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Human beings as part of the ecosystem 2020-04-05 18:31:28

Human beings as part of the ecosystem

We humans tend to regard ourselves as the masters of the world. But we are simply part of the ecosystem. There are more bacteria cells in and on our bodies than human cells. There are enormous amount of virus in and on our bodies as well.

We treat microbes as harmful in general. That is why we actively sterilize our environment. But most microbes around us are beneficial to us overall. Bacteria help us digest. Many viruses eat bacteria, preventing those bacteria from multiplying exponentially inside humans. The most potent antibiotics are produced by fungi. Penicillin, the most widely used antibiotics, is produced by Penicillium, a type of fungi. If antibiotics kill too many bacteria, fungi will overrun human bodies, for harmful fungi are no more checked by bacteria. Different kinds of microbes, by constraining each other, keep humans healthy most of the time.

Some bacteria probably do more harm than good. We try very hard to eliminate them or reduce their presence. We are more successful in developing vaccines or treatments against DNA based organisms, which are more stable and easier to target. But RNA viruses mutate very fast. It is more elusive to target the ever changing RNA viruses accurately. Many recent epidemics, such as HIV, influenza, and coronaviruses, are caused by RNA viruses.

When we suppress one type of microbes, we celebrate our success. But from the ecological perspective, we merely open a rich ecological niche, human bodies, for new hosts. This is why superbugs flourish in hospitals, where most known microbes are suppressed. When we eliminate one type of bacteria, it makes it easier for those weaker and less competitive pathogens to invade us. RNA viruses mutate very often. They make so many mistake. It is very difficult for them to compete with more stable, more powerful DNA organisms. But when humans eliminate DNA organisms, RNA viruses face less competition. It is we ourselves who make RNA viruses so successful invaders.

Are we hopeless facing microbes? We really need to assess our situation from a bigger picture, from a longer time frame. Are microbes our biggest threat? Not really! From ecological perspective, any society with below replacement fertility is doomed. The biggest threat to our society is the below replacement fertility. What is the cause for such a low fertility? There can be several reasons. One could be the overdrive of our immune systems in a sterile environment. When our immune systems face less external invaders, they often turn to our own cells. This could be the reason more auto immune diseases occur in clean environment. Women’s immune systems could also attack the cells of fetuses. There are evidence that the existence of some parasites is correlated to higher fertility rate.

From the ecosystem perspective, our war against microbes is futile over long term. In a society which could not reproduce itself, such a war is counterproductive.





















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A re-examination of models of epidemics 2020-03-31 10:48:31

A re-examination of models of epidemics

 

We develop models to predict the unfolding of events. Models in turn guide our responses to the unfolding of events. In the current pandemics of novel coronavirus disease, many governments adopt the policy of “herd immunity”. We attempt to "flatten the curve". It is to slow down the speed of infection. This is also to acknowledge, at least implicitly, we can do little to influence the total number of infections. We reach this conclusion based on the mathematical models of epidemics. But how accurate do these models describe the process of infection?

 

One type of popular models on epidemics is called SIR models. S, I, and R each represents a segment of the population. S represents the susceptible. I represents the infected. R represents the recovered, or removed.  The SIR model consists of three ordinary differential equations, each representing the rate of change of S, I, or R.  In the standard SIR model, we can adjust behaviors to "flatten the curve". But we can do relatively little to change the total number of infections. This is the theoretical foundation for the policy of “herd immunity”, which let every susceptible get infected and hopefully get recovered, (or removed, i.e., dead).

 

Does the model capture the main factors in epidemics? One of the most important factors in epidemics is the total number of infected. Many public media trace this number constantly and many people pay close attention to this number. However, this number does not appear in the SIR model. In SIR model, I represents the number of currently being infected, not the total infection number. With higher total infection number, more people and organizations adjust their behaviors. This will affect the rate of infection. When we put the total infection number into the model, the predicted results will change as well. In particular, not all or most susceptible have to be infected before the pandemics runs its course. If most individuals and institutions can adopt strong enough response, the pandemics can be stopped early on. Indeed, most infectious diseases do not infect majority of the population. Our behaviors not only affect the shape of the infection curve, but also the total infection number.

