This appendix provides source references and legal context related to diagnostic responsibilities in Japan, as discussed in Who Diagnosed You? Volume 1.
Additional resources—including original Japanese materials and research data on credential misrepresentation—are available.
This list was compiled by the author to document publications in which a researcher—here referred to as Mr. X—was involved and listed with an academic degree.
The following two papers explicitly list a medical doctor (MD) as the corresponding author:
・Modern Pathology (2012), MD
・The American Journal of Surgical Pathology (2014), MD
A complete list of 19 analyzed publications is available here:
Click the button below to download the full analysis (PDF):
Note: The list contains only publicly available information: journal name, publication year, and the academic
degree (e.g., MD) as attributed in the publication.
No author names, affiliations, or personal identifiers are included.
This list was compiled solely for the purpose of institutional ethics analysis and is not intended to target any specific individual.
Disclaimer:
The data presented here is based on publicly available PubMed records as of the publication of Who Diagnosed You? Volume 1.
While future updates or corrections may occur, the underlying issue of misconduct remains a matter of historical fact.
ICMJE & COPE Key Points
Before turning to the ICMJE and COPE frameworks,
it is worth noting that Elsevier’s Ethics in Research & Publication factsheet (2017) emphasizes that misrepresenting a researcher's relationship to their work—such as omitting or fabricating
authorship—is a form of misconduct that undermines confidence in scientific reporting:
*“Deliberately misrepresenting a scientist's relationship to their work is considered to be a form of misconduct that undermines confidence in the reporting of the work itself.”
— Elsevier Ethics in Research & Publication, 2017
[https://researcheracademy.elsevier.com/uploads/2018-02/2017_ETHICS_AUTH02.pdf]
This position aligns with the authorship standards set by ICMJE and COPE, detailed below...
🟦 ICMJE (International Committee of Medical Journal Editors)
1. Four Criteria for Authorship
According to ICMJE, individuals must meet all four of the following criteria to qualify as an author:
・Substantial contributions to the conception, design, acquisition, analysis, or interpretation of data
・Drafting or critically revising the manuscript
・Final approval of the version to be published
・Agreement to be accountable for all aspects of the work
“All those designated as authors should meet all four criteria for authorship, and all who meet the four criteria should be identified as authors.”
— ICMJE Recommendations
https://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html
2. Academic Degree Listing
ICMJE recommends listing each author’s highest academic degree, although implementation may vary by journal.
“Each author’s highest academic degrees should be listed, although some journals do not publish these.”
— ICMJE Guidelines
https://www.icmje.org/recommendations/browse/manuscript-preparation/preparing-for-submission.html
🟩 COPE (Committee on Publication Ethics)
1. Emphasis on Transparency
COPE stresses the need for transparency in authorship and contributor roles. Editors and publishers are responsible for ensuring guidelines are clear and consistently applied.
“Authors are accountable for following discipline-specific guidelines when they engage in authorship activities…”
— [COPE Authorship Guidelines]
(https://publicationethics.org/authorship)
2. Prevention of Misattribution
COPE explicitly identifies and discourages unethical authorship practices, including:
・Ghost authorship: Significant contributors not credited
・Guest authorship: Named individuals with no real contribution
・Gift authorship: Honorary naming based on status rather than effort
・These practices compromise trust and undermine scientific integrity.
🔎 Summary of Key Principles
• Academic degrees listed in publications should reflect actual, verifiable qualifications.
• Author credit must correspond to meaningful contribution—not title, status, or position.
• Authors and journals share ethical responsibility for transparent and accurate representation.
• Misrepresentation of degrees or authorship roles is a serious ethical breach, even if not illegal.
To provide context for how diagnostic responsibilities are regulated in Japan, the following official positions have been summarized. These serve as legal and institutional references for the issues discussed in this book. For original Japanese-language sources and documentation, please visit the Japanese page of this website.
1. Official Statement by the Japanese Society of Pathology (April 22, 2025)
In its 2025 official guidance, the Japanese Society of Pathology formally confirmed that pathological diagnosis—including assessments conducted outside of hospitals—constitutes a medical act
(i.e., subject to the Medical Practitioners Act) and must be performed only by licensed physicians.
