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中医药的危机

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5年来,帕特里夏·布斯一直使用中药治疗皮肤病。结果她不仅失去了双肾,还患上尿道癌。
For five years, Patricia Booth took a Chinese herbal remedy for a skin complaint. As a result, she has lost both kidneys and developed cancer of the urinary tract.
由于每周有三天去医院接受透析,所以曾是艾塞克斯(英国东南部的一个郡)高级公务员的布斯不得不放弃自己的工作。而其他时候,58岁的她只能待在家中。
The senior civil servant from Essex has had to give up her job, as she spends three days a week in hospital undergoing dialysis. For the rest of the time, Patricia, 58, is housebound.
缺乏监管:英国卫生部未能履行起监管中药的职责。
As the Old Bailey heard last month, the remedy she’d been sold contained aristolochia, a Chinese herb that should only have been given under prescription when she first bought it, and which was later banned.
正如上月中央刑事法庭(英国伦敦老贝利街)所了解的那样,她此前使用的药物内含有一种名叫“马兜铃”的中药,本来她首次购买这种中药时就应该凭医生处方。而且这种药物后来被禁止销售。
It is a shocking story, but even more shocking is that it almost exactly parallels the experience of catering manager Sandra Stay.
这太令人震惊了,而且更离谱的是,餐饮经理桑德拉·斯特身上发生的悲剧几乎与此一模一样。
Her kidneys were destroyed by a Chinese remedy containing the same contaminant. She, too, is on dialysis.
斯特的双侧肾脏同样被含有马兜铃的中药毁坏了,因此也接受了透析治疗。
In both cases, the herbalists involved walked free from court proceedings, leaving their patients sentenced to lives of pain and misery.
这两起案例中,给病人带来终身痛苦和悲惨生活的中医医生并没有受到法庭的起诉。
What makes it even worse is that Sandra’s story occurred ten years ago, highlighting the Government’s shameful lack of action in the intervening years.
更糟糕的是,桑德拉的不幸发生在10年前,这更突显了政府在这期间不作为的可耻行径。
In 2001, the Department of Health declared it was moving to tackle the problem by putting Chinese herbalists under the control of a new regulatory professional body; yet nine years later, despite calls from experts - including herbalists themselves - to regulate the practice, nothing has been done.
2001年,英国卫生部宣称正在着手解决这个问题,准备把中医作为一个新的专业团体纳入规范管理中。9年过去了,尽管包括中医自身在内的许多专家呼吁要监管这个行业,但至今政府依然按兵不动。
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结果是,任何人都能开中药店——估计英国有6千家中药店缺乏专业规范或监管,这可能埋下可怕的隐患。
As a result, anyone can set up a Chinese herbal medicine shop - there are an estimated 6,000 in the UK without any professional regulation or oversight into what they are doing - with potentially terrifying consequences.
比如让桑德拉和帕特里夏陷入人间地狱的罪魁祸首马兜铃,尽管已被明令禁止,但毫不知情的英国患者依然可以买到这种中药。
For instance, aristolochia, which destroyed Sandra’s and Patricia’s lives, is still being sold to unwitting British patients, despite being legally banned.
英国政府下属的药物安全机构“药品和保健品监管署”(MHRA, Medicines and Healthcareproducts Regulatory Agency)透露,正在追查两起马兜铃引发的新案件。该机构警告说,可能有一些医生仍不清楚这种成分危险而且已被禁用。另外,来历不明的廉价进口药物中可能也存这种成分。
The Government’s own drug safety agency, the Medicines and Healthcare products Regulatory Agency (MHRA), has said it is pursuing two new cases involving aristolochia. The agency warns that some practitioners may still be unaware that the ingredient is illegal and dangerous. It may also be hidden in cheap imported medicines of dubious origin.
专家们担心的不仅仅只是马兜铃。MHRA已调查了其他一些病人服用中药汤剂或中药药丸后患病甚至死亡的案例,这些中药含有像毒性植物、石棉、汞重金属甚至是更强效西药(来增强中药的药效)等违禁成分,或者被这些违禁成分所污染。
Banned: Patricia Booth and Sandra Stay were poisoned by the Chinese herb aristolochia, picturedIt’s not only aristolochia that is worrying experts. The MHRA has investigated other cases where patients have fallen ill or died after being sold Chinese herbal potions and pills that either contained, or were contaminated with, illegal substances, such as poisonous plants, asbestos, heavy metals such as mercury and even powerful Western medicines (to boost their potency).
伦敦国王大学(King’s College)针对11种中药湿疹膏的研究发现,其中8种含有儿童不宜的强效胆固醇。
A study of 11 herbal eczema creams by King’s College, London, found eight contained powerful steroids not suitable for children.