 

Other than SIR models, some simulations also explore the possible outcomes of epidemics. These simulations and other intuitive arguments suggest that our behaviors can not only flatten the curve, but also change the total number of infections. However, the dominant academic opinion seems to be that the majority of the population will be infected. This theory is presented as “science”. This theory forms the foundation of policies for many governments. There is no such thing as “science”. What we called “science” is usually the most established academic theories. Since the establishment of the SIR models, there has been no global public response as strong as the current coronavirus pandemic. Theories adequate enough in the past may not be able to represent the current situation. In this time of critical moment, we especially need to re-examine the foundation of the dominant theories that greatly influence our policies. It could save a lot of lives.

 

For detailed discussion on the mathematical models, please check

https://www.researchgate.net/publication/340309946_A_re-examination_of_models_of_epidemics

 

 



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My World View 2020-03-27 13:09:59

My World View

Recently I get a message inquiring about my world view. I don’t think about this topic that much. Maybe I just list some of my thoughts about research.

Like many others, I want to understand life. That is my basic drive.

To really understand something, we need to be able to present it as a mathematical theory. We may think we understand something very well. But there can be many inconsistencies in our understanding. Only when I can develop a mathematical theory of life, I can satisfy myself.

A mathematical theory has to be consistent with physical principles. Otherwise, the theory can’t describe much reality. To be specific, thermodynamic processes are the most universal processes in nature. A sound theory of life must be built on thermodynamic theory. The fundamental equations to describe life processes must be thermodynamic equations.

Currently, most equations that describe life processes and economic processes are ordinary differential equations. It is natural to start with ordinary differential equations because they are simpler. Actually, many popular ordinary differential equations, such as those in chaos theory, are simplified from original thermodynamic equations. However, we have to be aware that these equations do not represent reality accurately. We have to be careful when applying theoretical results to interpret reality.

One popular theory is the butterfly theory. It states that the flapping of wings by a butterfly in Brazil can generate a tornado in US. The theory was originally developed from equations on weather, which are thermodynamic equations. Since the original equations are too complex, they were simplified into ordinary differential equations. The butterfly effects were derived from simplified equations.

Do these simplified equations describe weather accurately? No, they don’t. We all know a butterfly in Brazil cannot generate a tornado in US. That is why we can forecast weather conditions very accurately for several days.

However, the theory of butterfly effect is still very popular in social sciences. It has been used to cover up deep structural problems in our social systems. Few researchers point out that the butterfly theory is not based an equation that describe reality accurately.

What I have done is to develop an analytical theory of life and human society based on physical and economical principles. The combination of physical and economical principles is very crucial.  A living system is a physical system that generate nonnegative returns on average.

Some say living systems are too complex to be described by a mathematical theory. But living systems are physical systems. And they are subject to additional constraints, the economical constraints, than general physical systems. Living systems, in particular human societies, must be easier to understand than general physical systems. Indeed, until several centuries ago, we have no clue how solar system works. But our ancestors can handle daily activities successfully for millions of years.

Some say human societies can’t be described accurately by a mathematical theory for humans have free will. When we drive on the road, we don’t think drivers on the opposite direction have free will. We know most of them want to drive safely. Occasionally, some drivers may be impaired. Rarely, some drivers may intentionally collide into other cars. Human mind, just like human body, is evolved to help us survive successfully in this world. There are general patterns how humans think. Human mind is not free.

Our theory consists of three parts. The first part is the entropy theory of mind. Mind is a reflection of reality.  Mind is more efficient if it captures the most important aspects of the world. Entropy law is the most universal law of nature. Entropy flows are what drive the directional movement of the world. The entropy theory of mind provides simple understanding to many psychological patterns.


