乳癌篩選的適當性

[李誠民]

X-Man先生您好!
對於住院醫師值班問題,您提供個人許多知識與多面相思維,個人相當感激!

乳癌篩選是我多年困擾問題,尤其是現在國健局強力推動的計畫,個人更是困擾,;最近一期BMJ登載的文章,更是與台灣國健局計畫差別極大,轉載如下:--Women in their 40s should not be screened for breast cancer, new Canadian guideline says
BMJ2011;343doi: 10.1136/bmj.d7625(Published 23 November 2011)
Cite this as:BMJ2011;343:d7625

台灣是45-59歲每兩年(?)作Mammography一次,個人知識中Mammography本身因放射劑量高,就有引發乳言危險,雖然目前有Low-radiation Mammography但仍有oncogenic effect,其次false-positive diagnosis rate很高(40%?).......等等負面文獻,所以Mammography for screen of breast cancer 一直是重要討論課題......

Mercola com. Cancer—cause,prevention
By Sayer Ji
October is the National Breast Cancer Awareness month in the U.S., and October 21 is National Mammography Day.
Zeneca Group plc., a pharmaceutical subsidiary of Imperial Chemical Industries and manufacturer of the blockbuster breast cancer drugs Arimidex and Tamoxifen, founded the National Breast Cancer Awareness Month in 1985 in order to promote the widespread adoption of x-ray mammography (and the sale of their products).1
While the increase in routine screenings has resulted in soaring breast cancer diagnoses, rates of invasive breast cancer have actually INCREASED in certain populations.2
Shocking Statistic: False Alarms May Be as High as 40 Percent!
A recent study and editorial published in the New England Journal of Medicine indicated that x-ray mammography screening may "save" only 1 person for every 2,500 screened.
Among the 2,500 screened at least 1,000 will have a false alarm, 500 would undergo an unnecessary biopsy, and 5 or more would become treated for abnormal finds that would never become fatal, i.e. their lives will be shortened due to medication/surgical/stress-induced adverse effects. Given these findings X-ray mammography may be far more effective at generating increased numbers of breast cancer diagnoses than in "preventing" malignancy and mortality associated with the disease. To the contrary, a growing body of clinical evidence indicates that the "low energy" x-rays used in breast screenings are up to 500% more carcinogenic than previously assumed and upon which current radiation risk models that favor mass breast screenings with ionizing diagnostic technologies find justification. The success of this highly popularized model of "prevention," which prevents nothing, is explained when we look deeper into who is behind AstraZeneca, the founding sponsor of National Breast Cancer Awareness Month.
AstraZeneca's Role in the Cancer Industry
AstraZeneca was in fact a by-product of one of the world's largest chemical (and carcinogen) producers, Imperial Chemical Industries (ICI). Before being acquired by AkzoNobel in 2008, ICI produced millions of pounds annually of known mammary carcinogens such as vinyl chloride. ICI demerged its pharmaceutical bioscience businesses in 1993 to form Zeneca Group plc., which later merged with Astra AB to form AstraZeneca in 1999.
AstraZeneca's best-selling cancer drug Tamoxifen is actually classified by the World Health Organization as a carcinogen. (To view toxicological data on this chemical visit our Problem Substances Database page on Tamoxifen). Presently all campaign ads and promotional events that are run by the National Breast Cancer Awareness Month foundation (which operates year round) must be "approved," i.e. "pink-washed," by AstraZeneca before being released for public consumption.
Other experts and organizations have pointed out this glaring conflict of interest:
"A decade-old multi-million dollar deal between National Breast Cancer Awareness Month sponsors and Imperical Chemical Industries (ICI) has produced reckless misinformation on breast cancer," ~ Dr. Samuel Epstein [a leading international authority on cancer-causing effects of environmental pollutants.]
"Imperial Chemical Industries has supported the cancer establishment's blame-the-victim attitude toward the causes of breast and other cancers. This theory attributes escalating cancer rates to heredity and faulty lifestyle, rather than avoidable exposures to industrial carcinogens contaminating air, water, food, consumer products, and the workplace."
..................................