去年,MHRA的研究人员发现,一种在英国销售的中国“草药伟哥”(加伊健,Jia Yi Jian)中所含的药物浓度达到危险程度。
Last year, MHRA researchers found that a Chinese ‘herbal Viagra’ sold in the UK contains dangerous levels of hidden pharmaceuticals.
对加伊健的产品检测结果发现,其含有有两种剂量超常的西药。而这两种西药是用于治疗肥胖和阳痿的处方药。它们在加伊健中的高剂量足以引发心脏病和高血压等严重副反应。
Tests on the product, Jia Yi Jian, revealed huge doses of two drugs prescribed by doctors for obesity and impotence. The levels were high enough to cause serious side-effects, including heart and blood pressure problems.
近来,“关节炎研究运动”(Arthritis Research Campaign)的工作人员警告说,一种治疗风湿的中药内含有雷公藤。如果雷公藤萃取不当的话,其毒性极大。
Researchers for the Arthritis Research Campaign recently warned that a Chinese herbal medicine for rheumatism contains thunder god vine, which is extremely poisonous if not extracted properly.
MHRA承认,“现在没有什么完全可靠的方法来评价中国的草药是否安全”,因为在英国,“产品安全、质量和产品信息的标准”总是变化无常。
The MHRA admits there is ‘no entirely reliable way of telling whether a traditional Chinese medicine is safe at present’ because ‘standards of safety, quality and product information’ in Britain are so erratic.
不过,遇到这类问题的不仅是西方国家。几年前,由于毒性超标,韩国政府销毁了871吨从中国进口的中药原料。
But it is not just the West that has problems. A few years ago, the South Korean authorities destroyed 871 tonnes of imported Chinese herbal medicine ingredients because of excessive levels of toxins.
毋庸置疑,中药具有强大的吸引力和潜力。许多病人认为它安全有效或能缓解他们的病情。
There is no doubt of the huge appeal and potential of Chinese herbal medicine. Many patients say it has safely cured or alleviated their conditions.
中国传统医学经历了两千多年的不懈发展,而西方医学正越来越多地深入探究中医的奥秘。
Traditional Chinese medicine has been assiduously developed over more than two millennia and Western medicine is increasingly delving into its secrets.
比如,德国制药业巨头默克(Merck)公司一直在试图从中药里寻找创新的抗癌药。和黄中国医药科技公司(Hutchison China MediTech)在一种中药提取物试验中发现,其极有可能攻克溃疡性结肠炎。
The German drugs giant Merck, for instance, has been studying Chinese herbs to develop pioneering cancer drugs. Trials of an extract of one herb by the company Hutchison China MediTech show significant promise for ulcerative colitis.
但是强效的中药在治病的同时也可能带来危害。在中药质量和用途得到正规监管之前尤为如此,就像萨德拉·斯特所付出的代价那样。
Studies by the respected Cochrane Collaboration report that Chinese herbs may help prevent diabetes, relieve Alzheimer’s and treat endometriosis.
住在英国东萨塞克斯郡霍伍市(Hove, East Sussex) 的萨德拉是6个孩子的母亲。1998年,她去一位中医那里治疗银屑病(又称牛皮癣)。由于常规药物无法治愈这种皮肤病,所以她想尝试一下中医治疗。
But strong medicinal herbs can harm as well as cure. This is especially true when their quality and use is still not properly regulated, as Sandra Stay discovered to her cost.
她回忆道:“那些亮亮的乳白色药丸早晚各服用15粒。那三年中我花了数百英镑购买这些药,不过它们的确有效。所以一旦我支付得起的时候,我就买一些。”
In 1998, Sandra, a mother of six from Hove, East Sussex, consulted a Chinese herbalist about her psoriasis. Conventional medicines failed to clear the skin problem, so she tried Chinese medicine.
但是萨德拉的健康却每况愈下。她开始每天呕吐,无缘无故就出现头痛和眩晕,而且一连好几日都是如此。
‘They were cream, shiny pills, 15 in the morning, 15 in the evening,’ she recalls. ‘It cost me hundreds of pounds over the three years that I took them, but they did seem to work. So I bought them when I could afford them.’
她的全科医生建议她去看专科,但她的病情让医生们困惑了好几个星期,直至体检才发现她出现了严重肾衰。医生们不得不切除她的双侧肾脏,如今她不得不接受每周三次的透析。
But Sandra’s health began to decline. She started vomiting every day and suffered from blinding headaches and giddiness, which could last for days.
