大学英语精读第三版（第五册）学习笔记（原文及全文翻译）——5B -The Breakthroughs in Medicine（医学上的突破）

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Unit 5B - The Breakthroughs in Medicine

The Breakthroughs in Medicine

James V. McConnell

I read with great delight Lewis Thomas's "The Medical Lessons of History" (July 3). It is good to know that such a wise and scholarly physician believes that we can learn from our past mistakes, and that he has some hope for the future of the medical sciences. It is a pity, however, that Dr. Thomas seems not to have learned the real lesson that history offers us — namely, that the "great breakthroughs" in any technology are always preceded by a radical change in how we view ourselves, and how we behave.

Take penicillin, for example. As Dr. Thomas points out, its benefits were denied us for a decade after its discovery by Sir Alexander Fleming. Dr Thomas holds that the medical doctors failed to put penicillin to use because they "disbelieved" it could do what plainly it did. Well, that’s a nice way of explaining matters. But in truth Fleming's colleagues ignored him for 10 years because they refused to accept scientific data showing that penicillin "worked". Just as a century earlier, the medical leaders in Vienna refused to accept Semmelweis’s studies showing that the death rate for childbed fever could be cut from about 26% to about 2% if the attending physicians would only wash their hands before delivering babies. In fact, medical doctors (like most of us) are highly reluctant to judge their actions solely in terms of the objective consequences of what they do. Like most other humans, MDs usually prefer that they be evaluated according to their intentions and feelings. Any reader who doubts my contention might remember that, in malpractice suits, the physician's defense typically is, "I followed standard medical procedure," rather than, "I did what was necessary to cure the patient." Just ask your own family physician some time what his or her own particular "cure rate" is for a given medical problem --- and demand statistical evidence to backup the claim. My guess is that you will shortly be dismissed as a patient.

As Dr. Thomas suggests in his article, medical technology is at another of those difficult crossroads. For the medical profession has blossomed in the past 100 years by taking the viewpoint that most human woes and miseries are biologically determined. In fact, man is not a purely biological animal; we are social and psychological animals as well. The long-term medical "cure rate" for obesity is less than 10%; the behavioral cure rate is about 60%. Yet most physicians continue to prescribe pills and fancy diets for weight loss, when what 90% of the patients need is encouragement in learning how to eat properly. These "cure rate" data have been reported in dozens of scientific journals for dozens of years. Yet just a month ago a man I know informed me that his doctor had told him, "You are too damned fat. If you don't lose weight, you're going to die, and it will serve you right." Needless to say, the man became so depressed that he went on an eating jag.

For almost a decade now, I have been sending behaviorally trained undergraduates into hospitals to help physicians learn how to handle their patients in more humane, rewarding ways. We have demonstrated time and again that we can take some of the most difficult patients imaginable and, using both love and behavioral technology, increase certain "cure rates" dramatically. Most of our techniques involve rewarding patients for following good medical regimens and teaching patients how to handle their own emotional and behavioral problems. Since we have ample objective proof that our techniques save lives, you'd think that the medical profession would be beating down our doors asking us to teach them our skills. Alas, what we get mostly is the response, "This patient is a medical case, not a psychiatric problem, and only pills and surgery will help."

Despite what Dr. Thomas has said, the next great leap forward will come when medical students are routinely taught that the way they act toward the patient — and the way the patient is taught to think, feel, and behave --- are as important in achieving a lasting "cure" as are drugs and surgical procedures. That's the real "medical lesson of history." I do hope that Dr. Thomas and his colleagues learn that fact before it’s too late.

参考译文——医学上的突破

医学上的突破

詹姆斯·V·麦康奈尔

我怀着极为喜悦的心情阅读了刘易斯·托马斯的《医学的历史教训》(7月3日）。得知这样一位睿智博学的内科大夫相信，我们可以从过去的错误中吸取教训，得知他对医学科学的未来怀有一些希望，是一件好事。然而，遗憾的是，托马斯大夫似乎并没有弄懂历史为我们提供的真正教训——那就是，在任何技术取得重大突破之前，总会有一种我们如何看待自己和我们如何行动方面的剧变。

以青霉素为例。正如托马斯大夫指出的，在亚历山大·弗莱明爵士发现青霉素后的十年中，我们一直未能享受到它的好处。托马斯大夫认为，当时的医生之所以不使用青霉素是因为他们“不相信”青霉素能产生它显然能产生的效力。啊，这倒是解释事物的一种好方式。但事实上，弗莱明的同事们之所以忽视了他十年之久，是因为他们拒绝接受表明青霉素“有效”的科学数据。正像在那之前一个世纪之时，维也纳的医学界泰斗们拒绝接受泽梅尔魏斯的研究一样；泽梅尔魏斯的研究表明，如果主治医生在接生婴儿前只要洗洗手，产褥热的死亡率就可以从26%左右减至2%左右。事实上，医生们（像我们大多数人一样）极不愿意只凭他们所做事情的客观后果来评判他们的行为。像大多数别的人一样，医生通常更愿意人们根据他们的意愿和感情来评判他们。任何怀疑我论点的读者可能都会记得，在医疗事故诉讼案中，内科医生的典型辩护词是“我遵循了标准的医疗程序”，而不是“我做了治愈患者所必须的事情”。找个时间问一下你的家庭医生，问一下他或她本人在某一医学难题上的“治愈率”——并要求看一看证实其说法的统计数据。我的猜想是，你很快就会作为不受欢迎的病人被他抛弃。

