A*******s
发帖数: 9638 | 1 在我住院医的时候， 有一个病人突然右手抖动不能自控， 所有的检查都正常，一个医
学生发现在有护士和医生在场的情况下病人就抖动的厉害， 可没人的时候就很少看到
他在抖， 比方说他吃饭的时候一点问题都没有， 可医生让他写个字都抖得不行。 于
是有个住院医出了个馊招：给他安慰剂来治疗他的精神障碍。
我们最终没有这么做， 因为所有的治疗应该是informed， 病人必须被告知，否则不道
德。
其实即使给安慰剂（sugar pill， vitamin）病人病情好转也不见得说明什么问题，
医学研究证明：安慰剂就是有效的。
如果一个医生对安慰剂的效果有充分的认识， 他/她就可以成为一个把医学从科学上升
到艺术高度的好医生。
治疗一个疾病是一个team work， 这个团队包括医生， 病人和他们的家人。 在一个有
evidence based 的科学诊断做出以后， 患者以及家属对医生的信赖由此就建立了。
医生实施治疗前， 会认真详细的解释治疗方案， 同时给予病人信心。
为什么这个信心很重要？ 安慰剂效应
micheal J fox， 拳王阿里，陈景润甚至邓小平等等得的Parkinson's病有很多治疗，
安慰剂效应的研究很有意思，当病人对这个治疗（手术和药物）有信心和期待，治疗效
果就好， 类似的研究还包括了抗抑郁药和镇痛， 大家有兴趣可以读读这篇文章：
http://www.jneurosci.org/content/25/45/10390.full
这篇文章至少让我想到了这些：
1. 手术置放电极（DBS)治疗Parkinson's疾病的效果很大程度取决于病人的态度， 所
以对于对DBS有怀疑态度的病人，没必要费时间去说服他们。
2. 抗抑郁药的作用不仅仅是serotonin，安慰剂的效果需要精神科医生发扬光大。
3. 针刺麻醉是不是可以用安慰剂解释了？ 当年提倡的时候大家都信，现在有了怀疑，
效果就打折扣了。
所以医学绝对不仅仅是什么webMD， 病人的信心建立在对医生的信赖上， 这个信赖就
是在与医生的接触中建立的。
我反对sunshine法案是因为它割断了医生和医药代表的联系， 一个新药的使用需要医
生对该药的信心， 这个信心可以传递给患者， 而这个信心的建立有赖于医药代表的帮
助。
安慰剂效应不是全部，但绝对不要低估了它。 | k********n
发帖数: 756 | 2 Placebo has its scientific basis. It has a little to do with patient's
confidence on his physicians and nothing to do with the sunshine act. The
sunshine act is absolutely necessary because money taint medical practice.
Please read Dr. David Franklin vs Pfizer case
Please read the response from Pharmaceutics, the PHRAMA
Please read how money can buy influence "the wrong war" in the Journal of
Headache, http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2005.05082_5.x/full
If your headache doctor is pushing you to take GBP, Topamax or get Botox,
and you can go on line and read that they got $60,000 last year for speaking
for those companies, then the patient should beware.
Money taint the accountability, not the other way around.
【在 A*******s 的大作中提到】
: 在我住院医的时候， 有一个病人突然右手抖动不能自控， 所有的检查都正常，一个医
: 学生发现在有护士和医生在场的情况下病人就抖动的厉害， 可没人的时候就很少看到
: 他在抖， 比方说他吃饭的时候一点问题都没有， 可医生让他写个字都抖得不行。 于
: 是有个住院医出了个馊招：给他安慰剂来治疗他的精神障碍。
: 我们最终没有这么做， 因为所有的治疗应该是informed， 病人必须被告知，否则不道
: 德。
: 其实即使给安慰剂（sugar pill， vitamin）病人病情好转也不见得说明什么问题，
: 医学研究证明：安慰剂就是有效的。
: 如果一个医生对安慰剂的效果有充分的认识， 他/她就可以成为一个把医学从科学上升
: 到艺术高度的好医生。
| A*******s
发帖数: 9638 | 3 I hope you read my thread more carefully then jump on your conclusion.
How much do you know Topamax? How many patients do you personally treat
with topamax? I tell you I use Topamax a lot, far more than you can imagine
. Do I get anything from J&J? Nil
Do not underestimate physician's moral standard including your collegues.
