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斯坦福專家:不要只盯著精準用藥,更要提倡精準醫療

柳仕魯(Andrew Nusca) 2019年04月09日

斯坦福大學醫學院院長希望人們少談一些精準用藥,多談談“精準醫療”。

斯坦福大學醫學院院長勞埃德·邁納希望人們少談一些精準用藥,多談談“精準醫療”。

當然了,精準用藥是真正患病時需要的對策。如果確診患癌,精準用藥就意味著,配合具體病癥和個人的基因對癥下藥。

精準醫療則是硬幣的另一面。“目標是精準地預測、預防和治療。”邁納在上周三出席于加州圣迭戈舉行的《財富》頭腦風暴健康大會時這樣解釋。

科研型內科醫生邁納表示,隨著精準醫療的發展壯大,對極其具體的精準用藥治療需求已經減少。他說,在心理疾病問題上,精準醫療也能打開局面。

“我們對心理疾病相關醫學的了解還處于初期。”邁納稱,“可是,科研進展的速度令人鼓舞,現在醫學上已經不再將抑郁視為單一疾病。”

抑郁可能需要分一些亞型,和癌癥比較類似。心理疾病之間的差別顯然很大。邁納認為,更全面分類可以幫助醫學專業人士“不局限于癥狀的表象,更透徹地研究,哪種治療方法可能最有效。”

他說,預測和預防心理疾病“是我認為正不斷取得進展的領域”。幸運的是,用人單位已經開始更重視員工的心理健康狀況,“注重提升職場的心理健康和幸福感。”

不過,還有很多工作需要做,尤其是地方醫院層面。邁納指出:“在美國,超過一半執業內科醫生忙得精疲力盡,這種現象不可接受。”

邁納認為,部分原因是電子病歷。內科醫生在電子病歷系統上花費的時間和給病人看病的一樣,甚至更多。“我覺得,投身醫學可不是為了當處理電子病歷的專家。”他說。

邁納稱,影響人體健康的各項因素之中,醫療保健和基因占了四分之一。社會、行為和環境方面的決定因素占了剩下四分之三。這就是我們需要更多精準醫療,以及可能要多休息的原因。

邁納指出:“打造整個社會的健康觀至關重要。”(財富中文網)

譯者:馮豐

審校:夏林

Lloyd Minor, dean of the Stanford University School of Medicine, wants to hear a little less chatter about precision medicine and a little more about “precision health.”

Precision medicine, of course, is the solution for when you’re really sick. Diagnosed with cancer? Precision medicine suggests a treatment that caters to your specific disease and your genetic makeup.

Precision health, meanwhile, is the flip side of that coin. “To predict, prevent, and cure precisely,” Minor said last Wednesday at Fortune’s Brainstorm Health conference in San Diego.

The need for ultra-specific precision medicine treatments is reduced with growth of precision health, argued the academic-physician. Consider mental illness—precision health could make a difference, he said.

“Our knowledge of the science behind mental illness is still in its infancy,” Minor said. “But the pace of scientific advances is encouraging. We’re moving beyond thinking of depression as one illness.”

Depression may require subtypes, not unlike cancer. And it’s clear that mental illnesses vary considerably. Thus a more holistic approach would allow medical professionals to “look beyond, or in addition to, the symptoms at what the most effective treatment may be,” Minor said.

Predicting and preventing mental illness “is an area where I believe we’re making some progress,” he added. Thankfully, employers are already beginning to focus more on mental health and wellbeing of employees to “make mental health and wellbeing a feature of the workplace.”

But there’s more work to be done—especially at your local hospital. “Over half the physicians practicing medicine in the United States are burned out,” Minor said. “That’s just unacceptable.”

Electronic health records are partly to blame, he said. Physicians are spending as much, if not more, time in front of EHRs as patients. “I don’t think any of us went into medicine because we wanted to be an expert in making an EHR work,” he said.

Medical care and genetics make up about one quarter of the total inputs for a person’s health, Minor said. Social, behavioral, and environmental determinants dictate the rest. Which is why the world needs more precision health—and perhaps a little more rest.

Said Minor: “The culture of wellness within our organizations is so critically important.”

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