【科普文分享】【科學 Fact-Check 系列】陳雲博士「銀離子凝膠」ㅤ兼教如何評讀文獻/No Stake 醫學生
//主旨寫係開頭:唔識唔緊要,但唔該唔好侮辱科學、侮辱醫學。
早前陳雲博士喺 Facebook 推廣發售一隻「銀離子超長效洗手凝膠」,指有「強大消毒效力」,可以「消毒手部,形成防護膜」、「直接噴於口罩」、「抑制病菌滋生」。而 K Kwong 則質疑呢個嘢嘅效用同安全性,而今日再有 Facebook Page「學民苦主大聯盟」發文引用多篇論文去支持返 Dr. Wan Chin 嘅產品。我今日先見到有單咁嘅事,姑且同大家一齊審閱一下相關證據,分析下「銀離子超長效洗手凝膠」係咪真係有 Dr. Wan Chin 所講嘅「強大消毒功能」。
TLDR:乖啦,用返酒精搓手液啦。
「大聯盟」Page 引用咗十篇文獻。喺實證醫學中,我地要去評讀一份文獻係咪真係佐證到呢個 treatment 或者 intervention 係真係「有用」,要睇幾樣嘢:Relevancy、Reliability、Validity、Applicability。
長話短說,「大聯盟」Page 所引用嘅文獻,全部都唔 relevant,同要探討嘅問題根本無關係。第一關都過唔到,所以絕不能用嚟佐證陳雲博士嘅「銀離子超長效洗手凝膠」真係有用。點樣先叫 Relevant?有所謂嘅 PICO question,要比較文獻中嘅研究入面四樣嘢係咪我地想探討緊嘅問題中嗰四樣嘢:
1) P for population:研究對象、目標對象
2) I for intervention:研究中嘅措施/治療/藥物/做法
3) C for comparison:我地用呢個 intervention 相對咩其他選擇去比較
4) O for outcome:我地想透過呢個 intervention 達到咩效果
我諗我地應該有嘅 PICO 係如下:
Population:陳雲博士冇講明「洗手凝膠」係針對比邊種人用,我當係任何人男女老幼都用得,都納入 population 中啦。
Intervention:佢發售緊嗰隻「銀離子超長效洗手凝膠」
Comparison:相比起唔用任何「搓手液產品」或者普遍酒精搓手液,效用為何。
Outcome:有冇「強大消毒效能」。我相信而家做呢啲產品促銷,重點都係要對抗武漢肺炎,所以必不可少除咗消滅細菌嘅能力,更加要 assess 埋佢消滅病毒嘅能力啦。
幾篇文獻:
一)“Trial of Silver Nitrate ... for the Prevention of Conjunctivitis Among Newborns”
P: 啱啱出世嘅 newborn 嬰兒,太狹窄,唔 relevant。
I: Topical Silver Nitrate Eyedrop,研究緊攞嚟滴眼嘅硝酸銀溶液,同「搓手凝膠」完全係兩回事,錯。
C: comparing with erythromycin,研究中係同抗生素 Erythromycin 比較,你會唔會用抗生素搓手先,又錯。
O: 研究中討論出現眼睛結膜炎、同鼻淚管阻塞嘅頻率,我想問又同「搓手凝膠」有咩關係呀???
二)“Dressings and topical agents for treating venous leg ulcers”
問題大同小異,你用含銀敷料對促進隻腳部潰瘍癒合嘅文獻,去討論「搓手凝膠」喺完整皮膚上面嘅消毒能力,兩件事係完!全!唔!關!事!呀!
三)“Silver: water disinfection and toxicity”
呢篇係討論緊用銀作水源消毒,特別係飲用水嘅消毒,又係唔關事。
醫學、科學係好嚴謹嘅一件事,呢個係點解我地係「專業」嘅原因。我地唔係「差不多先生」你唔好嘗試去同我拗「減低鼻淚管阻塞」、「促進腳部潰瘍癒合」、「飲用水消毒」,同「潔手效能」差唔多,唔好嘗試用 Topical silver nitrate 去證實嗰隻「銀離子超長效洗手凝膠」有用。我地做醫學研究嘅,就係差之毫釐,謬以千里。藥理學上,同一隻藥,經唔同 dosage route 去比(口服、靜脈注射、肌肉注射、皮下注射)可以有完全唔同嘅效能,藥份濃度稍稍唔同,喺人體上嘅反應都係可以有好大分別。箇中科學理論,你行外人唔明唔緊要,但唔該唔好班門弄斧,攞啲完全唔關事嘅論文出嚟講。唔好侮辱醫學、侮辱科學。
再者,所引用嘅文獻係咪真係講到銀咁有用?
