科学与数学newyorker.com编辑精选
不必要的医疗正在伤害患者的身心与财务
Unnecessary medical care is harming patients physically and financially (2015)
2015 — 2018，它一次次回到首页
黑点是上首页（≥ 50 分）的那次投稿，空心点是没冲上去的投稿，点越大分数越高。
导读
Atul Gawande 在《纽约客》发表的经典长文，指出美国医疗中大量不必要的检查、治疗和手术不仅没有带来健康收益，反而在身体和经济上伤害患者。文章以乳腺癌、甲状腺癌等过度筛查为例，质疑'多检查多治疗'的医疗文化。
为什么经久不衰：它对过度医疗的批判历经多年仍切中要害，美国医疗低效高成本的问题至今未解，是理解医疗体系弊端的必读之作。
HN 评论精选
以斯里兰卡为例说明没有诉讼恐惧的医疗体系成本可以低得多
我住在第三世界国家斯里兰卡。医疗虽不如美国先进，但除最复杂的病例外都还不错。绝大多数人使用公立医院的免费服务，想稍好点的服务可以去私立医院，也花不了多少钱。我最近在私立医院做了个眼睑小手术，只花了50美元。设施虽然简朴但干净够用。而且医生和医院不用时刻担心医疗诉讼——我怀疑这些因素与低费用关系很大。
hliyan查看英文原文
I live in a 3rd world country (Sri Lanka). Healthcare is not as advanced as it is in the US, but it is decent for all except the most complicated cases. The vast majority of people use the free services at state hospitals. If you want slightly better care, you can go to a private hospital and still come out with most of your wealth intact. I recently had a minor surgery to remove a conjunctival granuloma from my left upper eyelid. It was a private hospital, and it cost all of $50. Compared to US standards, the facilities were spartan, but adequate and hygienic. Also, doctors and hospitals do not live in constant fear of malpractice suites. I suspect these factors have a lot to do with the costs (in addition to the obvious cost-of-living adjustment for the third world).
亲历医院例行安排不必要检查的实例
今天想起这篇文章：当地医院骨科给所有患者预约就诊前拍X光片，即医生还没见到病人、无法判断X光是否有用时就先拍。我第一次就诊错过了拍片，医生说没关系，按我的症状根本不需要拍。我差点为一次毫无理由的昂贵不必要的X光买单。今天复诊我直接拒绝拍片，医生也同意，因为他同样不认为需要影像检查。
oftenwrong查看英文原文
This article came to mind this morning when I made my second visit to the orthopaedics department at a local hospital. The department schedules all patients for pre-appointment x-rays. That is, before the patient is even seen, before the doctor can determine if an x-ray would even be useful. On my first visit, I missed my x-ray appointment. The doctor I saw that day later said that was no problem. According to him, an x-ray wasn't necessary given my symptoms. I was scheduled for an expensive, unnecessary x-ray for no reason, basically. On today's visit I simply declined the x-ray, and the doctor I saw today was fine with that because he also did not recommend that any imaging be done.
引述《反脆弱》的'减法医学'理念：能自愈的病少干预
塔勒布在《反脆弱》中告诫人们除非真正必要不要接受医疗。医院里很多事情可能出错（被传染、失误等），只有收益大于风险时才值得去。得了癌症值得冒险，但能自愈的病，等待自愈的期望值更高。他支持'减法医学'：很多伤害来自吸烟、糖、防腐剂等，与其加药或手术，不如移除身体不适应的因素，让身体自愈。他举自己背伤的例子：医生建议手术，他只是等待，背自愈了且比手术更结实。
davidscolgan查看英文原文
In the book Antifragile Nassim Taleb cautions against medical care unless it's truly necessary. He argues that since so many things can go wrong in a hospital (you could get sick from someone else, mistakes could be made, etc), only go if the benefits outweigh the risks. And so if you have cancer, it's probably worth the risk. But if you have something that could just go away naturally, that's got a higher expected value of positive outcome. He is in favor of subtractive medicine - many harms are caused by adding such things as smoking, sugar, preservatives, etc, and instead of adding medicine or surgery, remove the elements that the body isn't evolved to tolerate and see if it heals itself. He gives the example of how he hurt his back weight lifting. The doctor proposed surgery. He just waited and his back healed itself, and in a way that is now more robust than if he had had surgery. As with all things, it's not a black and white kind of decision, but this mindset has worked well for me as a heuristic for health.
批评文章回避了防御性医疗背后的诉讼环境
写一篇关于医疗浪费的全面文章，却几乎不提医生面临的极度诉讼化环境，这有点不够诚实。不只是医生记得那个没做扫描的病人，律师也记得。
dwolfson查看英文原文
I find it slightly disingenuous to write a comprehensive article on wasteful medical care and yet barely mention the extremely litigious environment that doctors face. It's not just doctors that remember that one patient that didn't get scanned. Lawyers do, too.
用统计数据质疑文中关于筛查与死亡率的论断
我对文中'筛查大幅增加了乳腺癌、甲状腺癌、前列腺癌的检出，但死亡率几乎没有下降'的说法有异议。我查了SEER的乳腺癌和前列腺癌逐年发病与死亡数据。甲状腺癌发病率确实上升了，但它本来就不是什么杀手。'乌龟和兔子'的类比有误导性——很多'乌龟'是可能转化成跑得快的（致命的）。
puzzlingcaptcha查看英文原文
> For instance, cancer screening with mammography, ultrasound, and blood testing has dramatically increased the detection of breast, thyroid, and prostate cancer during the past quarter century. We’re treating hundreds of thousands more people each year for these diseases than we ever have. Yet only a tiny reduction in death, if any, has resulted. I take issue with that. Here are the statistics for breast cancer and prostate cancer (new cases and deaths) by year: http://seer.cancer.gov/statfacts/html/breast.html http://seer.cancer.gov/statfacts/html/prost.html The incidence of thyroid cancer has in fact increased, but it was hardly a killer in the first place. I find the 'turtles-and-rabbits' analogy to be misleading. Plenty of 'turtles' can undergo a transformation and become much faster (at killing you).
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