5-min read: Coffee with Uncle Reggie: “Physician, heal thyself.” (URS)
与曾叔叔喝咖啡闲聊五分钟:“医生,先治好你自己吧。” (Andy/sm 翻译)

A half scald design. One day in medical school, I spilled boiling water on my foot, which instantly looked like it was going to develop a plum-sized scald. I had just finished hearing a physiology lecture on the remarkable discovery of antihistamine, and the later invention of the worldwide-popular drug Benadryl, based on this discovery.
半个烫伤的设计。我还在医学院的时候,有一天,不小心把开水洒在脚上了,上面立刻出现了一块梅子般大小的烫痕。 当时我正好刚听完一个生理学讲座,内容是关于抗组胺药的伟大发现,以及之后在它基础上发明的全球广泛使用的药物苯海拉明(Benadryl)。

Suddenly in my mind I thought, “This is perfect. Doesn’t a scald always involve histamine release in the skin? And the swelling and bubble blister of scalding likely are related to histamine release? Maybe I can prevent all that with this relatively recent invention.
突然间我有了一个想法:“太好了!烫伤难道不就是会引起组胺在皮肤里的排放吗?而且因烫伤而起的水泡很可能跟组胺排放有关系。也许我可以用这个新发明来防止这一切的发生。

Photos 1A and 1B: Dr. George Rieveschl’s discovery of Benadryl solved half my scalded skin problem.

I was excited to immediately apply this “insight” and, not knowing any better, I decided I would do an instant experiment on myself. It was a “Why not?” kind of a decision. But I knew enough about the value of a controlled study by that time, so I put the Benadryl on only one half of the scald.
我兴奋地想马上把这个“灵感”实践起来,却不知道怎么做更好,便决定立即在自己身上试验一下。那是一种“为什么不?”类型的决定。不过,那时候我已经足够了解对照试验的重要性,于是把苯海拉明只抹在了一半的烫伤处。

And lo and behold, the next day, sure enough, the half that had the Benadryl had no swelling at all, whereas in the other, untreated half there was a beautiful half blister. It was quite astonishing to me, as it was the first controlled study I ever designed and executed! The first of many others in my life.
结果,第二天有苯海拉明的那一半果然一点都没肿,而另外没有治疗的那一半起了漂亮的半块水泡。这很让我震撼,因为这是我首次设计并实施的对照试验!在我一生中做过许许多多的试验里,这是第一项。

Photos 1A and 1B: Dr. George Rieveschl’s discovery of Benadryl solved half my scalded skin problem.

The inventor of Benadryl. Years later, I had the honor of giving the award lecture at a University of Cincinnati special award to Dr. George Rieveschl, the inventor of Benadryl. In my speech to the captive audience and to him , including Dr. Rieveschl, I told the story of how, thousands of miles far away in Hong Kong, I had heard the story of the dramatic discovery of antihistamine, and his later Benadryl invention, and had immediately applied the knowledge. Even though at the time there was no study that I knew of about its use in burns or scalds. I don’t think I had met Dr. Rieveschl before, and he had never heard my story. He was very amused by it, and wrote me an appreciation note. (See Photo 1.) Disappointingly, I discovered from him that apparently no one had actually followed up on my “earth-shaking discovery”. I’m still waiting for some enterprising researcher to do that!
苯海拉明的发明人。多年之后,当辛辛那提大学给苯海拉明的发明人George Rieveschl医生颁奖的时候,我很荣幸做颁奖演讲。我给包括Rieveschl医生在内的听众们讲述,我如何在千里之外的香港,听到了令人兴奋的抗组胺的发现以及随后的苯海拉明的发明故事,并且立即把这些知识应用起来,虽然我当时从未听说过苯海拉明在烫伤方面使用的相关研究。在此之前,我没有见过Rieveschl医生,他也没有听过我的故事。听完故事之后,他觉得很有意思,就给我写了一份便签表达他的赞赏 (见照片一)。遗憾的是,我从他那里得知,没人跟进过我的“惊天的发现”。我现在依然还在等待一个敢于创新的研究员来继续跟进!

我们有两只眼睛。我在辛辛那提大学的医学院上班时,有一位资深的眼科同事做出了一件令人震惊的事。他发明了眼睛手术的一种新技术,接着他用自己的一只眼睛来实践。这引起了不小的轰动,也在辛辛那提的主要新闻报纸上成了头条新闻。

Photos 2A and 2B: We have two eyes. A bold ophthalmology (eye) professor curiously viewed the opportunity, and operated on one of his own two! One eye diseased and two eyes pretty.
照片2A和2B:我们都有两只眼睛。一名大胆的眼科教授好奇地看到了这个机会,他在自己的一只眼睛上做了手术!一只得病的眼睛与两只漂亮的眼睛。

Quite shocking, but then on second thought, “Why not?” If he was going to operate on others, why not on himself?! He had two eyes, so there was some kind of experimental control. He could also see with the other eye during the operation. And even if, God forbid, something went wrong, he had one backup eye! That’s why God made two.
这的确很让人震惊,不过转念一想,“为什么不?”。他既然会在别人身上做手术,何不在自己身上做呢!?他有两只眼睛,可以在实验中做对照。他在给一只眼睛做手术的时候还可以用另一只眼睛看东西。即使出了事,他还有一只备用的眼睛呢!这正是为什么上帝给每个人创造了两只眼睛。

