Recollections with Dr. Tanaka

With all eyes on the IATDMCT Congess, Tokyo in 2017, we remember the First Congress of the Japanese Society for Therapeutic Drug Monitoring (1st CJSTDM, May 13th 1984) and the First International Congress of Therapeutic Drug Monitoring (1st ICTDM, October 20th 1988).  Dr. Tanaka shares his experiences that led to the beginnings of the Japanese Society, and these two important congresses.

Recollections: The First Congress of Japan Society for Therapeutic Drug Monitoring and the First International Congress of Therapeutic Drug Monitoring

Pre-JSTDM Days
Way back when – in 1978 or thereabout – I worked as a clinical doctor for the ICU at National Cardiovascular Center (currently the National Cerebral and Cardiovascular Center). I was not even aware of the term ‘TDM’. At the time, the patients we had there were mainly those who had just undergone cardiovascular surgeries. Intravenous injection was the standard procedure in ICUs, with a conservative initial dose based on past experiences, which we then tweaked depending on how it went. We assumed the effects would be proportional to the dose, and any deviation was regarded as individual variations.

Around 1982, Mr. Shigeki Ogitani, a medical technologist at the Clinical Laboratory, informed me that it was now possible to swiftly measure digoxin concentration in the blood. Arrhythmia after open-heart surgery was a common occurrence back then; to prevent this, overdrive pacing was employed with rapid digitalization to control heart rate. Xylocaine was also commonly employed to counter ventricular extrasystole. We were aware that the arrhythmia might have been caused by digoxin intoxication, but could not be sure; the cause for occasional convulsion was also unknown.

With the new method for concentration measurement, Mr. Ogitani and I started working on these issues, chiefly by scheduled monitoring of digoxin and xylocaine concentration. Along the way, we developed a method for rapid digitalization with no intoxication risk. The cause for convulsion turned out to be xylocaine overdose. More generally, we had an increasingly clearer view on the dose-effect relation by monitoring concentrations of various drugs in blood, urine and other secretions. This naturally led to better treatments, as well as to more appropriate initial doses for new drugs.

TDM Study Groups and their Growth in Japan
These experiences made us realize that TDM was an important development that had a huge clinical potential for patients. We felt the need for a study group to learn more about TDM around 1983. We learned that blood concentration monitoring was already performed for some time in paediatrics, so we got Dr. Takashi Mimaki (Pediatrics, Osaka University Hospital) involved. Now there were three of us – and there came more.

In January 1984, we set up the Japan Society for Therapeutic Drug Monitoring (JSTDM), with myself as President, Dr. Mimaki as Vice-President and Mr. Ogitani as Secretariat. On May 13th of the same year, the first Congress (1st CJSTDM) was held in the auditorium at the National Cardiovascular Center, and attracted nearly 200 participants from around the country.

It was then that we learned that there were already like-minded communities in the country. Since 1989, we collaborated with the Research Group for Therapeutic Drug Monitoring in Tokyo to hold an annual general meeting. In 1992 the meeting became CJSTDM, an annual congress and two annual seminars to promote TDM in locations throughout the country. In addition, we launched our own publication, the Japanese Journal of TDM (Jpn J TDM: Vol.1, No.1, 1984).

Going International
On May 17th, 1987, the 4th CJSTDM was held in Tokyo. A few months prior, Dr. Mimaki informed us that Prof. Philip Walson (Children’s Hospital, Columbus, Ohio), who had supervised his studies, suggested that there should be a TDM meeting in Hawaii to accommodate participants both from the U.S. and from Japan. We discussed this, and decided that it should be an international conference involving people from all over the globe so we could expand the opportunity to learn and share. (Dr. Mimaki later told me that Prof. Walson, upon hearing this, simply gave a smile – a nice smile or a wry one, there was no way to tell which.)

There was no IATDMCT back then. We knew very little about how TDM was recognized in countries around the world. We simply appreciated the clinical implications that TDM had, and wanted to know more about it in wider contexts, and build new international communities wherever possible.

It was in this spirit that the Council Members at the 4th CJSTDM decided to hold the first International Congress of Therapeutic Drug Monitoring (1st ICTDM). It was also decided that the Japan Society for Therapeutic Drug Monitoring (JSTDM) should thereafter be called the Japanese Society of Therapeutic Drug Monitoring (JSTDM).

The First International Congress
In the opening ceremony for the 1st ICTDM there were just short of 100 people in the audience. As the congress went on, things got busier. Television cameras came in and Prof. Pippenger was interviewed, aired later on the television news that day.

Those who gave Plenary Lectures and led Symposiums – all internationally prominent figures – also acted as chairs for other sessions. Prof. Sjoqvist smilingly said he had never played so many roles for a conference before. Our humble gratitude was represented with a tie and a thank-you note.

There were lively discussions, and poster sessions.

I cannot fail to mention the Welcome Reception, featuring a kimono show, which was quite popular. In addition, a tea ceremony was performed. To wrap things up, we held a Sayonara Party.

Everyone involved graciously volunteered their time; we can only thank them. We express our sincere gratitude to Prof. Walson, who helped us from preparation stages, as well as to Prof. Wong, Prof. Pippenger, Prof. Sjoqvist and other participants.

Next time, see you in Kyoto.

Kazuhiko ‘Pico’ Tanaka
Prof. Emeritus Osaka University of Pharmaceutical Sciences
Adviser, Kidney Center, Shirasagi Hospital