The second part of our theory is the entropy theory of value. All living systems survive by extracting low entropy from the environment. It would be natural to develop an entropy theory of value. Why such a theory faces great resistance? There are several reasons. One is Arrow’s statement. He investigated the possibility of entropy theory of value.  He observed that Shannon’s entropy measure doesn’t carry weight. So it is not very useful in economics. That was a simple mistake. Information measure does carry weight. A sentence can carry more information than a single letter. Everyone makes mistakes. But when an emperor makes a mistake, only he himself, or his close associates, can legitimately correct the mistake.

The third part of our theory is the production theory. It is an analytical theory of major factors in economic activities, such as fixed cost, variable cost, duration of investment, discount rate and uncertainty. Fixed rate and variable costs, asset duration are the basic quantities in accounting. Governments fine tune economic activities mainly by adjusting interest rates. Our theory was inspired by Black-Scholes option theory. Black had anticipated a general theory on economic activities based on similar method.

Our theory provides a concise and consistent understanding of biological and social activities. It has been around for about two decades now. Yet the established researchers, mainstream or not, take scant attention to it. Why is that?

Social theories are developed to advance the interests of themselves and their groups. The dominant groups hope to maintain the current social structure. They will promote an equilibrium theory, or end of history theory. The marginal groups hope to change the current social structure. Yet to make their theory attractive, they will claim their alternative social structure is the optimal or equilibrium state. Attractive social theories for dominant and marginal groups, such as general equilibrium theory, Marxist theory, major religions,  are all equilibrium theories.

Our theory is a non-equilibrium theory. Human societies are part of the biological systems. This is consistent with the non-equilibrium theory of biological systems in science. Our theory provides a unified understanding of biological and social systems. Our theory provides simple and coherent understanding of vast array of social phenomena. In standard social theories, most social phenomena are attributed to imperfectness, incompleteness, irrationality or externality.

The standard social theories may provide psychological comfort. We all need psychological comfort. It can be provided by religions with much lower costs than the dominant "social science" theories. This is why religions are advancing rapidly in today's world.

Our theory does not provide psychological comfort. It provides solutions to the problems in this world. It is time to leave psychological comfort to religions and leave the study of truth to sciences. The theories of "social sciences" are not consistent with science. The theories of "social sciences" uphold politically correct, and hence suppress factually correct. 

 




 











































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Demographics and Pandemics 2020-03-22 13:02:31

Demographics and Pandemics

Current coronavirus pandemics is spreading rapidly all over the world. While few countries are completely spared of this scourge, countries with aging demographics are hardest hit.

The coronavirus disease was originated from China. It has adopted a strict one child policy for many years. As a result, in a typical family, a couple at working age have to support four aging parents. This put great strain to many families and communities.

Other areas hard hit by the coronavirus disease, such as South Korea, Iran, Europe and North America, all have aging demographics. The areas with younger populations are less devastated by the advance of this disease. Why demographics makes such a great difference in the face of pandemics?

The existence of microbes is not the sole reason for pandemics. Microbes have existed for billions of years. Sometimes they cause pandemics. Sometimes they don’t. They may cause pandemics in some populations. They may not cause pandemics in other populations. The occurrence and spread of pandemics is the result of interactions of the whole ecosystem. Specifically, there can be several reasons.

First, older people generally have weaker immune systems. In a population with higher percentage of older people, more people are likely to get sick from the spread of microbes.

Second, in a society of older population, more effort is made to sterilize the environment. As a result, the environment contains less microbes than otherwise. However, the most effective antibiotics are often excreted by microbes, to protect themselves from competing microbes. Penicillin, the most important antibiotics, is produced by Penicillium, a type of fungi. That is why new microbes, such as superbugs, often thrive in highly sterile environment, such as hospitals. The paucity of existing microbes in an environment makes it easy for new microbes to take over the available niches. Since the advance of new microbes faces less resistance from existing microbes, people are more vulnerable to new microbes in a more sterile environment.

Third, with the aging of general population, the work force is aging as well. Many people work to the age of sixty five and beyond. The advent of any stress factor will greatly stress the work force and compromise their ability to carry on the routines.