ps:
文章主題 : 抗流感藥擴大釋出 強化防疫 (中央社新聞)

發表於 : 週二 11月 29, 2011 10:37 pm 1
2009年的H1N1流行,是藥廠製造的恐慌(2003年SARS沒成功)所以大賺疫苗與抗流感病毒藥--Tamiflu,西班牙等歐盟國家已向藥廠求償的法律訴訟事件,台灣還大量採購Tamiflu,好在台灣有詹啟賢先生有"千夫所指,吾往矣"的道德勇氣,負起戰略藥廠的角色(哪關他私人公司的角色?!);,至少在流感疫苗上,外國大藥廠無法為所欲為.....請為詹先生鼓掌!










註冊會員






註冊時間: 週一 11月 17, 2008 2:45 pm
文章: 4




（中央社記者陳清芳台北29日電）衛生署監測病毒資料，發現入冬流行的B型流感「山形(yamagata)」株病毒，不在疫苗預防範圍內，衛生署決定擴大釋出公費流感抗病毒製劑，加強流感防疫。
.................

[blind faith]

前輩您好:

台灣女性的乳癌好發年齡與歐美不同: 好發年紀比較輕,以更年期前婦女為主，相較於歐美國家，乳癌好發於停經後婦女，台灣大於三分之一乳癌病患是年齡介於45到55歲的女性，較國外平均年輕了10歲。

癌症篩檢的最終目的是希望能降低癌症死亡率
台灣醫院目前常用的方式: 抽tumor markers來screening ,是完全沒有evidence base 的!
國健局推行的癌篩, 其實到最後未必能如原先設想
我們都有點是使用國家工具,為做公衛的研究收data 的意味在...

對於 cancer screening 是否適切, harms & benefit, 長久以來歐美也有反對的聲音...
如 JNCI 的報告( sorry, 沒辦法弄到全文)
http://www.medscape.com/viewarticle/754 ... ews&spon=7

[williamtingyeh]

前輩您好:

台灣女性的乳癌好發年齡與歐美不同: 好發年紀比較輕,以更年期前婦女為主，相較於歐美國家，乳癌好發於停經後婦女，台灣大於三分之一乳癌病患是年齡介於45到55歲的女性，較國外平均年輕了10歲。

癌症篩檢的最終目的是希望能降低癌症死亡率
台灣醫院目前常用的方式: 抽tumor markers來screening ,是完全沒有evidence base 的!
國健局推行的癌篩, 其實到最後未必能如原先設想
我們都有點是使用國家工具,為做公衛的研究收data 的意味在...

對於 cancer screening 是否適切, harms & benefit, 長久以來歐美也有反對的聲音...
如 JNCI 的報告( sorry, 沒辦法弄到全文)
http://www.medscape.com/viewarticle/754 ... ews&spon=7

人種差異 也造成 screening programme 年紀上面的差異
自然 英國研究的outcome 不能直接套在台灣女性族群身上

還有 東方女性 以及 西方女性的 breast tissue 的 density 也有差異
會造成 screening tool的選擇差異

[李誠民]

blind faith賢拜您好!受益良多

個人非oncology 或breast cancer專長,數年前只是好奇而已,但台灣國健局推大腸癌與乳癌篩檢,似乎又與主要醫學期刊有許多矛盾處....

