中醫學

上一次查wiki的偽科學 約一年前

裡面是講 中醫不是偽科學

但我認為是

我猜測是編輯討論的爭議

現在在wiki talk裡面

http://zh.wikipedia.org/wiki/Talk:%E4%BC%AA%E7%A7%91%E5%AD%A6

 

之前對中醫最有興趣是前幾年我開始盡可能大量閱讀的時候

買了給外行人的類科普中醫書

曲黎敏、黃帝內經、穴道按摩、走近中醫、思考中醫、 還有一個小和尚學習中醫

都是評價很高

但我都沒辦法看完的書

那時候覺得是太艱澀、太牽強、鬼扯、

現在則是知道Taleb的my bullshit detector working very well

 

同時間在讀的 西方醫學的科普書則偶爾提到中醫、針灸一點點

大概褒貶皆有

專門針對中醫大量攻擊也因此成名的是方舟子

James Randi著作好像也有

另外更早開始抨擊的李敖

只要中國傳統文化在鬼扯的東西還沒有看過落出他的攻擊範圍之外

 

現在回想現今所讀到的中醫概念

目前還是跟西方早期的體液學說差不多

先有一大道理之後再衍生推論

Taleb所謂的 Top-Down Knowledge

但最重要的Top大前提理論是錯的

 

目前實證研究

針灸算是中醫裡面最有效

也是中醫一直主打的

但是wiki 裡面的連結

提到跟placebo 假針對照

根本只好一點點而已

安慰劑、illusion of control 效果才是驚人

信念的力量 The Biology of Belief Bruce Lipton、Bad Science

特別是信念的力量

特別寫到西方醫學太低估、太不重視安慰劑效應

作者言外之意這方面有很大發展空間

更強的安慰劑

美國諾貝爾獎得主、哈佛教授名醫做的 一顆萬元的特效藥(維他命)

安慰劑假手術

 

李華夏老師以前還講過現在想起來還很好笑的事

( 但真實性不知   因為後來我發現他講的事情真假參半)

中國大陸原本在做針灸穴道麻醉的研究

找一些農村艱苦耐受力過人的農民

在針灸後

做錄影開刀手術

幹部還會跟在忍耐中的農民喊話

為了黨國你要撐下去

期間不用麻醉一小時以上

 

之前看八卦版討論

好像在醫學實證評價更種另類醫療裡面

比中醫學更糟的是西方的藥草學、草藥學

類似一些中世紀背景的電動

天空之城(?)、亞特蘭提斯、炎龍騎士團、Diablo 會出現的那種藥水藥草

應該也是 Steve Jobs亂投醫、悔不當初去試的東西

醫生不如開一些大麻、麻醉藥物等給他還比較好

 

讀了之後跟修中國術數史有一樣有一點點好處

知道中國術數本身 兩大核心概念

天命論 vs 後天積德論  互相矛盾

 

中醫的話我可以稍微用中醫自己的理論

在內層、臟腑的問題

勉強勸阻家人穴道按摩、穴道針灸

中醫書自己就寫明這方面沒效用了

 

Antifragile Nassim Nicholas Taleb book 4 ch21 antibiotics 流行性感冒 腸胃炎

–2013/1/2—

1月2日禮拜三一早四點多起來有想吐的感覺

依照經驗這時候通常這時候催吐會舒服一點就到廁所吐了

接著去上班一兩個小時候又回去上廁所

之後八九點就請假回去休息了

這時候回宿舍前先買了體溫計

回宿舍開始查 陳皇光 看病的方法 跟 Mayo Clinic 就醫前的120個居家療法

對照之下認為應該是流行性感冒

而且症狀應該是A型

 

流感是病毒只能用支持性療法

之前類似感冒的病去看醫生吃藥

醫生會開退燒藥、止瀉、抗生素跟維他命

我後來覺得這種方式越來越不妙

原本就覺得發燒是身體升高溫度來增加免疫力

腹瀉我也不會覺得太不舒服  反而久久拉一下肚子覺得很不錯

綜合維他命我原本就有

抗生素則是這次看了antifragile我更加不吃了

 

抗生素會把身體較弱的菌殺死

而生存下來的較頑強的菌則會佔領剩下的環境

Art de Vany也說他超過50年沒吃過藥了

我要試看看這樣做

 

唯一有效的是流感抗病毒藥

http://flu.cdc.gov.tw/public/Data/092916254371.pdf

克流感(Tamiflu®)及瑞樂沙(Relenza)

查一下我不在公費使用者名單

自費吃藥 藥費要一千二

看感冒花2千 民怨沒給付    http://www.appledaily.com.tw/appledaily/article/headline/20121115/34642456/

 

我不在公費使用者名單

代表我不是會有嚴重併發症的危險群

而克流感

只能縮短病程1~2天  http://doctorwebber.com/news_detail.php?id=117

超弱

所以我幹嘛需要去看醫生吃藥?

