クリニックＦClinic F

09/02/2026

On Wagner’s Der Ring des Nibelungen—and What This Work Truly Reveals

Richard Wagner’s Der Ring des Nibelungen is a monumental music drama consisting of four works—Das Rheingold, Die Walküre, Siegfried, and Götterdämmerung. I have written about it many times on this blog.

Drawing on Norse mythology and Germanic legends, it depicts the rise and fall of the gods, the death of heroes, and ultimately the end of the world. Each time I listen, my understanding deepens, and I feel as though I am gradually unraveling the riddles Wagner embedded in the work.

Recently, I had the opportunity to hear “Brünnhilde’s Immolation Scene,” the culmination of this sixteen-hour epic, performed by the NHK Symphony Orchestra. This year marks the N響’s 100th anniversary, and I happened to receive a ticket for that evening from someone who holds a season subscription.

Listening to a magnificent soprano, a massive orchestra, and Wagner’s chromatic language with its frequent use of semitones, I wondered if my default mode network had kicked in—ideas and associations kept bubbling up one after another.

The Ring is often discussed as a critique of power, of capitalism, or as a mythological vision of apocalypse. Yet those readings alone leave behind a peculiar, unresolved aftertaste.

Why did Wagner depict everything so thoroughly, and yet never present a single image of a “correct” or ideal world? Why did heroes, gods, and institutions alike all have to fail? I feel there may be another way of reading this work.

If one follows The Ring carefully, there is no clear villain who destroys the world. Alberich is rational. Wotan is a ruler with a strong sense of responsibility. Siegfried possesses unquestionable innocence and goodness. Brünnhilde makes ethical judgments.

In other words, each of them makes what seems, at the time, to be the “right choice.” And yet the world still comes to an end. This is the most unsettling aspect of The Ring.

I read this work as a succession of four choices. In Das Rheingold, power is chosen. In Die Walküre, love is tested. In Siegfried, innocence is trusted. And despite all this, in Götterdämmerung, the world ends.

Power, love, and innocence are among the finest values humanity can believe in. And yet, even after exhausting all of them, the world could not be sustained. This is not a story of failure; rather, I think it is a record of humanity having played every best possible hand it had.

Less often noted is that The Ring is also a story about “coming to know.” As the drama unfolds, the characters come to understand one thing after another: that contracts are internally contradictory, that institutions kill love, that heroes cannot grasp the structures they inhabit, that prolonging life is not the same as solving a problem.

Finally, Brünnhilde understands everything. She knows how the world could be saved, how it could be continued, how it might avoid destruction—and yet she arrives at the conclusion that it cannot be continued.

Brünnhilde’s final act, leading to her death, is often described as self-sacrifice or redemption through love. To me, however, it appears to be an extraordinarily calm and lucid decision. What she accepts is not the role of improving the world, but the responsibility of ending it.

Not to save someone, nor to guarantee a future, but to refuse to carry on through further deception—she returns everything to the flames. It is a choice made not from emotion, but from intellect.

What The Ring shows is not that civilizations collapse because they are immature. Quite the opposite: the world is not destroyed by evil, but becomes impossible to sustain once it is understood too well.

The Ring is a record of the moment humanity becomes too intelligent. That is why, despite being a myth, it resonates so powerfully with the modern world.

After this, Wagner goes on to write Parsifal, but there he no longer tells a story about saving the world. Instead, he asks how one should behave in a world after it has broken, and what it means not to repeat the same mistakes.

If The Ring represents an “intellect that knows how to end,” then Parsifal represents an “attitude that refuses repetition.”

Wagner never depicted a happy vision of the future. He simply, quietly, left us with the question of how human beings—once they have understood too much—might still live. I came to feel that this coldness, and this honesty, form the true core of The Ring.

09/02/2026

I went to the 6th floor of the Nihombashi Takashimaya main store to see the solo exhibition of ceramic artist Yoshifumi Kawamura.

The gallery was bustling with visitors, and people naturally gathered in front of the works. Somewhat to my embarrassment, my own introductory text was also on display—but in the end, it is the vessels themselves that do the talking.

It was a quiet yet powerful exhibition, with a wonderful flow of energy throughout. The show runs until the 9th.

09/02/2026

One evening, almost by chance, I fell into watching a video of Seiji Ozawa conducting The Rite of Spring—most likely with the Boston Symphony Orchestra—and found myself completely absorbed for quite a while.

