陳馮富珍：傳統(tǒng)醫(yī)學(xué)滿足了很多需求卻得了個(gè)壞名聲

1、精選優(yōu)質(zhì)文檔-傾情為你奉上【特別推薦】陳馮富珍：傳統(tǒng)醫(yī)學(xué)滿足了很多需求，卻得了個(gè)壞名聲 陳馮富珍 世界衛(wèi)生組織總干事來自中華人民共和國的陳馮富珍博士曾獲加拿大西安大略大學(xué)醫(yī)學(xué)學(xué)位。她于1978年加入香港衛(wèi)生署；1994年，被任命為香港衛(wèi)生署署長；2003年，加入世界衛(wèi)生組織，擔(dān)任人類環(huán)境保護(hù)司司長；2005年6月，被任命為傳染病監(jiān)測(cè)與反應(yīng)司司長以及負(fù)責(zé)大流行性流感的總干事代表；2005年9月，被指定為主管傳染病部門的助理總干事；2006年11月9日，當(dāng)選為總干事。2012年5月，再度當(dāng)選為總干事?！菊楷F(xiàn)代醫(yī)學(xué)也有不足之處，有些是真實(shí)的有些是感覺到的。奇怪的是，這些不足導(dǎo)致了一種局面，就是傳

2、統(tǒng)醫(yī)學(xué)滿足了一種被很多人認(rèn)可的需求，卻得了個(gè)壞名聲?！颈疚臑殛愸T富珍在2015年8月19日澳門“國際傳統(tǒng)醫(yī)學(xué)論壇”上的演講】各位閣下，尊敬的部長們，尊貴的專家們、女士們、先生們：我很高興有此機(jī)會(huì)在國際傳統(tǒng)醫(yī)學(xué)論壇上講話，特別是我們剛剛在澳門成立了世衛(wèi)組織傳統(tǒng)醫(yī)學(xué)合作中心?，F(xiàn)代醫(yī)學(xué)和傳統(tǒng)醫(yī)學(xué)都能對(duì)健康作出獨(dú)特的貢獻(xiàn)，但兩者也都各有局限和不足。各國，特別是發(fā)展中國家，應(yīng)當(dāng)在有監(jiān)管的情況下，審慎地綜合使用這兩種醫(yī)學(xué)中的精華。1面對(duì)成千上萬感染者，現(xiàn)代醫(yī)學(xué)除了護(hù)理，什么都不能提供傳統(tǒng)醫(yī)學(xué)可大有作為，尤其能促進(jìn)初級(jí)衛(wèi)生保健和全民覆蓋，特別是在目前慢性非傳染性疾病已經(jīng)超過傳染性疾病，成為全球最大殺手的情況

3、下就更是如此。對(duì)于通常生活在發(fā)展中國家農(nóng)村地區(qū)的數(shù)百萬人來說，草藥、傳統(tǒng)療法和傳統(tǒng)醫(yī)學(xué)從業(yè)人員是主要的，有時(shí)甚至是唯一的衛(wèi)生保健來源。這種保健離家近，方便又實(shí)惠。在一些傳統(tǒng)醫(yī)學(xué)，如傳統(tǒng)中國醫(yī)學(xué)和淵源于印度的阿育吠陀系統(tǒng)中，傳統(tǒng)習(xí)俗依賴數(shù)百年來獲得的智慧和經(jīng)驗(yàn)。在這些情況中，傳統(tǒng)醫(yī)學(xué)有著濃厚的歷史和文化淵源，從業(yè)人員通常是家喻戶曉、令人尊重的社區(qū)成員，他們的能力和療法得到大家的信任。這種保健形式無疑能夠緩解，治療許多常見疾病，減少痛苦，緩解疼痛，還可避免有小病小痛的人蜂擁到診所和急診室。然而，這些眾所周知的優(yōu)勢(shì)，卻招致了對(duì)傳統(tǒng)醫(yī)學(xué)的若干批評(píng)之一。相信傳統(tǒng)治療師是抵御病癥和疾患的第一道和最佳防線，

