In Episode 5, Season 2 of “Tokyo Vice”, the fearsome, awesomely tattooed gangster Tozawa (Ayumi Tanida) reappears after a six-month absence. Since no one inside or outside the yakuza seems to know where Tozawa went after collapsing at a fancy dinner, most assumed the worst. Yet Tozawa is now fit and ready to wrest power from the Ōsaka oyabun (godfather) who stands between him and total power.
The yakuza-obsessed reporter Jake Adelstein (Ansel Elgort) asks his newspaper editor Eimi Maruyama (Rinko Kikuchi) about the mysterious liver disease that plagues Tozawa and other yakuza. Eimi says it’s shokugōyō—the “illness of the trade”, explaining, “Yakuza live a life filled with alcohol, shabu and tattoo needles. Do that long enough and you get liver disease.”
When Jake responds that Tozawa seems healthy, she responds, “It’s not something you get over”.
Alcohol and tattoos were clear enough, but shabu sent me on an online search. I associated the word only with shabu-shabu, a costly dish of sliced beef and vegetables poached at the table and dipped in sauces. Shabu means “swish”—but in “Tokyo Vice” it means methamphetamine, which in Japan is trafficked by yakuza, some of whom are also users.
Methamphetamine causes liver damage by compromising the immune system, making the organ vulnerable to infection. Cirrhosis and hepatitis are common among meth users, and the eventual result is liver failure.
Alcohol is also bad for the liver, but despite Japan’s robust drinking culture the country has a notably low rate of alcoholism. The reason is purely genetic: Up to 50% of Japanese have a nonfunctional ALDH enzyme that renders them unable to metabolize alcohol, leaving the liver unaffected. According to the NIH:
People with two copies of the defective gene respond to alcohol consumption with intense flushing and other unpleasant reactions, such as nausea. Consequently, these people consume very little alcohol and are at a much lower risk for alcoholism than people with functional ALDH genes. People with one copy of the defective gene also flush after ingesting alcohol and are at relatively lower risk for alcoholism than people with fully functional genes. In addition, these people have more intense, but not necessarily less pleasant, reactions to alcohol as assessed by both physiological and psychological measures. People with the defective gene variant also respond to alcohol consumption with characteristic changes in brain activity.*
That leaves tattoos, which for yakuza are elaborate, full-body patterns done with bamboo or steel needles. While hand-poked tattoos are more likely to cause blood contamination than tattoo guns, the greater risk is the enormity of the tattoos, which inhibit the body’s ability to sweat. Damaged sweat glands can’t clear toxins which then build up, leading to liver failure and death.
Tozawa,, we learn, needs a liver transplant but can’t travel to the U.S. to get one. (Organ donation is still largely taboo in Japan, so those seeking transplants need to travel abroad.) Denied a visa because of his criminality, Tozawa goes to Thailand for an experimental treatment. This, Eimi says, will buy him perhaps six months—but it is not a cure. Nevertheless, Tozawa makes the most of this borrowed time to eliminate his rivals and consolidate power over a new model of yakuza—one in which he is the CEO of an international conglomerate, not the oyabun (father) of a family of loan sharks, drug dealers and human traffickers.
Next: Tattoos in Japan: Taboo, Yet Omnipresent
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*”Genetic Influences Affecting Alcohol Use Among Asians,” by Tamara L. Wall, Ph.D, and Cindy Ehlers, Ph.D. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875758/