This clarification was obtained through a formal inquiry to the Ministry of Health and is now part of the Society’s official institutional stance.
2. Ministry of Health, Labor and Welfare Notification (March 28, 2025)
Issuing diagnostic-like notifications based on individual medical test results by non-licensed persons is regarded as a substantive diagnosis,
regardless of disclaimers or wording.
Such actions are deemed a violation of the Japanese Medical Practitioners Act.
Interpretation
Strictly speaking, the 2025 notification did not introduce a new legal framework. Rather, it clarified and reaffirmed pre-existing legal and administrative interpretations, with the specific aim
of eliminating formalistic loopholes and superficial disclaimers.
Nevertheless, by officially articulating these principles and issuing a nationwide directive, the government marked a significant turning point for clinical practice in Japan.
This was especially important in the context of diagnostic acts that do not involve direct patient contact—areas particularly prone to ambiguity when evaluated through a formalist
lens.
3. Official Statement by the Head of Pathology, Kyoto University (March 16, 2017)
Non-physicians should not perform pathological diagnosis in the field of human medicine.
This is not a matter of “whether one is capable” but a structural rule based on professional licensure.
Interpretation
This statement was issued in a personal capacity by a senior authority in the field, serving as a clear warning against allowing dentists to perform pathological diagnosis in medical (non-dental)
domains. Conversely, the very need for such a statement suggests that ambiguity has been tolerated within Japan’s diagnostic pathology community.
4. On Dental Practitioners Diagnosing Extra-Oral Conditions (the Medical Practitioners Act)
When a dentist engages in pathological diagnosis beyond the oral region, it may constitute a legal violation under the Medical Practitioners Act—even in the absence of diagnostic error.
Interpretation
Japanese law distinguishes between the Medical Practitioners Act, which applies universally across all health professions, and the Dental Practitioners Act, which serves as a special law
specifically governing dentists. The key provision is Article 17 of the Medical Practitioners Act, which prohibits anyone other than a licensed physician from practicing medicine. This
distinction defines the legal boundaries of diagnostic authority in Japan.
🔗 FOR MORE DETAILS (IN JAPANESE):
The following is an unofficial English translation of selected
provisions from Japanese law, provided for reference only. For the official and up-to-date legal text,
please consult the e-Gov Law Search:
https://laws.e-gov.go.jp
Medical Practitioners Act (Act No. 201 of 1948)
Article 1 (Purpose)
A medical practitioner shall engage in medical care and public health guidance, and shall practice medicine for the benefit of public welfare.
Article 4 (Licensure)
To become a medical practitioner, one must pass the national medical licensing examination and receive a license from the Minister of Health, Labour and Welfare.
Article 17 (Exclusive Right to Practice Medicine)
No person other than a licensed medical practitioner shall engage in the practice of medicine.
Article 18 (Title Protection)
No person other than a licensed medical practitioner shall use the title “medical doctor” or any misleading designation implying such status.
Article 31 (Penalties)
Any person who violates Article 17 or 18 shall be subject to imprisonment for up to three years or a fine of up to one million yen.
Dental Practitioners Act (Act No. 202 of 1948)
Article 1 (Purpose)
A dental practitioner shall be responsible for dental practice and shall contribute to the advancement of dental medicine and oral health.
Article 4 (Licensure)
To become a dental practitioner, one must pass the national dental licensing examination and receive a license from the Minister of Health, Labour and Welfare.
Article 6 (Scope of Practice)
A dental practitioner is authorized to engage exclusively in the medical treatment of teeth and oral health.
Article 18 (Title Protection)
No person other than a licensed dental practitioner shall use the title “dental practitioner” or any misleading designation implying such status.
Article 30 (Penalties)
Any person who violates Article 6 or 18 shall be subject to imprisonment for up to three years or a fine of up to one million yen.
📗 Hanabuchi Project
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organization.
It is currently operated from a registered base in Yokohama, Japan. For media inquiries,
📮 please see the contact form (written in Japanese).
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