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陈冯富珍 世界卫生组织总干事 来自中华人民共和国的陈冯富珍博士曾获加拿大西安大略大学医学学位。她于1978年加入香港卫生署；1994年，被任命为香港卫生署署长；2003年，加入世界卫生组织，担任人类环境保护司司长；2005年6月，被任命为传染病监测与反应司司长以及负责大流行性流感的总干事代表；2005年9月，被指定为主管传染病部门的助理总干事；2006年11月9日，当选为总干事。2012年5月，再度当选为总干事。
各位阁下，尊敬的部长们，尊贵的专家们、女士们、先生们： 我很高兴有此机会在国际传统医学论坛上讲话，特别是我们刚刚在澳门成立了世卫组织传统医学合作中心。 现代医学和传统医学都能对健康作出独特的贡献，但两者也都各有局限和不足。各国，特别是发展中国家，应当在有监管的情况下，审慎地综合使用这两种医学中的精华。 传统医学可大有作为，尤其能促进初级卫生保健和全民覆盖，特别是在目前慢性非传染性疾病已经超过传染性疾病，成为全球最大杀手的情况下就更是如此。 对于通常生活在发展中国家农村地区的数百万人来说，草药、传统疗法和传统医学从业人员是主要的，有时甚至是唯一的卫生保健来源。 这种保健离家近，方便又实惠。在一些传统医学，如传统中国医学和渊源于印度的阿育吠陀系统中，传统习俗依赖数百年来获得的智慧和经验。 在这些情况中，传统医学有着浓厚的历史和文化渊源，从业人员通常是家喻户晓、令人尊重的社区成员，他们的能力和疗法得到大家的信任。 这种保健形式无疑能够缓解，治疗许多常见疾病，减少痛苦，缓解疼痛，还可避免有小病小痛的人蜂拥到诊所和急诊室。 然而，这些众所周知的优势，却招致了对传统医学的若干批评之一。相信传统治疗师是抵御病症和疾患的第一道和最佳防线，可能会导致潜在威胁生命的医疗紧急情况，特别是当这种信念阻止或延迟获取主流医学时。 事实上，这一批评与实际情况并不十分相符。许多患重病的穷人之所以不去诊所或急诊室，其实是因为诊所和急诊室不可得或不可及。传统医学是默认的，但不是第一选择。它是唯一的备选方案。 造成危险的并不是施行传统医学本身，而是许多发展中国家不能普及基本卫生服务。 世卫组织开展的调查表明，只有略微过半的公共卫生设施能够提供治疗急性病的基本药物。而在私营设施，该数字上升到68%。这意味着很多设法到卫生设施就诊的人却两手空空地离去。 在另一些情况中，传统医学成为默认选择只是因为西医什么都无法提供。我们在西非的埃博拉疫情期间真切目睹了这一状况。 面对成千上万的感染者及其医生，现代医学除了支持性护理外，什么都不能提供，没有疫苗也没有治疗药物。患者及其家人当然更愿意在家中或者由传统治疗师进行护理，而不愿意被隔离到难以活着离开的治疗中心。 其它批评则集中针对用于监管传统医学质量和安全的薄弱体制框架。这个弱点在整个发展中世界普遍存在，涉及到所有医疗产品。 在药物方面，只有约20%的世卫组织会员国具备运转良好的监管机构。约50%具备程度不一的监管能力。而30%根本不具备或只具备有限的监管能力。 女士们，先生们： 现代医学也有不足之处，有些是真实的有些是感觉到的。奇怪的是，这些不足导致了一种局面，就是传统医学满足了一种被很多人认可的需求，却得了个坏名声。 在富裕国家，公众往往对过度医疗化和过度专业化的卫生保健有种消极反应，因为这类保健将患者当作一种身体专门部位的集合体而非一个完整的人来对待。人们希望能更多地掌控对其身体所作的治疗。他们希望对自己的健康进行自我调节。正如我们在拒绝疫苗接种运动中所看到的，科学往往得不到信任，有时甚至遭到诋毁。通过社交媒体传播的谣言可能比上百份精心编写并获得同行审评的研究报告更具影响力。 人们怀疑效力强大的新药物可能具有尚未发现或从未诚实披露的副作用。 人们还可能不相信自己的医生，希望获得第二方和第三方意见。他们寻找拥有更多专业知识的专家。促使中东呼吸综合征在大韩民国迅速传播的采购式就医和跳转医院的做法便清楚反映了人们的这些期望。 一些分析师将这种不满和不信任归因于现代医疗保健的制度、基础设施、培训、奖励措施以及导向。在许多国家，现代医疗保健制度要求医生用于每名患者的时间不得超过20分钟。 在这几分钟内，医生要行动，不要说话，要就药物、化验以及其它干预作出处方。这种做法与传统医学从业者的方法形成鲜明对比。 此外，从事家庭医学的医生数量大幅减少，而出现了更多的专科医生和亚专科医生。随着目前非传染性疾病日益增多，家庭医生的技能对于这类疾病的预防和连续护理至关重要，但这一职业却正在消失。 在研究与开发方面，曾对预期寿命产生惊人影响的现代医学奇迹在逐步放缓。真正新分子化合物的发现越来越少。 与抗生素不同，用于治疗慢性疾病和症状，如高血压等的许多药物，即便不需要终生，也需要长期服用，令人对累积的毒性作用感到担忧。用于治疗癌症和糖尿病的一些较新药物已经证明具有严重，有时甚至是威胁生命的副作用。 在治疗痴呆症或管理肥胖症方面仍有待开发药物。用于治疗癌症的许多昂贵药物仅能使生命延长几个月，而延长的这段生命的质量通常极其糟糕。 替代医学产业的惊人崛起弥补了现代医学中的一些不足之处。在若干北美和欧洲国家，草药、膳食补充剂以及其它一些所谓“天然”产品的生产和销售已成为一个巨大的赚钱产业。仅在美国，该产业的年业务额便达320亿美元。 该产业极力捍卫自己的领域、权利和利润，通过一些毫无根据的声称展开积极营销，招致了医疗界中很多人的怨愤。医疗专业人士指出，大多数替代药物系通过非处方销售或因特网进入市场，不受任何监管。 在他们看来，公众在冒险自行服用可能无效或有毒，或者两者兼具的产品。这种情况下，产业已将传统医学劫持，但摈弃了经验丰富的从业者的技能。 由此招致的敌意和愤怒显而易见于最近揭露和谴责该产业行为的一些书籍的名称，例如《哄骗或是治疗》《蛇油科学》，或《维生素和草药补充剂行业中的死亡、谎言和政治》。 所有这些出版物有一个共同的基本结论，就是：大多数传统药物和做法的疗效并没有在传统的临床试验中得到证实。 我想对此结论提出委婉的质疑。当传统医学在其文化和历史发源地由熟练、经验丰富和值得信赖的从业者实施时所产生的人类体验，是无法用科学方法进行准确和全面评价的。 对照临床试验可以评价干预措施或草药产品，但不能评价全面的体验。此外，对疼痛、焦虑和压力的抱怨几乎总是带有某种主观性。安慰剂效应是一种有大量记载的科学现象。 诺贝尔奖获得者伊丽莎白·布莱克本这样提醒辩论双方：“我们往往会忘记在人类生物学中大脑是多么强大的器官。”关于压力的生理效应的科学研究证实这一提醒是正确的。 富裕国家的多数医疗基础设施旨在管理传染性病原体并且在这方面做得很出色。但在预防和治疗非传染性疾病方面则远远不够有效，因为非传染性疾病的病因很少是互不关联的单一细菌、病毒或寄生虫等。 越来越多的证据表明，饮食、运动和减压可比大多数药物和外科手术更有效地预防或延迟心脏病发作。 在此，传统医学胜出。传统医学开拓了一系列干预措施，如健康饮食，运动，草药和减少日常压力的种种方法等。 女士们，先生们： 主张在正规卫生保健系统中给予传统医学更合法的地位的观点继续引发大量争论。 旨在整合传统医学和现代医学之精华的国家，最好不要将目光放在这两种方法的诸多不同之处上。相反，应当看到两者的共同之处，以帮助应对21世纪的独特卫生挑战。 谢谢大家。