正如托马斯大夫在他的文章中所说的，医学技术正处在另一个需要作出艰难抉择的关头。由于接受了人类的种种不幸和苦难大多是由其生物属性决定的这样一种观点，医疗业在过去的一百年中得到了蓬勃发展。而事实上，人类并不是单纯生物学意义上的动物；我们还是社会动物和心理学意义上的动物。长期以来肥胖病的医学“治愈率”不到10%，而行为治愈率为60%左右。虽然90%的病人需要的是鼓励他们学会适当饮食，然而大多数内科医生却继续开出减肥的药片，规定减肥的精选饮食。几十年来几十种科学期刊不断地报道过这些“治愈率”。 然而,就在一个月以前，我认识的一个人还对我说，他的医生告诉他，“你真是太胖了，再不减肥就没命了。死了也是活该。”不用说，此人变得非常沮丧，索性乱吃一通了。

近十年来，我一直把受过行为科学训练的大学本科生派到医院去帮助内科医生们学习如何以更富有人情味、更有效的方式对待病人。我们已经一再证明，我们可以接受一些最难治疗的病人，运用爱和行为科学技术双管齐下，显著地提高某些“治愈率”。我们的技术大多都包括以下内容：对遵守良好的医学养生法的病人给予奖励，教会病人处理好自己的情绪和行为问题。既然我们有充分的客观证据表明我们的办法确能治病救人，你自然会以为医务界同行们会纷纷前来，请我们把我们的技术教给他们的。可惜，我们在大多数情况下得到的竟是这样 的反应这位病人是一个医学病例，不是精神病方面的问题。只有药片和外科手术才有用。”

不管托马斯大夫说了些什么，当医科学生从常规教学中学到，他们对待病人的方式——以及教会病人如何思考、如何感受和如何行为的方式——在获得持久的“治愈”方面同药物和外科手术同样重要时，下一次的大飞跃就会到来。这才是真正的“医学的历史教训”。我衷心希 望托马斯大夫和他的同事们能尽快了解这一事实，否则就悔之晚矣。

Key Words:

delight    [di'lait]   

n. 高兴，快乐

v. (使)高兴，(使)欣喜

scholarly ['skɔləli]  

adj. 学究气的，学者派头的 名词scholar的形容

physician        [fi'ziʃən]  

n. 内科医生

radical    ['rædikəl]

adj. 激进的，基本的，彻底的

n. 激进分

evidence ['evidəns]

n. 根据，证据

v. 证实，证明

pity  ['piti]      

n. 同情，怜悯，遗憾，可惜

v. 同情，怜悯

particular       [pə'tikjulə]     

adj. 特殊的，特别的，特定的，挑剔的

n.

reluctant [ri'lʌktənt]      

adj. 不情愿的，勉强的

penicillin [.peni'silin]    

n. 青霉素

defense  [di'fens] 

n. 防卫，防卫物，辩护

lasting    ['læstiŋ] 

adj. 永久的，永恒的

动词last的现在分

imaginable     [i'mædʒinəbl]

adj. 可想像的，可能的

surgery   ['sə:dʒəri]

n. 外科，外科手术，诊所

response        [ri'spɔns]

n. 回答，响应，反应，答复

n. [宗

handle    ['hændl] 

n. 柄，把手

v. 买卖，处理，操作，驾驭

involve   [in'vɔlv]  

vt. 包含，使陷入，使忙于，使卷入，牵涉

emotional      [i'məuʃənl]     

adj. 感情的，情绪的

objective [əb'dʒektiv]   

adj. 客观的，目标的

n. 目标，目的;

rewarding      [ri'wɔ:diŋ]      

adj. 有报酬的，有益的

decade   ['dekeid]

n. 十年

emotional      [i'məuʃənl]     

adj. 感情的，情绪的

handle    ['hændl] 

n. 柄，把手

v. 买卖，处理，操作，驾驭

surgery   ['sə:dʒəri]

n. 外科，外科手术，诊所

certain    ['sə:tn]    

adj. 确定的，必然的，特定的

pron.

decade   ['dekeid]

n. 十年

rewarding      [ri'wɔ:diŋ]      

adj. 有报酬的，有益的

lasting    ['læstiŋ] 

adj. 永久的，永恒的

动词last的现在分

imaginable     [i'mædʒinəbl]

adj. 可想像的，可能的

objective        [əb'dʒektiv]   

adj. 客观的，目标的

n. 目标，目的;

involve   [in'vɔlv]  

vt. 包含，使陷入，使忙于，使卷入，牵涉

参考资料：

1. 大学英语精读(第三版) 第五册: unit5B The Breakthroughs in Medicine(1)_大学教材听力 - 可可英语
2. 大学英语精读(第三版) 第五册: unit5B The Breakthroughs in Medicine(3)_大学教材听力 - 可可英语
3. 大学英语精读(第三版) 第五册: unit5B The Breakthroughs in Medicine(2)_大学教材听力 - 可可英语

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