4、可能會(huì)導(dǎo)致潛在威脅生命的醫(yī)療緊急情況，特別是當(dāng)這種信念阻止或延遲獲取主流醫(yī)學(xué)時(shí)。事實(shí)上，這一批評(píng)與實(shí)際情況并不十分相符。許多患重病的窮人之所以不去診所或急診室，其實(shí)是因?yàn)樵\所和急診室不可得或不可及。傳統(tǒng)醫(yī)學(xué)是默認(rèn)的，但不是第一選擇。它是唯一的備選方案。造成危險(xiǎn)的并不是施行傳統(tǒng)醫(yī)學(xué)本身，而是許多發(fā)展中國家不能普及基本衛(wèi)生服務(wù)。世衛(wèi)組織開展的調(diào)查表明，只有略微過半的公共衛(wèi)生設(shè)施能夠提供治療急性病的基本藥物。而在私營設(shè)施，該數(shù)字上升到68%。這意味著很多設(shè)法到衛(wèi)生設(shè)施就診的人卻兩手空空地離去。在另一些情況中，傳統(tǒng)醫(yī)學(xué)成為默認(rèn)選擇只是因?yàn)槲麽t(yī)什么都無法提供。我們?cè)谖鞣堑陌２├咔槠陂g真切目睹了這一狀況

5、。面對(duì)成千上萬的感染者及其醫(yī)生，現(xiàn)代醫(yī)學(xué)除了支持性護(hù)理外，什么都不能提供，沒有疫苗也沒有治療藥物。患者及其家人當(dāng)然更愿意在家中或者由傳統(tǒng)治療師進(jìn)行護(hù)理，而不愿意被隔離到難以活著離開的治療中心。其它批評(píng)則集中針對(duì)用于監(jiān)管傳統(tǒng)醫(yī)學(xué)質(zhì)量和安全的薄弱體制框架。這個(gè)弱點(diǎn)在整個(gè)發(fā)展中世界普遍存在，涉及到所有醫(yī)療產(chǎn)品。在藥物方面，只有約20%的世衛(wèi)組織會(huì)員國具備運(yùn)轉(zhuǎn)良好的監(jiān)管機(jī)構(gòu)。約50%具備程度不一的監(jiān)管能力。而30%根本不具備或只具備有限的監(jiān)管能力。2在此，傳統(tǒng)醫(yī)學(xué)勝出女士們，先生們：現(xiàn)代醫(yī)學(xué)也有不足之處，有些是真實(shí)的有些是感覺到的。奇怪的是，這些不足導(dǎo)致了一種局面，就是傳統(tǒng)醫(yī)學(xué)滿足了一種被很多人認(rèn)可的

6、需求，卻得了個(gè)壞名聲。在富裕國家，公眾往往對(duì)過度醫(yī)療化和過度專業(yè)化的衛(wèi)生保健有種消極反應(yīng)，因?yàn)檫@類保健將患者當(dāng)作一種身體專門部位的集合體而非一個(gè)完整的人來對(duì)待。人們希望能更多地掌控對(duì)其身體所作的治療。他們希望對(duì)自己的健康進(jìn)行自我調(diào)節(jié)。正如我們?cè)诰芙^疫苗接種運(yùn)動(dòng)中所看到的，科學(xué)往往得不到信任，有時(shí)甚至遭到詆毀。通過社交媒體傳播的謠言可能比上百份精心編寫并獲得同行審評(píng)的研究報(bào)告更具影響力。人們懷疑效力強(qiáng)大的新藥物可能具有尚未發(fā)現(xiàn)或從未誠實(shí)披露的副作用。人們還可能不相信自己的醫(yī)生，希望獲得第二方和第三方意見。他們尋找擁有更多專業(yè)知識(shí)的專家。促使中東呼吸綜合征在大韓民國迅速傳播的采購式就醫(yī)和跳轉(zhuǎn)醫(yī)院的