她说:“中毒之前,我是一个非常活泼好动的人。过去,我是赛马场的餐饮经理,那既是我的工作,也是我的社交生活。”
Her GP referred her to a specialist, but her illness confounded doctors for weeks, until tests revealed her kidneys were severely damaged. They were removed and she now undergoes dialysis three times a week.
在萨德拉的案例中,中医诊所的业主被两次告上法庭,但最终都宣告无罪。因为尽管官方找到了诊所药架上的草药,但却无法证实诊所卖给萨德拉的就是这种草药。陪审团同时认为,这家诊所此前已采取措施来确保其药物中不含马兜铃。
‘Before I was poisoned, I was very active. I worked as a catering manager at racetracks. It was my social life as well as my work.’
在帕特里夏的案例中,中医医生应·苏珊·吴(Ying ‘Susan’ Wu)承认销售危险药物后,获得了两年假释。
When she read of Patricia’s case, she says she ‘felt terrible’. ‘It was a great shock to learn that this was still happening,’ she says.
法官杰里米·罗伯茨(Jeremy Roberts)表示,虽然没有任何专业团体来监管中药的销售,但并没有什么证据表明应女士了解该药的潜在危害性。他还补充道:“或许我们的法律存在缺口,那不妨让政府来解决。”
In Sandra’s case, the owners of the clinic were taken to court twice, but were ultimately acquitted because, although officials had found the herb on their shelves, it could not be proved that they had sold it to Sandra. The jury also accepted that the store had taken measures to ensure its medicines did not contain aristolochia.
但这显然是一个鸿沟而不是什么缺口。除了中药的质量外,中医医生的资格认证和他们的诊断能力也令人担忧。
In Patricia’s case, the Chinese herbalist Ying ‘Susan’ Wu received a two-year conditional discharge after admitting selling dangerous pills.
我们在10位中医那里诉说了自己的症状(都是典型的偏头痛症状),其中5人的诊断不是“阳虚”就是“湿气”或“肝火过旺”。令人放心的是,其他5位医生正确诊断出了偏头痛。
Judge Jeremy Roberts said that, as the sale of traditional Chinese medicines was unregulated by any professional body, there was no evidence that Ying knew of the potential harm. He added: ‘There may be a gap in our law here which the Government might wish to address.’
毒理学家黛比·肖博士(Debbie Shaw)是盖伊医院(Guy’sHospital)中医咨询服务处(Chinese Medicine Advisory Service)主任,她研究了40起由中药引起的肝损伤报告。
It is more of a chasm than a gap. As well as the quality of the remedies, another concern is the qualifications of the practitioners and their ability to diagnose.
她说:“从整体来看,中医是相对安全的。遗憾的是,有少量剧毒物质已经对人体造成了严重副作用。”
When we visited ten Chinese herbalists complaining of classic migraine symptoms, half of them diagnosed problems, from ‘manhood’ difficulties to ‘damp’ or ‘fire overdose’. The others, reassuringly, correctly diagnosed migraine.
肖博士相信,只要有正规监管,这些问题就能迎刃而解。过去14年里,她就是一直对部长们这样说。
Dr Debbie Shaw, a toxicologist who is the head of the Chinese Medicine Advisory Service at Guy’s Hospital, has studied 40 case reports of liver damage caused by herbal medicine.
她说:“1996年,我们首次向政府写递交这方面的官方报告。我们建议中医医生应该进行正规的注册。我不知道这些年里政府到底在犹豫什么。”
‘As a whole, Chinese medicine is relatively safe,’ she says. ‘The problem is that there are a few highly toxic things that unfortunately have had very severe effects on people.’
他们的确一直在原地打转。追溯到2000年,英国上议院科学技术委员会(Houseof Lords Committee on Science and Technology)呼吁制定从业医生的管理法规,并要求医生对其所处方的药品质量负责。
Dr Shaw is convinced that, with proper regulation, these problems could be tackled. As she’s been telling ministers - for the past 14 years.
2001年,政府表示应该付诸于行动。一张政府公布的时间表表明,这项管理法规会在2005年实施,但至今仍不见其踪影。
‘We wrote our first official report on this for the Government in 1996. We recommended that herbal practitioners should have proper registration,’ she says. ‘I have no idea why they have been dithering for all these years.’
相反的,部长们在2004年召开了一次相关各方参与的咨询会议,结果发现98.5%的反馈赞同制定管理法规。然而,部长们并未据此而动,反而在去年又召开了一次咨询会议。
They certainly have been dithering. Back in 2000, the House of Lords Committee on Science and Technology called for statutory regulation of practitioners and to make them accountable for the quality of medicines they prescribe.