■ 【以下为英文版本】 Excellencies, honourable ministers, distinguished experts, ladies and gentlemen, I welcome this opportunity to address the International forum on traditional medicine, especially as we inaugurate the WHO collaborating centre on traditional medicine in Macao. Modern medicine and traditional medicine make unique contributions to health, but both also have their limits and shortcomings. Countries, especially in the developing world, are wise to use the best of these two approaches in a carefully integrated and regulated way. Traditional medicine has much to offer, especially as a contribution to primary health care and universal coverage, and most especially at a time when chronic noncommunicable diseases have overtaken infectious diseases as the world’s biggest killer. For many millions of people, often living in rural areas of developing countries, herbal medicines, traditional treatments, and traditional practitioners are the main, sometimes the only, source of health care. This is care that is close to homes, accessible, and affordable. In some systems of traditional medicine, such as traditional Chinese medicine and the Ayurveda system historically rooted in India, traditional practices are supported by wisdom and experience acquired over centuries. In these contexts where traditional medicine has strong historical and cultural roots, practitioners are usually well-known members of the community who command respect and are supported by public confidence in their abilities and remedies. This form of care unquestionably soothes, treats many common ailments, reduces suffering, and relieves pain. It also keeps people with minor complaints and illnesses from flooding clinics and emergency wards. However, these well-known advantages contribute to one of several criticisms of traditional medicine. The belief that traditional healers are the first and best line of defence against illness and disease can lead to potentially life-threatening medical emergencies, especially when this belief blocks or delays access to mainstream medicine. In reality, this criticism does not align well with the situation on the ground. Many poor people with severe disease do not visit clinics or emergency wards precisely because none are available or accessible. Traditional medicine is the default, not the first choice. It is the only option available. The danger comes not from the practice of traditional medicine per se, but from the failure of so many developing countries to provide universal access to essential health services. Surveys undertaken by WHO show that essential medicines for the treatment of acute diseases are available in only slightly more than half of all public health facilities. For privately run facilities, the figure rises to 68%. This means that large numbers of people who manage to reach health facilities are leaving them empty-handed. In other cases, traditional medicine is the default option simply because Western medicine has nothing to offer. We witnessed this situation most vividly during the Ebola outbreak in West Africa. For the thousands of people infected and their doctors, modern medicine had nothing to offer, no vaccines and no treatments beyond supportive care. Patients and their families understandably preferred care in homes or by traditional healers to isolation in treatments centres where few left alive. Other criticisms centre on the