The author of this book, Bo Shining, is a doctor of clinical medicine in Peking University, the deputy chief physician of the Department of Critical Care Medicine of Peking University Third Hospital, and the founder of the Health Science Committee of China Health Management Association. There is no need to elaborate on other titles. Popular science is to introduce scientific knowledge in professional fields to non-professionals. According to Luo Zhenyu, the founder of app, there is no shortage of doctors with excellent medical skills, but few people can explain their professional medical knowledge to laymen. Bo Shining is such a person who is committed to popularizing medical knowledge in professional fields to the public and constantly emphasizing the importance of health management. So with the later story, Luo Zhenyu found Bo Shining and gave a lecture on "50 lectures on Bo Shining's medical knowledge" on the app. These handouts were put together to form the book.
This book has seven chapters, which can be divided into several parts. The first part is the premise of understanding medicine, the second part is an in-depth explanation of diseases and medical treatment, the third part is several important inventions in the evolution of modern medicine, the fourth part is about famous doctors who changed medicine, and the fifth part is about how doctors can make the best solution under limited conditions, how to be smart patients and how to finish the last journey of life. This book mainly answers the following questions.
Why did medicine come into being? "Saving one life is better than building a seven-story tower" is an idiom, which means that saving one life is better than building a seven-story tower, which is the best policy. Bo Shining pointed out that the ultimate goal of medical existence is to save lives, firstly to ensure survival, and secondly to improve the quality of life and let patients live with dignity. This also determines that medicine considers not only diseases, but also people themselves. In the process of fighting diseases, medicine is rational and calm, all steps should be rigorous and all operations should be standardized. The Department of Critical Care Medicine, where the author is located, is a real battlefield to fight against death and disease. It is a daily problem that doctors try their best to snatch life from death before providing rehabilitation support. In the milestone chapter of medical development, the author introduces several important events that promote medical development, such as the application of anesthesia technology, which greatly expands the possibility of clinical surgery, so doctors have the opportunity to explore the forbidden zone of life; The use of antibiotics makes bacteria have nowhere to hide, and wound infection can save lives without amputation; Evidence-based medicine (EBM) provides proven medical methods, which are more scientific and standardized in diagnosis, treatment and medication, and minimize iatrogenic damage; The side effects of drugs on the human body are getting less and less. Many diseases that were previously considered incurable can now be taken seriously. Only by improving the overall medical level can diseases be eliminated and the suffering of patients be alleviated. This is what the author wants to express, and the humanities accompanied by science are the real humanities.
What is a disease? In ancient times when medicine was underdeveloped, people with incurable diseases, especially those infected with serious infectious diseases, were considered possessed by the devil or condemned by the gods, and were likely to be burned to death or deported. At that time, the scientific and technological conditions were not enough to support people to form a correct understanding of diseases. Now, people can trace the cause, find the pathological basis of the disease, and really treat the "disease". Pay attention to the discussion of "disease" in the book, not "disease". For a long time, the one-size-fits-all treatment of headache and foot pain in western medicine has been criticized by many people. In technical terms, pain is a symptom, but it is not the cause. Symptoms are just a physical warning signal. For example, if a knife cuts a hand, it will bleed and feel pain, and people will retract their hands in time to avoid further injury. Another example is allergies. All kinds of uncomfortable reactions during contact make us automatically stay away from allergic substances, which is also the self-protection of the body, so we should treat the symptoms correctly and find the real pathogenic factors. Here, the author tries to convey the important idea of seeing the essence through phenomena. Why do we get sick? Bo Shining pointed out that to understand diseases, we must first understand the imperfections of the human body itself. Human genes are imperfect, and various genetic diseases such as thalassemia are related to genes. These pathogenic genes are passed down, and diseases are accompanied. Human organs are imperfect. For example, compared with other animals, human infancy is particularly long. Many animals can walk when they are born, and the newborn baby is very fragile and needs careful care; The adaptability of human body is not perfect. What we are now is the result of evolution. The environment is changing too fast, and the emergence of various new diseases is an example. The imperfection of evolution is the basis of disease. "I am here when I die of illness", and the journey of life is destined to be accompanied by illness. Chronic diseases are like this. There are no obvious symptoms in the early stage, and once found, it is already in the middle and late stage. Studies have proved that persistent Helicobacter pylori infection may lead to gastric cancer, and persistent high-risk human papillomavirus infection may induce cervical cancer. For more than ten years or even longer, the persistent injury of some tissues or organs of the body stimulated the compensation mechanism, and the undamaged part replaced the damaged part to complete the work, so that the human body could not perceive the difference. This brings us the enlightenment of disease prevention and treatment. First, it is necessary to screen diseases at an early stage. Cervical cancer screening can increase the early detection rate of cervical cancer by more than 8 times. Second, preventing diseases from the source or blocking them from the middle can effectively prevent the development of chronic diseases. Inoculation of cervical cancer vaccine can prevent human papillomavirus infection from the source, and infected people can take blocking measures. In addition to screening, the author emphasizes the need to establish a correct view of health. Human health can not be separated from the protection of its own immune barrier, and immunity is the internal logic of human health. We don't want to destroy all bacteria and viruses. On the contrary, we should live with them, exercise hard, improve the body's immune ability, and stay healthy after exposure to bacteria and viruses is the real health.
