2008年12月22日 星期一

Colonoscopy prep pills carry kidney risk

由於我兩周前吃過瀉藥 檢查直腸 所以將這則列出
Colonoscopy prep pills carry kidney risk

Anyone who's ever had a colonoscopy knows the worst part is preparing for it, not the procedure itself. You have to make sure your colon is as clean as a whistle so your doctor can get an unobstructed interior view.

In the old days — the late 20th century, that is — you had to drink a gallon of a special salty liquid to cleanse your bowels in basically one sitting. So patients cheered when tasteless tablets that would accomplish the same thing became available in 2000.

But last week, the Food and Drug Administration tempered that joy by adding a "black box" warning — the sternest warning possible — to the two prescription bowel cleansers that come in tablet form. The new warning stems from reports of kidney damage in patients who took the pills, which contain sodium phosphate, in preparation for a colonoscopy.

Also, the FDA, which can require warnings only on prescription drugs, said no over-the-counter sodium phosphate products should be used for bowel-cleansing. That led C.B. Fleet Co. to announce a voluntary recall of Phospho-soda, a non-prescription laxative that in larger doses has been used for bowel-cleansing.

The FDA says prescription Visicol, approved in 2000, and its successor, OsmoPrep, approved in 2006, should be used with caution by people over 55; those who are dehydrated; those who suffer from kidney disease, acute colitis or delayed bowel emptying; and people on medicines that affect kidney function. Medicines include diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers and, maybe, ibuprofen and other non-steroidal anti-inflammatory drugs.

Indiana University gastroenterologist Douglas Rex says he's been switching older patients to fluid bowel-cleansers that don't contain sodium phosphate since the first reports of kidney problems came out in 2005. Rex serves as a scientific adviser to Salix Pharmaceuticals, maker of Visicol, OsmoPrep and MoviPrep, one of the fluid products.

No one knows how many people may have suffered damage from the sodium phosphate bowel-cleansers, because even those who've lost 75% of their kidney function feel fine, says Columbia University pathologist Glen Markowitz. Markowitz, a Salix consultant, was lead author of a 2005 report on kidney damage in 21 patients who had taken sodium phosphate bowel-cleansers. Even when detected, he says, a connection to the products could be missed.

Dallas gastroenterologist Lawrence Schiller says a patient who had an easy time with the pills wasn't thrilled to learn of the kidney issue. Schiller left future choice of prep up to her, noting: "There's a one-in-a-million chance you could end up on dialysis with (the pills)."

Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

2008年12月21日 星期日

糖尿病病患 堅果 豆子等 比全麥食品還好

對後天糖尿病病患 堅果 豆子等 比全麥食品還好 又無心臟病負作用

Recommended Diet for Diabetics May Need Changing, Study Suggests

Published: December 18, 2008

People with Type 2 diabetes on a high-fiber diet kept their blood sugar under better control when they ate foods like beans and nuts instead of the recommended whole-grain diet, researchers have found.

Beans and nuts are among foods that only modestly increase blood glucose levels; scientists describe these foods as having a low glycemic index. The new study, which lasted six months, is one of the largest and longest to assess the impact of foods with a low-glycemic index, researchers said.

Participants on the low-glycemic diet also saw significant improvements in cholesterol after six months, with increases in HDL, the so-called “good” cholesterol associated with a reduced risk of heart disease, the study found.

“That’s an important issue today, because there’s a double whammy for people who are diabetic," said Dr. David J. A. Jenkins, lead author of the report and a professor of nutritional sciences at the University of Toronto. "If they’re men, they have twice the risk of heart disease, and if they’re women, they have four times the risk. If you can hit the heart disease to which they’re particularly vulnerable, you may have something useful."

“Pharmaceuticals used to control Type 2 diabetes have not shown the expected benefits in terms of reducing cardiovascular disease,” he added.

The study was published on Tuesday in the Journal of the American Medical Association.

Some 210 patients with Type 2 diabetes were randomly assigned to a low-glycemic diet or a high-cereal, high-fiber diet.

The high-cereal high fiber diet emphasized “brown foods” such as whole-grain bread and breakfast cereal, brown rice and potatoes with the skin on. The low-glycemic diet included beans, peas, lentils, pasta, quickly boiled rice and certain breads, like pumpernickel and rye, as well as oatmeal and oat bran cereals.

Both diets are low in saturated fat and trans fat. Both groups were told to limit their consumption of white flour and to eat five servings of vegetables and three servings of fruit each day.

Participants on the low-glycemic diet saw their hemoglobin A1C levels — a measure of blood glucose levels over recent months — reduced slightly, by 0.5 percent on average, but experienced significant improvements in HDL, which increased by 1.7 milligrams per deciliter of blood on average. Those on the high-cereal diet saw smaller reductions in hemoglobin A1C and slight drops in HDL.

Dietitians who work with people who have Type 2 diabetes said earlier studies had not demonstrated the benefits of low-glycemic index foods as clearly as this report.

“We’ve been telling people to eat whole grains for a long time," said Emmy Suhl, a nutrition and diabetes educator at the Joslin Diabetes Center in Boston. "What this study shows is that it’s not enough to have whole grains. It’s these very specific low-glycemic carbohydrates that do a much better job."

But, she said, following such a diet is complicated, since the glycemic index of a food can change depending on how it is prepared and served.

“People tell us again and again that diet is the hardest part of diabetes management,” she added.

2008年12月19日 星期五

《美國醫學會期刊》研究 食用豆類堅果 有益糖尿病患 2008-12-20中國時報【黃文正/紐約時報十九日報導】  最新一期《美國醫學會期刊》刊載的一篇研究報告指出,採用高纖低脂飲食法的第二型(成年型)糖尿病患者,在控制血糖濃度方面,食用豆類和堅果類食物,會比醫界習慣推薦的全穀類飲食法,效果更佳。  研究人員表示,豆類與堅果類食物因血糖指數較低,僅會適度增加血糖濃度。研究發現,接受低血糖飲食法的參與者,在半年之後,可明顯增加體內的HDL膽固醇(高密度脂蛋白),即俗稱的「好膽固醇」,對降低罹患心臟病的風險頗有助益。  「這是非常重大的發現,因為罹患糖尿病堪稱雙重打擊,」這篇研究報告的主撰人加拿大多倫多大學營養科學系教授傑金斯說,「如果是男性患者,他再罹患心臟病的機率,是一般人的兩倍;女性更高達四倍之多。」  「截至目前,用來控制第二型糖尿病的藥物,在降低心血管疾病方面並未達到預期的效果。」他說,這項研究對容易罹患心臟病的糖尿病患者應有不小幫助。  此項研究將二百廿名第二型糖尿病患者,隨機抽樣分成兩組,一組採行低血糖飲食法,另一組採用高纖維穀物飲食法。兩組採行的飲食中,飽和脂肪和反式脂肪都很低。  高纖維穀物飲食法強調「棕色食物」,例如全麥麵包、早餐麥片、糙米和連皮的馬鈴薯。低血糖飲食法則包括豆類、豌豆、扁豆、麵糰、快煮米飯(quickly boiled rice)以及黑麵包、裸麥麵包、燕麥粥和燕麥麩等。  經過半年後,低血糖飲食法這一組,糖化血色素(hemoglobin A1c)濃度平均微降○.五%,但對促進HDL膽固醇卻成效顯著,每公合血液平均可增加一.七毫克。  至於高纖維穀物飲食法那一組,糖化血色素濃度降低較少,而HDL膽固醇甚至輕微下降。

2008年12月14日 星期日


The High Price of Cheap Eats

Published: December 11, 2008

Dollar “value meals” at fast food restaurants may not be such a bargain when you look at the potential health costs.

