霏份之享
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選載自閻潤濤博客：
相對大多數人的觀點，真理隻掌握在少數人手中。
包括美國在內，有不少國家曾發生過醫生罷工事件，但都是保證急救醫生繼續開業，比如車禍急救、婦產科難產或產後大出血等急救醫生繼續上班。
根據當時醫學雜誌和新聞報道提供的數據，罷工期間死亡率不僅沒增加，還減少了很多。總的規律是：醫生罷工時間越長，人口死亡率下降越多，雖然不是絕對呈直線關係。
在美國1976年洛杉磯醫生短期大罷工期間，全市死亡率下降了18%。在加拿大Manitoba醫生罷工兩周期間，死亡率下降了20%。在British Columbia 的醫生罷工三周期間，死亡率下降了30%。在1976年的哥倫比亞Bogota醫生罷工52天期間，該市的死亡率下降了35%。在2000年以色列醫生大罷工期間，以色列最大的殯葬場（占處理全國死人總數的55%）在該月收到的死人數占1997, 1998，1999三年該月份平均數的60%，等於一個月的罷工期間死亡率下降了40%。在往前數的1973年，以色列為期一月的全國醫生大罷工，該月死亡人數下降了50%。在1983年以色列全國醫生大罷工長達85天的時間裏，全國死亡人數比以往同期死亡人數下降了50%。
到目前為止，還沒有哪個國家或地區醫生罷工超過三個月的，也就無法推理出醫生長期罷工對死亡率的終極影響。但有一點是絕對真理：即使所有的醫生都永久罷工，所有的醫院都關門，死亡率也不會減少100%，因為人總是要死的。
從以上數據得知醫生罷工長度與死亡率下降成正比的趨勢非常明顯。至於如何解讀這樣的真實數據，當真是仁者見仁智者見智。下麵是當時醫學家們的部分猜測。
上麵的英文原文我就不翻譯了，因為絕大多數海外讀者都懂英文（在日本的網友，很抱歉。）。即使不在說英語國家的網友，如果在醫學領域，也應該看得懂英文專業資料。
在十幾年前，這是熱門話題，甚至一些不在醫學領域裏的大眾也知道了“醫生罷工醫院關門的結果是人口死亡率下降”的報道。大家都知道李大師也聽說了這些報道才告訴他的學員們有病別去看醫生（然而，我大膽猜測，他本人有病會偷偷去看醫生）。
當然，這不是說你有了病就真的不該去看醫生，而是要對醫生的處理方案反複考慮，如果吃藥的話要清楚副作用是什麽。如果副作用太大，就要告訴醫生。
如果你問我對“醫生罷工醫院關門導致死亡率下降”的原因有何看法，我認為除了上麵英文裏邊提到的處方藥物副作用導致美國每年高達10萬人死亡200萬人受傷害的原因外，醫生罷工醫院關門期間死亡率的高速下跌可能有生活方式改變與心理作用的原因。比如，一直吃藥的病人由於對藥物的崇拜便不抑製自己的懶惰或貪婪行為，可突然間聽到醫生罷工了，沒有處方買不到藥了，便嚇壞了，不敢躺在床上看電視了，而是想補救，比如下床走路鍛煉身體，比如不敢多吃油膩的東西了，等等。這些生活方式的改變激活了身體的某信息係統。最終結果是延長了壽命。
心理作用也許不可忽視。比如，突然間的不利消息引發某種係統（作用類似於Heat shock Protein）的信息變化而導致免疫係統提高了效率。美國杜克大學的醫學家把病毒注入腦癌患者的大腦，突然間病毒進入，立刻激活了免疫係統，免疫係統就把癌細胞殺死（請Google搜索新聞報道）。對於心理作用如何誘發生理生化反應，醫學界還沒有搞清楚。我們知道，人很怕死，聽到震驚的消息便堅強了起來，巨大的心理反應便可引發戰勝困難的激情。一直吃藥，突然間藥停了，沒有醫生開方買不到了，“那還得了！我不能死！我要活下去！”這樣主動的活下去的心理便戰勝了過去被動地依賴藥物心理而導致壽命延長了。
還有一個因素必須考慮：雙盲試驗的標準
比如我們現在用的各類降低膽固醇的藥物，都是經過雙盲試驗驗證後才批準上市的。但這些雙盲試驗的標準可能隱含著巨大風險。潤濤閻隻是根據個人的猜測，這裏不是科普，而是飯後的大膽假設，隻提供在醫學研究領域的網友思考：
以降低膽固醇的藥物為例。凡是經過雙盲試驗證明能降低膽固醇的藥物而且副作用在可以接受的範圍內，便可被批準上市。其理論依據為：膽固醇高了會引發血管病。而最近的統計學結果告訴我們：在中年人當中，總膽固醇水平過高或過低都會影響健康。
而在高齡老人當中，總膽固醇水平最高的群體，反而會有最長的壽命。總起來說，到了成年後，膽固醇偏高的群體要比膽固醇偏低的群體壽命長。
由於我們並不完全了解人體的奧秘，生命科學剛走到盲人摸象的地步而已，我們假設降低膽固醇就可以降低血管病發病幾率，也就隱含著降低膽固醇就能延長壽命的推理，便以該新藥是否能降低膽固醇作為雙盲試驗的標準。就好比物理學家必須以地球圍繞太陽轉為依據來推理天體物理定律，一切以太陽圍繞地球轉為依據的物理定律都需要重新驗證，新藥物的雙盲試驗應該“以該藥物對壽命是否延長”為標準。
比如，一個新的藥物有降血脂的功效，副作用也在可允許的範圍內，需要做雙盲試驗：把該藥與“假藥”（澱粉製成看上去一樣的藥片---安慰劑），按年齡按血壓把高血脂誌願者分成兩撥，他們自己不知道自己吃的是真藥（試驗組）還是假藥（對照組）。經過20年後來統計他們兩組的死亡率。這樣，就避免了用血脂作為標準而導致壽命反而降低了的可能性。我這裏是假設，並不是說市場上有降低血脂而引發壽命縮短的證據。
其它任何藥物的雙盲試驗，都應該考慮壽命因素，因為那才是真正的有效指標。一吃藥很快就死掉了，不論這藥降低了什麽具體指標，也不能上市。“一些老人一直吃降低膽固醇的藥物，突然間醫生罷工了，買不到降低膽固醇的處方藥了，他們反而壽命延長了，導致在醫生罷工期間沒死掉。”這說不定也是一種解釋呢（當然這隻是假設。科學需要大膽假設小心求證）。
如果按照各次醫生罷工導致人口死亡率下降的邏輯，是不是該結論可以延伸？比如除了外傷急救、產婦急救外，所有其他醫生都罷工，處方藥物都停下來，長達三年，後果會怎樣？我們無法得知，因為沒有這樣的事實在任何國家發生過。如果我們假設這樣的長久罷工會導致平均壽命延長了或縮短了，都是猜測，沒有任何說服力。隻能是信者恒信，不信者恒不信。有趣的是：醫生罷工停止後，死亡率回到了罷工前的水平，而沒有增加。也就是說，罷工期間少死的人數，沒有在罷工結束後補上來。這包括洛杉磯那次醫生罷工（罷工期間和罷工結束後的數據統計結果）。
那麽，如何解釋在現代醫學誕生後人的壽命大幅度延長了的事實？