"癌症篩檢的最終目的是希望能降低癌症死亡率
台灣醫院目前常用的方式: 抽tumor markers來screening ,是完全沒有evidence base 的!
國健局推行的癌篩, 其實到最後未必能如原先設想
我們都有點是使用國家工具,為做公衛的研究收data 的意味在...----如果有證據顯示藥廠也有介入,那台灣醫師 公衛等等都別想在國際醫界----混(?);;,台灣衛生主管官署,甚至政府信用將破產,因為這目前是嚴重違反醫師道德行為(ethics)
對於 cancer screening 是否適切, harms & benefit, 長久以來歐美也有反對的聲音...
如 JNCI 的報告( sorry, 沒辦法弄到全文)
http://www.medscape.com/viewarticle/754 ... ews&spon=7"

1.為什麼台灣乳癌罹患人口,比歐美國家早十歲?
2.國健局推的乳癌篩檢,我的認知與媒體知識,都是用Mammography作screen,所以近十年來,台灣許多稍具規模醫院,都紛紛採購Mammography 設備,甚至更新速度不亞於 歐美先進國家(Low-energy?),這種設備投資會回收嗎?當然醫師 護士薪資下降,是必然結果?誰的錯?誰造成的?怪不得許多署立醫院院長 主任等遭收押(也許這就是前署長楊某人說的未爆彈--踩著單純 主任等遭收押(也許這就是前署長楊某人說的未爆彈--踩著單純思維醫師頭,磨取個人利益?)

3.您確定台灣國健局的乳癌篩檢是用tumor marker?這在醫學ethics是不道德的!
ps:有關tumor marker您可上網BMJ 輸入breast cancer tumor marker,這還是極具爭議,甚至是藥場的商業利益的陰魔
4. Mercola com.是因為個人美國友人,問到Fructose,我才上這個網站,才有個人發言引用的報導來源

謝謝指導與盼能繼續討論

[blind faith]

前輩您好:
先前有點語意不清,讓您誤會了!
我所指的醫院使用 tumor markers 做screening,是指在"自費健檢"癌症篩檢這塊!
Breast cancer screening 目前還是建議用MMG,亞洲國家因東方女性breast 較小,較dense,
MMG 有時不易判讀,亞洲醫師比較細心手巧, 有些會用breast echo 來screenng (也一直有 debate何者較好)
(近年來營養?較好,發育較佳,也就未必如此)

為何台灣女性乳癌年齡較低? 目前不清楚!
人種? 基因? 環境荷爾蒙? 都有人提.

其實,各種癌症的篩檢, 在目標"減少癌症死亡率"上,各國研究結果分歧
如以 PSA 來 screening prostate cancer, 美國和歐洲的datat 就不同!

我所指的,國健局推這四種癌症( 口腔癌,乳癌,子宮頸癌 ,大腸直腸癌) 篩檢,
對象並不完全依他國的條件,而是選台灣好發這些癌症的年齡層和有危險因子者,
真的會如預想降低 癌症死亡率嗎?
所以才說搞公衛的用國家機器(國健局),要求醫療端配合,收這樣子的 data
或許真能照顧國民健康, 但cost-effectivess 如何? 我們的預算花得值得嗎?
可以預想追蹤數年後,就有 nation-wide 的data, 就會有大的 paper 能publish.......

[stockk]

前輩您好:
先前有點語意不清,讓您誤會了!
我所指的醫院使用 tumor markers 做screening,是指在"自費健檢"癌症篩檢這塊!
Breast cancer screening 目前還是建議用MMG,亞洲國家因東方女性breast 較小,較dense,
MMG 有時不易判讀,亞洲醫師比較細心手巧, 有些會用breast echo 來screenng (也一直有 debate何者較好)
(近年來營養?較好,發育較佳,也就未必如此)

為何台灣女性乳癌年齡較低? 目前不清楚!
人種? 基因? 環境荷爾蒙? 都有人提.

其實,各種癌症的篩檢, 在目標"減少癌症死亡率"上,各國研究結果分歧
如以 PSA 來 screening prostate cancer, 美國和歐洲的datat 就不同!

我所指的,國健局推這四種癌症( 口腔癌,乳癌,子宮頸癌 ,大腸直腸癌) 篩檢,
對象並不完全依他國的條件,而是選台灣好發這些癌症的年齡層和有危險因子者,
真的會如預想降低 癌症死亡率嗎?
所以才說搞公衛的用國家機器(國健局),要求醫療端配合,收這樣子的 data
或許真能照顧國民健康, 但cost-effectivess 如何? 我們的預算花得值得嗎?
可以預想追蹤數年後,就有 nation-wide 的data, 就會有大的 paper 能publish.......