Fourth, the medical system and other service systems are already stretched thin even in normal times in an aging society. There is little spare capacity to cushion the extra burden. Furthermore, the arrival of a pandemics often significantly reduces the capacity of the social system. The impact of microbe invasion, or other disturbances, are much more pronounced in an aging society than in a young society.

In most of the Western societies, the birthrate has dropped below the replacement rate for several decades. Yet the policymakers pay scant attention to this vital indicator. To them, the financial markets are the leading indicator of the society. They take many measures to pop up the financial market, most of which further depress the birthrate. In Canada, pension deduction rate has been increasing continuously over time. This infuses more money into the financial market but reduces the amount of money to support young families at their most fertile period. In US, low interest rate and quantitative easing fuels the longest bull market in history. The same policies also diluted the few resources to ordinary families. Its birthrate has dropped to the lowest level in record.

Our society is not supported by the stock market. Our society is supported by food, electricity and fuels. Our society is supported by grocery stores cashiers and stockers, farmers and workers. This becomes plain and simple during crisis. We need more people, more young people with strong immune systems, more young people who can work effectively under stress. To achieve a younger demographics, we can’t keep our eyes glued to the financial indicators. We have to pay attention to birthrate and other vital biophysical indicators. This is the first step we need to take.



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The economy of RNA life 2020-03-20 07:56:23

The economy of RNA life

HIV, flu and recently coronavirus have caused havoc to human societies. These viruses are all RNA viruses. Are RNA viruses very strong? On the contrary, they’re very weak. If so, how can they cause so much damage?

Many of us, as babies or parents of babies, have read Three Little Pigs. In that story, one little pig built a straw house, the second little pig built a stick house, the last little pig built a brick house. RNA viruses are the straw house. DNA organisms are the brick house. Our immune systems can destroy RNA viruses easily, just like a wolf can destroy a straw house easily. So why RNA viruses can cause so much trouble?

It is much easier to build a straw house than a brick house. It takes a lot of time, effort and especially cost to build a brick house. When the last little pig struggled to build his brick house, the first little pig had already settled down in his straw house, raising many young piglets with his wife. Those piglets in turn build many new straw houses and raise many new babies. 

RNA viruses are the same. Comparing with DNA life, RNA viruses are very cheap to make. So RNA viruses can multiply very quickly in our bodies, although most of them are quickly destroyed by our immune systems.

Brick houses need some design standards. The shapes of doors, windows have to follow specific designs. Straw houses, on the other hand, are much more flexible. There is really no need for a building code for straw houses. Similarly, the structures of RNA viruses are are more flexible than more complex DNA life. RNA viruses are very unstable and mutate very fast. This makes it much harder for immune systems to develop specialized antibodies to efficiently eliminate RNA viruses. 

Many people expect the arrival of vaccines will eliminate coronavirus soon. However, the record of developing vaccines against RNA viruses is mixed. We have not been able to develop HIV vaccine, despite tremendous efforts. Flu vaccines are not very effective, because flu viruses, as RNA viruses, mutate very fast. DNA pathogens, such as smallpox viruses, are more stable. It is easier to develop vaccines against DNA pathogens in general. So we might not be able to find effective vaccines against coronavirus soon.

RNA viruses can mutate very fast. It is very easy for RNA viruses inhabiting non human hosts to acquire segments of viruses that inhabiting human hosts. It is relatively easy for RNA viruses to evolve the ability to inhabit human hosts. Even if vaccines against novel coronavirus turns out to be successful, new RNA viruses may emerge to host human species. RNA viruses can jump from species to species easily. We will face constant threat of new RNA virus pandemic, giving the high density and high mobility of human population.

So are we hopeless in dealing with RNA viruses? If RNA viruses are so successful, maybe we can learn something from them. The key of RNA viruses’ success is their low cost and simplicity. Our modern society is too expensive to maintain. As a result, our families couldn’t afford to have two children on average. With less and less young people, our population ages. This makes our society very vulnerable to any disturbances. 