weak institutional frameworks for regulating the quality and safety of traditional medicine. This weakness is likewise pervasive throughout the developing world, for all medical products. For medicines, only around 20% of WHO Member States have a well-functioning regulatory authority. Around 50% have variable regulatory capacity. And 30% have no or only very limited regulatory capacity. Ladies and gentlemen, Modern medicine also has some shortcomings, both real and perceived. Paradoxically, these shortcomings have created a situation where traditional medicine meets a perceived need, yet earns a bad name at the same time. In wealthy countries, the public often reacts in a negative way to health care that is seen as over-medicalized and over-specialized, with the patient treated like a collection of specialized body-parts, and not as a whole person. People want more control over what is done to their bodies. They want to self-regulate their own health. As seen in the movement of vaccination refusal, science is often mistrusted, sometimes even vilified. Rumours spread via social media can carry more weight that hundreds of well-designed peer-reviewed research reports. People are suspicious that powerful new drugs may have side effects that have either not yet been detected or were never honestly disclosed. People may also mistrust their doctors. They want second and third opinions. They look for an expert with more expertise. These expectations were well illustrated by the practice of doctor shopping and hospital hopping that contributed to the rapid spread of MERS in the Republic of Korea. Some analysts attribute this dissatisfaction and mistrust to the system, the infrastructure, the training, the incentives, and the orientation of modern medical care. In many countries, this system dictates that a doctor spend no more than around 20 minutes with each patient. During these few minutes, the doctor is expected to act, not talk, to order medicines, tests, and other interventions. This practice contrasts sharply with the approach used by traditional practitioners. Moreover, the number of doctors practicing family medicine continues to shirk dramatically in favour of more specialists and sub-specialists. Family physicians are a vanishing profession right at the time when the rise of NCDs makes their skills essential for prevention and the continuity of care. On the R&D front, the miracles of modern medicine, which have had such a stunning impact on life expectancy, are slowing down. The discovery of truly novel molecular compounds is becoming rare. Unlike antibiotics, many drugs for the treatment of chronic diseases and conditions, like high blood pressure, need to be taken long-term, if not life-long, raising concerns about cumulative toxic effects. Some newer drugs for treating cancer and diabetes have shown severe, sometimes life-threatening side effects. A drug for treating dementia or managing obesity has yet to be discovered. Many expensive drugs for treating cancer prolong life for only a few months, and the quality of that added life is often miserable. The phenomenal rise of the alternative medicine industry responds to some of these shortcomings in what modern medicine has to offer. In several