一)“Conjunctivitis” 論文:“However, the effect was modest and against microorganisms of low virulence. The results suggest that parental choice of a prophylaxis agent including no prophylaxis is reasonable...” 成效只係 modest(唔太多),而主要只係針對比較致病力低嘅微生物(low virulence),所以結論係就算唔用呢隻 eyedrop 都係合理選擇(no prophylaxis is reasonable)。題外話,最新證據 silver nitrate eyedrop as prophylaxis for neonatal conjunctivitis 容易引致 chemical conjunctivitis(化學性結膜炎),所以已經好少人用嚟做 prophylaxis 你又知唔知?
二)“Dressing” 論文:“Silver dressings may increase the probability of venous leg ulcer healing”,“However, ... we cannot be very confident about any conclusion” 睇清楚啲,係 may,「可能」促進癒合,係唔能夠有任何確切結論呀。
三)“Silver: water disinfection and toxicity”:“The efficacy of silver, especially in terms of drinking-water disinfection, is currently a long way from convincing.” 又一次,現時證據不足,亦提及大部份研究只聚焦係細菌、甚至只係大腸桿菌,唔夠全面。
再一次重申:科學證據係好、好、好嚴謹嘅一門學問,唔該唔好喺一篇論文見到一兩個個別數字符合你嘅主張就斷章取義攞出嚟講。唔係一個數字大過另一個就係嗰樣嘢有效啲,我地要睇統計學、要睇各種影響因素,先有結論。以上我 quote 呢三段都係文獻中嘅 conclusion 部份所落嘅最後結論,而唔係斷章取義。
寫咗兩個半鐘去睇返啲文獻再寫咗二千字,我都覺得自己嘥時間,但我寫係因為我真係接受唔到有人打住「科學」嘅名號,去侮辱科學,侮辱我地嘅專業。我地用咁多年嘅時間去認真鑽研點樣 appraise 一份 evidence,點樣去做好研究。好似早前我啲同學整酒精搓手液派街坊都用哂專業化學儀器,將成份計到一分一毫都絕對準確,就係因為我地嚴謹嘅精神,知道關乎大家健康嘅事我地唔會輕率看待。我喺呢個 page 鬧過元秋蒸口罩,評論過朱凱廸布口罩效用欠佳,到今次一樣,係唔想見到人得到錯嘅資訊。
我接受唔到人隨便攞支「銀離子超長效洗手凝膠」,quote 幾篇唔關事嘅論文,就用嚟同無知婦儒去佐證呢支嘢真係某程度上代替到洗手或者酒精搓手液嘅功效。比人呃錢事少,影響到健康事大。
宗教團體就做返宗教團體嘅事,你地相信開壇作法可以請到大鵬鳥嚟抗疫我唔理你,我亦都唔會嘗試反駁,因為呢啲係你地嘅專長。但更加希望大家學識尊重科學、尊重醫學,呢個係我地嘅專業,唔好平時就大講陰謀論鬧人「醫學霸權」,想賺錢時又亂用醫學研究斷章取義。再講多次,我唔會接受人咁樣侮辱我地,我再嘥時間我都會打咁樣一篇文反駁。
講完,以下開放你地鬧我。:)//
modest醫學 在 余海峯 David . 物理喵 phycat Facebook 的精選貼文
【科普文分享】再證食維他命 D 補充劑預防骨折無用!/Little fat ball
//香港骨質疏鬆學會去年曾發表數據指,現時香港每年有 9,590 個骨質疏鬆新症,涉及的醫療費用高達 6.6 億,隨著人口老化,到 2050 年每年骨質疏鬆新症將會升至 2.7 萬多宗,所需醫療開支更會高達 19 億,骨質疏鬆造成骨折毫無疑問將會成為更多人注意的公共健康問題,影響著社會與經濟。很多人為了預防骨折,都會服食維他命 D 補充劑加強吸收鈣,但這又真的有效護骨嗎?