最近的这次咨询会议上,卫生部发言人说:“我们收到5千至6千份反馈,我们正在整理这些信息,以便明确下一步的方向。”
In 2001, the Government said it should go ahead. A timetable was announced, which would have seen regulation implemented in 2005. But it didn’t happen.
“我们将尽快公布结果。我们不会预先干扰结果的产生,但我们在作出决策时,首要考虑安全问题。”
Instead, ministers launched a consultation process with interested parties in 2004, which found that 98.5 per cent of responses were in favour of statutory regulation. But instead of acting upon this, ministers launched another consultation process last year.
预计该结果将在今年夏天出炉。中医医生们表示,现在迫切需要采取行动,但由于政府的拖拉,他们对此表示担忧和怀疑。
Of this latest consultation, a Department of Health spokesperson says: ‘We received between 5,000 and 6,000 responses and we are working through these to see what the way forward should be.
迈克尔麦金泰尔(MichaelMc·tyre)是“欧洲草药和传统中医医生协会”(EuropeanHerbal and Traditional Medicine Practitioners Association)的主席,他批评英国政府在制定中药销售法规上的碌碌无为。“现在到了停止纸上谈兵而付诸行动的时候了。”
'Our response will be published as soon as possible. We won’t pre-empt the outcome, but safety will be our main concern in making decisions.’
所有受到影响的专业团体都迫切希望出台有助于提高中药安全性的法律。
The results are expected this summer. The practitioners say that the need for action is now urgent, but given the Government’s foot-dragging, they are worried and sceptical.
传统中医协会(Association of Traditional Chinese Medicine)的会员已超过700家。早在2005年,该协会就警告说,那些“冒牌货”和“江湖”郎中正在毁坏中医的形象。现今已到了火烧眉毛的紧迫关头。
Michael McIntyre, chairman of the European Herbal and Traditional Medicine Practitioners Association, has criticised the Government’s ‘abject failure’ to provide regulation of herbal medicines sold in Britain. ‘It is time to stop talking and start acting,’ he said.
去年4月生效的几项欧盟法规规定:到2011年,所有中药材在销售前都必须得到官方安全认证。这些规定旨在确保质量控制、建立副反应报告机制和规范成分标签。大家早就翘首期待这一切的到来。
All the professional organisations affected are keen for laws that help them improve safety.
法规还严禁不合格的中医医生从业或配制自己的药方。拥有450家会员的中药注册协会(Registerof Chinese Herbal Medicine)秘书艾玛·法兰特(Emma Farrant)认为,事实上,这可能会让数以千计的中医医生失业,哪怕他们此前规规矩矩安全行医多年。
As far back as 2005, the Association of Traditional Chinese Medicine, which has more than 700 members, warned that ‘dodgy and fake’ practitioners were damaging the image of Chinese medicine. This sense of urgency is fuelled by a fast-approaching deadline.
法兰她表示,解决办法是在2011年截至日期前实施中医医生专业法规。
Under EU rules that came into force last April, by 2011 all medicinal herbs must be officially certified as safe before being sold. The regulations aim to ensure quality control, reporting of adverse effects and proper labelling of contents. All of this is long overdue.
简而言之,这部专业法规在保护病人利益的同时也保护合法的医生。
The regulations also ban unregulated health practitioners from commissioning or formulating their own medicines. This would effectively put thousands of Chinese health practitioners out of business, no matter if they have been working safely and ethically for years, says Emma Farrant, the secretary of the 450-member-strong Register of Chinese Herbal Medicine.
不过,这却招致了一些首席医生和科学家的反对,比如皇家学院医学会( Academy of Medical RoyalColleges)和医学院理事会(Medical Schools Council)。因为他们认为这可能给予中医医生过多的权力。
The solution, says Farrant, is to introduce professional regulation for Chinese herbal practitioners before the 2011 deadline.
这种行业保护观念和政府的踌躇不前意味着,我们最终揭开这个特别的中国之谜还有待时日。
Put simply, professional regulation will protect patients; it will also protect the legitimate practitioner.
对帕特里夏和桑德拉这些失职行为的受害者来说,那并不会给她们带来什么安慰;对那些规规矩矩安全开业并以此谋生的中医医生来说,那也保护不了他们——最终,那也保护不了我们这些被挤在夹缝中的可怜病人。
However, this is being opposed by some leading doctors and scientists, including the Academy of Medical Royal Colleges and the Medical Schools Council, because it may give Chinese practitioners an air of authority they consider unmerited.
标签:中医药
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2010-03-04 20:14 编辑:kuaileyingyu
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