Doctors also believe in "fate"? Really believe
Original Wang Xingfei Fictitious Time
Whether you choose chemotherapy, X-ray examination or heart transplantation, every medical decision is a risk.
From the first human blood transfusion more than 300 years ago to the development of vaccines in COVID-19 today, risks are accompanied by the emergence of every new treatment.
Blood transfusion, anesthesia, chemotherapy, vaccines, antibiotics, X-ray examination, organ transplantation, genetic engineering, biological agents, Dr. Paul Offit (author of The Story of Vaccine) started with nine great achievements of modern medicine and told the story of risks behind each medical progress this time.
In the 20th century, the average life expectancy of Americans increased by 30 years, largely due to the progress of modern medicine. At the same time, every medical breakthrough is accompanied by victory and tragedy.
Do we accept new technologies and when?
Faced with this medical uncertainty, our old friend, Dr. Wang Xing, the author of "Patient’s Family, Please Come" and other books, said: "In fact, although most technical risks are now very controllable, the probability of risks is still not zero, not to mention the exploration of new technologies. You will find that when a new treatment appears on social media, the most indifferent is actually the doctor. Not because they don’t accept new things, but because they understand the uncertainty behind new technologies. The doctor’s job is to try to play the most beneficial card for the patient on the premise of knowing the uncertainty. This is the’ life’ that doctors believe. "
Do doctors also believe in "life"? !
Wen | Wang Xing
(Peking University, Ph.D. in Oncology, Deputy Chief Physician, Department of Thoracic Surgery, Shanghai First People’s Hospital)
Do doctors believe in life? Really believe it.
Many doctors, including me, don’t necessarily have any religious beliefs, but most of them believe in fate. This is not a feudal superstition, such as not eating mangoes (busy) and eating apples (safe) when on duty, although many times we really want to do so. The "fate" that doctors believe is essentially probability. Because modern medicine is an uncertain science based on probability.
When a doctor is a rookie, he can be independent, not because of how many operations he can perform, how complicated situations he has handled and how to save the day, but because of his courage. At the beginning of the operation, there was nothing I was afraid to do, and I was full of momentum, but today, ten years later, I am afraid of a lot. This kind of cowardice is not simply to give up the challenge, but to recognize the probability.
Dr. Wang is at work. Tuyuan Wang Xing Weibo
Assuming that the probability of a risk is one in a thousand, and you treat at least 1000 patients in ten years, this risk will change from a small probability event to a high probability accident.
In recent years, immunotherapy has become more popular in the field of lung cancer. Because of some policies of benefiting the people, most of the immunotherapy drugs have dropped from the initial course of 10,000 yuan to around 1000 yuan. This is certainly gratifying, but it is a headache for doctors that when the price is lower than many auxiliary drugs to relieve vomiting, it will lead to a result-because patients lack the necessary understanding of the side effects of such drugs, they think that since this drug is not expensive, it is nothing to add.
On one occasion, the day before, we lamented that the patient was obviously better after taking the medicine for two days. The patient returned home happily and received news from the patient’s family the next day that the patient had left. From the experience, it is likely that there is an outbreak of immune cardiotoxicity, the probability is about 5%, there is no reason, and even the key markers can not be found to determine who is the 5%.
Young doctors are reluctant to talk about risks and think the probability is too low. But I will talk about the risks and let patients know that whether it is surgery or medication, we are all gambling. I still remember that a patient in the department suddenly fell to the ground when he went to the toilet the next day after surgery. After investigation, he found that it was an acute cerebral infarction, so he quickly rescued it and spent hundreds of thousands. The final outcome was a vegetative state, and the patient died soon.
Stills of In the World
It was originally a simple minor operation, but the patient lost his life. Despite the timely rescue, the patient’s lover expressed gratitude to us, but the family members still questioned us-
"Should surgery be done?"
"If the operation is not done, can the patient live for many years?"
"Why didn’t you emphasize with your family that you would have a cerebral infarction before the operation? If you knew there was this risk, we wouldn’t be in a hurry."
If I were a family member, I would ask the same question. No way, the surgeon’s job is to bury his emotions in a grave that belongs to his own heart and continue to work with a cold mask. But the more you work, the more timid you are, and the more you will nag patients about risks, instead of boasting about your strength and downplaying the operation.
I hope more people will read this book precisely because it is not preaching, but telling people with facts that medical risks are a problem that cannot be ignored.
Although medicine has developed from witchcraft of offering sacrifices to ghosts and gods to today, it is still full of many uncertainties. This is the origin of the title, gambling on life, or literally translated as-you have to gamble on your life.
This is no exaggeration. Nowadays, technologies that look very mature: blood transfusion, antibiotics, vaccines, anesthesia … These medical inventions not only bring about the improvement of people’s well-being, but also bring disastrous consequences.
Stills of Everything About Dr. Tang
If the key word of the author’s The Story of Vaccine is "cost", then the key word of Gambling Life is "uncertainty".
At the time of writing this book, the COVID-19 epidemic was raging all over the world, and all countries were on the track of vaccine, hoping to develop a unique vaccine, so that their countries could gain great advantages in this era. On April 7th, 2020, FDA approved an antimalarial drug named hydroxychloroquine for the treatment of Covid-19 infection in the absence of research results on drug effectiveness. Many people, including the then president of the United States, think that what harm can it do to try? Unfortunately, many research results show that hydroxychloroquine can neither treat nor prevent Covid-19 infection, and about 10% of drug users have severe arrhythmia. Two months later, the FDA withdrew the drug recommendation.
It can be said that one of the purposes of this book is to accuse the American government of ignoring the potential risks of new medical technologies in order to "win". Different from the history of western medicine which is narrated according to time, Gambling Life has no intention of exaggerating the success and tragedy stories behind nine modern medical advances, but conveys a profound lesson to us-whether, when and how we should accept new technologies.