Stravinsky’s The Rite of Spring is a score notorious as a kind of “conductor-killer”: the meter changes constantly, accents are displaced, and multiple rhythms surge forward simultaneously.

Many conductors manage to hold it together by focusing on “clearly indicating the beat,” somehow giving the performance a coherent shape.

But Ozawa is different. His conducting doesn’t control rhythm from the outside; it feels as though the rhythm wells up from within.

He has the entire score in his head and never looks at the music. The sound rises up as a truly “primitive impulse.”

This, I think, is what makes Seiji Ozawa so extraordinary.

Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube.

09/02/2026

Does Disease Really Decrease in “Health Checkup Nation” Japan?

Yesterday, I had the opportunity to share drinks with a group of young business leaders, and the topic came up as to whether one should undergo regular medical checkups and comprehensive health screenings. Japan is an exceptionally prominent “health checkup nation,” and it would not be an exaggeration to say that few other countries have populations that undergo routine medical examinations as regularly as Japan does.

To begin with the conclusion: people have become less likely to die, but disease itself has not decreased. This, in my view, is the true picture of Japan when seen through international comparison. What health checkups provide is early detection, not prevention.

The Gap Between Life Expectancy and Healthy Life Expectancy

Japan has long boasted one of the highest average life expectancies in the world.
However, the gap between life expectancy and healthy life expectancy—that is, the period of life spent in poor health—is by no means short.

Average life expectancy in Japan: among the highest globally

Gap with healthy life expectancy: approximately 9–12 years

This long period of ill health can also be understood as the result of detecting diseases early and then living with them for a long time thereafter.

Analyses by GBD Japan have shown that the prevalence of chronic diseases such as

cardiovascular disease,

diabetes, and

musculoskeletal disorders

remains persistently high in Japan.

Have Health Checkups Reduced the Onset of Disease?

This question requires a calm and measured assessment.
The conclusion is that health checkups have reduced disease severity, but not disease incidence itself.

For example, in cancer screening, detection rates of early-stage cancers have increased and five-year survival rates have improved. At the same time, however, age-adjusted incidence rates remain flat or have slightly increased.

This phenomenon—including the effects of overdiagnosis—suggests that rather than reducing disease occurrence, screening may be extending the period during which a condition is labeled as a disease. This point was also noted in the New England Journal of Medicine (2012; 367:1995–2005).

Where Is Japan’s Medical Spending Going?

A natural follow-up question is whether medical institutions rely on health checkups and ancillary services to compensate financially because insurance-based medical care alone is unsustainable. On this point, the answer may be partly yes.

Japan’s insurance-based medical system faces structural constraints, including:

extremely low unit prices for medical services,

insufficient reflection of labor intensity in reimbursement, and

low profitability in the long-term management of chronic diseases.

International comparisons by the OECD characterize Japan as a so-called “high-density, low-compensation model,” marked by long physician working hours and low reimbursement rates (OECD Health at a Glance, 2023).

As a result, many medical institutions use health checkups, diagnostic imaging, and mixed private-pay services as financial buffers.

The Lack of Incentives to “Reduce Disease”

If Japan’s healthcare system were to be summarized in one phrase, it would be a structure with weak incentives to reduce disease.

Early detection of disease → more medical interventions

Long-term outpatient care → continued reimbursement

Perfect health → no evaluation from the medical system

In this structure, the more prevention succeeds, the more medical revenue declines.

What the Lancet Data Show

In 2019, The Lancet published the Global Burden of Disease Study 2017, which addressed this issue with overwhelming data:

Global burden of 87 risk factors in 204 countries and territories, 1990–2017
(The Lancet, 2019; 393:1958–1972)

The approximate breakdown of factors determining healthy life expectancy is as follows:

Medical care: 10–15%

Genetics: around 20%

Lifestyle, environment, and social structure: over 60%

In other words, there is a clear limit to what hospitals can do, and health is largely determined outside the examination room. This conclusion is no longer an extreme view, but a widely accepted consensus in preventive medicine and public health.

Most chronic diseases progress quietly within daily life for years before symptoms appear. Medicine is extraordinarily powerful, but it is a force that works after something has broken, not a force that prevents it from breaking. Up to this point, most experts are in agreement.

Opinion A: Therefore, Health Checkups Are Meaningless

From this premise, it is almost natural to conclude that no matter how many checkups one undergoes, they do not lead to health.

