我是医生,任何治疗都是为治愈病情

2021-04-23 网络 网络

最近,张煜医生讲述了他所了解的肿瘤治疗领域的黑幕,如乱用药、诱导病人接受不必要的治疗,导致病人人财两空等,并点名了某三甲医院医生,称对方“让患者花10倍的钱,生存期明显缩短”。

最近,张煜医生讲述了他所了解的肿瘤治疗领域的黑幕,如乱用药、诱导病人接受不必要的治疗,导致病人人财两空等,并点名了某三甲医院医生,称对方“让患者花10倍的钱,生存期明显缩短”。

 

帖子一出,舆论哗然,一时间无论内行外行,都将目光聚焦到肿瘤科,更是将文章中那位被点名的医生推到风口浪尖。

 

事实上,这已经不是张煜医生第一次揭露内幕,文章中提到的那位医生,在他知乎的另一条动态里,有提到更具体的身份,是上海某知名三甲医院普外科的医生陆巍。甚至还具体提到了,陆巍医生曾让患者自费3万一次,去进行早就被国家已经明令禁止临床治疗收费的NKT治疗。

 

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NKT治疗,在2016年前后,这个词一度非常火,原因就是魏则西事件。据调查,魏则西生前一直听信的“细胞免疫疗法”,就包括NKT治疗,在魏则西事件之后,国家卫计委对包括NKT之内的细胞免疫治疗进行了收紧,只允许用于临床研究,而不能进行临床治疗。

 

 

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 肿瘤治疗,真的那么黑吗

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事实上,超适应证用药在肿瘤治疗领域是被讨论已久的话题。

 

2017年发表于Journal of clinial pharmacy and therapeutics的文献综述指出,在系统回顾了1975年-2016年间23项抗肿瘤药物使用的研究后发现,住院患者的抗肿瘤药物超适应证使用率为18%-41%。在成年肿瘤患者中,13%-71%的病人接受过至少一次的超适应证用药。

 

超适应证用药之所以在肿瘤治疗领域普遍,除了张煜医生提到的“因利益驱动/医生知识更新不及时”以外,更多的是:药品说明书滞后于临床实践。

 

药品说明书更新程序复杂,耗材耗时,往往在临床研究已经证明某些药物可以产生疗效,但药品说明书还未更新。

 

抗肿瘤药物研发上市后可能对多种肿瘤有效, 但是制药公司考虑到成本因素以及申请新适应症的时间,没能及时更新药品说明书。

 

因而,在临床实践中,特别是当肿瘤患者先前的治疗药物或方案疗效不佳,现阶段又没有合适的药物时,出于及时治疗的需求,医生和患者都愿意承担风险去尝试新的治疗药物。

 

比如说,奥沙利铂被批准的适应症是结肠癌,但临床中常用于乳腺癌患者治疗;曲妥株单抗被批准用于ERBB2阴性乳腺癌 , 但是在ERBB2阳性乳腺癌中也有使用等等。

 

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在这次张煜医生曝光的事件中,也涉及了超适应证用药的情况。他在一篇知乎动态之中,晒出过陆巍医生对一名胃癌肝转移患者的手写化疗方案。

 

里面出现的药物包括卡培他滨、奥沙利铂、培美曲塞、安罗替尼等。张煜医生质疑该方案的一个重要的点,就是某些药物不对症,比如培美曲塞,并没有胃癌的适应症,“说明书也没有说能治疗胃癌”,类似的还有安罗替尼。

 

我们无法确定这是出于对疗效考虑的超适应证用药,还是出于一己私利。对此,有媒体咨询了业内专家,但最后发现,专家们的意见也不一样。

 

天津医科大学总医院副主任医师、肿瘤学博士邵宜,以及哈佛医学院附属麻省总医院血液与肿瘤博士后研究员梁鑫,邵宜博士在丁香园的采访中表示赞同张煜医生的说法,认为培美曲塞、安罗替尼的使用没有必要。

 

梁鑫博士的则偏向于认为方案有合理之处,并给出了前沿研究的证据。

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在肿瘤治疗领域,我们很难通过某一两种药,来定性“良心”还是“黑心”,也不是简单一句“缺乏监管”能够概括的。

 

 

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用药体制监管?

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比如上文就提到的,为什么在国家明确规定NKT不能用于临床治疗的情况下,陆巍医生依然可以给病人开相关的治疗,并且通过了医院的审核和收费呢,医院究竟有没有监管?

 

比如说,除了陆巍医生之外,文章中还提到了很多医生,会故意夸大病情,诱导患者进行不必要的治疗。那么现在都是真的吗?如果是的话,又应该如何查处?

 

目前,对于张煜医生的看法,在业内,也是众说纷纭。有人赞赏他的孤勇,有人认为他是单纯的学术观点太保守,有人则认为他哗众取宠,抹黑医生群体来为自己引流。但无论动机如何,只要所属属实,能让医疗行业能有一点的改善,那这种曝光,就是有意义的。

 

 

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功亏一匮千里之堤,溃于蚁穴害群之马

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医疗领域,或许存在一些害群之马,其实是社会不良风气在医疗领域的表现。在各行各业或多或少都有点不正之风的情况下,你没法指望医疗行业成为世外桃源和不受社会不良风气污染的净土。

 

你不能指望中国的官员都不腐败;你不能指望中国的执法人员都不腐败;你不能指望中国的媒体都不腐败;同样,你也别指望中国医疗行业是一片没有任何污染的净土。

 

中国医疗行业的害群之马,肯定是有的。

 

但是,道德败坏的医务人员,不会比给莆田系做广告的媒体更多,不会有收莆田系车马费的记者更多,不会比给莆田系当后台的各部门官员更多,不会比收莆田系保护费的执法者更多。

 

中国医生中败类的比例,不会比官员中贪腐者多,不会比记者中无耻者多,不会比执法者中收黑社会保护费者多,不会比任何一个行业中的败类比例更多。

 

但我也坚信99%的医生,任何诊断治疗都是为治愈患者病情考虑,就像我不是药神剧中所说:我是医生,我会为了患者战斗至最后一刻。

 

参考资料:

1.http://finance.sina.com.cn/roll/2016-05-05/doc-ifxryahs0069406.shtml
2.https://mp.weixin.qq.com/s/OF0SQMjnUG4Xrj-yoVlzZQ
3. 知乎-张煜医生
4. Saiyed, M.M., Ong, P.S. and Chew, L. (2017), Off‐label drug use in oncology: a systematic review of literature. J Clin Pharm Ther, 42:251-258. https://doi.org/10.1111/jcpt.12507

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    2021-04-23 805009625

    不发表观点

    0

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    2021-04-23 zy&kt

    更多的是:药品说明书滞后于临床实践。

    0

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    2021-04-23 ms8000001383156651

    赞成你的说法

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    2021-04-23 ZJYYY7

    emmmm

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