到目前為止，沒有人能給出確切的解釋，隻能是推理，雖然公認的是醫學的發展和醫院的普及。可是根據醫生罷工三個月死亡率下降百分之五十的事實來看，我們有必要從另外的角度審查最近一百年來人類壽命大幅度增加的原因。
第一個原因應該歸功於抗生素。抗生素至少在人類進化的短時間內起著巨大的減少胎兒夭折的作用。說人類進化的短時間內，是指也許用不了一千年，抗所有抗生素的超級細菌就會進化出來，而在幾千萬年的哺乳動物進化過程中，千年隻是一瞬。
第二個原因應該歸功於食物的供應。這是農學家培養出來了各種高產品種以及化學家合成了化肥、農藥等增產物質。在這以前，人類基本上處於半饑餓狀態。根據歐洲很多科學家的研究發現，人類在身體生長發育的孩童時期如果經曆長久的饑餓，這些人的壽命會縮短，哪怕活下來的人群後來不再遇到饑餓，這些人在經曆長時間饑餓階段其DNA會被甲基化其結果是細胞早日進入衰老。科學家已經清楚，細胞衰老、細胞死亡是一個主動過程。更糟糕的是：在精子還沒產生之前經曆過饑餓的男孩，即使在他們有了生殖能力後不再經曆饑餓，他們下一代的孩子照樣縮短壽命。該理論早在上世紀初被蘇聯遺傳學家米丘林證明了，這就是那時著名的“獲得性遺傳學”。當時被西方尤其是美國哥倫比亞大學的西方現代遺傳學鼻祖---摩爾根學派斥之為胡言亂語的偽科學。所以，現在西方科學家不用米丘林的“獲得性遺傳學”而改用“表現遺傳學”（epigenetics），其實二者說的是一回事。歐洲科學家的此項研究結果發表後被美國的《時代周刊》2010年第一期作為封麵報道過（封麵題目是：為何你的DNA與你的孩子不相符Why Your DNA Isn't Your Destiny）。隨著大饑荒時代漸行漸遠， 後代的壽命也就逐步延長，除非發生新的大饑荒而斬斷這一過程。
第三個原因應該歸功於戰爭與社會動蕩減少。二戰後雖然也有一些戰爭，但死人的規模與過去比可以忽略不計了。由於法治的發展與警察的增加，各國國內百姓之間被土匪、幫派互毆殺死的人數也越來越少。
第四個原因應該歸功於一些外科手術的普及。比如闌尾炎，不做手術的後果大家都清楚，而手術成功率高達九成以上。還有產婦產後大出血的急救等等。
第五個原因應該歸功於傳統醫藥的被取代。我們知道，在現代西醫流行開以前，幾乎各個民族都有自己的“土醫生”。中國北邊有蒙古大夫，即使沒有文字的印第安人也有他們自己一套“土醫學”。比如，抽煙的惡習是來自於印第安人。當時的歐洲人看到印第安人在吸煙，由於語言不通，便誤以為人人都可以抽煙。而事實上，印第安人的醫生用抽煙給患病者治病呢。病好了，就必須戒煙。就拿我們的傳統中藥來說，幾乎大多數中藥裏都有重金屬等毒素，我們的傳統醫學稱之為“以毒攻毒”。由於事實上並不能治病的這些毒素被西藥取代後（等於停止服用中藥裏的毒素），甭管西藥是否有延長壽命的作用（抗生素肯定有延長壽命的作用），僅僅取消“以毒攻毒”的毒素進入人體，人口平均壽命就大幅延長了。（這當然是理論推理，因
為我們人類曆史上沒有不看醫生的對照組。非但如此，“有病亂投醫”是人類的共性。）
第六個原因應該歸功於科學知識的普及。這包括獻血輸血、體育鍛煉、肥胖症或糖尿病控製飲食、食物營養搭配等無數科學知識被發現與被公眾接受。
對於內科藥物如此廣泛的被利用到了極端程度（很多國家65歲以上的人吃藥花錢遠遠超過吃飯的費用），是否對人的壽命延長起了正麵作用，尚需探討研究才能得出結論。
美國的醫療總開支平均每人每年朝1萬美元躍進，十年前就超過了每人每年7000美元大關。但美國的人均壽命遠低於日本香港瑞士，甚至低於古巴，排名在第35位。與美國人吃藥太多可能有相關性。如果按照醫療器械的先進程度、醫院的高級程度、醫生占人口比例、醫生水平來說，美國都是一流的，遠在古巴之上。
美國的醫療總開支平均每人每年朝1萬美元躍進，十年前就超過了每人每年7000美元大關。但美國的人均壽命遠低於日本香港瑞士，甚至低於古巴，排名在第35位。與美國人吃藥太多可能有相關性。如果按照醫療器械的先進程度、醫院的高級程度、醫生占人口比例、醫生水平來說，美國都是一流的，遠在古巴之上。
世界人均壽命排名（2011年，數據來自國際衛生組織）
1 日本 83.4
2 香港 82
3 瑞士 82.3
4 澳大利亞 81.9
5 意大利 81.9
6 冰島 81.8
7 以色列 81.6
8 法國 81.5
9 瑞典 81.4
10 西班牙 81.4
11 挪威 81.1
12 新加坡 81.1
13 加拿大 81
14 奧地利 80.9
15 安道爾 80.9
16 荷蘭 80.7
17 新西蘭 80.7
18 愛爾蘭 80.6
19 韓國 80.6，
20 德國 80.4
21 英國80.2
22 比利時 80
23 芬蘭 80
24 盧森堡 80
25 希臘 79.9
26 列支敦士登 79.6
27 塞浦路斯 79.6
28 馬耳他 79.6
29 葡萄牙 79.5
30 斯洛文尼亞 79.3
31 哥斯達黎加 79.3
32 智利 79.1
33 古巴 79.1
34 丹麥 78.8
35 美國 78.5
1 日本 83.4
2 香港 82
3 瑞士 82.3
4 澳大利亞 81.9
5 意大利 81.9
6 冰島 81.8
7 以色列 81.6
8 法國 81.5
9 瑞典 81.4
10 西班牙 81.4
11 挪威 81.1
12 新加坡 81.1
13 加拿大 81
14 奧地利 80.9
15 安道爾 80.9
16 荷蘭 80.7
17 新西蘭 80.7
18 愛爾蘭 80.6
19 韓國 80.6，
20 德國 80.4
21 英國80.2
22 比利時 80
23 芬蘭 80
24 盧森堡 80
25 希臘 79.9
26 列支敦士登 79.6
27 塞浦路斯 79.6
28 馬耳他 79.6
29 葡萄牙 79.5
30 斯洛文尼亞 79.3
31 哥斯達黎加 79.3
32 智利 79.1
33 古巴 79.1
34 丹麥 78.8
35 美國 78.5
通過奧巴馬的醫療改革後，所有的美國窮人也都可以根據需要看醫生、吃處方藥了。再過30年後，我們可以回頭看，美國的較貧困人口的平均壽命是縮短了還是延長了。也就可以判斷出“把藥當成飯吃”的習慣對壽命的作用是正的還是負的。
我認為，我們不能把吃藥當成宗教信仰一樣的依賴，而應該在身體鍛煉、注意適當飲食等方麵下點功夫。光靠“以預防為主”還不夠，還要加上“得病後也要靠鍛煉、注意飲食、勞逸結合”來協助藥物治療。