台灣健保目前是公衛學者掌控 自肥也就不足為奇(偽可愛)

我們的全聯會啞巴群................ (挖鼻孔)

[施肇榮]

前輩您好:
先前有點語意不清,讓您誤會了!
我所指的醫院使用 tumor markers 做screening,是指在"自費健檢"癌症篩檢這塊!
Breast cancer screening 目前還是建議用MMG,亞洲國家因東方女性breast 較小,較dense,
MMG 有時不易判讀,亞洲醫師比較細心手巧, 有些會用breast echo 來screenng (也一直有 debate何者較好)
(近年來營養?較好,發育較佳,也就未必如此)

為何台灣女性乳癌年齡較低? 目前不清楚!
人種? 基因? 環境荷爾蒙? 都有人提.

其實,各種癌症的篩檢, 在目標"減少癌症死亡率"上,各國研究結果分歧
如以 PSA 來 screening prostate cancer, 美國和歐洲的datat 就不同!

我所指的,國健局推這四種癌症( 口腔癌,乳癌,子宮頸癌 ,大腸直腸癌) 篩檢,
對象並不完全依他國的條件,而是選台灣好發這些癌症的年齡層和有危險因子者,
真的會如預想降低 癌症死亡率嗎?
所以才說搞公衛的用國家機器(國健局),要求醫療端配合,收這樣子的 data
或許真能照顧國民健康, 但cost-effectivess 如何? 我們的預算花得值得嗎?
可以預想追蹤數年後,就有 nation-wide 的data, 就會有大的 paper 能publish.......

台灣健保目前是公衛學者掌控 自肥也就不足為奇(偽可愛)
我們的全聯會啞巴群................ (挖鼻孔)

這與專業有關，跟醫學會比較有關係吧

政府找學者(醫師)背書
各醫學會要出聲表示意見才對

[stockk]

前輩您好:
先前有點語意不清,讓您誤會了!
我所指的醫院使用 tumor markers 做screening,是指在"自費健檢"癌症篩檢這塊!
Breast cancer screening 目前還是建議用MMG,亞洲國家因東方女性breast 較小,較dense,
MMG 有時不易判讀,亞洲醫師比較細心手巧, 有些會用breast echo 來screenng (也一直有 debate何者較好)
(近年來營養?較好,發育較佳,也就未必如此)

為何台灣女性乳癌年齡較低? 目前不清楚!
人種? 基因? 環境荷爾蒙? 都有人提.

其實,各種癌症的篩檢, 在目標"減少癌症死亡率"上,各國研究結果分歧
如以 PSA 來 screening prostate cancer, 美國和歐洲的datat 就不同!

我所指的,國健局推這四種癌症( 口腔癌,乳癌,子宮頸癌 ,大腸直腸癌) 篩檢,
對象並不完全依他國的條件,而是選台灣好發這些癌症的年齡層和有危險因子者,
真的會如預想降低 癌症死亡率嗎?
所以才說搞公衛的用國家機器(國健局),要求醫療端配合,收這樣子的 data
或許真能照顧國民健康, 但cost-effectivess 如何? 我們的預算花得值得嗎?
可以預想追蹤數年後,就有 nation-wide 的data, 就會有大的 paper 能publish.......

台灣健保目前是公衛學者掌控 自肥也就不足為奇(偽可愛)
我們的全聯會啞巴群................ (挖鼻孔)

這與專業有關，跟醫學會比較有關係吧

政府找學者(醫師)背書
各醫學會要出聲表示意見才對

全聯會可以要求專科醫學會表示意見 不是嗎?

