J：How do you explain this treatment, which is difficult to explain, including its effects, to owners?
Ushigusa：I don’t recommend many new things to pet owners. I make it very clear that it is not a dream cure and that it may or may not work.
I have been practicing hyposensitization therapy for a long time. Simply put, it is a treatment in which the allergen causing the allergy is injected subcutaneously in gradually increasing doses so that the body becomes accustomed to the allergen. However, hyposensitization therapy is a treatment based on epidemiological data and there is no established logic behind it. Various theories have been proposed, but they cannot be proven, nor is there any evidence of a mechanism of action. However, it has been defined by the WHO as “the only treatment that promotes spontaneous healing of allergies.
I think that immuno-cell therapy, like desensitization therapy, has a background that is too complicated to prove. It is important to try to prove it, and of course we want to prove it, but it does not mean that we cannot use it without proof. I feel that for owners, it is not a question of not wanting to use or not using a therapy if the theory of therapy has not been proven. With the cooperation of such owners, I think it is necessary to receive criticism in the course of clinical practice, make improvements in those areas, and further develop the theory. Even treatment methods that are considered the “golden standard” have a theory as a mechanism, but there is not necessarily sufficient data to prove the theory. As clinicians, we must make efforts to build up the theory little by little, but this is not the case in the area of whether we should not use the theory unless we have it all figured out. It is with these thoughts in mind that I provide explanations to owners.
J：What are your expectations for J-ARM in the future?
Ushigusa：I would like to see more academic backup. For example, I would like to perform flow cytometry of cells one at a time, but hospitals are currently paying for it, so the more immuno-cell therapy they perform, the busier they get and the more they lose money. I believe that such technical backup is necessary both financially and physically. Also, I think there is a limit to what clinicians alone can discuss, especially in the field of immunology. We can give them a lot of cases, but I hope J-ARM will back us up on the academic side.
We would also like to have guidelines that the veterinary community is currently trying to formulate that we can be assured of safety as long as we follow them. First of all, as veterinarians, we would very much like to see a unified base guideline that is well developed and implemented. After all, epidemiological data is the only way for immuno-cell therapy to break through, as is the case with desensitization therapy. I believe that if guidelines are established, the standards for data will be established, and it will be necessary for the academic societies to organize the data. If the standards are set up properly, no one will be able to complain even if there are difficulties in proving the theory.
J：Can you tell us about your future prospects in advancing cell therapy?
Ushigusa：We clinicians are the pilots, not the ones who develop or build the planes. We are to steadily accumulate epidemiological data and create the groundwork to increase the number and quality of data. As you accumulate the data, someone may or may not recognize you. I believe that the market and the results of treatment will prove and determine this. In order to properly determine what is certain, if this kind of data is compiled, it will be easier for clinicians to know which treatment is appropriate, and guidelines will make it safer to use. If we don’t have diagnostic criteria to apply, everything will not be clear, but once the guidelines are established, we can let the data build up that we can use. We can move away from the status quo of, “If you put in cells, they will get better, so that’s good.” We can get away from the current situation where we say, “If you put cells in, they will get well.
The best way is to accumulate both basic research data and clinical data. It is impossible for a single clinician to accumulate both of them. Eventually, it would be nice to have many colleagues who can work together with both clinicians and researchers.
J：I think you are right. Thank you very much for your valuable talk.
（Interview Date: November 16, 2013）
Kannai Animal Clinic
Adress: 6-3 Yoshida-cho, Naka-ku, Yokohama, Kanagawa 231-0041, Japan
Phone：045-243-6417
http://www.geocities.jp/kac2436417/