由於醫生大罷工後導致人口死亡率下降的結局，使得醫生長期罷工成為不可能了（醫學協會不會讓任何地區的醫生大罷工了，因為罷工期間的死亡率大幅下降的事實無法改變。看醫生的人少了，醫界遠期利益的後果不堪設想），也就無法得知醫生長期罷工（比如10年，在此期間不能有“土醫藥”攙和進來）對人口平均壽命的影響是怎樣的。
我們隻知道：地球人擺脫了饑餓後，本代人和下一代人的壽命就長了很多。過去的歐洲和現在非洲的例子非常明顯。那些還有大量孩子在發育期常常挨餓的地區，人口壽命都很短。他們的下一代，即使不再有饑餓，壽命照樣會短很多。如果有一天有一個國家或民族，除了急救外不再吃藥（由於醫生長期大罷工）時間長達一代人，我們才會有真正的對照組。在這之前，有病還得看醫生。
我每年都體檢一次，心裏有個譜。我也開始吃Metformin降低血糖。效果跟不吃差不多。如果吃藥，吃飯猛吃猛喝，不鍛煉，效果還不如不吃藥但控製飲食外加鍛煉身體。可我還是喜歡吃藥，可以給自己多吃飯少鍛煉壯膽。
我試過多次了，凡是自己控製飲食，早晨走路，不吃藥，血糖也不高（自己驗血糖非常簡單，一分鍾足夠）。如果反過來，猛吃猛喝不鍛煉，按時吃藥，血糖也高。這讓我想起了十幾年前的熱門話題：醫生大罷工無法繼續買到處方藥後導致死亡率下跌。
今天講這個話題可是地地道道的炒冷飯。那時至少在醫學領域的學者們此話題炒得熱火朝天。當然，其它領域裏的網友未必清楚這事。無論如何，希望網友們尤其是上了年紀的，在體檢的前提下，要多鍛煉身體，注意健康飲食（當然了，藥該吃還得吃）。
------------------
題外話：
除了“沒醫生結果沒想象的那麽糟”外，沒有政府也差不到哪裏去。
幾年前比利時度過了一年半國家沒政府的日子，大家過得都不錯。有了政府後，大家也沒覺得好到哪裏去。“這地球上缺了誰都成”真的不是空話。“沒有共產黨就沒有新中國”是徹頭徹尾的欺騙。哪個黨學不會整人、學不會腐敗？中國要是沒政府，老百姓絕對比有政府的日子過得好。隻是沒辦法試驗一次而已。有人會說沒了政府就會大亂。而事實上，大亂的根源便是有太多的人想當政。如果人人認同不需要政府，沒人想當政了，就不會亂。
在中國，一開始需要一個會飛的大老虎，誰想當政就飛過去吃掉誰，那就沒人想當政了，天下太平。所以，所有的主義裏，無政府主義才是最高的理論，是人類社會最後的結局。地球上所有的共產主義試驗都是失敗的，而比利時的無政府主義試驗是成功的。
醫生罷工，死亡率下跌。要是政府官員罷工不上班也不領工資，百姓的日子就好太多了。什麽民主政府啊，專製政府啊，都是偽命題。最好是沒有政府。法院監獄也一樣。不是先有犯人後有法院（監獄)，而是先有法院(監獄)後有犯人。等到法院監獄去除了，也就沒有犯人了。這一點已經有了驗證的，比如取消了死刑的國家或地區，死在殺人犯手下的人數立刻減少而非增加。我們需要把被人類顛倒了的思維重新顛倒過來，人類社會才能煥然一新，走向正途。
我們隻知道：地球人擺脫了饑餓後，本代人和下一代人的壽命就長了很多。過去的歐洲和現在非洲的例子非常明顯。那些還有大量孩子在發育期常常挨餓的地區，人口壽命都很短。他們的下一代，即使不再有饑餓，壽命照樣會短很多。如果有一天有一個國家或民族，除了急救外不再吃藥（由於醫生長期大罷工）時間長達一代人，我們才會有真正的對照組。在這之前，有病還得看醫生。
我每年都體檢一次，心裏有個譜。我也開始吃Metformin降低血糖。效果跟不吃差不多。如果吃藥，吃飯猛吃猛喝，不鍛煉，效果還不如不吃藥但控製飲食外加鍛煉身體。可我還是喜歡吃藥，可以給自己多吃飯少鍛煉壯膽。
我試過多次了，凡是自己控製飲食，早晨走路，不吃藥，血糖也不高（自己驗血糖非常簡單，一分鍾足夠）。如果反過來，猛吃猛喝不鍛煉，按時吃藥，血糖也高。這讓我想起了十幾年前的熱門話題：醫生大罷工無法繼續買到處方藥後導致死亡率下跌。
今天講這個話題可是地地道道的炒冷飯。那時至少在醫學領域的學者們此話題炒得熱火朝天。當然，其它領域裏的網友未必清楚這事。無論如何，希望網友們尤其是上了年紀的，在體檢的前提下，要多鍛煉身體，注意健康飲食（當然了，藥該吃還得吃）。
------------------
題外話：
除了“沒醫生結果沒想象的那麽糟”外，沒有政府也差不到哪裏去。
幾年前比利時度過了一年半國家沒政府的日子，大家過得都不錯。有了政府後，大家也沒覺得好到哪裏去。“這地球上缺了誰都成”真的不是空話。“沒有共產黨就沒有新中國”是徹頭徹尾的欺騙。哪個黨學不會整人、學不會腐敗？中國要是沒政府，老百姓絕對比有政府的日子過得好。隻是沒辦法試驗一次而已。有人會說沒了政府就會大亂。而事實上，大亂的根源便是有太多的人想當政。如果人人認同不需要政府，沒人想當政了，就不會亂。
在中國，一開始需要一個會飛的大老虎，誰想當政就飛過去吃掉誰，那就沒人想當政了，天下太平。所以，所有的主義裏，無政府主義才是最高的理論，是人類社會最後的結局。地球上所有的共產主義試驗都是失敗的，而比利時的無政府主義試驗是成功的。
醫生罷工，死亡率下跌。要是政府官員罷工不上班也不領工資，百姓的日子就好太多了。什麽民主政府啊，專製政府啊，都是偽命題。最好是沒有政府。法院監獄也一樣。不是先有犯人後有法院（監獄)，而是先有法院(監獄)後有犯人。等到法院監獄去除了，也就沒有犯人了。這一點已經有了驗證的，比如取消了死刑的國家或地區，死在殺人犯手下的人數立刻減少而非增加。我們需要把被人類顛倒了的思維重新顛倒過來，人類社會才能煥然一新，走向正途。
昧名 發表評論於
幾年前我從澳洲來美國，驚訝於美國的民生行業竟然如此落後：醫療、健康（醫療不是健康）、教育（例如6所Naturopathic Medical大學那些誤人子弟的課程設計，如今已是7所大學控製著這個行業，但其實都是一樣地落後) 、銀行、網速、金融（高盛係統與其他中小證券行可說是天壤之別）、洛杉磯的城市規劃（別處幾個州我隻是走馬觀花，所以感覺還不錯。隻是深深體會到洛杉磯高速的到處賭塞是常態）等等。看著我媽被藥
物折磨得站不起來了，我爸的各種病痛交織在一起，不僅是身體，連神經係統也幾近垮掉。我管不了別人，隻是趕緊把施加在我爸媽身上的所有醫藥手段全部叫停。然後我花了近兩年時間才讓我爸媽重拾健康。如今我媽才知道，他倆現在每年每人都不到1千元的體檢費用，比起6-7年前他們每人4萬多元的醫療開銷。原來那時是在用自己的健康為代價養著好多醫生們呢。
益生菌 發表評論於