In fact, we don’t need to look into RNA viruses for insight. Many societies have much higher fertility rates and much younger populations than the western societies. But because of their simple social structures, we often patronize them. Very often, those could not afford a single child rush to help those having seven or eight children. Some couldn’t see the simple fact that a society with above replacement fertility rate is more youthful, more energetic and more dynamic than a society with below replacement fertility rate.

We demand heavier and heavier armor to protect our aging society. But the heavy armor only wears us down. When the nimble viruses break through our containment, we are utterly exposed and helpless. To revive our aging society, we have to abandon the heavy and restrictive armor. We need to reduce our burden. We need to light ourselves up. We need to rejuvenate our society with more babies and juveniles.

RNA life are more ancient than DNA life. RNA life are simple, agile and versatile.  RNA viruses have weathered all attempts to eliminate them by large and complex  DNA life. The complex and clumsy machineries of human society will never eliminate the eternally young RNA life.  We have to be humble, to live with them, to accept discipline from them and to learn from them.























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Broad spectrum medicines 2020-03-14 20:01:30

Broad spectrum medicines: Our first choice against new diseases

When we face new diseases, such as novel coronavirus disease, we often feel powerless and get panic. Is there any method we might follow to protect ourselves? Our own immune systems provide some wise guidelines.

Our immune systems include innate systems and adaptive systems. When we encounter new pathogens, our immune systems don’t have targeted methods against them. Our body will enlist broad spectrum innate immune systems to fight off the unfamiliar invaders. The heavy bombardments can be brutal, often causing damages to our own cells and tissues as well. But they are the best available weapons.

At the same time, our immune systems will study the new pathogens, with the hope to develop specific antibodies in the future. These antibodies will target those specific pathogens if they invade us again. This method will target and destroy invaders precisely. It will cause little collateral damage to ourselves. This is part of our adaptive immune systems.

In summary, our immune systems consist of two major parts: broad spectrum innate systems and targeted adaptive systems. When we encounter new pathogens, our primitive and broad spectrum innate immune systems will defend ourselves against unfamiliar intruders. We should adopt the same strategy protecting ourselves from unfamiliar new diseases. We should use primitive and broad spectrum medicines defending ourselves against new diseases, until and if more specialized medicines become available. 

What are the broad spectrum medicines we have? Antiseptics kill most germs. They are the true broad spectrum medicines. Among antiseptics, alcohol is the most commonly used. Since ancient times, alcohol based drinks have been used as clean drinks and as medicine. A routine rinse of mouth with hard liquor, such as whisky, probably provide good protection against many new and old pathogens.

Other than alcohol (ethanol), phenol has been used as an antiseptics for more than a hundred years. Phenol based throat spray, such as Chloraseptic, is available without prescription. It is easy to get over the counter, cheap and convenient. In recent years, Dr Li Yuehua has advocated the use of phenol as a broad spectrum medicine for many kinds of illness, including the current novel coronavirus disease. Phenol throat spray may provide good protection against many pathogens. As the toxicity of phenol is high, we should follow the instruction of its use carefully. In particular, we need to spit out the spray. 

With the advance of a new diseases, the medical system may get overwhelmed. The whole society may become panic. At such a time, we should be more self reliant. We should also recognize that the medical systems may not be able to provide more effective service against the new pathogens than the readily available broad spectrum medicines, such as alcohol and phenol. The medical system may market some sophisticated drugs. But until these drugs prove to be effective against new pathogens clinically, we should not have high expectations on them. Our body doesn't have high expectations on our adaptive immune systems when we encounter new pathogens.

Finally, get a lot of sunshine, drink plenty of hot water and be happy. They are the best broad spectrum medicines.

The following are pictures of some of the phenol throat sprays on the market.


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Is this true 2020-03-14 15:50:43

Is this true?

On unimportant issues, few have incentives to distort truth. Truth is easy to find. On important issues, many have incentives to distort truth. Truth can be difficult to find. 