What checkups detect are already established lesions or states immediately preceding them. Their root causes lie in daily life and cannot be fully captured by screening. Moreover, as screening becomes more sophisticated, it also detects abnormalities that require no treatment or only observation, increasing anxiety and unnecessary medical intervention (NEJM, 2012; 367:1995–2005).

Health cannot be obtained simply by lining up numerical values. Health checkups are not a means of creating health; they are merely a form of visualization.

Of course, individuals with high genetic risk—such as familial cancer—should undergo specialized screening. On the other hand, Masataka Itsumi, a widely known Japanese television announcer when I first became a physician, died young of gastric cancer. He was cautious due to family history and reportedly underwent gastroscopy every six months. Even so, the disease could not be avoided.

If one reads the Lancet data head-on, the conclusion is clear: before investing more in checkups, we should change the structure of daily life itself.

Opinion B: Precisely Because of That, You Should Get Checkups

That said, starting from the same premise can also lead to a different conclusion.

It is true that lifestyle is the dominant determinant of health, and medical care contributes only 10–15%. However, that 10–15% represents a domain where failure is not acceptable.

Even with a well-regulated lifestyle, disease occurs at a certain probability due to:

genetic predisposition,

aging, and

environmental factors.

The role of health checkups is not to create health, but to detect deviations before they become irreversible. For diseases such as cancer and cardiovascular conditions—where timing of detection dramatically affects survival and prognosis—early detection can be decisive (NEJM, 2013; 368:1279–1290).

What matters is not turning checkups into a talisman.
Having a checkup does not mean you are safe.
Having a good lifestyle does not mean checkups are unnecessary.

The Lancet data do not deny health checkups themselves; they warn us to position them correctly.

So, which do you believe?
Opinion A or Opinion B.

They appear to be opposites, yet both are medically grounded.
Which path you choose depends on how you define health.

Will you entrust your future health to the examination room,
or will you build it day by day through your daily life?

I hope this helps inform that choice.

09/02/2026

Happy birthday

09/02/2026

Why So Many Small Opposition Parties Coexist

Last year marked the 100th anniversary of the Shōwa era, so I organized a project titled “Looking Back on 100 Years of Shōwa History.” The aim was to gain a deeper understanding of Japan by studying modern history. In doing so, I came to realize that at the core of Japan’s postwar political history lay the will of the GHQ to prevent constitutional revision. As long as the Constitution cannot be amended, Japan has no real foundation as a fully independent state.

The Liberal Democratic Party, born in 1955 through the merger of conservative forces, has functioned not merely as a political party, but as the core of a system in which a change of government is structurally difficult to occur.

There are three key points.

1) “Managed opposition” that never crosses the constitutional revision threshold
The distribution of seats in both the House of Representatives and the House of Councillors makes it virtually impossible for ruling and opposition parties combined to exceed the two-thirds majority required for constitutional amendment.

2) Opposition parties exist, but are “strong enough not to win”
A fragmented structure in which many opposition parties with only minor differences coexist
Parties with similar policy positions repeatedly split and reorganize
As a result, votes do not consolidate, while criticism alone spreads

3) The effects of the electoral system
Including the shift from multi-member districts to the current parallel system of single-member districts and proportional representation
The system is designed so that “the largest force is always advantaged”
For opposition parties, it becomes more rational to “exist” than to “take power”

Why it is easier for opposition parties not to win

This is not a conspiracy theory, but a matter of institutional design and incentives.

For the ruling party:
– Integration with the bureaucracy, industry groups, and the budgetary process

For the opposition:
– The ability to speak in ideals without bearing responsibility
– No need to shoulder the costs of policy failure
– Yet still able to secure seats and public party subsidies

In other words, a paradoxical equilibrium has emerged in which
“opposition parties that do not seriously aim for a change of government”
are the most stable.

The real reason constitutional revision never happens

Even before public opinion comes into play, pro-revision forces are dispersed so that they never exceed the two-thirds threshold.
Opposition parties have no incentive to unite.
The ruling party does not need to muster the resolve to push constitutional revision through in earnest.

As a result, the Constitution becomes fixed as an untouchable symbol.

Vote splitting is not a failure—it is designed to happen.

New parties are easy to form.
They disappear easily.
They rarely merge.
They cannot create a shared platform.

As long as this structure remains, no matter how many opposition parties emerge, and no matter how many elections are held, the outcome will not change.