物折磨得站不起來了，我爸的各種病痛交織在一起，不僅是身體，連神經係統也幾近垮掉。我管不了別人，隻是趕緊把施加在我爸媽身上的所有醫藥手段全部叫停。然後我花了近兩年時間才讓我爸媽重拾健康。如今我媽才知道，他倆現在每年每人都不到1千元的體檢費用，比起6-7年前他們每人4萬多元的醫療開銷。原來那時是在用自己的健康為代價養著好多醫生們呢。
益生菌 發表評論於
膽固醇偏高的群體要比膽固醇偏低的群體壽命長。
____________________
膽固醇謊言，以及由此而來的治療騙局(藥物降膽固醇)，可以休矣。
____________________
膽固醇謊言，以及由此而來的治療騙局(藥物降膽固醇)，可以休矣。
真的？？ 發表評論於
前幾天聽到NPR裏麵也介紹了一篇論文，是說心髒病醫生開全國大會，不在醫院的時候，嚴重心髒病的病人死亡率反而下降的。文章的作者認為可能和過度治療有關。
British Medical Journal 2000;320:1561 ( 10 June )
British Medical Journal 2000;320:1561 ( 10 June )
News
Doctors' strike in Israel may be good for health
Judy Siegel-Itzkovich, Jerusalem
Doctors' strike in Israel may be good for health
Judy Siegel-Itzkovich, Jerusalem
Industrial action by doctors in Israel seems to be good for their patients' health. Death rates have dropped considerably in most of the country since physicians in public hospitals implemented a programme of sanctions three months ago, according to a survey of burial societies.
The Israel Medical Association began the action on 9 March to protest against the treasury's proposed imposition of a new four year wage contract for doctors. Since then, hundreds of thousands of visits to outpatient clinics have been cancelled or postponed along with tens of thousands of elective operations. Public hospitals, which provide the vast majority of secondary and tertiary medical care, have kept their emergency rooms, dialysis units, oncology departments, obstetric and neonatal departments, and other vital facilities working normally during the industrial action.
In the absence of official figures, the Jerusalem Post surveyed non-profit making Jewish burial societies, which perform funerals for the vast majority of Israelis, to find out whether the industrial action was affecting deaths in the country.
"The number of funerals we have performed has fallen drastically," said Hananya Shahor, the veteran director of Jerusalem's Kehilat Yerushalayim burial society. "This month, there were only 93 funerals compared with 153 in May 1999, 133 in the same month in 1998, and 139 in May 1997," he said. The society handles 55% of all deaths in the Jerusalem metropolitan area. Last April, there were only 130 deaths compared with 150 or more in previous Aprils. "I can't explain why," said Mr Shahor.
Meir Adler, manager of the Shamgar Funeral Parlour, which buries most other residents of Jerusalem, declared with much more certainty: "There definitely is a connection between the doctors' sanctions and fewer deaths. We saw the same thing in 1983 [when the Israel Medical Association applied sanctions for four and a half months]."
Motti Yeshuvayov of Tel Aviv's only burial society said that he had noticed the same trend in the Tel Aviv metropolitan area in the past two months. The only exception to the trend of decreasing deaths has been in the Haifa area.
