Over the past several years, Dr. Pickler has facilitated a tour group of physicians and healthcare managers from Japan around the Cleveland and Akron areas of Ohio for the purpose of examining current practices of healthcare delivery in the United States. The program, designed and sponsored by Dr. Reichiro Okada, is an annual function each year. This week-long program includes tours to hospitals with presentations by healthcare professionals. The program is sponsored by the Center for Global Health Affairs in Cleveland, Ohio, the Socio-Medical Research Institute in Tokyo, Japan and by the Healthcare MBA Program at Baldwin Wallace University in Berea, Ohio, U.S.A.