How do we tell truth from lies? We don’t. We pick up stories based on our own interests, not based on truth. If a story is aligned with our interest, it is an interesting story. We get interested. If a story is not aligned with our interest, it is not an interesting story. We don’t get interested.

If you know where your interest lies, you know which story to believe and to share. There is no need to know truth. If you don’t know where your interest lies, why are you so curious about truth? In movies, someone accidentally witnessed truth is often ruthlessly hunted down. If you are not seeking trouble, why do you seek truth?

Of course, truth is not always suppressed. Sometimes, truth may be aligned with the interest of powerful parties, even dominant parties. It is when truth is mostly aligned with the interest of dominant parties, scientific breakthroughs flourish. This is rare in human history. Today is certainly not such a day.

Humans are social animals. We all need social approval. It is natural to write and share stories. But just stop asking if a story is true. That destroys all the pleasure in socializing.











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苯酚用于预防和治疗新冠肺炎 2020-03-13 10:10:09

苯酚用于预防和治疗新冠肺炎

苯酚用于医疗,已经有一百多年的历史了。最近一些年,李跃华医生发现苯酚是一种广谱药物,可以治疗很多疾病,特别是对当下流行的新冠肺炎,有明显的预防和治疗效果。

李跃华的方法是用稀释的苯酚溶液注射四个穴位,这个需要专业人员的参与。市面上有出售一种口腔喷剂,是百分之一点四的苯酚溶液。这种喷剂应该和注射方法有类似的效果。这种喷剂无需医生处方,可以直接在柜台上买到,非常方便,也非常便宜。

苯酚化学结构简单,容易和很多分子反应,这是它成为广谱药物的化学基础。同时,它也会对人体组织造成损伤。我们要注意剂量和安全。另一种广谱药物是酒精,更加常用。

下面是这种苯酚喷剂的照片。

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李跃华的治疗方法 ZT 2020-03-08 08:03:56


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一个临床医生谈李跃华事件:谁都不是局外人,关键是救命制 2020-03-06 13:32:42

李跃华事件,闹的沸沸扬扬。神医、神棍、非法行医,在各种帽子加身下,李跃华又多了一个说不清的韩国之行....


日前,有自媒体放出消息“非法行医”的李跃华医生受邀,将赴韩国抗疫!但很快事件反转,韩国使馆回应“李跃华赴韩抗疫”:没有获得签证的可能。


先不论韩国之行事件虚实,但这事炒的太高调,又是上级指示、又是代表国家的,这种民族主义式的炒作,很容易被舆论反噬 。我认为,对李跃华既不能过度捧杀,也不能一边倒地喊打。让李跃华代表国家,这是他无法背负之重,但另一面,一边倒地说人家骗子,这也是居心不良,谁会在疫情期间冒着传染风险上门给人看病的?还是给两位老人出诊?


现在各种李跃华的消息真真假假,这里给李跃华辟个谣。今天,朋友圈热传一篇文章《李跃华不去韩国了内幕》,经向李跃华求证:此文属于伪造李跃华头像、伪造对话,用心险恶,完全把李跃华推到政府对立面。



李跃华说:我不是神医、也不是骗子,我只是从临床、从实践中、从自己身上摸索出了医学界不太受关注的东西,刚好这些东西在疫情上派上用场了,对病毒确实是有作用的,”病毒确实是医学界的老难题,如果我们能够突破,继续验证,对社会的贡献是巨大的。”


不管怎么说,我个人认为,李跃华事件有积极的社会意义,他的个人经历、疫情期间救人、非法行医问题、苯酚穴位疗法,临床试验、还有医疗制度等,都提供了一个较好的标本。现在社会各界有很多人关注,其中有不少是医疗系统的人士。


最近,我们收到一位医生朋友的来信,国内三甲医院执业医师、多年临床一线实战的正规医师顾经宇,他从另一个角度谈了对李跃华事件的看法。


一个医生谈李跃华事件:谁都不是局外人


我公开表达对李跃华事件的看法,我身边有不少熟人婉转地质疑我:怎么为李说话呢。我不讨论李跃华“非法”行医的问题,这件事看似“闹剧”背后,有深层的意义,事件中老百姓更关注的是效果,是法外的情和理,是在走投无路时、如何自救、求救、得救。