The coastal city of Netanya has only one hospital, and it has been spared the industrial action because staff have to sign a no strike clause with their contract. Netanya's burial society, headed by Shlomo Stieglitz, reported 87 funerals last month, the same number as in May 1999. It reported 97 in April compared with 122 in April 1999, and 99 in March as compared with 119 in March 1999. Mr Stieglitz said that his burial society services not only Netanya but also other cities, including Hadera and Kfar Sava, where hospital doctors have joined the sanctions.
Avi Yisraeli, director general of the Hadassah Medical Organization, which owns two university hospitals in the capital, offered his own explanation. "Mortality is not the only measure of harm to health. Lack of medical intervention can lead to disability, pain, and reduced functioning. Elective surgery can bring about a great improvement in a patient's condition, but it can also mean disability and death in the weakest patients. And patients who do not undergo diagnosis or surgery now could decline or die in a few months due to the postponement."
During the months of the strike, patients "have been going more to their family doctor and to hospital emergency rooms, which have not been affected by sanctions," Professor Yisraeli said.
The Israel Medical Association began the action on 9 March to protest against the treasury's proposed imposition of a new four year wage contract for doctors. Since then, hundreds of thousands of visits to outpatient clinics have been cancelled or postponed along with tens of thousands of elective operations. Public hospitals, which provide the vast majority of secondary and tertiary medical care, have kept their emergency rooms, dialysis units, oncology departments, obstetric and neonatal departments, and other vital facilities working normally during the industrial action.
In the absence of official figures, the Jerusalem Post surveyed non-profit making Jewish burial societies, which perform funerals for the vast majority of Israelis, to find out whether the industrial action was affecting deaths in the country.
"The number of funerals we have performed has fallen drastically," said Hananya Shahor, the veteran director of Jerusalem's Kehilat Yerushalayim burial society. "This month, there were only 93 funerals compared with 153 in May 1999, 133 in the same month in 1998, and 139 in May 1997," he said. The society handles 55% of all deaths in the Jerusalem metropolitan area. Last April, there were only 130 deaths compared with 150 or more in previous Aprils. "I can't explain why," said Mr Shahor.