總額預算制下 受害的是全體醫師

[李誠民]

blind faith先生!謝謝指證

我還是強調我非oncology or breast cancer 專長,只是關注這一題而已,尤其是馬英九先生愛將--邱淑媞任國健局長後,大力推動嚴正篩檢,更讓我好奇!

前些時 後,本網站有大腸癌篩檢,因給付低(但還是有許多診所掛布條),所以開放給藥局也做篩檢(?),大腸篩檢是驗糞便潛血檢查,假陰性與假陽性的問題更多,當然也有tumor marker,也同樣是Breast Ca.用來做篩檢的問題,爭議極大;;您提的PSA(prostat Ca screen至少有十年歷史),較無爭議..........

PS:Beast Ca.不是因女性荷爾蒙變化,所以停經前與停經後婦女False-diagnosis有關?
Echo-是利用組織density 不同,-而來判讀,女性荷爾蒙隨時有變化,乳房組織Density就有改變,您覺得Echo 能取代Mammography screen?(雖然避免了放射性帶來的oncogenisity問題)
如果一種篩檢會帶來更多傷害,而false-diagnosis又高,治療藥物本身又有問題一大堆,.........
難道就為了發表文章???

[jyuan]

做乳篩的得利者會有哪些啊？？

機器廠商？
各大醫院放射科？

[李誠民]

Jyuan先生您好!
以台灣代理商 醫院 (放射科?)都是 在為跨國性大藥廠賺錢而已,但台灣醫師已被健保制度教育成只會賺小利,不客氣說::台灣所謂的專家---專科醫學會的大教授們,能招待出國,參加個國際會議,最好能上台報告一下,發表個論文,就很滿意了;就算有回扣,也相當有限(還要冒被羈押的風險),....
跨國性大藥廠是從政府著手,主導政策,一路吃到藥品銷售,如果台灣醫界還沒反省能力,到頭來還是窮忙一場,醫院投資,如果無法合理回收,當然所有醫生 護士 檢驗師....工作環境變差,薪資降低

我再次強調::我非ONCOLOGY OR BREAST專長,所以才引用Mercola Com.的有關Breast Ca.從Screen,treatment到最後癌症藥物治療,一路吃乾抹淨,以前我只是個人閱讀雜誌,對Mammography screen感到好奇,

歐 美先進國家對癌症篩選與治療,多屬保險或自費,絕沒有政府出面強 美先進國家對癌症篩選與治療,多屬保險或自費,絕沒有政府出面強力推銷(?),在加上許多想曝光的類似電視名嘴,借知名度說些似乎合理的大道哩,卻絕口不提她存在的風險,當然立委(歐美的國會議員)得利最大

台灣健保呈現巨額虧空,政府還不知(真不知還是假不知?)節制醫療資源的浪費,只為配合執政黨選舉,不拖垮政府財政才怪!