Many of these low-cost menu items are packed with fat, salt, cholesterol and processed meat, notes The Cancer Project, a nonprofit cancer prevention organization. The group has produced a list of what it says are the five unhealthiest items sold at the nation’s largest fast food chains.

The organization’s dieticians reviewed so-called value menus at five of the largest fast food chains in the nation, awarding points for such unhealthy characteristics as sodium, fat and low-fiber content. Jack in the Box’s junior bacon cheeseburger topped the list as the worst offender. The burger costs just one dollar but is packed with 23 grams of fat, including 8 grams of saturated fat, 55 milligrams of cholesterol and 860 milligrams of sodium and just one gram of fiber.

The Cancer Project is affiliated with the Physicians Committee for Responsible Medicine, which aggressively promotes a low-fat, vegetarian diet. The organization’s list was spurred in part by a concern that during tough economic times, more people will resort to eating inexpensive fast foods, said Krista Haynes, a dietitian with the project.

A spokeswoman for Jack in the Box said that the junior bacon cheeseburger is a “great value” but that diners may also choose from healthier options, like salads and a fruit cup. They’re more expensive, however: an entrée salad with grilled chicken strips is $4.99, and a fruit cup is $2.29.

“Our guests can also customize their order, so if you’re dining on a budget you have a lot of choices at Jack in the Box,” said Kathleen Anthony, media relations manager at Jack in the Box.

The other four menu items on the cancer group’s list were:

* In second-worst place, the 89-cent Taco Bell cheesy double beef burrito, with 460 calories, 20 grams of fat and a whopping 1,620 milligrams of sodium.

* In third-worst place was the one-dollar Burger King breakfast sausage biscuit, with 27 grams of fat, including 15 grams of saturated fat and over 1,000 milligrams of sodium.

* Fourth worst went to the one-dollar McDonald’s McDouble, which contains 19 grams of fat and 65 milligrams of cholesterol.

* Last, and least-worst, was the Wendy’s junior bacon cheeseburger, for $1.53, with 310 calories and 16 grams of fat.

Being overweight can increase the risk for diabetes and heart disease, and the American Cancer Society recommends limiting high-fat foods, which are associated with an increased risk of certain cancers, and eating plenty of fruits and vegetables.

But Alice H. Lichtenstein, director of the cardiovascular nutrition laboratory at Tufts University in Boston, questioned whether the declining economy would have much effect on people’s eating habits.

“It would be nice if they decided it was better for their budget to start preparing food at home more often," she said.

2008年11月18日 星期二


培林(瘦肉精)的問題是 美國允許一定量的...

林杰樑:毒奶翻版 衛署沒學聰明


根 據美國禮來藥廠的資料,肉豬上市前二十八天加二十ppm的培林(瘦肉精)於飼料中,可使每頭豬隻增加瘦肉五公斤,降低脂肪三公斤,節省飼料十八點五公斤, 並且可提早四天達到上市的體重,又可減少十八公斤的排泄物。有醫師表示,對豬如此有效的藥物,人吃到肚子真的對身體都沒有影響嗎?




2008年11月16日 星期日

飲食之安全 阻塞呼吸道窒息死亡

繼前一陣子 學生因爭 "大胃王"而阻塞呼吸道窒息死亡
學生或成人都應該提醒自己 注意飲食之安全


東海大學20歲日文系大三女學生賴宣諭,大前天深夜11 時40分許,在宿舍溫習功課時,接到同是田徑隊的陳姓男學生電話,隨即下樓。陳男說,當晚他帶著別校4位金門籍同學,與賴女在宿舍前石椅聊天,因賴女曾說 沒喝過酒,他們準備了一瓶金門58度高粱酒,並將酒倒在酒瓶蓋上給她,她喝下後說:「好淡喔!」












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2008年11月10日 星期一

抗膽固醇藥物也能對心臟病 中風有利

抗膽固醇藥物 statin drugs 也能對心臟病 中風有利--- 降低風險

《每日電訊報》和《每日郵報》都在頭版報道了抗高血脂藥他汀(statin)能減低心臟病風險的神奇效應。報道說,研究發 現,即便膽固醇正常的人服用他汀也可以大大降低心臟病和中風的幾率。《每日電訊報》說,鑒於這項令人驚奇的研究結果,政府需要修訂有關向病人發放降低膽固 醇藥物的指導原則。《每日郵報》在報道中列出了一些數字:英格蘭和威爾士每年有四百萬人服用他汀。在英格蘭,每年有一萬人因服用他汀而挽救了性命。

The Los Angeles Times leads with a new study that found statin drugs can cut in half the risk of seemingly healthy people suffering a heart attack. The findings are bound to be a boom for statins, which millions of people already take to manage their cholesterol, as experts say that if this new treatment were widely adopted it could help prevent 50,000 heart attacks, strokes, and deaths each year.


Cholesterol-Fighting Drugs Show Wider Benefit

Published: November 9, 2008

A large new study suggests that millions more people could benefit from taking the cholesterol-lowering drugs known as statins, even if they have low cholesterol, because the drugs can significantly lower their risk of heart attacks, strokes and death.

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The study, involving nearly 18,000 people worldwide, tested statin treatment in men 50 and older and in women 60 and older who did not have high cholesterol or histories of heart disease. What they did have was high levels of a protein called high-sensitivity C-reactive protein, or CRP, which indicates inflammation in the body.

The study, presented Sunday at an American Heart Association convention in New Orleans and published online in The New England Journal of Medicine, found that the risk of heart attack was more than cut in half for people who took statins.

Those people were also almost 50 percent less likely to suffer a stroke or need angioplasty or bypass surgery, and they were 20 percent less likely to die during the study. The statin was considered so beneficial that an independent safety monitoring board stopped what was supposed to be a five-year trial last March after less than two years.

Scientists said the research could provide clues on how to address a long-confounding statistic: that half of heart attacks and strokes occur in people without high cholesterol.

“These are findings that are really going to impact the practice of cardiology in the country,” said Dr. Elizabeth G. Nabel, director of the National Heart, Lung and Blood Institute, which was not involved in the research. “It’s at a minimum an extremely important study and has the potential to be a landmark study.”

The study is stirring debate over who should take a blood test to check CRP and under what circumstances someone with high levels of the protein should be given a statin. Because heart disease is a complex illness affected by many risk factors — including smoking, hypertension and being overweight — most researchers said high CRP alone should not justify prescribing statins to people who have never had heart problems.

Some experts cautioned against testing people for the protein unless they had other risk factors, and they said more research was needed to pinpoint the patients for whom the benefit of statins outweighs the risks. On rare occasions, statins have been linked to muscle deterioration or kidney problems, and some patients reported fogginess of memory. Other researchers recommended testing for CRP more frequently and using statins more aggressively.

The study, called Jupiter, is also fueling a debate among scientists about the protein’s importance and inflammation’s role in heart disease.

Dr. Nabel said national panels were likely to revise their official guidelines for doctors to recommend CRP testing and statin therapy for some people not previously considered candidates.

Current practice, she said, is to treat people with high cholesterol with statins and to counsel people at low risk for heart disease about diet and exercise.

“What cardiologists have never known what to do about is the intermediate range” of patients, Dr. Nabel said, who may be overweight, smoke or have hypertension but do not have the most serious red flags of high cholesterol or diabetes. “I think CRP will emerge as a new risk factor added to traditional risk factors.”

The leader of the Jupiter study, Dr. Paul M. Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston, said expanding statin use could prevent about 250,000 heart attacks, strokes, vascular procedures or cardiac deaths over five years.

Some experts not involved in the study said several million more Americans should probably be taking statins. About 16 million to 20 million do now.