Meir Adler, manager of the Shamgar Funeral Parlour, which buries most other residents of Jerusalem, declared with much more certainty: "There definitely is a connection between the doctors' sanctions and fewer deaths. We saw the same thing in 1983 [when the Israel Medical Association applied sanctions for four and a half months]."
Motti Yeshuvayov of Tel Aviv's only burial society said that he had noticed the same trend in the Tel Aviv metropolitan area in the past two months. The only exception to the trend of decreasing deaths has been in the Haifa area.
The coastal city of Netanya has only one hospital, and it has been spared the industrial action because staff have to sign a no strike clause with their contract. Netanya's burial society, headed by Shlomo Stieglitz, reported 87 funerals last month, the same number as in May 1999. It reported 97 in April compared with 122 in April 1999, and 99 in March as compared with 119 in March 1999. Mr Stieglitz said that his burial society services not only Netanya but also other cities, including Hadera and Kfar Sava, where hospital doctors have joined the sanctions.
Avi Yisraeli, director general of the Hadassah Medical Organization, which owns two university hospitals in the capital, offered his own explanation. "Mortality is not the only measure of harm to health. Lack of medical intervention can lead to disability, pain, and reduced functioning. Elective surgery can bring about a great improvement in a patient's condition, but it can also mean disability and death in the weakest patients. And patients who do not undergo diagnosis or surgery now could decline or die in a few months due to the postponement."
During the months of the strike, patients "have been going more to their family doctor and to hospital emergency rooms, which have not been affected by sanctions," Professor Yisraeli said.
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Excerpt from: Confessions of A Medical Heretic
Excerpt from: Confessions of A Medical Heretic
By Robert S. Mendelsohn, M.D. Chicago: Contemporary Books, 1979, p. 114
(Note: By "Church" he is referring to the medical establishment, which he says is far more a religion than a science)
"How truly deadly the Church is comes into stark relief whenever there’s a doctor’s strike. In 1976 in Bogota, Columbia, there was a fifty-two day period in which doctors disappeared altogether except for emergency care. The "National Catholic Reporter" described "a string of unusual side-effects" from the strike. The death rate went down 35%. A spokesman for the National Morticians Association said, "It might be a coincidence but it is a fact." An 18% drop in the death rate occurred in Los Angeles County in 1976 when doctors there went on strike [note: it was a work slowdown] to protest soaring malpractice insurance premiums…. When the strike ended and the medical machines started grinding again, the death rate went right back up to where it had been before the strike.
"The same thing happened in Israel in 1973 when the doctors reduced their daily patient contact from 65,000 to 7,000. The strike lasted a month. According to the Jerusalem Burial Society, the Israeli death rate dropped 50% during that month. There had not been such a profound decrease in mortality since the last doctors’ strike twenty years before!
"I’ve been saying right along that what we need is a perpetual doctors’ "strike." If doctors reduced their involvement with people by ninety percent and attended only emergencies, there’s no doubt in my mind that we’d be better off."
"The same thing happened in Israel in 1973 when the doctors reduced their daily patient contact from 65,000 to 7,000. The strike lasted a month. According to the Jerusalem Burial Society, the Israeli death rate dropped 50% during that month. There had not been such a profound decrease in mortality since the last doctors’ strike twenty years before!
"I’ve been saying right along that what we need is a perpetual doctors’ "strike." If doctors reduced their involvement with people by ninety percent and attended only emergencies, there’s no doubt in my mind that we’d be better off."
*************************************************************************************************************************Extract from: Medical Journal of Australia 1999; 170: 404-405
Editorial
The human element of adverse events
Is a certain level of error inevitable in healthcare?
Quality in Australian Health Care Study (QAHCS) (1) together with the Harvard study on which it was based (2), were groundbreaking studies that for the first time systematically revealed the nature and scale of iatrogenic injury in healthcare.
Morbidity due to healthcare appears to be a major public health problem, and it is very unlikely that this problem is confined to Australia and the United States. The QAHCS revealed particularly high levels of adverse events (AEs), in part because it took a broader, quality-of-care approach rather than one focused on negligence and compensation…..
Is a certain level of error inevitable in healthcare?
Quality in Australian Health Care Study (QAHCS) (1) together with the Harvard study on which it was based (2), were groundbreaking studies that for the first time systematically revealed the nature and scale of iatrogenic injury in healthcare.
Morbidity due to healthcare appears to be a major public health problem, and it is very unlikely that this problem is confined to Australia and the United States. The QAHCS revealed particularly high levels of adverse events (AEs), in part because it took a broader, quality-of-care approach rather than one focused on negligence and compensation…..
….The findings from the QAHCS (5 years ago) suggested that each year 50 000 Australians suffer permanent disability and 18 000 die at least in part as a result of their healthcare. Further evidence emerged in 1997 with the publication of AE rates in Victorian hospitals (3). Since then, thousands more Australians have presumably been injured or died through deficiencies in the healthcare system. Furthermore, the QAHCS found that AEs lost Australia over three million bed-days per annum. In its interim report, the National Expert Advisory Group pointed out that the extrapolated potential saving from preventable AEs in 1995-96 would be $4.17 billion (4). AEs also lead to increased disability benefits and time lost off work, which all impact on the Australian economy.
1. Wilson RM, Runciman WB, Gibberd RW, et al. The Quality in Australian Health Care Study. Med J Aust 1995; 163: 458-471.
2. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. N Engl J Med 1991; 324: 370-376.