North American and European countries, the production and sale of herbal medicines, dietary supplements, and other so-called “natural” products have become a huge and profitable industry. In the USA alone, this industry is a $32 billion a year business. The industry fiercely defends its territory, its claims, and its profits. Aggressive marketing that makes unsubstantiated claims has antagonized many in the medical establishment. As medical professionals argue, most alternative medicines are introduced onto the market, via over-the-counter sales or the Internet, without any regulatory oversight. In their view, the public risks self-medication with products that are potentially ineffective or toxic, or both. In this case, industry has hijacked traditional medicine, but without the skills of experienced practitioners. The resulting hostility and indignation are readily apparent in the titles of recent books that expose and condemn the industry’s behaviours, like “Trick or treatment”, “Snake oil science”, or “Death, lies, and politics in the vitamin and herbal supplement industry.” All of these publications share one fundamental conclusion: the efficacy of most traditional medicines and practices has not been confirmed in conventional clinical trials. I would like to gently challenge that conclusion. The scientific method was not designed to accurately evaluate the full human experience that occurs when traditional medicine is delivered by skilled, experienced, and trusted practitioners in its cultural and historical home. Controlled clinical trials can evaluate the intervention or the herbal product, but not the full experience. Moreover, complaints of pain, anxiety, and stress nearly always have a subjective dimension. The placebo effect is a well-documented scientific phenomenon. As Nobel laureate Elizabeth Blackburn reminds both sides in the debate: “We tend to forget how powerful an organ the brain is in human biology.” Scientific research on the physiological effects of stress confirms the validity of that reminder. Most medical infrastructures in wealthy countries were designed to manage infectious agents and did that job very well. They have done far less well with the prevention and treatment of NCDs, which rarely have a discrete cause like a single bacterium, virus, or parasite. Evidence is mounting that diet, exercise, and stress reduction can do a better job of preventing or delaying the onset of heart disease than most drugs and surgical procedures. Here, traditional medicine excels. Traditional medicine pioneered interventions like healthy diet, exercise, herbal remedies, and ways to reduce everyday stress. Ladies and gentlemen, The view that traditional medicine should be given a more legitimate place within the structure of formal health care systems continues to provoke considerable debate. Countries aiming to integrate the best from traditional and modern medicine would do well to look not at the many differences between the two approaches. Instead, they should look at those areas where both converge to help tackle the unique health challenge of the 21st century. Thank you.■ 版权声明：本文来源：世界卫生组织官方网站，版权归相关权利人所有。尊重知识与劳动，转载请保留版权信息。 |
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