我作为一名内临床医生,在实际工作中,我接过太多的电话和咨询,他们咨询我时,根本不管我是哪个专科,而是什么问题都问,心脏病、肝脏病、肾脏病、甚至妇科病……。


当一个人亲自得了新冠肺炎,到处打电话、无人医治、一床难求、崩溃绝望的时候,他愿不愿意让李跃华来试一试呢?他愿不愿意让一个有医师证的产科医生试一试治肺炎(其实她不会治肺炎)?甚至,他愿不愿意按照网友发给他的某个可笑的建议试一试?


我见过太多、站在道德制高点上说大话不腰疼的人,实际在求生的时候,比别人更怕死、更卑微、更低级、更不顾一切。


在疫情密集期间,微博上,求助多到数不过来。在医疗资源爆仓的情况下,我们能苛责谁?我看了太多崩溃的求助,没有床位,又能苛责谁?


关于李跃华的“穴位注射”,这种疗法本身确实在临床上有使用,至于能否用苯酚穴位注射治疗新冠肺炎?是苯酚的作用?还是穴位注射的作用?这个疑问有待科学的考察考证。


有人说李跃华的治疗方法未经验证。那请问:面对新冠肺炎,哪个治疗方法是早已得到了验证?面对新冠都是试验,区别在于有没有披上“官批”的外衣。同样是试验,凭什么有的被推荐、有的被拒绝?凭地位吗?凭头衔吗?反观李的注射疗法,至少他曾在自己身上试验过无数次。至少目前没有报道说他的疗法哪怕是耽误了谁。所以,不要进行双重标准的指责。





当然,我更想谈谈这起事件背后的社会意义。


社会意义1:生命由谁做主?

社会上那些走投无路的病人,有没有权力自己决定找李医生治疗?——扩展而言,对于任何疾病,当一个病人求医无门、走投无路的时候,病人有权利定自己找谁治疗吗?有权利决定自己的生死一搏吗?甚至:病人能不能自己做主、把性命托付给所谓的民间高手? 


社会意义2:如何奖罚分明?

现在骗子太多太多了、虚假宣传太多太多了。如何才能奖励真正的救治、惩罚虚假欺骗呢?这个话题,今天肯定无法全面讨论。我相信大家都能一致的观点是:现在的关键问题在于:对各种行骗、各种作恶的监管不力、惩罚太低,比如:各种预付费的会员卡,突然之间商家关门了,无数用户投诉无门,甚至发展为一条龙服务的骗局——关键不在于有人骗,而在于对恶人的监管不力、惩罚太低。 


社会意义3:医生出手救人,应考虑生命第一,还是不违规第一?

当病人自己决定找某人治疗时,如果当前的法规不允许某人(即使是正规在职医生)治疗,这时生命权第一位?还是不违规第一位?医生决定出手救人的权力能放大或哪怕被临时许可吗?


社会意义4:如何及时获得尝试性治疗的合法途径?

此次疫情中,不仅仅是李跃华这样民间医生,也有大牌医师的困境,他们受困于制度、非常无力。我们要亟待推动的是对于危重病、久治不愈的难治病开展尝试性治疗的快速许可制度。


这一次新冠疫情,很多医生急切地想救人。就连武汉大学药学院教授丁虹,拥有无数闪亮的头衔,疫情伊始,悲天悯人、积极思考,她想推出她的甘草酸三联方案,但反复被删,还用了所有可能的渠道向上反映…但获得的回复是“先做临床,否则违法”。还有同济医学院法医教授刘良,四处申请`进行尸体解剖,结果阻力重重,他只能通过自媒体发声,好在引起了公众的关注,终于能开展工作了。


再比如:我是三甲医院正规有证真医师,我组建了一支难治病团队,我们也思考了一套方案想上前线,但是,我们既没有丁虹教授、刘良教授的闪亮头衔,也没有两位教授那样在互联网上发声的勇气和人气,我们只能敲敲键盘写点自己的诊疗设想。 