3. O'Hara D, Carson NJ. Reporting of adverse events in hospitals in Victoria 1994-1995. Med J Aust 1997; 166: 460-463.
4. National Expert Advisory Group on Safety and Quality in Australian Health Care. Interim report - Commitment to quality enhancement. July 1998.
1. Wilson RM, Runciman WB, Gibberd RW, et al. The Quality in Australian Health Care Study. Med J Aust 1995; 163: 458-471.
2. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. N Engl J Med 1991; 324: 370-376.
3. O'Hara D, Carson NJ. Reporting of adverse events in hospitals in Victoria 1994-1995. Med J Aust 1997; 166: 460-463.
4. National Expert Advisory Group on Safety and Quality in Australian Health Care. Interim report - Commitment to quality enhancement. July 1998.
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Metro, May 11, 2005
Metro, May 11, 2005
Prescription Drugs 'kill 15,000 a year'
Thousands of people are killed each year by common prescription drugs, scientists revealed yesterday.
They suffer heart attacks because the medication disrupts the electrical activity controlling their heartbeat.
Seven drugs are said to present a danger, including the antibiotics erythromycin and clarithromycin.
The others are domperidone and cisapride, for gastro-intestinal disorders, and anti-psychotic drugs pimozide, haloperidol and chlorpromazine.
Dr Bruno Stricker said: 'Sudden cardiac death can be attributed to these drugs in around 9,000 people in Europe and 6,000 in the US.'
Researchers studied 775 cases of sudden heart deaths and found the seven drugs were responsible for 320.
They calculated this worked out to about 15,000 deaths each year across Europe and America.
The chances of someone in the West dying from sudden cardiac arrest is normally one or two in a thousand.
The risk for those taking the drugs was found to be up to three times higher - about three in a thousand. Patients who had been on the drugs for less than about 90 days were said to be in the greatest danger…"
Thousands of people are killed each year by common prescription drugs, scientists revealed yesterday.
They suffer heart attacks because the medication disrupts the electrical activity controlling their heartbeat.
Seven drugs are said to present a danger, including the antibiotics erythromycin and clarithromycin.
The others are domperidone and cisapride, for gastro-intestinal disorders, and anti-psychotic drugs pimozide, haloperidol and chlorpromazine.
Dr Bruno Stricker said: 'Sudden cardiac death can be attributed to these drugs in around 9,000 people in Europe and 6,000 in the US.'
Researchers studied 775 cases of sudden heart deaths and found the seven drugs were responsible for 320.
They calculated this worked out to about 15,000 deaths each year across Europe and America.
The chances of someone in the West dying from sudden cardiac arrest is normally one or two in a thousand.
The risk for those taking the drugs was found to be up to three times higher - about three in a thousand. Patients who had been on the drugs for less than about 90 days were said to be in the greatest danger…"
*************************************************************************************************************************
Prescription drug reactions kill more than 100,000 a year
By BRENDA C. COLEMAN
April 15, 1998
Associated Press
Prescription drug reactions kill more than 100,000 a year
By BRENDA C. COLEMAN
April 15, 1998
Associated Press
CHICAGO ¯ Bad reactions to prescription and over-the-counter medicines kill more than 100,000 Americans and seriously injure an additional 2.1 million every year ¯ far more than most people realize, researchers say.
Such reactions, which do not include prescribing errors or drug abuse, rank at least sixth among U.S. causes of death ¯behind heart disease, cancer, lung disease, strokes and accidents, says a report based on an analysis of existing studies.
"We're not saying, 'Don't take drugs.' They have wonderful benefits," said Dr. Bruce H. Pomeranz, principal investigator and a neuroscience professor at the University of Toronto.
"But what we're arguing is that there should be increased awareness also of side effects, which until now have not been too well understood."
The harm may range from an allergic reaction to an antibiotic to stomach bleeding from frequent doses of aspirin, Pomeranz said. The study, by Pomeranz and two colleagues at his school, Jason Lazarou and Paul N. Corey, did not explore which medications or illnesses were involved.
The authors analyzed 39 studies of hospital patients from 1966 to 1996. Serious drug reactions affected 6.7 percent of patients overall and fatal drug reactions 0.32 percent, the authors reported in Wednesday's Journal of the American Medical Association.
In the study, serious injury was defined as being hospitalized, having to extend a hospital stay or suffering permanent disability.
The most surprising result was the large number of deaths, the authors said. They found adverse drug reactions ranked between fourth and sixth among leading causes of death, depending on whether they used their most conservative or a more liberal estimate.
In 1994, between 76,000 and 137,000 U.S. hospital patients died, and the "ballpark estimate" is 106,000, Pomeranz said. The low estimate, 76,000 deaths, would put drug reactions sixth. The ballpark estimate would put them fourth, he said.
An additional 1.6 million to 2.6 million patients were seriously injured, with the ballpark estimate 2.1 million, he said.
More than two-thirds of the cases involved reactions outside hospitals rather than in hospitals, the authors reported.
Experts commended the study but disagreed whether the estimates are on target.
Dr. David W. Bates of Partners Healthcare Systems and Brigham and Women's Hospital in Boston said the estimates may be high. One reason, he said, is that they may overrepresent large medical centers, which treat sicker than average patients, who are more prone to reactions.
"Nonetheless, these data are important, and even if the true incidence of adverse drug reactions is somewhat lower than that reported ... it is still high, and much higher than generally recognized," he said.
Dr. Sidney M. Wolfe, director of the consumer advocacy Public Citizen Health Research Group, said he believes the numbers are on target.
