語聴覚士などの資格を取るよう日々専門性を磨くため研鑽を積んでいますが、このほかにも健康スポーツ学科の学生も健康に関することを研究しています。私は、こうした専門性は、各地域の行政の現場で生かす余地は大きいと思うし、専門性を高めれば高めるほど引く手数多になると思います。4年間できらりと光る何かを身につけて欲しいと思います。この春も京都府に就職し、早速峰山の丹後保健所に勤務になった保健師がいます。彼女は、専門とする病気のことだけでなく、今の感染症や、食べ物、健康に渡るまで色々なアドバイスを地域の人々にしていくことになるでしょうが、必ずこの大学で学んだことが生きると思います。
また、この大学は、他ではあまり例がない特別な英語プログラムやSLSを提供していますが、こんな良い機会を是非しっかりと活用してほしい。与えられると、あまりありがたみがなく感じるかもしれないが、しっかりやれば必ず自分の強みにつながってきます。
Q:プライベートについてお聞かせください。
今の楽しみは、趣味の読書と言いたいところですが、このコロナ禍の中、内閣府の新型コロナウイルス感染症対策分科会や新型インフルエンザ等対策有識者会議基本的対処方針等諮問委員会、厚生労働省新型コロナウイルス感染症対策アドバイザリーボード、京都府のホームページ等々毎日チェックをしていてじっくりと本を読んでいる暇があまりありません。本当に蔓延が早く収まって欲しいものです。
Professor WATANABE Yoshiyuki
In this edition of “Tell Us Teacher,” we spoke with Professor WATANABE Yoshiyuki, Dean of the Faculty of Health and Medical Sciences and a specialist in epidemiology and public health.
Q:When and why did you decide to pursue a medical career?
My grandfather and father were pharmacists, so I was familiar with the world of medicine from a young age. My parents always told me that if I wanted to go into medicine, I should become a doctor instead of a pharmacist.
However, I loved social studies, and by the time I was in the fourth grade, I had already read all the fifth and sixth-grade social studies primers I could get my hands on. At the same time, I also loved math. Therefore, when I became a high school student, I thought that the economics department was interesting, but medicine was not necessarily categorized as a pure science. Then I decided to enter medical department and seriously studied physics and chemistry, which were my weak subjects.
Q:You worked at the Kyoto Prefectural University of Medicine (“KPUM”) Hospital after you obtained your medical license, right?
While I was still a student at that university, I met my mentor, who was one of the first public health professors. He was originally a gastroenterologist, and a gastroscope specialist in particular.
I did not choose to become a resident doctor at the University Hospital of the Prefectural University of Medicine, but I joined a public health clinic and worked as an internist, mainly a gastroenterologist, for four years at hospitals in Shiga and Osaka. By chance, the hospital I worked at in my fourth year after graduation was Osaka Railway Hospital, a hospital in the pre-privatization era of Japan National Railways where only its employees and their families had medical examinations. I had a lot of free time, and I was worried that I would be left out of the medical field, so from the fifth year after graduation, I decided to study further at my alma mater, the Graduate School of the KPUM. At that time, I had the opportunity to learn about epidemiology, which was not yet very popular in Japan, and I went to Nagoya University for a year to study under a professor who was a leading expert in cancer epidemiology at that time. Under him, I became very proficient in the basics of epidemiology.
After that, I became an assistant professor at the Kyoto Prefectural University of Medicine in 1986, where I stayed for 33 years. One of the interesting things about KPUM is that it is a prefectural university, so I was able to hold administrative positions in the Kyoto Prefecture government while also working as a professor. During my 33 years at the university, I served as the director of the Sonobe Public Health Center, the director of the Chutanto Public Health Center, the director of the Yamashiro Minami Public Health Center, and the director of the Public Health and Medical Countermeasures Division of the Health and Welfare Department of Kyoto Prefecture four times, for a total of about seven years in all.
The experience I earned during that time has been very useful for my research. Also, in working with local government administrators, I learned just how talented public servants can be.
Q:What sort of research are you working on?
My specialty has been epidemiological research on gastrointestinal diseases since I joined the Department of Social Medicine at KPUM in 1982. My dissertation was also an epidemiological study on the etiology of colorectal cancer, entitled “A Case-control Study of Diet and Some Factors in Colorectal Cancer in Kyoto, Japan.” I have been practicing and evaluating colorectal cancer screening using fecal occult blood tests for about 25 years since 1982, and I also started serological screening using H. pylori antibody titer and pepsinogen tests for atrophic gastritis against gastric cancer using barium tests since 1994.