Is it necessary for an ordinary person to know how to cure diseases? Because of the complexity and professionalism of medical care itself, it is difficult to explain it clearly to foreign banks, so I only try to export it. The most important activities in the medical process are diagnosis and treatment. The author puts forward the following conclusions: diagnosis is a cycle of hypothesis and verification. In the face of brand-new diseases, doctors need to use their knowledge reserves and past experience to keep an open mind and judge the condition. Treatment is the interaction between medical goals and patients' needs. All efforts made by doctors are aimed at matching medical goals with patients' needs. Orthodontics is a typical case. The doctor's goal is to make the teeth tidy through medical operation, evaluate whether to extract teeth before correction, and achieve the "beautiful" effect that patients want as much as possible. At the same time, the role of medical activities is also inseparable from drugs. The curative effect of drugs is getting better and better, and the side effects on the body are getting smaller and smaller, which can also reflect the improvement of medical level. Quinine, a specific drug for malaria. People accidentally found that monkeys also have malaria. Monkeys with malaria will desperately eat the bark of a tree and eat malaria for a while. Later, people ground this bark into powder and made it into medicine. Quinine does have the effect of treating malaria, but it has great side effects. Eating too much will kill people. At that time, people only knew that bark could fight malaria, but its mechanism of action was not clear, and patients had to endure the side effects of drugs. Another example is the contraceptive pill, which has developed from a single photo to three photos now. The design of the three photos is more in line with the changing process of estrogen and progesterone in women. The overall progesterone is 30% less than that of a single photo, and there are fewer adverse reactions. Gleevec, a specific drug imported from India for the treatment of chronic myeloid leukemia in the famous movie Dying, compared with ordinary chemotherapy, the survival rate of patients receiving Gleevec increased to 89%. Before that, only 30% patients could live for five years. Scientists found an abnormal chromosome in the patient's tumor cells, which proved that this chromosome was related to the disease. The accurate pathogenesis was found, which made the appearance of Gleevec possible. Clinically, patients have good tolerance and high survival rate. This also shows that only with a deeper understanding of diseases can good drugs appear.
Why should we attach importance to public health projects? Respiratory diseases, digestive diseases and infectious diseases, two major systemic diseases, can be prevented by the simplest methods. Wearing masks, washing hands frequently, paying attention to personal hygiene and other repeated education, cleaning drinking water, cleaning the sanitary living environment, vaccinating and placing condom dispensers in public places can effectively reduce the occurrence of related diseases. Since the biggest black swan broke out in COVID-19 this year, people all over the country have to wear masks, but the incidence of seasonal respiratory diseases has unexpectedly dropped. People can't go out, and takeout can't be delivered home. Cooking by yourself not only improves cooking skills, but also reduces the incidence of gastrointestinal diseases. Public health seems simple, but it is not. Effective public health management can produce positive externalities, such as a person vaccinated, which not only protects himself, but also indirectly protects others. When most people in a system are safe, others will benefit even if they don't produce antibodies. Public health has positive externalities, the effect appears late, and the market does not provide enthusiasm. These characteristics determine that this public health project can only be provided by government agencies. Free mosquito nets and condoms, compulsory vaccination, centralized garbage disposal, water filtration system and tobacco control in public places are all for the health of the vast majority of people. Public health is called the most cost-effective health project by the author.
The following chapters, one chapter introduces the milestone of medical evolution, and the other chapter introduces big doctor who changed medicine. Vaccines, anesthetics, antibiotics, chlorpromazine for the treatment of mental illness, birth control pills and other inventions with great influence. I am proud to see that two of the six big doctor's medicines came from China, namely Lian Dewu and Lin. Lian Dewu, a government official in the late Qing Dynasty, studied in the West and engaged in the study of infectious diseases. A sudden plague in the northeast put him in danger. He did three things: control the source of infection, cut off the route of transmission, and protect susceptible people. In order to control the source of infection, soldiers went door to door to search for infected people and bodies. All the people were sent to the hospital, all the bodies were burned and buried, and all the houses were disinfected. Secondly, plague is spread through respiratory tract, so Lian Dewu took measures to reduce people flow and isolation, implemented strict traffic control, stopped the railway, isolated all arriving passengers for about a week, promoted the use of simple masks, and divided patients into severe, mild and suspected hospitals according to the severity of symptoms, and treated patients with different conditions separately to prevent cross-infection. In less than four months, there were no reports of plague deaths. The reason why this plague was grandly introduced is that it was the first successful case of controlling the epidemic by scientific means in China, and it is still sobering to read now. Lian Dewu's introduction of controlling the plague is exactly the same as that of COVID-19 this year. This shows the importance of scientific prevention and precise policy. The other person is the famous Lin, who is the only female doctor among the six people. It is said that Lin personally delivered 50,000 babies in her life, and was called "the mother of thousands of babies". She founded China Obstetrics and Gynecology Department, devoted her life to the medical career in China, and never married. Lin's love for medical career, tenacious character and her noble personality charm are deeply moved and admired.
The last chapter can be summarized as how to upgrade the doctor to fight monsters. As doctors, we often seek the optimal solution under the condition of incomplete information, and we must overcome irrational impulses and make the best decision. Time waits for no one, so we must quickly grasp the key points and take care of a patient as quickly as possible. This is the road to progress for every doctor. As a patient, actively cooperate with doctors, screen early and treat early, develop a healthy lifestyle, strive to improve the quality of life, and be the first person responsible for health. Because of health, life is infinitely wonderful. As described in Tagore's poems, life is as gorgeous as summer flowers and death is as beautiful as autumn leaves. This is the best destination in life.
Based on the basic principles of health and disease, this book quotes a lot of scientific data and documents, and expounds profound scientific principles in easy-to-understand language. From popular science to cognition, readers can learn many practical knowledge points and have a deeper understanding of diseases and health. There is no doubt that the author has made a successful and beneficial attempt in medical science popularization.
August 3, 20201