Heart Disease: Treat or Prevent?

One of the greatest killers in the Western world is heart disease. The death rate from the disease has been increasing at an alarming speed for the past thirty years. Today in Britain, for example, about four hundred people a day die of heart disease. Western health-care systems are spending huge sums of money on the surgical treatment of the disease.

This emphasis on treatment is clearly associated with the technological advances that have taken place in the past ten to fifteen years. In this time, modern technology has enabled doctors to develop new surgical techniques and procedures. Many operations that were considered impossible a few years ago are now performed every day in U.S.hospitals. The result has been a rapid increase in heart surgery.

Although there in no doubt that a large number of people benefit from heart surgery, critics of our health-care systems point out that the emphasis on the surgical treatment of the disease has three clear disadvantages. First, it attracts interest and financial resources away from the question of prevention. Second, it causes the costs of general hospital care to rise. After hospitals buy the expensive equipment that is necessary for modern heart surgery, they must try to recover the money they have spent. To do this, they raise costs for all their patients, not just those patients whose treatment requires the equipment. The third disadvantage is that doctors are encouraged to perform surgery - even on patients for whom an operation is not at all necessary - because the equipment and surgical expertise is available. A federal government office recently said that major heart surgery was often performed even though its chances of success were low. In one type of heart surgery, for example, only 15 percent of patients benefited form the surgery.

In the recent past, medical researchers have begun to emphasize the fact that heart disease is associated with stress, smoking and a lack of exercise, and we can often reduce the risk of heart disease by paying more attention to these factors.

More and more people are realizing that there is a connection between heart disease and the way they live. As a result of this new awareness, attitudes toward health are changing. In the past, people tended to think that it was sufficient for good health to have a good doctor who could be relied on to know exactly what to do when they became ill. Now they are realizing that merely receiving the best treatment for illness or injury is not enough. They are learning that they must take more responsibility for their own health. Today many people are changing their dietary habits and eating food with less fat and cholesterol. Many are paying more attention to reducing stress in their lives. The number of smokers in the United States is now far below the level of twenty years ago as many people succeed in breaking the habit and as fewer people take it up. More and more people are aware of the benefits of regular exercise like walking, running, or swimming; some have begun to walk or ride bicycles to work instead of driving. Millions have become members of health clubs and have made health clubs one of the fastest growing businesses in the United States today. And now the beneficial effects of these changing attitudes and behaviors are beginning to appear: an encouraging decrease in deaths from heart disease.

有了病才去治還是沒病先預防?

心臟病是西方世界的最大殺手之一。在最近三十年以前，心臟病的死亡率正在以驚人的速度上升。例如，今天在英國每天大約有四百人死于心臟病。西方的各級衛生保健機構在心臟病的外科手術治療方面正在耗費大筆的金錢。

這種老是強調治療的作法顯然與最近十到十五年內技術的進步有很大關系。在這一段時期內，現代技術使醫生們研制出了一些新的外科手術方法和程序。兩三年前還認為是不可能做的很多手術，現在在美國的各大醫院里每天都在做。其結果就使對心臟實行外科手術的病例迅猛地在增強。

盡管有很多人從心臟外科手術中得到了好處，還是不容懷疑的；但是，對我們的醫療保健機構提出批評的人士都指出，強調用外科手術治療心臟病的作法很明顯有三大害處。第一，這種作法使得人們在興趣和財力資源的分配上忽略了預防心臟病的問題。第二，這種做法導致了一般的醫療費用的上漲。各醫院都購置了從事現代心臟外科手術所必須購置的昂貴設備之后，這些醫院必須千方百計收回花費在這些設備上的購置費用，而不僅僅是提高了需要使用這些昂貴設備來加以診治的患者們的費用。第三個害處就是鼓勵醫生去開刀--甚至對那些根本不需要動手術的病人也給開了刀--因為，要弄到一張專家同意手術的鑒定書、要使用這些設備都是唾手可得的。美國聯邦政府辦公廳最近宣布說即使成功的機率很低也還要經常對心臟動用外科大手術。例如，有一種外科手術，只須15%的患者在手術后病情有所好轉。

最近這幾年醫學研究人員們開始強調這樣一個事實，即心臟病與人的精神緊張、吸煙成癖，缺乏鍛煉有密切關系，如果多加注意這些因素我們通常都能降低患心臟病的機率。

越來越多的人意識到人們的生活方式與心臟病之間有密切的關系。由于認識到了這一點，人們對待健康的態度正在轉變。過去多數人都有這樣一種看法：變為當人們生病以后，只要能有一位可以信賴的好醫生，這位醫生能確切地知道該怎么治，這對保障一個人的健康來說已經足夠了。現在人們認識到傷病以后僅僅能得到最好的治療是很不夠的。人們已經知道了自己應當對自己的身體更加負起責任來。今天許多人正在改變飲食習慣，人們都吃低脂肪低膽固醇的食物。許多人更加注意減少生活中精神緊張的壓力。美國現在吸煙的人數要比20年前少得多，因為有許多人成功地戒掉了這種惡習，還因為開始嘗試吸煙滋味的人也越來越少。還有越來越多的人嘗到了像走路、跑步、游泳之類的按時鍛煉的甜頭。有些人開始步行或騎自行車上班而不坐汽車。數百萬人已經成了健身俱樂部的會員，這就使健身俱樂部成為今日美國發展最迅速的行業之一。現在人們對待健康的態度的轉變，人們行動的轉變所帶來的好處已經開始顯露出來了：因心臟病致死的病例下降了，這使人們得到很大的鼓舞。