Mercola com. Cancer—cause,prevention
By Sayer Ji
October is the National Breast Cancer Awareness month in the U.S., and October 21 is National Mammography Day.
Zeneca Group plc., a pharmaceutical subsidiary of Imperial Chemical Industries and manufacturer of the blockbuster breast cancer drugs Arimidex and Tamoxifen, founded the National Breast Cancer Awareness Month in 1985 in order to promote the widespread adoption of x-ray mammography (and the sale of their products).1
While the increase in routine screenings has resulted in soaring breast cancer diagnoses, rates of invasive breast cancer have actually INCREASED in certain populations.2
Shocking Statistic: False Alarms May Be as High as 40 Percent!
A recent study and editorial published in the New England Journal of Medicine indicated that x-ray mammography screening may "save" only 1 person for every 2,500 screened.
Among the 2,500 screened at least 1,000 will have a false alarm, 500 would undergo an unnecessary biopsy, and 5 or more would become treated for abnormal finds that would never become fatal, i.e. their lives will be shortened due to medication/surgical/stress-induced adverse effects. Given these findings X-ray mammography may be far more effective at generating increased numbers of breast cancer diagnoses than in "preventing" malignancy and mortality associated with the disease. To the contrary, a growing body of clinical evidence indicates that the "low energy" x-rays used in breast screenings are up to 500% more carcinogenic than previously assumed and upon which current radiation risk models that favor mass breast screenings with ionizing diagnostic technologies find justification. The success of this highly popularized model of "prevention," which prevents nothing, is explained when we look deeper into who is behind AstraZeneca, the founding sponsor of National Breast Cancer Awareness Month. AstraZeneca's Role in the Cancer Industry
AstraZeneca was in fact a by-product of one of the world's largest chemical (and carcinogen) producers, Imperial Chemical Industries (ICI). Before being acquired by AkzoNobel in 2008, ICI produced millions of pounds annually of known mammary carcinogens such as vinyl chloride. ICI demerged its pharmaceutical bioscience businesses in 1993 to form Zeneca Group plc., which later merged with Astra AB to form AstraZeneca in 1999.
AstraZeneca's best-selling cancer drug Tamoxifen is actually classified by the World Health Organization as a carcinogen. (To view toxicological data on this chemical visit our Problem Substances Database page on Tamoxifen). Presently all campaign ads and promotional events that are run by the National Breast Cancer Awareness Month foundation (which operates year round) must be "approved," i.e. "pink-washed," by AstraZeneca before being released for public consumption.
Other experts and organizations have pointed out this glaring conflict of interest:
"A decade-old multi-million dollar deal between National Breast Cancer Awareness Month sponsors and Imperical Chemical Industries (ICI) has produced reckless misinformation on breast cancer," ~ Dr. Samuel Epstein [a leading international authority on cancer-causing effects of environmental pollutants.]
"Imperial Chemical Industries has supported the cancer establishment's blame-the-victim attitude toward the causes of breast and other cancers. This theory attributes escalating cancer rates to heredity and faulty lifestyle, rather than avoidable exposures to industrial carcinogens contaminating air, water, food, consumer products, and the workplace."
..................................

ps:
文章主題 : 抗流感藥擴大釋出 強化防疫 (中央社新聞)

發表於 : 週二 11月 29, 2011 10:37 pm 1
2009年的H1N1流行,是藥廠製造的恐慌(2003年SARS沒成功)所以大賺疫苗與抗流感病毒藥--Tamiflu,西班牙等歐盟國家已向藥廠求償的法律訴訟事件,台灣還大量採購Tamiflu,好在台灣有詹啟賢先生有"千夫所指,吾往矣"的道德勇氣,負起戰略藥廠的角色(哪關他私人公司的角色?!);,至少在流感疫苗上,外國大藥廠無法為所欲為.....請為詹先生鼓掌!

[李誠民]

Blindfaith賢拜您好!

(BMJ2009;339doi: 10.1136/bmj.b3527(Published 22 September 2009)
Cite this as:BMJ2009;339:b3527)

"• Tumour markers can contribute usefully to patient management, but awareness of their limitations is essential
• The main application of tumour markers is in monitoring
• Measurement of α fetoprotein and human chorionic gonadotrophin is mandatory in the management of germ cell tumours
• Carcinoembryonic antigen (CEA) is recommended for postoperative follow-up of patients with stage II and III colorectal cancer if further surgery or chemotherapy is an option
• Prostate specific antigen (PSA) may be used for detecting disease recurrence and monitoring treatment in patients with prostate cancer
• In some high risk patients, measurement of α fetoprotein, CA125, or CA19-9 may aid early detection of hepatocellular carcinoma, ovarian cancer, or pancreatic cancer, respectively
• Opportunistic screening with panels of tumour markers is not helpful, nor is measurement of CA125 in men or PSA in women"

