Book review: Can Medicine Be Cured? 書籍摘要:醫學能治好嗎?

This book, written by recently retired gastroenterologist Dr. Seamus O’Mahony, presents a brutal account of the problems with 21st century medicine. Since the huge leaps in healthcare during the ‘Golden Age’ of the 1940s to 1980s, he claims that the industry has been heading in a direction that benefits neither patients nor doctors, and makes the case for a comprehensive restructuring.

這本書由最近退休的胃腸病學家Dr. Seamus O’Mahony寫的，提出了對21世紀醫學問題的殘酷描述。自20世紀40年代至80年代醫療業的巨大飛躍以來，他聲稱，醫療行業一直朝著既不能使患者或醫生受益的方向發展，並提出全面重組的應有理由。

On the part of patients, Dr O’Mahony argues that increasing dissatisfaction with medicine is the result of excessively high expectations, patient herding, and the erroneous belief that medicine should cure all disease. Since most diseases that kill us now are the result of old age, the medical industry has invested huge amounts of time and money into the prolonging of life to maintain the mirage of progress. With immortality as the seeming end goal, we are waging an impossible war against death, rather than valuing healing and the relief of suffering.

就患者而言，Dr. O’Mahony認為，對醫療系統的不滿情緒增加,是因為期望過高、病人一起分組以及藥物應該治癒所有疾病的錯誤信念。鑒於現在大多數殺死我們的疾病都是由於老化，醫療行業投入了大量的時間和金錢來延長生命，以維持”進步”的幻想。以永生為目的，我們正在與死亡進行一場不可能的戰爭，而不是重視治愈和減輕痛苦。

Twenty percent of all adults in Scotland are on five or more medications, which are likely to cause side-effects and drug interactions, rising to over 90% in nursing home residents. Ironically, patients at the end of life are not usually looking to prolong it. Not only is death inevitable, but it is generally accepted to be a good and necessary conclusion to life. Thus, we have a philosophical, moral and existential paradox at the heart of medicine.

在蘇格蘭,20%的成年人正在”服用”5種或5種以上的藥物,這些藥物可能導致副作用和藥物相互作用，在療養院居民中，這一比例為90%以上。諷刺的是，生命接近盡頭的患者們通常不希望延長自己的壽命。死亡不僅不可避免，而且人們普遍認為死亡是生命中一個良好和必要的結論。因此，我們在醫學的核心有一個哲學、道德和存在的悖論。

As in any pseudo-religion, there are unquestioned rituals in medicine, one of which is prolific medical research. Dr. O’Mahony argues that too much funding and effort is put into research studies which could be better distributed towards countries where citizens still die of easily treatable diseases. Disproportionate sums of money produce tiny advancements in studies that are often inefficient, irreplicable and use questionable statistical methods. Such studies are sometimes motivated by doctors’ desires to further their own career or for prestige and attention from the media, which goes against the idea that spending should be prioritised according to the level of benefit generated from the resources available.

就像任何偽宗教一樣,醫學界也有無可置疑的儀式,其中之一是多產的醫學研究。Dr. O’Mahony博士認為：太多的資金和努力被投入到研究上，可以將金和努力更好地分配給國民仍然死於易治性疾病的國家。不成比例的資金在研究中產生微小的進步，這些研究往往效率低下、不可複製,並且使用可疑的統計方法。這種研究有時是出於醫生追求自己的事業或獲得媒體的聲望和關注的動機，這與應根據可用資源產生的收益水平來優先考慮支出的想法背道而馳。

An example of one glorified medical research study is the Human Genome Project, which produced negligible tangible benefits given the huge investments it received. Differences in social structure, lifestyle and environment account for more disease than genetic differences, yet the public and medical community alike seemed swayed by the hype in this instance. 

人類基因組計劃就是其中一項令人讚嘆的醫學研究的例子，該計劃獲得巨額的投資， 產生微不足道的利益。社會結構，生活方式和環境的差異導致的疾病多於遺傳差異，但公眾和醫學界似乎都受到這種炒作的影響。

There is also an obsession with metrics and targets in medicine, which dehumanises patients and sees them as machines on a conveyor belt to be fixed. Given the interplay of other factors on physical health, such as environment and mental wellbeing, the medicalisation of the ‘vicissitudes of living’ only serves to harm the patient and detract from more helpful solutions. 

醫學中還對指標和目標產生了癡迷，這種指標使患者失去人性，並視之為要固定的傳送帶上的機器。鑒於其他因素(如環境和心理健康)的相互作用，正常的生活變化被醫學化只會傷害患者，並減損更有用的解決方案。

Besides this, the system as it currently functions does little to help doctors. Doctors are retiring early because of the overwhelming combination of expectation, responsibility and blame placed on them. They must manage huge amounts of uncertainty while portraying the kind of omniscience that instils blind faith in their patients (a quick recovery typically follows thereafter). As doctors’ power has been reduced, they have become like a cog in the ‘medical machine’ and must submit to high levels of managerialism. 

除此之外，該系統目前的功能對醫生幫助不大。醫生們提前退休了，因為期望、責任都放在他們身上。他們必須處理大量的不確定性，同時描繪出對於患者產生盲目信念的無所不知（此後通常會迅速康復）。隨著醫生權力的減少，他們變得像”醫療機器”中的一個”齒輪”，必須服從高度的管理主義。

If we liken the provision of medical treatment to any consumer-seller interaction, there seems to be a mismatch in the way the service is provided. In a traditional interaction, the purchaser bears the responsibility of their choice, having been given adequate information. However, in medicine it is the doctor who bears responsibility. This means that while all health secretaries in the UK are advocating for greater patient choice, this is incompatible with a single publicly funded service. 

如果我們將醫療提供與任何消費者與賣方的互動進行比較,似乎不匹配。在傳統的互動中，購買者在獲得充分資訊后，承擔自己選擇的責任。然而在醫學上卻是醫生承擔責任。這意味著，儘管英國所有衛生秘書都提倡更多的患者選擇，但這與單一的公共資助服務不協調。

“There will never be a time when the public and healthcare professionals will agree that spending on health has reached an adequate level”, says O’Mahony. In fact, the more healthcare given to a population, the greater their demand for care. As for who should provide healthcare — the market or the state — the answer probably lies somewhere in the middle. 

Dr. O’Mahony說:「公眾和醫療保健專業人員永遠不會同意衛生支出已經達到足夠的水準」。事實上，對人口的醫療保健量增加，人們對醫療的需求也就更大。至於誰應該提供醫療保健——市場或國家——答案可能就在中間的某個地方。

This book was enlightening for a layman like me as it tackled several challenging questions about healthcare and medicine. Having had several conversations about healthcare with my students, it seems there might be much to emulate from the Taiwanese healthcare system, which is generally perceived to be efficient, affordable and high-quality (albeit presumably containing issues of its own).

這本書對像我這樣的門外漢很有趣，因為它處理了幾個具有挑戰性的醫療保健和醫學問題。在和我的學生就醫療保健問題進行了幾次交談之後，臺灣醫療系統似乎有很多值得效仿的地方，人們普遍認為，臺灣醫療系統效率高、價格合理、品質高，儘管可能包含自己的問題。