7、做法便清楚反映了人們的這些期望。一些分析師將這種不滿和不信任歸因于現(xiàn)代醫(yī)療保健的制度、基礎(chǔ)設(shè)施、培訓(xùn)、獎(jiǎng)勵(lì)措施以及導(dǎo)向。在許多國家，現(xiàn)代醫(yī)療保健制度要求醫(yī)生用于每名患者的時(shí)間不得超過20分鐘。在這幾分鐘內(nèi)，醫(yī)生要行動(dòng)，不要說話，要就藥物、化驗(yàn)以及其它干預(yù)作出處方。這種做法與傳統(tǒng)醫(yī)學(xué)從業(yè)者的方法形成鮮明對(duì)比。此外，從事家庭醫(yī)學(xué)的醫(yī)生數(shù)量大幅減少，而出現(xiàn)了更多的?？漆t(yī)生和亞?？漆t(yī)生。隨著目前非傳染性疾病日益增多，家庭醫(yī)生的技能對(duì)于這類疾病的預(yù)防和連續(xù)護(hù)理至關(guān)重要，但這一職業(yè)卻正在消失。在研究與開發(fā)方面，曾對(duì)預(yù)期壽命產(chǎn)生驚人影響的現(xiàn)代醫(yī)學(xué)奇跡在逐步放緩。真正新分子化合物的發(fā)現(xiàn)越來越少。與抗生素不同，

8、用于治療慢性疾病和癥狀，如高血壓等的許多藥物，即便不需要終生，也需要長期服用，令人對(duì)累積的毒性作用感到擔(dān)憂。用于治療癌癥和糖尿病的一些較新藥物已經(jīng)證明具有嚴(yán)重，有時(shí)甚至是威脅生命的副作用。在治療癡呆癥或管理肥胖癥方面仍有待開發(fā)藥物。用于治療癌癥的許多昂貴藥物僅能使生命延長幾個(gè)月，而延長的這段生命的質(zhì)量通常極其糟糕。替代醫(yī)學(xué)產(chǎn)業(yè)的驚人崛起彌補(bǔ)了現(xiàn)代醫(yī)學(xué)中的一些不足之處。在若干北美和歐洲國家，草藥、膳食補(bǔ)充劑以及其它一些所謂“天然”產(chǎn)品的生產(chǎn)和銷售已成為一個(gè)巨大的賺錢產(chǎn)業(yè)。僅在美國，該產(chǎn)業(yè)的年業(yè)務(wù)額便達(dá)320億美元。該產(chǎn)業(yè)極力捍衛(wèi)自己的領(lǐng)域、權(quán)利和利潤，通過一些毫無根據(jù)的聲稱展開積極營銷，招致了醫(yī)

9、療界中很多人的怨憤。醫(yī)療專業(yè)人士指出，大多數(shù)替代藥物系通過非處方銷售或因特網(wǎng)進(jìn)入市場(chǎng)，不受任何監(jiān)管。在他們看來，公眾在冒險(xiǎn)自行服用可能無效或有毒，或者兩者兼具的產(chǎn)品。這種情況下，產(chǎn)業(yè)已將傳統(tǒng)醫(yī)學(xué)劫持，但擯棄了經(jīng)驗(yàn)豐富的從業(yè)者的技能。由此招致的敵意和憤怒顯而易見于最近揭露和譴責(zé)該產(chǎn)業(yè)行為的一些書籍的名稱，例如哄騙或是治療蛇油科學(xué)，或維生素和草藥補(bǔ)充劑行業(yè)中的死亡、謊言和政治。所有這些出版物有一個(gè)共同的基本結(jié)論，就是：大多數(shù)傳統(tǒng)藥物和做法的療效并沒有在傳統(tǒng)的臨床試驗(yàn)中得到證實(shí)。我想對(duì)此結(jié)論提出委婉的質(zhì)疑。當(dāng)傳統(tǒng)醫(yī)學(xué)在其文化和歷史發(fā)源地由熟練、經(jīng)驗(yàn)豐富和值得信賴的從業(yè)者實(shí)施時(shí)所產(chǎn)生的人類體驗(yàn)，是無法

10、用科學(xué)方法進(jìn)行準(zhǔn)確和全面評(píng)價(jià)的。對(duì)照臨床試驗(yàn)可以評(píng)價(jià)干預(yù)措施或草藥產(chǎn)品，但不能評(píng)價(jià)全面的體驗(yàn)。此外，對(duì)疼痛、焦慮和壓力的抱怨幾乎總是帶有某種主觀性。安慰劑效應(yīng)是一種有大量記載的科學(xué)現(xiàn)象。諾貝爾獎(jiǎng)獲得者伊麗莎白·布萊克本這樣提醒辯論雙方：“我們往往會(huì)忘記在人類生物學(xué)中大腦是多么強(qiáng)大的器官。”關(guān)于壓力的生理效應(yīng)的科學(xué)研究證實(shí)這一提醒是正確的。富裕國家的多數(shù)醫(yī)療基礎(chǔ)設(shè)施旨在管理傳染性病原體并且在這方面做得很出色。但在預(yù)防和治療非傳染性疾病方面則遠(yuǎn)遠(yuǎn)不夠有效，因?yàn)榉莻魅拘约膊〉牟∫蚝苌偈腔ゲ魂P(guān)聯(lián)的單一細(xì)菌、病毒或寄生蟲等。越來越多的證據(jù)表明，飲食、運(yùn)動(dòng)和減壓可比大多數(shù)藥物和外科手術(shù)更有效地預(yù)