“The Jupiter trial very convincingly used CRP as a way to identify another group of high-risk individuals who would not otherwise have been treated and supports the concept that those people should be treated with a statin,” said Dr. Daniel J. Rader, a heart researcher at the University of Pennsylvania School of Medicine who was not connected to the study.

Some consumer advocates and doctors raised concerns about the expense of putting relatively healthy patients on statins, which would cost the health system billions of dollars. Name-brand statins can cost $3 a day, but generics are much cheaper. Dr. Ridker said he believed that the widening use of the drugs might prevent costs associated with heart attacks and surgery.

Several experts said that although the research was significant and would affect clinical practice, the study as published did not give enough detail about which patients should now be tested for CRP or given statins.

In an accompanying editorial, Dr. Mark A. Hlatky, a professor of health research at Stanford University, questioned the cost of expanding statin use. He also said that the study, which tested people with levels of the protein over two milligrams per liter, did not indicate whether that level or a higher CRP level should be the threshold for treatment.

Dr. Sidney Wolfe, director of the health research group for Public Citizen, a nonprofit consumer advocacy group, said the study did not give enough detail about the effect of statins on participants who had only high protein levels, compared with those who also smoked or had a condition called metabolic syndrome.

Some experts questioned whether stopping the trial early had limited the possibility of some more meaningful data. Dr. Ridker said it had not.

He said the published study, as well as unpublished data, indicated that all the statin-takers experienced the same benefit, including those considered “very low risk” because they had no risk factors other than high levels of the protein.

The trial was one of the few to test statins that included many women, Hispanics and blacks, groups that all showed similar benefit from statins.

Like many clinical trials, the Jupiter study was sponsored by a pharmaceutical company, in this case AstraZeneca. It makes the drug in the trial, rosuvastatin, which is sold as Crestor. The most potent statin on the market, Crestor has been criticized by consumer health advocates who say it is more likely to lead to muscle deterioration and kidney problems.

In 2005, the Food and Drug Administration rejected a petition by Public Citizen to ban Crestor, saying its risks were not substantially different from similar drugs.

In the Jupiter study, in which people got either rosuvastatin or a placebo, there was no increase in muscle or kidney problems for those taking the statin. There was a small increase in diabetes.

Dr. Timothy J. Gardner, president of the American Heart Association, said some recent statin trials “have been either negative or in some ways concerning in terms of complications.” But, he added, “this one is pretty clearly a winner for statin therapy.”

Dr. Ridker, a co-inventor of a CRP test, said he first sought federal financing for the study and was turned down. He and the other scientists interviewed for this article, except for Dr. Nabel, Dr. Gardner and Dr. Wolfe, have consulted for or received research money from stain makers.

Although Crestor, which has 9 percent of the American cholesterol-lowering market, was used in this study, several experts said it seemed likely that the effect would be the same for other statins in appropriate doses, including generics.

Lisa Nanfra, executive director of commercial operations for AstraZeneca, said the company believed that there was a “unique profile of Crestor” and that the drug was “the most effective statin at lowering” bad cholesterol. The company plans to use results from the Jupiter study to seek F.D.A. approval to widen its claim about Crestor’s effectiveness.

The role of the protein and inflammation in heart disease is hotly debated. Dr. Ridker believes inflammation plays an important role, probably by causing plaque in the arteries to rupture. “Screening for cholesterol alone is like having two passengers in a car but only one air bag,” he said. “If we’re not screening for CRP, we don’t have the opportunity to save that person’s life.”

Others say cholesterol is much more important. Dr. Scott Grundy, a heart expert at the University of Texas Southwestern Medical Center, pointed out that in the Jupiter study, the statin not only lowered the protein but also significantly cut already low cholesterol levels, raising questions about whether the benefit actually came from giving patients superlow cholesterol. And because CRP can rise with short-term infections unrelated to chronic inflammation, some experts said test results needed to be weighed against other aspects of the patient’s health.

“CRP is not a standard test that everyone should have,” Dr. Rader said. “It is an additional test that you should do if you’re on the fence.”

Dr. Andrew M. Tonkin, head of cardiovascular research at Monash University in Melbourne, Australia, said though the results for those who took the statin were “strikingly positive,” given that the people in the study were relatively healthy, there needed to be a cost-benefit analysis to decide: “Are there people in whom the potential gains, although significant, are not so great as to warrant taking statins?”

2008年11月9日 星期日

Study finds 'cold hands, warm heart' a myth

Study finds 'cold hands, warm heart' a myth


Muneyoshi Yanagi (1889-1961), who founded the Nihon Mingeikan (Japan Folk Crafts Museum) in Tokyo, found beauty in everyday household utensils made of earthenware pottery and wood. In his book "Teshigoto no Nihon" (Japan and handicrafts) from Iwanami Shoten Publishers, Yanagi noted that folk handicrafts are beautiful precisely because they are fashioned by the human hand.

One thing that distinguishes the human hand from a machine is that the former is connected to the heart, Yanagi asserted.

"The hand does not just move," he went on. "It is always attached to the heart in a deep way. ・The heart lets the hand enjoy its labor and makes it honor morality." In the eyes of this respected connoisseur, every handicraft item is ultimately a work of the human heart.

On the hand-heart relationship, an amusing news item emerged in October. According to research by a team of psychologists from two U.S. universities, the old adage, "Cold hands, warm heart" seems to have no basis in truth: Their research found that people with warm hands did tend to be more generous or kinder to others than those with cold hands.

For instance, subjects holding a cup of hot coffee tended to have a more favorable impression of a stranger they met than those holding iced coffee. The same tendency was also noted in a similar experiment using hot or cold therapeutic pads.

Is this proof, after all, of the inseparable relationship between the hand and the heart? It appears the warmth one feels in one's hand reaches one's heart, even though one may not be aware of it.

The season's first snow has arrived in northern Japan. Friday was ritto, the first day of winter in the traditional calendar. The transition from autumn to winter seems smooth this year, and many leaves on trees in a copse in my neighborhood are changing color. On a showery day when you can hear raindrops falling on dead leaves, it must be good for the heart to gently wrap one's hands around a hot drink.

A poem by Machi Tawara goes: "'It's cold,' I say/ The warmth of being with someone/ Who responds, 'It's cold.'" This conjures an image of a couple rubbing their hands together, breathing out white clouds in the winter chill.

The same exchange--"It's cold." "Yes, it is."--is likely being heard in a wave moving southward from the northern parts of the country.

--The Asahi Shimbun, Nov. 7(IHT/Asahi: November 8,2008)

the best prescription for illness is hope

Clear communication brings a healing touch


Essayist Yoko Kishimoto, referring to her fight against cancer, wrote that when listening to a doctor's explanation it is important to keep a pen and notepad handy.

She always takes notes and whenever a difficult technical term pops up, her pen stops. When she stops writing, she knows she does not understand the words. The doctor also notices. That is why she can ask questions.

Sometimes, the doctor offers to rephrase an explanation using layman's terms, according to Kishimoto, who spoke at a recent symposium in Tokyo called "heart-felt medicine and the power of language."

When patients see a doctor, the conversation tends to start with anxiety on the patient's part. They also tend to be nervous. There is even a condition known as "white coat hypertension," in which some patients' blood pressure rises due just to the stress of seeing their doctor.

On top of that, if they feel helpless, even when they try to take notes, it becomes increasingly difficult to understand unfamiliar terms.

In an effort to break down the language barrier between doctors and patients, attempts are being made to explain tricky medical terms. As a first step, the National Institute for Japanese Language chose 57 difficult words. For example, shinjun (infiltration) is defined as "cancer spreading to surrounding tissue" and kankai (remission) is listed as "a steady condition in which symptoms are stable."