近年已有多個研究已指維他命 D 補充劑無甚用處,例如去年刊於《刺針》的大型審視報告明言[1] 維他命 D 補充劑不論高或低劑量也好,也無法預防食用者減低骨折機會或增加骨骼中的礦物密度,全球各衛生機構可能需要更改現有指引。
上周刊於《美國醫學會雜誌 Network Open》的審視報告 [2] 亦再確認類似說法,指單獨服食維他命 D 補充劑未能預防老人家骨折風險,相反同時服食鈣與維他命 D 補充劑則有適量 (modest) 的護骨作用,可減少 16% 髖部骨折風險,其他骨折風險則可減約 6% 。
長久以來,營養學界都知道鈣與維他命 D 對維持骨骼健康非常重要,但強調是從日常膳食中攝取。就鈣而言,自然是吃多點奶類製品如芝士、乳酪等,但維他命 D 在其他食物中較為少見,最好的攝取方法是曬太陽與吃三文魚等脂肪較多的魚類。
問題是,超過 66% 港人每日逗留於室內 6-10 小時,且絕大部份都怕曬黑,身體難以透過曬太陽製造足夠維他命 D [3] 。怕不夠維他命 D ,可每周至少兩次在上午 10 時至下午 3 時在陽光底下露臉、手臂、雙腿位置曬 5-30 分鐘就可以,不過記住別塗上防曬產品,以免皮膚接觸不到關鍵的紫外線。
過去醫學界亦建議大家要定期做負重運動幫助維持骨骼密度、增強肌肉力量與改善平衡,有助於降低跌倒的風險。另外,亦應減少過量攝取酒精,以及不要抽煙避免骨質流失。
牛津大學流行病學與公共衛生醫學教授 Robert Clarke 領導的團隊審視了 28 份研究,其中 11 份為觀察性研究,追蹤老人家 5–15 年內的骨折比率,並發現血液維他命 D 水平較高的人士較少出現骨折。不過要留意兩者並不一定是因果關係,高血液維他命 D 水平可能只是其他活動造成的現象,例如這批人可能本身有多點戶外運動,自然有更高的骨骼密度與維他命 D 含量。
另外 17 份被團隊審視的報告, 11 份只測試維他命 D 補充劑,其餘 6 份則測試同時服食鈣與維他命 D 補充劑的骨折情況;全部接受研究的人士均為 62–85 歲老人家,他們都被追蹤最多 5 年。整體而言,同時服食鈣與維他命 D 補充劑的人比服食安慰劑或無服食任何補充劑的人髖部骨折風險減 16% ,其他骨折風險則可減約 6% 。
講這麼久,大家最關心還是:到底如何知自己不夠維他命 D ?當然是要去做個身體檢查喇!如果真的發現有缺乏維他命 D ,又因其他健康問題不能曬太陽,才考慮服食補充劑吧!//
modest醫學 在 玳瑚師父 Master Dai Hu Facebook 的最佳貼文
【玳瑚師父客人見證】《非一般的餐會》
The Extraordinary Meal Session (English version below)
文 / 蔡豪華 Written by Louise Choy
首先,我要感謝玳瑚師父慈悲允許我出席這次寶貴的餐會。我本身對玄學有錯誤的觀念,選擇了隨波逐流,大家信什麼,我就跟著信。但那晚的餐會讓我茅塞頓開,像一道光明把我心中的疑团驅散,敞開了我的心房,去愛地球上的每一個生命,從细小的螞蟻到另一個人。我也學到我們的每一句話,每一個動作,都會產生相對的效果,影響著我們的健康。
據報導,癌症是我國的首號殺手,也是最耗金錢的病症,因為化療和電療都非常昂貴。我在大學時期曾經與癌症病患接觸,目睹了他們接受治療時的痛苦。他們經歷身心靈的巨變,讓我看了很心痛,聽到他們在化療時所發出的痛苦呻吟聲,我有時更會淚眼盈眶。我當時很想為他們做點什麼。這些病患和他們的家人還得面對金錢和精神上的壓力,苦不堪言。但僅管醫生盡了全力去拯救,也會有病人的病情毫无改善。
所以我會想,除了醫藥治療,我們還能如何幫助癌症病患或預防癌症呢?這些年我得到的答案,包括養成健康良好的生活習慣及基因遺傳。良好的生活素質能夠避免疾病,這是無可置疑的。可是這些就能保證我們不會患癌嗎?我有一位親戚,他平時不抽煙喝酒,天天跑步運動,飲食也非常健康,但最後還是患癌。他家族也沒有患癌的前科,你可以想像我們接獲這消息後的訝異。
其實要避免患癌,就必須把視野擴大去探討科學、人體運作及醫學之外的領域。參研居家風水及八字命理,和我們平日的作息,是確確實實能夠幫我們抗癌的。我就在昨晚找到了答案。請相信我,玳瑚師父所給予我們的教導,讓我思考了很久才能夠「消化」,內容浩瀚,但非常值得我們去學習和廣傳給那些有需要的人。
玳瑚師父不單單講解有關抗癌的訊息,也包括其它的疾病,如男性健康、女性健康、腦中風、心臟病、等等。讓我記憶最深刻的是,師父告訴我,我家裡隱藏了一位就連我都沒有發覺的「靈異朋友」。我向鄰居的傭人打聽這屋子的歷史後,才驚覺師父果真料事如神。
我照著師父的建議去做,就再也沒有在半夜三更聽到傢具移動和牆壁敲擊的聲音了。
我非常感激他給我指點迷津,也很慶幸能夠出席師父的餐會,有緣分認識這位謙虛和踏實的師父。
如果師父再辦另一個餐會,我鼓勵大家出席,並持著一個開通的思維以及尊敬的心。最後,希望大家獲益後,要將愛分享出去,給您的至親至愛,不認識的人,甚至自己的敵人。:)
……………………
First of all, I would like to thank Shifu Daihu for his kind and compassionate heart to allow me to attend such precious tea session with him. I am someone who does have misconception what chinese metaphysics is all about and go by the cookie cutter (meaning whatever the mass choose to follow to believe in, I will follow to believe). But after this tea session, it opens up my mind like a big parachute and shifting my heart to love all beings on earth e.g from tiniest ant to human and be mindful of our words and actions that can create cause and effect which eventually lead to health problems.