09/02/2026

From tomorrow, February 4, through February 9, from 10:30 a.m. to 8:30 p.m., a pottery exhibition by Mr. Kifumi Kawamura of Kita-Kamakura will be held on the 6th floor of the main building at Nihonbashi Takashimaya. I am planning to stop by as well to offer my greetings.

03/02/2026

Persimmon, metal, early titanium, and modern titanium. They’re all totally different in size. And persimmon is incredibly difficult—I can’t find the sweet spot at all. It really makes you appreciate how great golfers used to be.

02/02/2026

Here’s another interesting find I brought back with me. A persimmon fairway wood my father used some forty years ago, alongside a metal-head driver from a brief era that disappeared within just a few years. And there’s also a Mizuno T-Zoid titanium driver—brand new at the time. These are practically collector’s items now. Still, I can’t help but marvel at how people managed to hit the ball with clubs this small.

02/02/2026

On this visit home, I found a B-3 sheepskin jacket tucked away in the underfloor storage. I used to wear it back when I was a student—more than thirty years ago. In those days, before down jackets were even a thing, this was the best protection against the cold. I think I’ll start wearing it again for a while.

02/02/2026

Tokyo Is at It Again—with Another Strange Idea

Cash transfers exist in municipalities around the world. Finland and Barcelona are often cited examples. But why do they need to be turned into points?

Once you make them points, upfront infrastructure investment is required—meaning tens of billions of yen disappear before a single benefit is delivered. One can’t help but wonder: does some of that money end up circulating back to particular players?

There will likely be restrictions on where the points can be used, and expiration dates as well. That alone is stressful.

Points tend to sit unused. Cash, on the other hand, gets spent.
Even as an economic stimulus, this approach raises questions.

Whether the goal is
poverty relief,
public health,
or economic support—

cash transfers are the cheapest, fastest, and most reliable option in every case.

02/02/2026

The “Anatomy” of a Medical Paper: Why I Stopped Reading the Results First

“Have you seen it? A groundbreaking paper just came out.”

Whenever I hear words like that—on social media or in the corridors of academic conferences—I notice a certain cool detachment in myself. Of course, as someone who works in research, I want to respect new findings. But experience has taught me something: it is extraordinarily rare for a single paper to dramatically change the world starting tomorrow.

Especially now, we live in an era where generative AI can assemble the skeleton of a paper and polish presentation slides into elegant form. The very quality of information has entered a different phase altogether.

Against this backdrop, my way of engaging with academic papers has changed decisively from what it once was.

How I Read Papers When I Was a “Consumer”

In the past, I was a fairly standard—one might say “efficient”—reader. I started with the Results section, then moved on to the Discussion. In a short amount of time, I grasped “what this paper is trying to say” and stored the new knowledge away in a mental drawer.

As a mode of knowledge consumption, this approach is extremely effective.
But it has a fatal flaw—one I only realized after stepping over to the writing side myself.

The Paper as a “Malleable Narrative”

Once you start writing papers, you are confronted with a fact that may be uncomfortable to admit: results are far more malleable than we tend to believe.

Which statistical methods are chosen

Where the analytic boundaries are drawn

Which subgroups are brought into focus

Which outcomes are elevated to center stage

With a certain marketing sensibility, all of these can be woven into a convincingly “beautiful story.” On the stage of an academic paper, the ball is sometimes placed on a slope—so that it naturally rolls in a particular direction.

A Shift Toward “Anatomical Reading”

These days, after reading only the title and background of a paper, I close the page once.

Then I stop and ask myself:

“If I were entrusted with this study under these assumptions, what kind of results would I produce—and what kind of story would I construct?”

Only after sketching my own hypothesis and narrative structure in my head do I finally turn to the Results section. When I do, what emerges is not a tidy sense of “that makes sense,” but something much more visceral: the author’s intention.

Why was this result selected?
Why was that data discarded?
Why was this particular slope necessary?

At that point, the act is no longer about receiving knowledge. It becomes closer to an anatomy—carefully dissecting a researcher’s thought process, one incision at a time.

Reading papers with diligence is admirable.
But we must not remain unaware of the “slope” on which a paper is built. The results and interpretations presented may be nothing more than what inevitably rolled down that incline.

In an age where generative AI can mass-produce “plausible answers,” what is demanded of us is not the speed at which we arrive at answers. Rather, it is the ability to read the artifice and struggle hidden within the process that produced them.

To read a paper, I have come to think, is to engage in an intellectual struggle with the human intentions that exist on the other side of the text.