This book tells readers with cold figures how the hidden bugs in the beautiful medical discoveries in the name of cure have led to disasters step by step. In the process of reading, I was deeply touched. Medical study only made me see the increasing life span of human beings, but I didn’t see that the flashes in medical history superimposed the unique arrogance of human beings, which made history trample on bones and blood and tears again and again.
Human discovery of medicine is often accompanied by several kinds of mistakes:
The first category is insufficient cognition.
The author takes blood transfusion as an example. At first, people learned to transfuse blood from cattle and sheep. When an accidental transfusion of human blood succeeded, they fell into a gambling game, because after transfusion, there was a certain probability that people would die. Today, we know that people have ABO blood type and Rh blood type, and only the correct blood transfusion method can be established. After people thought that they had discovered the natural law and started blood transfusion, they were educated again, because the disaster caused by the spread of hepatitis B and AIDS caused by blood transfusion was far more serious than before. You will find that the more ordinary people are, the more confident they are, and the more confident they are, the greater the cost.
The second category is that the pace is too big and there is a lack of supervision.
Known as "one of the most serious large-scale poisoning incidents in the 20th century", the protagonist is an antibiotic called sulfanilamide, which is still commonly used today. At that time, four weeks after the drug was put on the market, 353 people took it and 105 people died, including 34 children. Finally, it was found that the problem was not sulfanilamide, but the solvent of the drug. The solvent contains lethal diethylene glycol, which will cause nephrotoxicity. On March 5, 1938, President Roosevelt signed the Food, Drug and Cosmetics Act. Since then, American pharmaceutical companies have been required to list all drug ingredients on the labels and fully carry out product safety tests before they can obtain the marketing permission of the FDA.
The third category is "a dead horse is a living horse doctor".
The most typical example is biotherapy. In the Wei Zexi incident, Wei Zexi tried biological therapy in the treatment of chondrosarcoma with a desperate mentality, and eventually he lost both money and money. The effectiveness of many seemingly "new drugs" and "new therapies" has not been fully verified, and the huge temptation of fame and fortune brought by a star therapy has also driven doctors to ignore ethics and regulatory processes to promote clinical trials. This "two-way trip" to human trials is disastrous, such as the incident of genetically editing a fetus that made a lot of noise a few years ago. These experiments will bring unpredictable and huge risks to individuals and human beings. The author thinks that we must firmly control the brakes under our feet.
via:www.sagarhospitals.in
The fourth category is the false confidence generated by animal experiments.
A successful heart transplant for chimpanzees does not mean that people will succeed. There are great species and individual differences between species and people. Social media often reports that a drug has played a good role at the cellular and animal levels, and it sounds as if human beings are about to conquer a certain disease. However, as long as graduate students who have experienced basic scientific research and training know that there is a huge gap between drugs from outside to inside, and from animals to people. What is effective at the cellular level may not be effective at the animal level, and what is effective at the animal level may not be effective in human trials, and even lead to a series of chain reactions. The exquisiteness of the human body also determines that any method of changing the structure and adjustment of the human body is bound to have defects.
Gambling on Life is a sober book, which refers to the U.S. government, which is eager to promote large-scale clinical trials without evidence, and hopes that every struggling patient can remain rational during treatment. In the book, you will learn that in the history of medical development, people who have been drugged may or may not fall asleep; People who have been vaccinated may resist the virus or die of the vaccine itself; Even blood transfusion, a common operation in modern society, was once a gamble.
Stills of "Emergency Room Story"
No one wants to gamble. It’s like a patient asking me if I can be cured. If I answer "It depends on my life", it will probably cause a contradiction between doctors and patients. In fact, although most technical risks are already very controllable, the probability of risks is still not zero, not to mention the exploration of new technologies. You will find that when a new treatment appears on social media, the most indifferent is actually the doctor. Not because they don’t accept new things, but because they understand the uncertainty behind new technologies.
The doctor’s job is to try to play the most beneficial card for the patient on the premise of knowing the uncertainty. This is the "fate" that doctors believe.
* Some pictures are from the Internet.
Bet one’s life
[America] By Paul Offit, translated by Qiu Xiaochen
Publication date: May 1, 2024
Shanghai Translation Publishing House
brief Introduction of the content
Whether you choose chemotherapy, X-ray examination or heart transplantation, every medical decision is a risk.
Dr. Paul Offit pointed out that from the first blood transfusion over 300 years ago to the development of vaccines in COVID-19 today, risks are accompanied by the emergence of every new treatment.
In the 20th century, the average life expectancy of Americans increased by 30 years, largely due to the progress of modern medicine. At the same time, every medical breakthrough is accompanied by victory and tragedy.
Do we accept new technologies and when?
Blood transfusion, anesthesia, chemotherapy, vaccines, antibiotics, X-ray examination, organ transplantation, genetic engineering, biological agents, "Gambling for Life" starts with nine great achievements of modern medicine and tells the risk story behind each medical progress.
Brief introduction of the author
Paul A. Offit, professor of vaccinology, professor of pediatrics at perelman Medical College, University of Pennsylvania, and director of the Vaccine Education Center of Philadelphia Children’s Hospital. He is a member of the vaccine working group of the National Institutes of Health (NIH) and the vaccine and related biological products advisory committee of the Food and Drug Administration (FDA). Previously, he was a member of the Advisory Committee on Immunization Practice of the Centers for Disease Control and Prevention (CDC).
His medical popular science works include The Story of Vaccine, Do you believe in magic? "gambling" and so on.
Original title: "Doctors also believe in" life "? ! Really believe it. 》
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