Many loan words also are used by doctors. Reading those in the list, I realized my ignorance and had to correct quite a few of my misunderstandings. I hope that the new explanations will convey the warm-heartedness of doctors, as well as a better understanding of medical terms.

Clinical psychologist Hayao Kawai, who died last year, liked the phrase "the best prescription for illness is hope." While I know doctors are busy, I want them to keep this apt saying in their hearts.

When doctors' words are backed with warmth, they can be more than just easy to understand. They may also carry the power to heal.

--The Asahi Shimbun, Nov. 5(IHT/Asahi: November 6,2008)

2008年11月8日 星期六


那醫生說 這樣
改改/修正X光片 算便宜點


"When I told my doctor I couldn't afford an operation, he offered to touch up my x-rays."Henny Youngman

醫生要看 X片時

2008年10月28日 星期二

Chasing the secret of long life

Chasing the secret of long life


An old volume I recently picked up at a used bookstore in Tokyo contains an anecdote about Herman Boerhaave (1668-1738), a Dutch physician who became famous in Europe during his lifetime. The story concerns a certain unpublished manuscript owned by Boerhaave, which was discovered with its seal intact among his personal effects after his death.

The title translates as "the deepest secrets of medicine" in English, and the book was thought to contain the secret of longevity.

At auction, bids for the book rose higher and higher, even though nobody knew anything about the content. This episode shows how the human thirst for knowledge of good health and long life has been with us through the ages.

More than ever, people today eagerly lap up any health-related information. While we shouldn't fall for dubious or phony health tips, newspapers are full of stories about medical experts' opinions and research findings, such as a recent claim that drinking green tea prevents diabetes. Such stories apparently appeal to a large readership.

Being over 50, I am greatly interested in the recent news that drinking "seven cups of green tea a day" keeps diabetes at bay. For some time, however, my beverage of choice has been coffee because coffee drinkers are said to be at a lower risk of liver cancer.

Yet were I to start guzzling both green tea and coffee at teatime to "run after two hares," as the saying goes, I suppose my midsection would soon become bloated.

Just the other day, it was reported that elderly men in their 60s and 70s who are "somewhat chunky" are likely to live longer than their skinnier peers. Many people must have been greatly heartened by this news, but let's get this clear: If your bulk owes mostly to fat, and not muscle, you are actually at a greater risk.

Keeping healthy is a multidimensional commitment. We must beware of placing too much trust in any single theory or discovery, as it will only put us on an emotional roller coaster and wear us out.

Back to Boerhaave. The book was auctioned off at an exorbitant price, but the pages turned out to be blank.

The only words it contained were to the effect: "Keep your head cold, your feet warm, and your body relaxed. That way, you can laugh at all doctors."

I leave it up to each reader to decide whether Boerhaave was a sarcastic doctor or a wise observer of human nature.

--The Asahi Shimbun, Oct. 27(IHT/Asahi: October 28,2008)

2008年10月24日 星期五

placebo effect 醫生病人關係

placebo effect

Stories in the Service of Making a Better Doctor

Aaron Houston for The New York Times

Tia Harmon, a patient at Saint Barnabas Medical Center in Livingston, N.J., listens as Dr. Benjamin Kaplan reads from "Kitchen Table Wisdom: Stories That Heal," by Dr. Rachel Naomi Remen.

Published: October 23, 2008

The white-coated crowd with stethoscopes slung casually around their necks would have looked familiar to anyone who has attended morning hospital rounds. Resident physicians and medical students milled about, chatting animatedly, and at the appointed hour, the attending physician signaled to begin.

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Aaron Houston for The New York Times

Dr. Richard S. Panush

But instead of filing toward a patient’s room, the group at Saint Barnabas Medical Center in Livingston, N.J., settled into a conference room at the end of the hall, not to recite details of patient cases but to read “Empty Pockets,” a personal essay by Dr. Kevan Pickrel from The Annals of Internal Medicine. In the piece, Dr. Pickrel describes being unable to save a 36-year-old woman, then going to the waiting room to inform the woman’s family of her death:

“The youngest daughter sat on Dad’s lap looking at pictures in an outdoors magazine. The older sat watching her hands rest in her lap. [The] husband’s eyes lifted to me and met mine. I didn’t, couldn’t, say a word.... He turned back toward his daughters, a single father, and they lifted their eyes to his. As he drew a breath to begin, his eldest daughter knew.

After the reading, the attending physician, Dr. Sunil Sapra, looked up at the group assembled. “Do you identify with any of these situations?” he asked.

“Yes, it happens all the time,” a resident responded immediately. Others nodded in agreement, and one resident flicked a tear away.

The next morning, in a similar room at New York-Presbyterian Hospital in upper Manhattan, a group of obstetrics and gynecology residents gathered to read E.B. White’s short story “The Second Tree From the Corner.” Told from the perspective of an anxiety-ridden patient, the story ends with the main character finding meaning in his life and suddenly feeling liberated:

“He felt content to be sick, unembarrassed at being afraid; and in the jungle of his fear he glimpsed (as he had so often glimpsed them before) the flashy tail feathers of the bird courage.”

As the reading ended, one of the young doctors commented on how personally fulfilling it was to help her patients and how those feelings invigorated her, even after many hours of work. Other doctors in the room nodded in agreement.

While it has long been understood that clinical practice influenced the youthful writing of doctor-authors like Chekhov and William Carlos Williams, there is now emerging evidence that exposure to literature and writing during residency training can influence how young doctors approach their clinical work. By bringing short stories, poems and essays into hospital wards and medical schools, educators hope to encourage fresh thinking and help break down the wall between doctors and patients.

“We’re teaching the humanities to our residents, and it’s making them better doctors,” said Dr. Richard Panush, a rheumatologist and chairman of the department of medicine at Saint Barnabas.

The idea of combining literature and medicine — or narrative medicine as it is sometimes called — has played a part in medical education for over 40 years. Studies have repeatedly shown that such literary training can strengthen and support the compassionate instincts of doctors.

Dr. Rita Charon and her colleagues at the program in narrative medicine at Columbia University’s College of Physicians and Surgeons found, for example, that narrative medicine training offered doctors opportunities to practice skills in empathy. Doctors exposed to literary works were more willing to adopt another person’s perspective, even after as few as three or four one-hour workshops.

“You want people to be able to leave their own individual place,” Dr. Charon said, “and ask what this might be like for the child dying of leukemia, the mother of that child, the family, the hospital roommate.”

Over the last 15 years, an ever-increasing number of medical schools have begun offering narrative medicine to medical students. These courses often involve writing, reading and discussing works by authors as diverse as Leo Tolstoy, Virginia Woolf, Lori Moore and various doctor-authors. Students then explore the relevance of these texts, and their own writing, to their clinical work.

But until recently, few educators have attempted to bring such literary training into residency programs.

Residency is the most intense period of a young doctor’s life. The years spent squirreled away in hospitals and clinics are rich in clinical learning, but the wealth of that experience comes at the cost of free time.

And with time at a premium, residency program directors and clinical educators have been hesitant to add narrative medicine to their curricula, particularly since it has never been clear that such an addition would have any effect other than further overworking the trainees.

That could be changing.

For over a year now, Dr. Panush, a tall, bespectacled, soft-spoken man with the lean physique of a runner, has been systematically incorporating literature into the daily rounds of every one of the internal medicine residents at Saint Barnabas Medical Center.

As part of the Accreditation Council for Graduate Medical Education’s Education Innovations Project, Dr. Panush and his faculty colleagues bring poetry, short stories and essays to rounds each day and discuss them in the context of the patients they see. These daily discussions, supplemented by offsite weekly conferences, form the core of the residents’ narrative medicine experience.