 

禮拜三躺了幾乎一整天

禮拜四醒來身體好多了

幾乎全好了

為了保險起見也請假修養看書

 

不過禮拜四早上在宿舍碰到很nice的陳盈霖醫師

他問我今天請假阿

我說對我好像得流感

他說不是有打疫苗嘛

我說對

那就應該不是流感  應該是腸病毒

 

我瞬間覺醒回去翻書

其實症狀也符合腸病毒

………還是要交給專家

 

—2014/1/2—-

12月出國前

其實身體不舒服了五天

但都撐著

出國前一天去看病拿藥

普通感冒

把藥帶出國

很不舒服時再吃

 

算是成功

2013年沒吃藥

—-

My Paleo Diet 原始飲食

2012/09/18

我決定把Paleo Diet各類名稱

Evolution Diet 演化飲食

Caveman Diet 洞穴人飲食

Paleo Solution

通稱Paleo Diet  原始飲食

不吃

穀類、豆類、蛋、奶、糖。

穀類包含:米:白米尤其不可

小麥製品:麵條、麵包、餅乾

豆類:所有豆類、豆莢類

奶:任何乳製品

糖:唯一攝取糖的途徑是水果

繼續閱讀

腰背部 醫療治療 Iatrogenics

作者 doubleXL (往XL邁進) 標題 Re: [問卦] 有沒有當人蠻痛苦的

八卦 時間 Fri Dec 20 00:35:51 2013

https://disp.cc/b/654-740a

其實這個較早讀到應該是在

醫生,你確定是這樣嗎?  Jerome Groopman

阿不是

應該是  別把醫師當做神   David H. Newman

我那時候就知道背部手術幾乎都是沒有效    是真的太沒效了

後來讀Taleb fb跟Antifragile又更加確定

因為前三個月  重訓大腿肌肉姿勢不佳

前後痛了一個月

我那時候沒去就診

因為就診他要給我治療我也不會做

給我一百萬我都不會讓他做侵入性治療

這時候可能當個無知的人會比較快樂

我不知道原作者多年後讀到這些書會怎樣

我想到有印象中另外一個應該PTT Nurse版的前板主(女)

下半身癱瘓

他是院方承認是醫療疏失了

好像拿了600 or 700萬賠償

結果這筆錢一大部分讓叔叔阿姨伯父之類的管理

過了兩年吧  然後錢的方面弄的不清楚

結果反而是因為錢的緣故  (F B R)

最後自殺

This is NOT A sad story.

It’s sad storieS.

我又想到印尼玩水上運動女服務生  會講國語原來在台中當過看護七年

錢寄回家給老公養小孩

後來回家先生離開

這種是我(非自願)聽過別人講了大概4、5個例子

自己碰到又是一個

那時候我開玩笑說要跟我們一起去晚餐去club嗎

當然

原本D友人說他年齡方面應該有說謊

(我一直相信別人,不知道被騙了多少次我還是繼續相信)

最好事後給他錢

我其實不想幹嘛想直接給他一些錢了

 

錢幾乎是"生存"最重要的要素之一

我會對親人講

不要太相信別人

也不要相信我

行醫經驗、醫學文獻與各領域知識

柯文哲對洪仲丘的發言有幾點讓我想到以前曾跟身邊人講過的

 

行醫經驗、醫學文獻

相君講過他認為醫師的學習、經驗等等是最重要 而不是書上寫的內容

書上寫的跟實際的不一樣

我看過ptt八卦版上面有人發問過 居然有醫師看他病時  開藥什麼還查電腦google

他覺得醫師很不專業  對醫師很沒信心….等等

繼續閱讀

Why Doctors Die Differently 醫師決定的死亡方式和一般人、他的病人不同

 

醫師決定的死亡方式和一般人(他的病人)不同

 

從Art De Vany fb看來

之前看到Art De Vany fb轉貼某篇文章

後來我找不到 (我討厭facebook主要原因之一)

 

卻看到了一篇有趣文章

同樣是很基本的Agency Problem

醫師的考量跟病人不同

類似問題好幾本書討論過了

但這篇文章的例子倒是第一次

要消除Agency Problem

許多書的作者跟Taleb建議

不要問醫師要怎麼做!

