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Structured paternalism consists of the setting of public policy by centralized authority without the benefit of surveillance and research to guide it. It is a concept deeply embedded in Japanese society, based on the belief that the central government is the highest authority. It strongly affects decision-making regarding medical care, in that many policies are set without the guidance of either the public at large or physicians and scientists. The 1990s, however, have seen a diminution of this structured paternalism, as is illustrated by public policy regarding AIDS. The general public is becoming more knowledgeable about this disease and has become more willing to voice its opinion and even take action. The government, in particular the Ministry of Health and Welfare, is becoming more responsive to public and expert opinion. Individual providers within the medical profession are often succeeding in providing excellent medical care to HIV/AIDS patients despite a lack of well-conceived guidelines.