One year into the program, Dr. Panush and his colleagues looked at the effect of these daily discussions on the residents and their patients. What they found were significant improvements in patient evaluations of residents and patients’ health and quality of life, from hospital admission to discharge.

A handful of other residency programs across the country have taken steps toward establishing narrative medicine training for their residents, including Vanderbilt University’s Department of Surgery and New York/Presbyterian Hospital-Columbia’s Department of Obstetrics and Gynecology. As with the program at Saint Barnabas, it has been the doctors within these departments who have initiated the workshops, sessions and lectures.

“As we improve the technology of medicine, we also need to remember the patient’s story,” said Dr. A. Scott Pearson, an associate professor of surgery at Vanderbilt University Medical Center.

To that end, Dr. Pearson has completed a pilot study examining the feasibility of incorporating narrative medicine into Vanderbilt’s surgical residency and has plans to make such training available eventually to all surgical residents at his medical center. Dr. Pearson believes that narrative medicine will not only help residents reflect on what they are doing and how they might do better, but may also aid surgical educators in teaching professionalism and communication skills.

“Narrative medicine changed my entire approach to medicine,” said Dr. Abigail Ford, a senior resident in obstetrics and gynecology at New York-Presbyterian Hospital/Columbia who studied under Dr. Charon as a medical student. “As a doctor you are really a co-author of patients’ experiences and need to hear their story and take it on.”

With her former professor’s guidance, as well as the support of Dr. Rini Ratan, the residency program director, Dr. Ford has initiated a narrative medicine program for her fellow obstetrics and gynecology residents. While the program is still in its first year, “we’ve always run over,” said Dr. Ford. “People have to be dragged away.”

“Our hope is to look at it in terms of physician empathy,” added Dr. Ratan, “Does it add anything? Does it prevent natural jadedness over the course of the busy training process? Does it prevent burnout?”

In the near future, Dr. Ratan and Dr. Ford also hope to begin doing the kind of patient outcome evaluations that Dr. Panush and his colleagues have begun.

“To do what we’re doing is pretty simple,” said Dr. Panush. “But the measurement stuff is harder. The program needs to be supported institutionally and internally.”

Despite such challenges, the effects of these programs are striking. Dr. Benjamin Kaplan, a second-year resident at Saint Barnabas, remarked on the transformation he saw in fellow resident physicians during the first year of the humanities program.

“Their management of patients changed,” Dr. Kaplan said. “They remembered to do things that I don’t think they would have otherwise done, like always talking to the family, gently touching patients, and continually explaining the course of treatment and what the doctors are thinking so patients know.”

And the time commitment? “It does get pretty busy,” Dr. Kaplan conceded. “But if you want to make time for it, you can. Spending a half hour a day to remember that we are all human, not just doctors or pharmacists or nurses or patients, is important enough that I think you should do it.”

Although it is still too early to determine the long-term effects of narrative medicine on doctors in training, residents were quick to note that certain essays, short stories and poems they have read on rounds continue to influence their work.

Dr. Ramesh Guthikonda, a second-year resident at Saint Barnabas, spoke about a poem called “When You Come Into My Room,” by Stephen A. Schmidt. In the poem, published in The Journal of the American Medical Association, a man struggling with chronic illness lists all that he believes a doctor meeting him should know:

“When you come into my hospital room, you need to know the facts of my life

that there is information not contained in my hospital chart

that I am 40 years married, with four children and four grandchildren....

that I love earthy sensuous life, beauty, travel, eating, drinking J&B scotch, the theater, opera, the Chicago Symphony, movies, all kinds, water skiing, tennis, running, walking, camping...

that I am chronically ill, and am seeking healing, not cure.”

The poem so affected Dr. Guthikonda that he began regularly asking his patients about their hobbies and families, and he enrolled in a Spanish class so he could learn to better pronounce their names. “My rapport with patients, especially with my Hispanic patients, was not up to the mark,” he said. “I never asked about the patients’ lives, about who they are. I am much more sensitive to those issues now.”

Reflecting on the changes in Dr. Guthikonda, Dr. Panush said, “We changed the way he thinks and does medicine. You can’t put a p-value on that.”

Have literary works made you a better caregiver or patient? Click here and join the discussion on the Well blog, “Combining Literature and Medicine.”

2008年10月23日 星期四

每天只要做五件簡單的事 長保健康

泰晤士報一篇文章報道,科學家說,每天只要做五件簡單的事情,就可以保持腦健康,減少精神疾患。 這些簡單的事包括整理花園,修理自行車,做飯等。 科學家們還建議,要保持身心健康,享受快樂人生有關鍵幾步,這幾步是: 保持同家人,朋友的聯繫﹔多活動,包括走路,跳舞,體育活動等﹔要善於注意到每天那些令人愉快的時刻﹔要不斷獲取新的知識﹔幫助別人和社區能增加你的滿足感。

October 22, 2008

Do five simple things a day to stay sane, say scientists

Simple activities such as gardening or mending a bicycle can protect mental health and help people to lead more fulfilled and productive lives, a panel of scientists has found.

A “five-a-day” programme of social and personal activities can improve mental wellbeing, much as eating fruit and vegetables enhances physical health, according to Foresight, the government think-tank. Its Mental Capital and Wellbeing report, which was compiled by more than 400 scientists, proposes a campaign modelled on the nutrition initiative, to encourage behaviour that will make people feel better about themselves.

People should try to connect with others, to be active, to take notice of their surroundings, to keep learning and to give to their neighbours and communities, the document says.

Its advice to “take notice” includes suggestions such as “catch sight of the beautiful” and “savour the moment, whether walking to work, eating lunch or talking to friends”. Examples of learning include mending a bike or trying to play a musical instrument.

“A big question in mental wellbeing is what individuals can do,” Felicia Huppert, Professor of Psychology at the University of Cambridge, who led part of the project, said. “We found there are five categories of things that can make a profound difference to people’s wellbeing. Each has evidence behind it.” These actions are so simple that everyone should aim to do them daily, she said, just as they are encouraged to eat five portions of fruit and vegetables.

Critics of the recommendation said that the Government and health professionals ought not to be prescribing individual behaviour in this way. “The implication is that if you don’t do these banal things, you could get seriously mentally ill, and that trivialises serious mental illness. What is happiness, anyway? It’s so subjective,” Claire Fox, director of the Institute of Ideas, said.

Although the report has no immediate policy implications, ministers will pay attention to it because Foresight is headed by the Government’s chief scientist, Professor John Beddington.

The project investigated ways of improving the nation’s “mental capital”, which Professor Beddington likened to a bank account of the mind. “We need to ask what actions can add to that bank account, and what activities can erode that capital,” he said.

Among the other issues it highlights is a strong link between mental illness and debt. Half of people in Britain who are in debt have a mental disorder, compared with just 16 per cent of the general population.

Rachel Jenkins, of the Institute of Psychiatry in London, who led this section of the report, said: “We’ve known for a while there’s a link between mental health issues and low income, but what more recent research has shown is that that relationship is probably mostly accounted for by debt.”

The report advocates more flexible working, days after Lord Mandelson, the Business Secretary, announced a review of government plans to extend such arrangements.

Cary Cooper, Professor of Organisational Psychology and Health at the University of Lancaster, a co-ordinator of the report, said: “People who choose to work flexibly are more job-satisfied, healthier and more productive.”