要問醫師,如果今天你是病人(或是家屬)

你會怎麼做?

常常你會得到不一樣的答案。

 

ttp://online.wsj.com/article_email/SB10001424052970203918304577243321242833962-lMyQjAxMTAyMDIwODEyNDgyWj.html

 

Why Doctors Die Differently

Careers in medicine have taught them the limits of treatment and the need to plan for the end

 

By KEN MURRAY       * LIFE & CULTURE     * February 25, 2012

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach.

It was diagnosed as pancreatic cancer by one of the best surgeons in the country,

who had developed a procedure that could triple a patient’s five-year-survival odds—from 5% to 15%—

albeit with a poor quality of life.

Charlie, 68 years old, was uninterested.

He went home the next day, closed his practice and never set foot in a hospital again.

He focused on spending time with his family.

Several months later, he died at home. He got no chemotherapy, radiation or surgical treatment.

Medicare didn’t spend much on him.

 

Charlie是一位有名的骨科醫師,

被美國最有名的外科醫師診斷出胰臟癌(類似Steve Jobs)

用一個療程可以把五年存活率從5%提升到15%,但是生活品質會不好(副作用很大)。

Charlie不想用,不接受化療、放射線治療也不開刀。

花時間陪家人,在家過世。

In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions.

In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and

should not be taken to save their lives should they become incapacitated.

That compares to only about 20% for the general public.

(As one might expect, older doctors are more likely than younger doctors to have made “arrangements," as shown in a

study by Paula Lester and others.)

較多的醫師選擇自己的臨終方式

(簽不急救同意書之類的)

 

沒辦法碰到病人醫師會想要治療(搞)你

這樣他才有錢賺才能養家

(東貞藏、Jesse Livermore:我也要生活阿)

但如果今天是他

他就不要了

What You Can Change and What You Can’t Martin Seligman 改變

Martin Seligman 書除了最新的 Flourish之外

有興趣的都買齊了

我只能說是我非常喜愛的作家

讓人感到他是據科學角度風趣解釋真心想幫助讀者的人

書中一開始引的 Serenity Prayer

God, grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.

就是這本書的主題

要知道去接受不可改的事情

勇氣去改變應該改變的事情

要能區分什麼是可以改變的,什麼是不能改變的

 

我沒有預想到會在這本書讀到近來常閱讀的瘦身減肥問題

因為我看完Why we get fat 面對肥胖的真相 後

我暫時不打算看相關類型的書了

12章一開始就講  除非是短期效果 不然節食是沒有用的

 

作者的看法

1. 節食是沒有用的

2. 只會使體重問題更糟

3. 對健康不好

4. 會引起飲食失常  貪食症或 厭食症

 

過胖的迷思

吃太多

胖子人格

不肯動

意志力不堅定

都是錯的

 

1990 美國人花在瘦身業三百多億美金

約等於聯邦在教育、勞工、社會福利上開支總和。

學者的一致看法

1. 任何一種減肥法都可以一兩個內減輕體重

2.幾年內一定會胖回來

Oprah 減肥成功又失敗

作者試10幾種方法一開始都成功後來都失敗

 

有12項優質的長期追蹤研究  數千名受試者

結果一樣

瘦身商業機構有大量的顧客長期資料

但從不公開

你可以猜想為什麼

 

但這本書討論有一個非常重要的重點

是我近來讀了飲食相關內容最大的心理疑惑點

而且怕不能說服親人的點

這是我的觀點,不是原作者的

就是如果我現在體重控制良好

事實上 我自己和親近的人都不胖  算是沒有嚴重肥胖過

那我為什麼要做低糖飲食、阿金飲食、演化飲食?

 

還有所有體重正常的人

林盃就是喜歡吃飯、麵、含糖飲料跟各類澱粉類食品

我可以吃所有我愛的照我原本的方式

等到我胖了之後再減就好

If it ain’t broke, don’t fix it

right ?

 

 

NO!