Since I became the first professor of the Department of Social Medicine and Humanities at the Research Center for Neurological Diseases and Geriatrics at KPUM in 1998, I have been engaged in epidemiological research on diseases related to arterial effects such as stroke and dementia. In addition, I have been involved in epidemiological studies of infectious diseases, such as the study of the causes of the outbreak of enterohemorrhagic E. coli O157:H7 as well as H. pylori. In Japan, I was in charge of about 10,000 people in four towns in Kyoto Prefecture in the JACC study, a collaborative cohort study of about 110,000 people in 45 regions nationwide on lifestyle-related diseases and conducted baseline surveys from 1986 to 1988. In the J-MICC study, which is a collaborative cohort study of approximately 100,000 people in 13 regions throughout Japan to evaluate gene-environment interactions in the development of lifestyle-related diseases, I was in charge of approximately 6,500 people throughout Kyoto Prefecture.
Q:How would you like to contribute to society through your current research?
Since elementary school, I have always preferred social studies to science. Although I initially worked as an internal medicine physician, particularly as a gastroenterologist, after graduating from medical school, I realized that I would inevitably focus exclusively on education and research in social medicine after entering a graduate school of social medicine.
Since epidemiological studies are characterized by the fact that the data belongs to the institution conducting the study, I entrusted all the data to my collaborators at KPUM when I retired from the institution in March 2019, just before I was transferred to Kyoto University of Advanced Science. At the time of my retirement, however, I was granted the title of Professor Emeritus of KPUM, so I continue to conduct basic research funded by the Ministry of Education, Culture, Sports, Science and Technology using data from the J-MICC study. Epidemiological research can only be conducted with many collaborators, so I would like to continue to be involved with the J-MICC study as long as I am physically and intellectually able. Since the Ministry of Education, Culture, Sports, Science and Technology’s scientific research funds are funded by taxpayers’ money, I would like to produce the best results possible and provide them to the people of Japan and Kyoto Prefecture, thereby contributing to the promotion of lifestyle-related disease prevention.
Q:As the chair of our university’s Infectious Disease Control Team, you have been spearheading the university’s overall health safety measures since last year. What kind of unique challenges does COVID-19 pose?
COVID-19 will probably continue for another year or two. 100 years ago, we had the Spanish flu, which is actually flu, and the whole world suffered a lot from it, but since then, vaccinations and special drugs have been developed, and although there are a small number of deaths every year, the flu has been kept under control and prevented from causing a pandemic. COVID-19 may also become like influenza in the future with the development of special drugs.
However, I don’t think that our lives will easily return to the way they were in 2019, before COVID-19. In retrospect, it is hard to imagine just how poor our hygiene was in terms of covering our mouths when coughing or washing our hands. In the future, awareness of the importance of cleanliness will probably increase considerably, and industries and companies that are firmly committed to environmental hygiene will survive while those that are not will be eliminated. There is talk of COVID-19 fatigue, but you must not stop here. I think that this new state of paying attention to environmental hygiene will become the “new normal”.
Q:What message do you want to share with your students?
Students in KUAS study hard every day to develop their specialized skills so that they can obtain qualifications as nurses or speech pathologists. In addition, our students in the Department of Health and Sports Sciences study health-related subjects as well. I think that there is a lot of room for this kind of expertise to be used in local government administrations, and the higher the level of expertise those students possess, the higher the demand for them will be when they graduate. In four years, when those students graduate, I want them to shine. One of our nursing graduates got a job in Kyoto Prefecture this spring was immediately employed at Tango Health Center in Mineyama. She will not only advise her community on the diseases she specializes in, but also infectious diseases, food, and health. I think that the things she learned at KUAS will serve her well.
KUAS also offers special English programs and SLS programs, which are rare in other universities, and I hope that our students will take advantage of these opportunities. You may not feel very grateful for these programs now, but if you try hard, these programs will surely become a strength for you in the future.
Q:Tell us about your private life.
I would like to say that my current pleasure is reading books as a hobby, but in the COVID-19 crisis, I have little time to read such books as I have to spend every day checking reports from the Subcommittee on Coronavirus Measures of the Cabinet Office, the Advisory Board on Coronavirus Measures, the Advisory Board on Coronavirus Measures of the Ministry of Health, Labor and Welfare, the Kyoto Prefecture website, and so on. It is my strongest wish that the pandemic come to an end soon.