"however, a recent audit in a single Greek hospital found that only about 10% of requests for tumour markers were appropriate.4 The cost of inappropriate testing of tumour markers was estimated to be about €23 974 (£21 000; $35 000) a month, even without including the cost of unnecessary second level follow-up inveSerum tumour markers: how to order and interpret them
stigations such as colonoscopy and ultrasonography.4
However,
awareness of the limitations of tumour markers is crucial not only because of the economic implications of their misuse but even more importantly because inappropriately used tumour marker results can cause patients additional anxiety and distress"

在前幾期BMJ文章:大意是希臘國債問題,導因於健保(Health care)被過度濫用,從以上文章節錄,個人才了解文章意義,謝謝您提供Breast Ca. tumor marker(自費項目,而非台灣乳癌篩檢用Mammography...,Mammography不是更可怕?!),大腸直腸癌刪檢,台灣國健局為節省醫師合理報酬,會是甚麼品質?醫師再次等著背黑鍋---如同藥價黑洞的問題::台灣健保制度的不合理與不知尊重醫師專業的重要性!!!!

The Truth About the Drug Companies: How they deceive us and what to do about it
BMJ2004;329doi: 10.1136/bmj.329.7470.862(Published 7 October 2004)
Cite this as:BMJ2004;329:---Dr Marcia Angell, a member of Harvard Medical School's Department of Social Medicine, has written a painstakingly researched book on the wiles and ways of what has come to be called “big pharma.” It is a clear exposé of the American drug industry and is written in the impassioned but impeccable prose we expect from a former editor of the New England Journal of Medicine.

"
"Angell remembers the philosopher Immanuel Kant: “Physicians think they do a lot for a patient when they give his disease a name.” And she writes, “As the whole world knows, there is now a condition recently christened ‘erectile dysfunction,’ and a drug, Viagra [sildenafil], and two me-toos, Levitra and Cialis, to treat it. Advertisements for these drugs feature not decrepit old men but young athletes. The implication is obvious. Any episode of impotence, no matter how rare and how mild, is ‘erectile dysfunction,’ there is a pill for it, and if this macho quarterback is not too embarrassed to ask for it, you don't have to be either.”"

"Among the many wiles exposed are big pharma's use of contract research organisations to exert undue influence over clinical research and its insidious seduction of doctors. In 2001 drug companies gave doctors nearly $11bn worth of “free samples.” This was in addition to the “food, flattery, and friendship” provided by drug company representatives to doctors (BMJ 2003;326: 1189)---不就是前些時 後的罕見疾病用藥問題,台灣衛生署還出面說:藥廠答應(?)再繼續提供一年免費.....照這邏輯,台灣國人還需瞌頭謝謝外國藥廠鴻恩呢??

The final chapter, “How to Save the Pharmaceutical Industry—And Get Our Money's Worth,” gives seven essential reforms, chief of which is for the Food and Drug Administration to compare new drugs not with placebos but with old drugs, to see whether there are any additional benefits.Angell's goal is access to good drugs at reasonable prices, which requires public pressure to spur the government to action against big pharma's powerful and ubiquitous lobbyists (more numerous than the members of Congress)(美國每位參議員有十個有關 醫藥的說客--Lobbyists) and its political campaign contributions. She has performed an important public service in focusing on the drug companies and their disingenuousness. The reform of big pharma starts with a public outcry against the abuses she has shown. And here doctors should stand by their patients, not their purses."---僅節錄數段,供參考!
ps:再次感謝!
全聯會在哪?不趁著選舉表明醫師立場,待何時?!--就教施肇榮醫師

[李誠民]

MK前輩您好!經常拜讀您提供議題與發言,個人尊敬!

但不知您為甚麼將2011-5-11的謝炎堯教授發表的有關醫師工時的文章再次提出(2011-12-2),本網站發言是一面倒的無禮批評,對這位前輩似乎是成見極深,或是這網站發言的都是 些打屁!發勞騷的人物?
因不是全聯會官方網站(?又有它Logo)全是攪局的人,還是衛生署醫政處外圍組織成立的網站??---誤導國人與媒體對醫師的錯誤認知?.........

PS:請MK前輩告知原委,謝謝!