老鼠餓過一次之後,就會永遠改變了他對食物的處理方式

回復原來體重之後,整個新陳代謝就緩慢下來

身體變得更會儲存脂肪

節食之後的人  做相同的運動 消耗掉的能量比未減肥之前少

(相較於沒節食過的控制組)

節食的飢餓訊息會觸發身體善於儲存能量脂肪的機制

減緩新陳代謝速度並堅持持續進食

狂節食狂吃久一點都會 regression to the mean

 

 

一個一百萬美國人的研究

體重增加跟死亡率增加有關

但過去五年減去五十磅以上的人罹患心臟病跟中風機率都較高

體重上下起伏比維持肥胖危險

節食是體重上下起伏主要原因

中年之後體重逐漸增加比體重穩定好,然後都比體重上下起伏好。

哈佛校友畢業後體重逐漸增加15磅以上的人比所有其他人的死亡率低三分之一

但是不知道原因。

 

節食容易造成憂鬱症,造成貪食症,疲倦。

 

當然現在我讀有好幾個點都不同意

我的看法是不要變胖

不要等胖了之後再減!

到時候很容易把自己陷入危險困境

 

各種飲食減肥療法實行者

只能The Median Isn’t the Message來反擊了

Steve Jobs因太晚接受正統醫學治療判了自己死刑

Steve Jobs doomed himself by shunning conventional medicine until too late, claims Harvard expert

http://archive.is/3prR

http://www.dailymail.co.uk/news/article-2049019/Steve-Jobs-dead-Apple-CEO-shunned-conventional-cancer-medicine.html

Steve Jobs因太晚接受正統醫學治療判了自己死刑

Apple CEO’s choice of alternative treatment ‘led to an unnecessarily early death’, Dr Ramzi Amir says

他選擇另類醫療導致完全沒必要的早逝

Steve Jobs would probably be alive today if he had not put off conventional medical treatment in favour of alternative remedies, a leading cancer doctor has said.

Dr Ramzi Amri, a researcher at Harvard Medical School, claims the Apple boss had a mild form of cancer that is rarely fatal and that his choice of treatment ‘eventually led to an unnecessarily early death’.
Writing on Quora, a forum frequented by Silicon Valley executives, Dr Amri said: ‘Let me cut to the chase – Mr Jobs allegedly chose to undergo all sorts of alternative treatment options before opting for conventional medicine.
Claims: Steve Jobs, pictured in June, would probably be alive today if he had not put off conventional medical treatment in favour of alternative remedies, a leading cancer expert said
Steve Jobs當初如果選擇正統治療,而不要拖延,卻去選擇另類療法。他今天很可能還活著。
Dr Ramzi Amri,哈佛醫院院研究者稱說Jobs得到的是很少會致命的輕微癌症,他選擇療法導致完全沒必的早逝。
Dr Ramzi Amri,: 我直說好了(Let me cut to the chase),Jobs宣稱選擇各種的另類療法,而不先選擇正統醫療。
His death certificate, released by the Santa Clara County Public Health Department this week, said that Mr Jobs had a ‘metastatic pancreas neuroendocrine tumor’ and there would not be an autopsy.

The certificate also stated that Mr Jobs had the cancer for eight years before his death and that he was first diagnosed in October 2003.
Leading authority: Dr Ramzi Amri is an expert on pancreatic cancer who works at Harvard Medical School

