OBJECTIVE: Japan is one of the major pharmaceutical suppliers around the world. It produces about a quarter of total pharmaceuticals in the world market, second to the U.S. Even with her high productivity, she has been pointed out the poorest balance of trade in pharmaceuticals. This study investigates the fact of balance of trade in Japanese pharmaceutical markets. METHODS: Using OECD Health Data 2002 4th ed., we calculate the balance of exports and imports of pharmaceutical manufacture of Japan. The result will be compared with ones in other OECD countries. We also look over the trend in the net profit of pharmaceuticals in Japan for the last two decades. RESULTS: Findings from the 23 country data available show similar results with previous studies, in which Japan has worse balance of trade in real terms of money. However, the ratio of balance of Japanese pharmaceutical trade, calculated in purchasing power parity in US$ was 1.65 in deficit in 2000. This takes place in the midst of all countries analyzed. Rather, excluded seven countries showing positive net profits in pharmaceuticals trade, only three countries in red figures were in better condition than in Japan, behind twelve countries. Same results appeared when current exchange rates in US$ were used. It was also found that the ratio of balance has shown improvements from 2.25 in 1980 to 1.65 in 2000, via 2.06 in 1990 (figures all in deficit). CONCLUSION: Japanese pharmaceutical industry in international markets has been considered more badly than it actually is. However, it is still true that the balance of trade in pharmaceuticals in Japan should be improved. The reason why Japan shows the current feature should be discussed in further studies