现在的问题是:官批太难太难,所以制度需要改进。从这次事件,有值得我们推动制度的建立:尤其对于危重病、久治不愈的难治病开展尝试性治疗的快速许可制度。


我们每个人,都可能急需体制外的救治。


我举两个社会广泛关注的例子:


2007年11月,孕妇李丽云在北京朝阳医院分院,病危,陪行人肖某拒绝签字(后查明其实无夫妻之法律关系),医生无法救人,孕妇死亡。为什么?一个病人已经在医院了,还明明不是医疗技术救不过来,为什么却在医生眼皮底下死了?


——这就是:当时没有制度许可(更别谈保护)医生出手救人。

——这就是:体制内救治途径失效。

——这就是:事件之后出台新规:紧急情况下可以由医院负责人签字救人。

——这也是那次悲剧带给社会的重大积极意义。 


2019年,聊城假药案以及电影《我不是药神》所反映的,同样是病人难以从体制内获得续命。


请问,这时:医生有没有权力告诉病人世界上有什么药?病人有没有权力自己(想方设法从体制外)买药?


——可恰恰在法律修改前,医生和病人如果做了这类救命的事是违法的。

——你说,是该谴责医生和病人呢?还是应该赋予医生和病人自主权。

——好在,聊城事件后,药品管理法时隔18年首次全面修改。

——这是多么的真正造福百姓。 


更常见的真实困境是:某病人在某县二级医院重病无法转院,自己决定请京城A专家飞刀,虽然联系上了A专家,但是,没有法规上的许可,A专家可以飞刀救人吗?——直到现在,还没有相关救治制度出现。有没有一个制度保障医生敢于出手救人?


又比如:疫情中,国颁诊疗方案反复修改(现为第6版),这就意味着最初的推荐可能并不合适。

——这就要问:临床一线医生,在诊疗病人时,如果一开始根本就不同意国颁的诊疗方案,该怎么办?他们可以自主决策吗?

——当然,摆在桌面上的回答会是:允许的。


作为一名身在著名三甲医院一线20年的正规医生,我在我的岗位上,看到许多的绝望。有的绝望,是客观的病情,人力确实无法改变。但也有很多绝望,是制度的困境,人力可以做,却无法做。



所以我们普通人,真正能呼吁的,是推动一些制度的建设。

比如:(1)当一个病人确实走投无路时,在体制内无法获得治疗时,他有权寻求体制外的救治吗?

(2)生命权vs制度,如何处理?

(3)推动制度上保护和保障医生出手救人。

(4)推动建立:(尤其对于危重病、久治不愈的难治病)开展尝试性治疗的快速许可制度。 

(5)推动制度上保护和保障医生`用创新手段治疗危重病人、难治病人,而不是束手束脚地照搬指南/共识/规范——因为指南/共识/规范不适用于危重病人、难治病病人!


在我看来,李跃华至少是社会底层有爱心的普通人。我们大义凛然地处罚他,能改变什么?能拯救什么?能产生什么正能量? 


即使李跃华的疗法真实有效、即使他证照齐全,但是,他仍然没有接诊权、他的治疗方案也不在国颁的方案内,那些走投无路的病人们,有没有权力自己决定找他打针治疗?如果李跃华接手了,还是违法违规吗?


有时只能感叹:国人的自救和救人的权力都太小了,太受限了,小到马路上扶个人都胆战心惊。而真正任性的行骗、任性作恶,自由和尺度都太大了,还太不受监管和惩罚了。 


1,疾病无情义、制度可进步。

2,处罚一两个未见实际危害的底层小民,远不如推动救命制度的建立。


我期盼:李跃华事件,能推动一些制度的建立和进步。作为临床医生,我郑重疾呼:急待从制度上确立,临床诊疗措施尤其对于危重病、久治不愈的难治病,应当由施治医生酌情决策,不受常规指南、共识、诊疗规范的约束。
















































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