I thank Dr. Kurosu for his interest in my article.1Although I am unable to make any specific comments on the current state of clinical anesthesia in Japan, I believe that Dr. Kurosu's concerns about nonacademic anesthesia practice in Japan have parallels in the history of American anesthesiology. The American Society of Anesthesiologists is now celebrating its centennial. In the past century, the American Society of Anesthesiologists and American anesthesiologists have dealt with many problems, which include dealings with government regulation, fair professional compensation, attracting talents to the specialty, and many more similar to the current Japanese situation.2 

American anesthesiologists have a century of experience; Japanese anesthesiologists have only had approximately half that time to seek solutions to these problems. Dr. Eugene Sinclair, American Society of Anesthesiologists President from 2004 to 2005, in assessing progress of American anesthesia in a century, observed that the dedication and commitment of pioneers and past leaders laid the foundation of professionalism in our specialty that commands a respectful stature among our peers in medicine and in the public. He believes that our current generation will continue to build on past achievements and predicts that future anesthesiologists will regard prospective improvements in patient care with equal admiration.2 

Current obstacles for Japanese anesthesiology may have their traditional roots indigenous to Japanese society. Pioneers in Japan with great visions, such as Michinosuke Amano, M.D. (Professor Emeritus, Department of Anesthesiology, Keio University, Tokyo, Japan), and Hideo Yamamura, M.D. (Professor, Department of Anesthesiology, University of Tokyo, Tokyo, Japan), established the specialty with true professionalism half a century ago.1Given time, the new generations of Japanese anesthesiologists will confidently face any challenges, adapting to a new practice environment ably, and will prevail in the new century. During his 2005 Rovenstine lecture, Mark Warner, M.D. (Professor and Chair, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota), advised that modern anesthesiologists should dedicate themselves to honor those who have passed before them by making the difficult transitions necessary to thrive in the future.3Current leaders in anesthesiology, either Japanese or American, should take up the challenges to further the vision and goals set by our pioneers. Examining the history of our profession will help prepare us to encounter these trials and prevail. I hope my article will continue to generate thoughtful and healthy debates on the anesthesiology practice in Japan.

St. Louis University School of Medicine, St. Louis, Missouri. ikedas@slu.edu

Ikeda S: Government Account for Relief in Occupied Area: A Japanese physician's journey to a new medical specialty. Anesthesiology 2005; 103:1089–94
Bacon DR, McGoldrick KE, Lema ML: The American Society of Anesthesiologists: A Century of Challenges and Progress. Park Ridge, Illinois, The Wood Library–Museum of Anesthesiology, 2005
Park Ridge, Illinois
The Wood Library–Museum of Anesthesiology
Warner MA: Who better than anesthesiologists? The 44th Rovenstine Lecture. Anesthesiology 2006; 104:1094–101