Steps to happiness

Developing relationships with family, friends, colleagues and neighbours will enrich your life and bring you support

Be active
Sports, hobbies such as gardening or dancing, or just a daily stroll will make you feel good and maintain mobility and fitness

Be curious
Noting the beauty of everyday moments as well as the unusual and reflecting on them helps you to appreciate what matters to you

Fixing a bike, learning an instrument, cooking – the challenge and satisfaction brings fun and confidence

Helping friends and strangers links your happiness to a wider community and is very rewarding

Source: Foresight report

2008年10月16日 星期四

Power of Pee Keeps Klitschko's Fists Pounding

From the Fringe | 15.10.2008

Power of Pee Keeps Klitschko's Fists Pounding

Medical practitioners of both the holistic and traditional varieties have long used urine for treatment purposes, but boxer Vitali Klitschko may have devised a brand new therapy with the help of his son's wet diapers.

While treatments with names like "the urine cure" and "urine therapy" tout the liquid's cleansing characteristics -- with some even praising it as a cure for nearly every malady -- Ukrainian boxer Vitali Klitschko had practical demands for the waste product.

He used his son's wet diapers to help keep his fists from swelling up after winning his WBC heavyweight title match against Nigeria's Samuel Peter, Klitschko told German mass-market daily Bild on Tuesday, Oct. 14.

"Baby wee is good because it's pure, doesn't contain toxins and doesn't smell," the 37-year-old boxer told the paper after winning the title bout on Saturday.

"I wrap diapers filled with my three-year-old son Max's wee around my fists," he said, adding that the idea originated with his grandmother. "The nappies hold the liquid and the swelling stays down."

DW staff (sms)

2008年10月11日 星期六

What’s the Healthiest Diet of All?

October 3, 2008, 11:33 am

What’s the Healthiest Diet of All?

Diners at an outdoor cafe in Corsica, France.Diners at an outdoor cafe in Corsica, France. (Ed Alcock for The New York Times)

What exactly do doctors mean by a “healthy diet”?

Many of us consider the Mediterranean diet to be the closest thing known to an ideal meal plan, rich in vegetables, fruits, legumes, cereals, fish, olive oil and, yes, a bit of red wine with meals. Compared to traditional American menu — high in red meat and in butter and other dairy products — the Mediterranean diet is lower in saturated fat, more varied and often more satisfying.

Decades worth of research also suggests that this way of eating is healthier. Many studies have documented reduced rates of heart disease and cancer among those adhering to a Mediterranean diet, compared to those eating more red meat and dairy-based regimens. Most of these studies have involved observations rather than actual intervention trials, however, and they have varied in size.

Now the British Medical Journal has published a systematic compilation of a dozen of the most methodologically sound of these observational studies, which included over 1.5 million people followed for up to eighteen years, analyzing cardiovascular consequences and some other important health outcomes. This large meta-analysis found decreased cardiovascular death as well as cancer mortality, and a lowered incidence of Parkinson’s disease and Alzheimer’s disease, in those following the Mediterranean diet versus those on other diets.

While such meta-analyses have limitations and cannot be considered as persuasive as large, randomized intervention trials, the new study further supports the idea that the Mediterranean diet can confer important health benefits.

Different diets abound, many even promoted by physicians. But it’s a mistake to think of a diet as a temporary measure; instead, it is a lifetime commitment to healthy choices. Need to lose weight now? Don’t rush. Take comfort in knowing that even a modest incremental reduction can confer significant health benefits, lowering your risk of heart disease or diabetes. Crash diets only set us up for “yo-yo” weight loss and regain.

Whatever eating habits you adopt must be sustainable over the long term. Many researchers regard this as the Mediterranean diet’s greatest strength. You can stick to it, and like it, year after year.

How sad, then, to learn that a diet that whose adherents were among the longest-lived in the world is now fading from view. The governments of Greece, Italy, Spain and Morocco have asked that UNESCO designate the Mediterranean diet an “intangible piece of cultural heritage.” But as The Times recently reported, fast food is proliferating across the Mediterranean region, threatening to propagate a U.S.-style obesity epidemic.

In Greece, three-quarters of the adult population is now overweight or obese, and at increasing risk for diabetes, heart disease and arthritis, among other maladies. “Much of the highly praised diet didn’t exist any more,” said a senior economist at the United Nations who conducted a recent survey of regional eating habits. ”It has become just a notion.” Rather than turning our backs on this traditional diet, the new data suggest we could all derive substantial health benefits from it.

[For some dishes with a Mediterranean flair, check out The Times' Recipes for Health. -- Eds.]

2008年8月21日 星期四

The Juggle: The Key to Happiness: Money, Family, or Positive Thinking?


| | |

而最新一期Journal of Family Psychology上發表的一篇長期研究論文再次肯定了這種觀點:要讓自己更幸福,最好的辦法是加強親情,而不是多掙錢。

這 項研究對274位已婚人士進行了10年的跟蹤調查,關注他們在各個時期的幸福感,研究發現,“家庭社會支持”的改善能夠讓研究對象覺得自己的生活更幸福, 而加薪則起不到這樣的效果。如果家庭成員互相幫助,相親相愛,經常交談,坦誠相對,很少吵架,那麼家庭的社會支持度就很高。研究對象的薪資變化並沒有影響 長時間的幸福感。(當然,研究表明,以固定的時間點衡量,這個大多由中產階層組成的研究對象群體中收入較高者總體來說幸福感略強,不過幸福的家庭生活的效 應更強。該研究由得克薩斯大學奧斯汀分校(University of Texas, Austin)的研究人員牽頭進行。)

這項研究從 長期角度出發,這一點不同尋常。通過將家庭生活與工作進行對比,反映出了這些方面常常在日常生活中互相沖突的方式。而研究結果對我來說很真實。雖然加薪或 事業上的成功對於我也是很愉快的調劑,但我覺得真正有意義、讓我覺得滿足的是我與自己的孩子、兄弟姐妹以及侄子侄女們的親情。

當 然,幸福是個復雜的話題。另外一些專家──其中最著名的就是心理學家、著有《學會樂觀》(Learned Optimism)和《真實的快樂》(Authentic Happiness)的馬丁﹒塞利格曼(Martin Seligman)──認為,幸福的基石更多地關乎人的內心,在很大程度上是基於一個人發掘、關注和表達正面情緒的能力。這些專家說,產生快樂和幸福感的 心態是可以習得的,這種心態可以防止沮喪和覺得人生無味的情緒產生。


Sue Shellenbarger

WSJ The Juggle: The Key to Happiness: Money, Family, or Positive Thinking?

| | |
That 'Nobody on his deathbed ever said, 'I wish I'd spent more time at the office,'' is a well-worn idiom.

Yet a new long-term study, published in the latest edition of the Journal of Family Psychology (subscription required) affirms that thinking: Fortifying family ties, not making more money, is the best way to become a happier person.

The research, based on a 10-year look at 274 married people's happiness over time, found that improvement in 'family social support' had the power to make people happier over the life of the study, while increases in income did not. Families were rated high in social support if members were helpful and compassionate with each other, talked often and honestly, and fought infrequently. A change in income over the life of the study didn't change subjects' reported happiness over time. (To be sure, when measured at any fixed point in time, higher-income people in this mostly middle-class sample tended to be slightly happier in general, says the study, led by researchers at the University of Texas, Austin; a happier family life had an even bigger effect, however.)

The study is unusual in taking a long-term perspective. By pitting family against work, it mirrors the way these priorities often compete in daily life. And the findings ring true for me. While increases in income or career success have been pleasant distractions for me, I derive fundamental meaning and contentment largely from my relationships with my children, my brother and sister and my nieces and nephews.

Of course, happiness is a complex topic. Other experts - most notably psychologist Martin Seligman, author of the bestselling books 'Learned Optimism' and 'Authentic Happiness' - say the underpinnings of happiness are more internal, based largely on the individual's ability to cultivate, focus on and express positive emotion. The mind-set that produces happiness and well-being can be learned, serving as an antidote to depression and meaninglessness, these experts say.

