〔記者鍾麗華／台北報導〕林口長庚醫院臨床毒物科主任林杰樑表示，我國規定不得使用瘦肉精，理當就是不得檢出。衛生署經過毒奶事件，更應瞭解食品安全，學聰明才對。
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？
而林杰樑指出，國人喜歡吃豬肉、吃豬內臟，對瘦肉精更是有潛在風險；至於美國與日本的飲食習慣是以牛肉為主，少吃豬肉，更別說是豬內臟。
如果人體吃下過多的瘦肉精，會發生心臟、血管的問題，產生心跳加快、血壓升高等症狀。
國外曾發生即便烤熟的豬肉也有問題，如果有交感神經功能亢進者則更要小心，最好的自保之道，還是少吃內臟。
男生慫恿女大生喝烈酒，備58度金門高粱酒，「喝完這瓶給妳600元」，女生喝下2/3瓶，醉昏嘔吐物噎住窒息亡。
11月14日是世界糖尿病日，全球許多地方的醫生舉行各種活動，來提高人們對糖尿病的重視。
目前，全世界每年死於糖尿病的人數大約有300萬，而全球共有大約2.5億人患糖尿病，這些還都只是比較保守的估計。
據信，死於糖尿病的人要高於死於愛滋病的人，而且據預測還會有更多的人死於這種疾病。
醫生們說糖尿病正在成為21世紀的最大的流行病，並且正在越來越向發展中國家蔓延。
印度形勢嚴峻
在印度，據估計有大約一億人患糖尿病，佔世界糖尿病患者總數的三分之一，而且這一數字還正在日益上升。
專家們說這其中的部分原因是印度正變得越來越富有，而這導致了人們生活方式的改變。很多人越來越不愛動而導致肥胖。糖尿病還可能導致其他的綜合症，例如心臟病、失明等。
在印度的鄉村，有越來越多的人患上二型糖尿病，這種病是由於在人們變得富有之後，生活方式的改變，比如運動的少了，並且吃新鮮的水果和蔬菜也少了。
而許多人並沒有意識到這種生活方式的轉變，為糖尿病的形成敞開了大門。
印度政府計劃設立公共教育項目來警告印度公民認識糖尿病的危險。
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.
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?”2008/11/8
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)
2008/11/6
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)
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