11、防或延遲心臟病發(fā)作。在此，傳統(tǒng)醫(yī)學(xué)勝出。傳統(tǒng)醫(yī)學(xué)開拓了一系列干預(yù)措施，如健康飲食，運(yùn)動(dòng)，草藥和減少日常壓力的種種方法等。3應(yīng)當(dāng)看到傳統(tǒng)醫(yī)學(xué)和現(xiàn)代醫(yī)學(xué)的共同之處女士們，先生們：主張?jiān)谡?guī)衛(wèi)生保健系統(tǒng)中給予傳統(tǒng)醫(yī)學(xué)更合法的地位的觀點(diǎn)繼續(xù)引發(fā)大量爭論。旨在整合傳統(tǒng)醫(yī)學(xué)和現(xiàn)代醫(yī)學(xué)之精華的國家，最好不要將目光放在這兩種方法的諸多不同之處上。相反，應(yīng)當(dāng)看到兩者的共同之處，以幫助應(yīng)對(duì)21世紀(jì)的獨(dú)特衛(wèi)生挑戰(zhàn)。謝謝大家?！疽韵聻橛⑽陌姹尽縀xcellencies, honourable ministers, distinguished experts, ladies and gentlemen,I welcom

12、e this opportunity to address the International forum on traditional medicine, especially as we inaugurate the WHO collaborating centre on traditional medicine in Macao.Modern medicine and traditional medicine make unique contributions to health, but both also have their limits and shortcomings. Cou

13、ntries, especially in the developing world, are wise to use the best of these two approaches in a carefully integrated and regulated way.Traditional medicine has much to offer, especially as a contribution to primary health care and universal coverage, and most especially at a time when chronic nonc

14、ommunicable diseases have overtaken infectious diseases as the worlds biggest killer.For many millions of people, often living in rural areas of developing countries, herbal medicines, traditional treatments, and traditional practitioners are the main, sometimes the only, source of health care.This

15、is care that is close to homes, accessible, and affordable. In some systems of traditional medicine, such as traditional Chinese medicine and the Ayurveda system historically rooted in India, traditional practices are supported by wisdom and experience acquired over centuries.In these contexts where

16、 traditional medicine has strong historical and cultural roots, practitioners are usually well-known members of the community who command respect and are supported by public confidence in their abilities and remedies.This form of care unquestionably soothes, treats many common ailments, reduces suff

17、ering, and relieves pain. It also keeps people with minor complaints and illnesses from flooding clinics and emergency wards.However, these well-known advantages contribute to one of several criticisms of traditional medicine. The belief that traditional healers are the first and best line of defenc

18、e against illness and disease can lead to potentially life-threatening medical emergencies, especially when this belief blocks or delays access to mainstream medicine.In reality, this criticism does not align well with the situation on the ground. Many poor people with severe disease do not visit cl

19、inics or emergency wards precisely because none are available or accessible. Traditional medicine is the default, not the first choice. It is the only option available.The danger comes not from the practice of traditional medicine per se, but from the failure of so many developing countries to provi

20、de universal access to essential health services.Surveys undertaken by WHO show that essential medicines for the treatment of acute diseases are available in only slightly more than half of all public health facilities. For privately run facilities, the figure rises to 68%. This means that large num

21、bers of people who manage to reach health facilities are leaving them empty-handed.In other cases, traditional medicine is the default option simply because Western medicine has nothing to offer. We witnessed this situation most vividly during the Ebola outbreak in West Africa.For the thousands of p