Readers, do you think your personal happiness derives from external factors such as family support, or internal emotions? What role, if any, do money and career success play?

2008年8月20日 星期三



Story Image

YUMMY: Olives, prawns, grapes - all holiday favourites - and good for you too

Tuesday December 11,2007

By Victoria Fletcher Health Editor

GOING on a Mediterranean diet may be the best way to achieve a long and healthy life.

Nutritious holiday-style food can slash the risk of dying of common diseases, according to a new study.

People who fill their plate with fruit and vegetables, nuts, olive oil, grains and legumes reduced their risk of dying from heart problems and cancer by up to 22 per cent.

The more they substitute unhealthy foods such as processed meats for nutritious alternatives like fish, the lower their risk of death.

The researchers believe the report proves the value of ditching burgers and fries in favour of the fresh foods of the type eaten in the Mediterranean.

The US study monitored the health of more than 380,000 men and women aged between 50 and 71 who were in good health.

They were questioned about their diet, including the amount of alcohol they drank and their intake of dairy products.

The researchers gave every volunteer a score based on their diet sheet. Anyone who ate more “healthy” foods than the national average were awarded an extra point for each portion consumed.

The research by the National Cancer Institute in Maryland found that once influences such as smoking and social class were excluded, men with the healthiest diet reduced their risk of dying from cancer by 17 per cent and of cardiovascular disease by 22 per cent. For women, the results were less dramatic. Those who ate the healthiest diet reduced their risk of dying of cancer by 18 per cent and of heart disease by 19 per cent.

Dr Panagiota Mitrou, who led the study, said: “These results provide strong evidence for a beneficial effect of higher conformity with the Mediterranean dietary pattern on risk of death from all causes, including cancer and cardiovascular disease.”

The study, published in the American journal Archives of Internal Medicine, found that most people who eat a Mediterranean-style diet are also more educated, do more exercise and do not smoke. Last night, British experts said that it was hard to know how much these other factors might have affected the results.

Tim Key, the deputy director of the Cancer Epidemiology Unit said: “This does tell us that people with a certain lifestyle including eating a Mediterranean diet have lower mortality. But it does not tell us that if you switch from an unhealthy diet to eating these foods, it will reduce your risk. That is the important question.”

The study is the latest of many to suggest a link between the Mediterranean diet and good health.

Earlier this year another American study showed that a diet rich in Mediterranean foods can halve the risk of developing serious lung disease.

Another study published in the journal Thorax in April suggested that children raised on Mediterranean foods were less likely to develop asthma and allergies.

2008年8月11日 星期一

Rember may halt the progression of Alzheimer's disease

Spectrum | 12.08.2008 | 04:30

Breakthrough in the Battle Against Dementia

The breakthrough certainly made the front pages of all the major newspapers. UK scientists say they have developed a drug which may halt the progression of Alzheimer's disease.

In clinical trials, the drug - called Rember – proved at least twice as effective as current medicines. Rember slowed the rate of mental decline of Alzheimer’s patients by as much as 80%. Britain’s Alzheimer’s Society has hailed the development a major breakthrough in the battle against dementia. From London Stephen Beard reports.






2008年8月1日 星期五


我沒這樣做 有些故事也姑妄聽之



天生萬物各有所長,也各得其所。鳥生雙翼,適於在天空翱翔;魚生鰭尾,利於在江海泅泳;人生兩腿,長於在陸地健行。今日,人類發明了太多先進的交通工具替 代兩腿,固然可使遠行方便,也肯定會造成兩腿退化的危機。記得年輕時有一次在歐洲法瑞邊境健行,參加的有中、美、英、法、德、東歐等各國同學,不過走了十 幾公里,美國同學已經累得不行了,大家都笑說美國人的腿退化得特快,因為美國的交通工具最發達。

中國人的交通工具比較落伍,反而更能保持雙腿的強韌。過去中國大陸的洋車伕,專靠兩腿維生,曾讓人道主義者大肆悲歎,卻真實地表現了人類強健的體能。我從 小雖然體弱,並無礙於健行,走個一天半日都不成問題。十四歲時,為了逃避戰禍,曾經有日行六十公里,一口氣從濟南走到天津的經驗。

如今,年歲日增,有目的步行的機會日減,只能為走而走了。為走而走,最好的時間在清晨,那是一日中最美好的時光。夜貓子自然無福消受,即使沒有熬夜,但習 慣賴床的人,也會錯過了這份福氣。雖然每天清晨升起的都是同一個太陽,但朝陽就硬是與中午的烈日或傍晚的夕照不同,朝陽所喚起的是心靈中旺盛的生命力量, 就像植物在朝陽照拂下往上瘋長一樣。加上清晨的空氣由於七八個小時沒有車輛及夜中暫停排煙的煙囪汙染,也沒有那麼多人群吐出的二氧化碳,經過一夜的沉澱, 顯得特別清新。

俗諺:一日之計在於晨。誠然,人們經過一夜的休歇,按理說早晨的精神最為飽滿。有人晨讀,增益腦力;有人晨跑,鍛鍊體魄,只要早晨的時光善加利用,一天都 覺得有勁兒。我過去選擇晨泳,因為比晨跑舒緩,不會氣喘咻咻,又因南台灣燠熱,泳池可以消暑。如今到了維城,六月仍然春寒料峭,實在沒有下水的意願,又到 了不堪負荷晨跑的年紀,只好用走的了。


同住在維城的黃永武兄,住家附近有不少林地,每天都到樹林裡晨走,風雨無阻。「下雨天,穿件雨衣就行,這樣清新的空氣,浪費了可惜!」他說。我非常佩服他 這種持之以恆的精神。我家附近沒有樹林,興起時可以走到不遠的陶米山上迎接朝陽,但多半就在周遭的街巷中走走。與台灣的城市極不相同的是,這裡清晨住宅區 的街道上闃無人跡,也無行駛中的車輛,靜悄悄的,只有枝頭的鳥聲此起彼伏。街旁都是住宅前庭的綠色草坪、花圃,還有各種樹木,房屋遠望都隱沒在樹叢中,走 在街道上跟在公園裡無異。

寓目的景色無非是花草樹木。早春常見的是水仙、鬱金香、櫻花。較晚上場的是杜鵑、玫瑰、牡丹、罌粟、雛菊,還有眾多我叫不出名字的花草。其中杜鵑尤多,有 紅,有白,常常是一簇簇,開得轟轟烈烈,吸人眼眸。樹木則以松、柏、杉、楓、白楊、櫻花樹為多,櫻花和楓樹分別在春秋兩季各顯顏色,松柏四季長青,白楊特 別高大,常可成為一條街的地標。當然樹木中還有眾多果樹,尤以蘋果、梨、桃、櫻桃、李子、無花果最為常見。奇怪的是從未見過石榴和棗子,此二者在中國北方 非常普遍,氣溫類似的加國,不知何故竟無此等品種。每家的前庭和後院都會按照各自的口味打理,有的注重翠綠的草坪,有的精選各色的花卉,有的布置著奇石、 怪木,有人庭院中居然有熱帶的棕櫚、芭蕉,蔚為奇觀。