There are a lot of good doctors there and you can not just judge them based
on your imagination. There are some dirty deals but they will get caught or
how do you know them?
speaking
【在 k********n 的大作中提到】
: Placebo has its scientific basis. It has a little to do with patient's
: confidence on his physicians and nothing to do with the sunshine act. The
: sunshine act is absolutely necessary because money taint medical practice.
: Please read Dr. David Franklin vs Pfizer case
: Please read the response from Pharmaceutics, the PHRAMA
: Please read how money can buy influence "the wrong war" in the Journal of
: Headache, http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2005.05082_5.x/full
: If your headache doctor is pushing you to take GBP, Topamax or get Botox,
: and you can go on line and read that they got $60,000 last year for speaking
: for those companies, then the patient should beware.
| k********n
发帖数: 756 | 4 Nobody is judging you, don't get defensive. By the way, national health
bureau in China is refusing implementing laws because they believed in
moral education and standard. Also, headache is treated with vasoactive
herbals and neuro-nutritional supplements for many years on numerous patient
you could imagine.
Anyway, what you said did not provide any evidence to support your
conclusion or reject my conclusion. I feel that you were just showing off or
pea cocking. If it was so, you should go and talk to high school kids who
have not heard of your Topamax or your nurses who did not know Pubmed and
AAN.
imagine
based
or
【在 A*******s 的大作中提到】
: I hope you read my thread more carefully then jump on your conclusion.
: How much do you know Topamax? How many patients do you personally treat
: with topamax? I tell you I use Topamax a lot, far more than you can imagine
: . Do I get anything from J&J? Nil
: Do not underestimate physician's moral standard including your collegues.
: There are a lot of good doctors there and you can not just judge them based
: on your imagination. There are some dirty deals but they will get caught or
: how do you know them?
:
:
| A*******s
发帖数: 9638 | 5 Thank you for judging me to be defensive and showing off. Are you so
amnestic?
If you have not used any topamax before, please just simply shut up.
【在 k********n 的大作中提到】
: Nobody is judging you, don't get defensive. By the way, national health
: bureau in China is refusing implementing laws because they believed in
: moral education and standard. Also, headache is treated with vasoactive
: herbals and neuro-nutritional supplements for many years on numerous patient
: you could imagine.
: Anyway, what you said did not provide any evidence to support your
: conclusion or reject my conclusion. I feel that you were just showing off or
: pea cocking. If it was so, you should go and talk to high school kids who
: have not heard of your Topamax or your nurses who did not know Pubmed and
: AAN.
| k********n
发帖数: 756 | 6 The sources: personal involvement with the Big Pharma, the headache
specialist who refused speaking at the national meeting, from the gossips in
the headache conference, from the study I conducted, NOT from the number of
pill I prescribed. Also, my colleagues and chairman would seriously doubt
my competency and decision making if I had prescribed Topamax to "many
patients they could not imagine".
All physicians should support the Sunshine Act. It is the personal,
professional, and social responsibility. | A*******s
发帖数: 9638 | 7 I would worry about your attitude rather than sunshine law if I were your PD
, seriously.
Do you know why only Depakote and topamax are only two AEDs used for
migraines although there are so many AEDs? Do you know Topamax is generic
now and more and more physicians are writing it? Do you know Topamax now is
used for weight loss?
My advice for you is to listen, listen and listen, it's not the time for you
to talk like that.
in
of
【在 k********n 的大作中提到】
: The sources: personal involvement with the Big Pharma, the headache
: specialist who refused speaking at the national meeting, from the gossips in
: the headache conference, from the study I conducted, NOT from the number of
: pill I prescribed. Also, my colleagues and chairman would seriously doubt
: my competency and decision making if I had prescribed Topamax to "many
: patients they could not imagine".
: All physicians should support the Sunshine Act. It is the personal,
: professional, and social responsibility.
| k********n
发帖数: 756 | 8 It would be wasting my time to discuss with a person who often starts with
the useless statement like below.
PD
is
you
【在 A*******s 的大作中提到】
: I would worry about your attitude rather than sunshine law if I were your PD
: , seriously.
: Do you know why only Depakote and topamax are only two AEDs used for
: migraines although there are so many AEDs? Do you know Topamax is generic
: now and more and more physicians are writing it? Do you know Topamax now is
: used for weight loss?
: My advice for you is to listen, listen and listen, it's not the time for you
: to talk like that.
:
: in
| A*******s
发帖数: 9638 | 9 Useless instead of priceless? Anyway, it takes time.
【在 k********n 的大作中提到】
: It would be wasting my time to discuss with a person who often starts with
: the useless statement like below.
:
: PD
: is
: you
|
|