22、eople infected and their doctors, modern medicine had nothing to offer, no vaccines and no treatments beyond supportive care. Patients and their families understandably preferred care in homes or by traditional healers to isolation in treatments centres where few left alive.Other criticisms centre o

23、n the weak institutional frameworks for regulating the quality and safety of traditional medicine. This weakness is likewise pervasive throughout the developing world, for all medical products.For medicines, only around 20% of WHO Member States have a well-functioning regulatory authority. Around 50

24、% have variable regulatory capacity. And 30% have no or only very limited regulatory capacity.Ladies and gentlemen,Modern medicine also has some shortcomings, both real and perceived. Paradoxically, these shortcomings have created a situation where traditional medicine meets a perceived need, yet ea

25、rns a bad name at the same time.In wealthy countries, the public often reacts in a negative way to health care that is seen as over-medicalized and over-specialized, with the patient treated like a collection of specialized body-parts, and not as a whole person. People want more control over what is

26、 done to their bodies. They want to self-regulate their own health. As seen in the movement of vaccination refusal, science is often mistrusted, sometimes even vilified. Rumours spread via social media can carry more weight that hundreds of well-designed peer-reviewed research reports.People are sus

27、picious that powerful new drugs may have side effects that have either not yet been detected or were never honestly disclosed.People may also mistrust their doctors. They want second and third opinions. They look for an expert with more expertise. These expectations were well illustrated by the prac

28、tice of doctor shopping and hospital hopping that contributed to the rapid spread of MERS in the Republic of Korea.Some analysts attribute this dissatisfaction and mistrust to the system, the infrastructure, the training, the incentives, and the orientation of modern medical care. In many countries,

29、 this system dictates that a doctor spend no more than around 20 minutes with each patient.During these few minutes, the doctor is expected to act, not talk, to order medicines, tests, and other interventions. This practice contrasts sharply with the approach used by traditional practitioners.Moreov

30、er, the number of doctors practicing family medicine continues to shirk dramatically in favour of more specialists and sub-specialists. Family physicians are a vanishing profession right at the time when the rise of NCDs makes their skills essential for prevention and the continuity of care.On the R

31、&D front, the miracles of modern medicine, which have had such a stunning impact on life expectancy, are slowing down. The discovery of truly novel molecular compounds is becoming rare.Unlike antibiotics, many drugs for the treatment of chronic diseases and conditions, like high blood pressure,

32、need to be taken long-term, if not life-long, raising concerns about cumulative toxic effects. Some newer drugs for treating cancer and diabetes have shown severe, sometimes life-threatening side effects.A drug for treating dementia or managing obesity has yet to be discovered. Many expensive drugs

33、for treating cancer prolong life for only a few months, and the quality of that added life is often miserable.The phenomenal rise of the alternative medicine industry responds to some of these shortcomings in what modern medicine has to offer. In several North American and European countries, the pr

34、oduction and sale of herbal medicines, dietary supplements, and other so-called “natural” products have become a huge and profitable industry. In the USA alone, this industry is a $32 billion a year business.The industry fiercely defends its territory, its claims, and its profits. Aggressive marketi

35、ng that makes unsubstantiated claims has antagonized many in the medical establishment. As medical professionals argue, most alternative medicines are introduced onto the market, via over-the-counter sales or the Internet, without any regulatory oversight.In their view, the public risks self-medicat

36、ion with products that are potentially ineffective or toxic, or both. In this case, industry has hijacked traditional medicine, but without the skills of experienced practitioners.The resulting hostility and indignation are readily apparent in the titles of recent books that expose and condemn the i

37、ndustrys behaviours, like “Trick or treatment”, “Snake oil science”, or “Death, lies, and politics in the vitamin and herbal supplement industry.”All of these publications share one fundamental conclusion: the efficacy of most traditional medicines and practices has not been confirmed in conventiona

38、l clinical trials.I would like to gently challenge that conclusion. The scientific method was not designed to accurately evaluate the full human experience that occurs when traditional medicine is delivered by skilled, experienced, and trusted practitioners in its cultural and historical home.Controlled clinical trials can evaluate the intervention or the herbal product, but not the full experience. Moreover, complaints of pain, anxiety, and stress nearly always have a subjective dimension. The placebo effect is a well-documented scientific phenomenon.As Nobel laureate Elizabeth Blackbur