除了欣賞各家的花木,同時也瀏覽了各種房屋的造型與顏色。每家都似乎別出心裁,不願與鄰居類同,有高有矮,有肥有瘦,有的漆成灰藍,有的粉白,有的土黃, 有的赭紅,有的暗綠。屋頂也有黑、灰、褐、綠、紅等各種顏色,如從高空俯瞰,可能會像是多彩的畫盤。共同點是一律木材建築,絕無磚石、鋼筋結構;另一個共 同點是均有前庭與後院,與左右鄰家的間距不像溫城的房舍那麼緊密,大概皆在三五公尺開外,前後鄰居或隔了一條街,或隔著兩個後院,距離就更遠了。所有住宅 高不過兩層,最常見的是一層加一個地上地下各半的地下室。這樣的木製房屋居然十分堅固,多可撐過百年。木質的彈性大,可以防震,不過最怕龍捲風,可能也抵 不住台灣時常過境的狂颱。美國的木屋就常常被龍捲風掀掉屋頂,甚至火柴盒似地吹上天空,就像兒童故事《綠野仙蹤》裡敘述的一般;幸而維城從未被龍捲風光 顧。

每晨總選擇不同的路徑,一面走,一面飽覽路邊的風光。偶然遇見另一個晨走的人,如果是本地人,對方一定露出笑容,先說一聲「早安」;如果是東方人,不論是 中國人或印度人,對方多半板著臉,漠然以對。並非東方人無禮,只是東方文化沒有跟陌生人打招呼的習慣。一般住在大城市的歐洲人也不會如此友善。蓋想當年歐 洲人移民北美地廣人稀的荒寒之地,舉目無親,遇見陌生人會感到分外親切,這種友善的習慣遂被後代子孫保持了下來。習慣影響了態度,瞭解此點可以防止不必要 的偏見。

晨走非但可以健身,兼可療病。我國先人早就研究出一套人體穴道的網絡,腳底與手掌的穴道關係到內臟器官,是故腳底或手掌按摩可以療治某些內臟的疾病。走路 就等同輕微的腳底按摩。成大退休教授于維杰對我說,多年前診斷出攝護腺癌,他於是開始每天走兩小時以上,走了幾個月居然把癌症走沒了。從此他總向朋友宣傳 走路的好處。多年前高行健在北京時診斷出肺癌,一時萬念俱灰,立刻丟下一切跑到大西南深山峻嶺中漫遊,半年後回到北京,再照X光,原來肺中的陰影完全消失 不見了。他當時以為從前是誤診,今天看來恐怕也是走路的功效。一趟西南行,使他寫出《靈山》一書,為華人摘下第一座諾貝爾文學獎。還有作家郭楓,幾年前患 了淋巴腺癌,非常嚴重,幸賴台大醫院的醫術高明,挽回一命。後來的復健就全靠每天清晨到烏來山林中晨走,幾年下來,如今雖到了從心所欲之年,容光煥發,健 康猶勝曩昔。


2008年7月30日 星期三


How the New Quality Movement Is Transforming Medicine.

W. Edwards Deming (1900-93)生前就這樣說過

“The best way for a student to learn a skill is to go to work in some good company (or hospital), under masters, and get paid while he learns.” W. Edwards Deming, Out of the Crisis

Re: QRDC開會7/11記錄
我常說 我可以寫出不在會議記錄中的許多事情
上次會議中 我強力建議品質學會成立healthcare 委員會
我說日本科技連盟 JUSE多年前就出版過"醫療品質手冊"
我說..... 我說.....

現在 用紐約時報的一篇書評代替"我說"

唯一要補充的是 提議人似乎也可以當跑腿...


2008年7月28日 星期一

The heartbreaking long goodbye

2008/7/29 晨

The heartbreaking long goodbye

By David Willis
BBC News in Missouri

Dianne Kerley and Flossie
Dianne struggles to communicate with her mother
The old lady stared blankly, not a hint of recognition on her face.

Next to her on the bed sat two of her closest relatives - her daughter and grandson.

They hugged her, teased her, squeezed her hand: nothing.

They talked of hobbies, and pets, and adventures from her past: not a word.

Then - briefly - the haunted expression grew into a smile and both planted kisses on her pallid skin.

For Dianne Kerley and her son Mike it was the best they could hope for.

Fifteen years ago Dianne's 78-year-old mother Flossie (Mike's grandmother) was diagnosed with Alzheimer's disease.

Since then she has lost not only her memory, but the ability to look after herself, as well as the ability to walk and talk.

Traumatic deterioration

They say that Alzheimer's begins with forgetting your keys and ends with you forgetting what your keys are for, but it is a whole lot worse than that.

Flossie no longer recognises her family

Before long Flossie's sense of balance and co-ordination will be compromised.

In the final stages of the disease so too will her ability to breathe.

Until then all Dianne and Mike can do is undertake a heartbreaking weekly pilgrimage to a nursing home in eastern Missouri and watch her fade away before their eyes.

"It was two years ago - at Thanksgiving," said Dianne, recalling the last time her mother recognised her.

"Ten or 12 seconds and then it was gone.

"She was like: 'Well hi! How are you?' and I'm like: 'Well, we sure do miss you,' and she was like: 'You do?. Then all of a sudden the fog just went over - and that was it."

It is difficult to imagine a slower, more agonising death.

Alzheimer's leaves the patient a prisoner in their own body whilst systematically eroding everything about them that makes them human.

What should be the golden years are marked by blank stares and tragically unrequited expressions of love.

My own grandmother

Flossie's situation reminded me of my grandmother.

Sprightly and independent, she was like a granny from central casting - white hair, glasses, rocking chair and slippers.

It is very traumatic for Dianne and Mike

She came to live with us shortly after my parents married and she was a hoot.

She helped out at children's tea parties, always had the best biscuits in the house, and allowed me to watch shows on her black and white TV that my mother frowned on.

But as the years went by, Granny started to change.

Not only would she say the same things, she would do the same things, time and time again.

She would list the names of everyone in the family before arriving at mine, come in to tell us something and then forget what she had come to say.

All the time she was becoming befuddled by tasks which once seemed second nature.

Slowly but surely her sharp mind and sense of fun began to fade like a tropical sunset.

When she lost control of her bladder my mother decided she could not cope and we put her in a home.

The first time I visited she barely recognised me.

A few more trips and she had lost the ability to speak.

Months later a nurse rang to say granny had faded away in her sleep.

We shed a tear then breathed a huge sigh of relief.

New hope

The fact is that even though Alzheimer's was discovered more than 100 years ago it is only in the last two decades that we have really come to know anything about it.

Lab work
Trials of new treatments are in progress

Lack of funding has a lot to do with it.

The US government spends roughly eight times as much on cancer research as is does researching Alzheimer's disease, and half what it spends on substance abuse.

Finally, though, there is some hope.

This week the Irish-American company Elan and the US firm Wyeth will jointly announce they are pressing ahead with the $300m (£151m) trial of a drug which could block the production of a protein called beta amyloid which many scientists believe causes Alzheimer's.

Present in all of us, too much beta amyloid can cause plaques to form in the brain, and those plaques feast on brain cells.

There is a lot at stake, not least financially. If a drug is discovered which prevents Alzheimer's half the population of the US alone could eventually end up taking it.

Need is great

Never has the need been greater: as the first baby boomers turn 60 the fear is the heath care system could be overwhelmed by what some are predicting could be an epidemic of Alzheimer's disease.

It costs $50,000 a year just to keep Flossie in a nursing home.

Back in Missouri, Mike and Dianne are bidding her farewell: "There's that pretty smile, sleep tight OK?"

Flossie sits perfectly still - beyond hooded eyelids brain cells are dying.

As she reaches the hallway Dianne stifles a tear.

Hers is the heart-rendering tragedy of the long goodbye.

You can watch David Willis's report on BBC World News America at at 0030 BST on BBC News and at 0000 BST (1900 ET / 1600 PT) on BBC World News and BBC America (for viewers outside the UK only).

Are you or is someone you know suffering from Alzheimer's disease? Are you affected by the issues in this story? Send us your comments using the form below.