The number of MR in Japan in 2017 was 62,433, decreased by 1.2% from that of previous year.While Until 2016, CSO had been driving the growth of MR organization until 2016, we saw huge drop in 2017, as it couldn’t hold the pool of MR any longer, due to the decreased demand from pharma. 
The number of MR in Japan is yet too large. Among developed nations, Japan follows the United States in terms of number of MR. Importantly, when we look at the number of physicians per number of MR, Japan has below five (physicians/MR), while the United States has approximately thirteen. We see considerable gap and an outstanding issue in terms of productivity. 
As foreign firms expand their businesses in Japan, now over half of top 10 companies who have largest MR organization are non-Japanese pharma companies. Now, pharma companies have been facing the needs of cost reduction, due to the recent slow sales and shrinking domestic pharma market. 
Pharmaceutical firms’ sales-centric approach had been criticized for a long time, but no practical measures were not taken, as medical institutions and physicians relied on the financial contribution done by pharma companies. The Diovan scandal that occurred in 2013 finally changed the situation surrounding MR dramatically. It pushed the back of MHLW, Ministry of Health, Labor, and Welfare, to create the new regulation onto clinical researches, which was implemented in April 2018. Academia is now required to follow the similar processes of clinical studies. 
The Diovan case also shed the light on the unproductivity of MR to the public. Now pharma companies have been very eager to have MSL and medical affairs team take over MR’s primary function. Accordingly, pharma companies have started to decrease the number of MR. CSOs are also facing the difficult phase, due to the decreased needs of MR in pharma. There is no question that going forward, a major shift will be made towards so-called e-MR services deployed over the Internet, such as MR-kun provided by M3.