"I've read most of these studies, and they represent large hospitals, small hospitals ... a heterogeneous sample of the kinds of hospitals in this country, and include a whole range," Wolfe said by telephone Tuesday from Washington.
Such reactions, which do not include prescribing errors or drug abuse, rank at least sixth among U.S. causes of death ¯behind heart disease, cancer, lung disease, strokes and accidents, says a report based on an analysis of existing studies.
"We're not saying, 'Don't take drugs.' They have wonderful benefits," said Dr. Bruce H. Pomeranz, principal investigator and a neuroscience professor at the University of Toronto.
"But what we're arguing is that there should be increased awareness also of side effects, which until now have not been too well understood."
The harm may range from an allergic reaction to an antibiotic to stomach bleeding from frequent doses of aspirin, Pomeranz said. The study, by Pomeranz and two colleagues at his school, Jason Lazarou and Paul N. Corey, did not explore which medications or illnesses were involved.
The authors analyzed 39 studies of hospital patients from 1966 to 1996. Serious drug reactions affected 6.7 percent of patients overall and fatal drug reactions 0.32 percent, the authors reported in Wednesday's Journal of the American Medical Association.
In the study, serious injury was defined as being hospitalized, having to extend a hospital stay or suffering permanent disability.
The most surprising result was the large number of deaths, the authors said. They found adverse drug reactions ranked between fourth and sixth among leading causes of death, depending on whether they used their most conservative or a more liberal estimate.
In 1994, between 76,000 and 137,000 U.S. hospital patients died, and the "ballpark estimate" is 106,000, Pomeranz said. The low estimate, 76,000 deaths, would put drug reactions sixth. The ballpark estimate would put them fourth, he said.
An additional 1.6 million to 2.6 million patients were seriously injured, with the ballpark estimate 2.1 million, he said.
More than two-thirds of the cases involved reactions outside hospitals rather than in hospitals, the authors reported.
Experts commended the study but disagreed whether the estimates are on target.
Dr. David W. Bates of Partners Healthcare Systems and Brigham and Women's Hospital in Boston said the estimates may be high. One reason, he said, is that they may overrepresent large medical centers, which treat sicker than average patients, who are more prone to reactions.
"Nonetheless, these data are important, and even if the true incidence of adverse drug reactions is somewhat lower than that reported ... it is still high, and much higher than generally recognized," he said.
Dr. Sidney M. Wolfe, director of the consumer advocacy Public Citizen Health Research Group, said he believes the numbers are on target.
"I've read most of these studies, and they represent large hospitals, small hospitals ... a heterogeneous sample of the kinds of hospitals in this country, and include a whole range," Wolfe said by telephone Tuesday from Washington.
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Prescription drugs put more than 250,000 in UK hospitals every year
More than a quarter of a million people are admitted to UK hospitals every year after suffering a serious reaction to a prescription drug, a new survey has found.
The drugs that are most likely to cause a serious reaction are aspirin, diuretics, warfarin, and the NSAIDs (non steroidal, anti-inflammatory drugs).
The figure is a rough calculation based on the number of people who had been admitted to a group of hospitals with drug reactions over a six-month period in 2004.
But the total is probably a gross under-estimate of the damage caused by pharmaceuticals. Hospital doctors are notoriously bad at reporting drug side effects, and so it’s quite possible that many admissions have not been registered as such.
The survey also only attempts to measure those reactions that required hospital care. Many, many others suffer at home – and may not even know that the drug is to blame.
The heart of the problem is the way that drug adverse reactions are captured. Doctors are supposed to report all reactions on a ‘yellow card’ system that was introduced in 1964. Its pioneer, Dr Bill Inman, once told WDDTY that he estimated only 12 to 20 per cent of all reactions are reported. If this is so, the true level of admissions to UK hospitals from drug reactions may be closer to our own estimates of 1.2 million people a year.
And they wanted to ban vitamins?
(Source: WHAT DOCTORS DON'T TELL YOU - E-news broadcast. 258 - 18 May 2006, which in turn referenced BMJ 2006;332:1109 (http://bmj.bmjjournals.com/cgi/content/extract/332/7550/1109).)
Prescription drugs put more than 250,000 in UK hospitals every year
More than a quarter of a million people are admitted to UK hospitals every year after suffering a serious reaction to a prescription drug, a new survey has found.
The drugs that are most likely to cause a serious reaction are aspirin, diuretics, warfarin, and the NSAIDs (non steroidal, anti-inflammatory drugs).
The figure is a rough calculation based on the number of people who had been admitted to a group of hospitals with drug reactions over a six-month period in 2004.
But the total is probably a gross under-estimate of the damage caused by pharmaceuticals. Hospital doctors are notoriously bad at reporting drug side effects, and so it’s quite possible that many admissions have not been registered as such.
The survey also only attempts to measure those reactions that required hospital care. Many, many others suffer at home – and may not even know that the drug is to blame.
The heart of the problem is the way that drug adverse reactions are captured. Doctors are supposed to report all reactions on a ‘yellow card’ system that was introduced in 1964. Its pioneer, Dr Bill Inman, once told WDDTY that he estimated only 12 to 20 per cent of all reactions are reported. If this is so, the true level of admissions to UK hospitals from drug reactions may be closer to our own estimates of 1.2 million people a year.
And they wanted to ban vitamins?
(Source: WHAT DOCTORS DON'T TELL YOU - E-news broadcast. 258 - 18 May 2006, which in turn referenced BMJ 2006;332:1109 (http://bmj.bmjjournals.com/cgi/content/extract/332/7550/1109).)
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