As mentioned, cancer is one of the common disease in Singapore and considered one of the most expensive disease to treat or cure e.g requires costly chemotherapy and radiotherapy. I have worked with cancer patients during university days and had witnessed cancer patients going through cancer treatments. The psychological and physical changes in a cancer patient is drastic and painful to watch. Sometimes, I teared silently to myself whenever I saw patient moaning and groaning in pain during chemotherapy. I told myself I wish I could do more for these people. Not forgetting, the financial and emotional stress put on their families can be too heavy and draining to bear. There also come to a point where doctors have exhausted their medical expertise and have done everything they could to save a cancer patient but still, there are no signs of cure or improvement.
So I wonder - Beside medical treatment, what else can be done to prevent or help a cancer patient? Well, the answer I have got over the years range from adopting a healthy lifestyle or genetics. Yes no doubt, a healthy lifestyle does play a part but what if someone who leads a healthy lifestyle, and still stricken with cancer? One of my relatives who doesn't smoke, jogs and exercises everyday. He eats healthily but in the end he was stricken with cancer. Also, his family has no history of cancer. Imagine seeing our shock expression when we came to know he has got cancer.
Well, the answer to prevent cancer goes beyond the surface of understanding of how our body works, scientific and medical way. But rather understanding of our home Fengshui, Bazi and our daily actions do play a part in cancer prevention. So last night, I found the answers and trust me, it took me awhile to digest the lessons given by Master Dai Hu, it was overwhelming but yet worthwhile for us to learn and pass the message to others who needs it.
Master Dai Hu not only covered the topics on cancer but also other health issues ranging from women and men health, stroke, heart disease and many more. One particular insight Master Daihu gave me was that something (a ghost) existed in my house which I wasn't aware of and he nailed it 100% with accuracy (I verified my house's history with my neighbour's maid) !
I followed the advice of Master Dai Hu and the mysterious noises from the movement of furniture and banging of the wall just disappeared without a trace.
I am so grateful that he pointed it out to me! I never regret coming down to attend his tea session and felt so blessed to know this down to earth and modest master.
Come and attend his next tea session if there is. Go to him with an open mind and with respect. Last but not the least, don't forget to spread love to your loved ones, strangers and even enemies once you leave the tea session. :)
www.masterdaihu.com/非一般的餐會/
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