Leading authority: Dr Ramzi Amri is an expert on pancreatic cancer who works at Harvard Medical School
Dr Amri claimed that Mr Jobs succumbed to the disease more quickly because of his apparent refusal to embrace ‘conventional treatment’, especially over the last year, the period when he visibly began to lose weight.
Dr.Amri:特別是去年Jobs明顯變得消瘦就是他不願意接受正統醫療的緣故。
The pancreatic cancer expert wrote: ‘It seems that even during this recurrent phase, Mr Jobs opted to dedicate his time to Apple as the disease progressed, instead of opting for chemotherapy or any other conventional treatment.’
在再復發的時候,Jobs也仍選擇投身工作,讓疾病擴展,而不是去化療或是別的正統醫療。
For nine months between his diagnosis in 2003 and at least July 2004, Mr Jobs ‘decided to employ alternative methods to treat his pancreatic cancer, hoping to avoid the operation through a special diet ‘, according to a 2008 CNN Money article.
在他被診斷的2003年到2004年七月間,這九個月Jobs決定去做另類療法來治療胰臟癌,
希望藉由特別的飲食法來避免開刀。
But the rapid advance of the cancer caused Mr Jobs to undergo an operation known as a ‘Whipple procedure’ in which he had his pancreas and duodenum removed.
但是快速的癌症擴展使得Jobs要去做一個叫 ‘Whipple procedure’ 的手術,把他的胰臟跟12指臟切除。
Dr Amri suggests that this procedure, which is only undertaken if the cancer is quickly spreading, might not have been necessary had the Apple CEO pursued conventional medicine sooner.
Dr. Amri 表示這樣的治療只有在癌症及快速擴散才做,如果Jobs早一些去做正統醫療,可能就不需要到這種地步。
He wrote: ‘The only reason he’d have a transplant would be that the tumour invaded all major parts of the liver, which takes a considerable amount of time.’
Dr Amri claims that had Mr Jobs had the cancer surgically removed immediately after the disease was diagnosed then he may well have survived with ‘no residual side-effects’.
He added that as Mr Jobs had comparatively mild neuroendocrine tumors, compared to the far more aggressive pancreatic adenocarcinoma tumours that 95 per cent of pancreatic cancer sufferers have.
He wrote: ‘In my series of patients, for many subtypes, the survival rate was as high as 100 per cent over a decade.’
Dr Amri said he had the ‘profoundest respect for Mr Jobs and his legacy’ and did not wish to offend anyone with his comments.
But he added: ‘I have done 1.5 years of research on the type of tumour that affected Steve Jobs and have some strong opinions on his case, not only as an admirer of his work, but also as a cancer researcher who has the impression that his disease course has been far from optimal.’
When contacted by website Gawker, Dr Amri said: ‘I wrote that on a personal title and it’s my personal opinion.’

ALTERNATIVE TREATMENTS

It is unclear what ‘special diet’ Steve Jobs may have adhered to after he was diagnosed with the tumour. He was known to be a pescetarian, so ate fish alongside a vegetarian diet.
He may have consulted a dietician after diagnosis because people with pancreatic disease often find it hard to digest fat. Enzymes are often prescribed to help break down food as the pancreas is not working as effectively.

Alternative treatments that may relieve symptoms of the disease – such as nausea and pain –  include acupuncture, herbal supplements such as plant-derived enzymes and massage therapy. However, there is no robust medical evidence any of these could actually fight the disease.

另類療法也許會舒緩症狀,例如噁心或疼痛。

針灸、草藥(提供酵素)和按摩治療。

但是,沒有堅實的醫學證據這些能夠對抗疾病。

We know that Mr Jobs didn’t follow the controversial ‘Gonzalez protocol’, which is supposed to treat pancreatic cancer using vegetable juices, 150 daily supplements and having coffee enemas. This is because Dr Nicholas Gonzalez himself said the Apple-founder had not gone to him. He went on to say had Jobs done so he could have saved his life – although the early termination of a trial comparing chemotherapy to Gonzalez’ protocol would suggest otherwise.

Meanwhile Dr David Gorski, from the Barbara Ann Karmanos Cancer Institute, is cautious about judging Mr Jobs’ decision to not have immediate treatment.
He said on sciencebasedmedicine.org: ‘While Jobs certainly didn’t do himself any favours by waiting nine months to undergo definitive surgical therapy of his tumor, it’s very easy to overstate the potential harm that he did to himself by not immediately letting surgeons re-sect his tumor shortly after it was diagnosed eight years ago.’
He added: ‘There is no information of how large the tumour was upon its discovery or by how much it grew during those nine months. Whatever the case was, the surgery was apparently a success, with complete removal of the tumour.’
Mr Jobs originally had an islet cell neuroendocrine tumour, which tend to be slow growing and can be treated even if they spread to the liver.

Nassim N. Taleb on alternative medicine chiropractors

After reading your chapter on medicine, I am wondering what are your thoughts on chiropractors (I refuse to get any kind of invasive treatment or drugs for a lumbar injury I’ve had for some time and have been advised to visit the chiropractor regularly).
收回 · 
  • 你和 Kees Maassen 都說讚。
    • Nassim Nicholas Taleb My approach (I insist) is ultra-orthodox, ultra-scientific, evidence-based meaning even more against alternative medicine. Chiropractors hardly show any effectiveness beyond the placebo. Go take a walk with a 5-fingers in the woods instead.
      8月11日 4:17 · 收回 · 12
    • Mateo Naranjo Thanks for the advice!
      8月11日 4:28 傳自手機 · 讚