He did what? We were all amused and awed in medical school when we read about a most famous self-experimenter, Dr. John Hunter, who inoculated himself with syphilis in order to study it! Syphilis! We thought that was outrageously bold, and I had not known of anybody with similar guts! But it made medical history for sure.
他到底做了什么?在学医的时候,我们读到一位很知名的自我实验家John Hunter医生,让我们感到即好玩又敬畏。他为了研究梅毒,居然给自己接种!梅毒!我们觉得这种做法是无比大胆的,我之前都不知道还有如此有胆识的人!无论如何,这在医学界里确实成了历史性的事件。

Photos 2A and 2B: We have two eyes. A bold ophthalmology (eye) professor curiously viewed the opportunity, and operated on one of his own two! One eye diseased and two eyes pretty.
照片2A和2B:我们都有两只眼睛。一名大胆的眼科教授好奇地看到了这个机会,他在自己的一只眼睛上做了手术!一只得病的眼睛与两只漂亮的眼睛。

Actually, the more complicated story is that he thought he was studying gonorrhea transmission, but it turned out the pus sample he used was contaminated by syphilis. Gonorrhea or syphilis, I’m not sure either is genteel.
其实,这个故事比较复杂的版本是,他原来想研究的是淋病的传播,但结果他用的样本被梅毒沾染。反正,不管是淋病还是梅毒,都给人不太雅观的感受。

The Brits have Shakespeare. The medical books we read then were British, and the Brits loved to tell little stories of medical history mixed in with medicine or surgery. The stories were usually much more interesting than the medical text, and I loved to read them, often before I read the boring stuff.
英国人有莎士比亚。当时我们所读的医学书籍都来自英国。英国人很喜欢在医学或手术知识中间加添一些医学历史的小故事。这些故事通常比医学知识本身更有意思,我很喜欢,所以往往先看完它们,之后再继续读那些晦涩的部分。

You don’t really see that in American medical books, which tend to be very dry and technical. In my own writings, however, in American books on pediatric nutrition, I also tried to introduce good stories. This was quite unusual for America, but I think it did liven up the books! Although I never had a story quite as dramatic as Dr. Hunter’s.
在美国的医学书籍里基本上见不到这样的故事,它们通常很枯燥而专业。我自己在写作美国的有关儿科营养的书籍时,尝试着引入一些好故事。这种写作手法在美国不太常见,但我认为这样做会使那些书生动起来!虽然我自己并没有像Hunter医生一样戏剧性的故事发生。

A cowpox child. Self-or family experimentation by medical doctors actually has a long forgotten history and is probably not as horrific as it sounds! The legendary smallpox vaccine inventor, Dr. Jenner, dramatically (and safely) inoculated his family gardener’s 8-year-old son with cowpox when he was experimenting with his smallpox vaccination strategy.
牛痘孩子。实际上,医生拿自己或家人来做实验有着早已被人遗忘的历史,或许这件事并没有听起来那么恐怖!天花疫苗的传奇发明人爱德华·詹纳(Edward Jenner)医生在研究天花疫苗接种策略的时候,大胆地(同时也安全地)给自己家园丁八岁的儿子接种牛痘。

It was a breakthrough success, but it was certainly a hugely bold move. If you can’t do it on yourself, at least an “extended family member” is a reasonable surrogate, I guess! I’m pretty sure no one signed official “consent for medical experimentation” legal papers then, whether family or not.
那一次是一个突破性的成功,但做法确实非常大胆。如果不能在自己身上做,一个“大家庭的成员”至少可以当合理的代替者吧!我敢说,当时谁都没有在什么正式的“知情同意书”这类法律文件上签名,无论参与者是否是家属成员。

“Physician, heal thyself.” During the COVID-19 crisis, it was a bit surprising that a large number of medical health professionals did not take the vaccine when it was first available. About 50% of the entire staff at “my” children’s hospital initially declined. That does make it quite difficult to convince the general populace, when even highly respected healthcare professionals do not want to take it.
“医生,先治好你自己吧”。新冠肺炎疫情期间,有大量的医疗专家没有第一时间接种疫苗,这让我有些惊讶。我之前工作过的儿童医院里,大概有一半的员工最初都拒绝接种疫苗。如果连受众人尊敬的医疗专业人士都不愿意接种疫苗的话,那么要说服普通大众就更困难了。

Photos 3A and 3B: Skin has many opportunities to do “controlled” studies. At the minimum you can photograph the course of treatment readily! The differences before and after might be due to an X Factor. (See text). So far, trying to kill moles like this has been only roughly 50% successful. I think I’m giving up on this study.
照片3A和3B:在皮肤上有很多机会可以做“有对照的”研究。最起码你能很方便地把疗程拍摄下来!前后的区别可能是因为X因素(见正文)。目前为止,尝试除掉这种黑痣只得到了50%的成功率。我想我该放弃这项研究了。

So the lesson could easily be, “physician, heal thyself”; otherwise, don’t try to heal me!” Or, to “the authorities”, please convince the hospital staff first, before imposing the vaccine on the rest of the country.
所以,人很容易得出这样的结论:“医生,先治好你自己吧”,否则别来治疗我。或者对“当局”来说,在推行全民免疫之前,请先说服医护人员吧。

“Can I ask you a question?” Although some people think it’s not a fair question, I personally think that asking your doctor or other responsible health professional directly something like, “If it was your child, would you do x, y and z?” is a reasonable question. It’s safe to assume that if the health professional himself wouldn’t want that treatment for his own child, maybe I should reconsider the issue!
“我可以问你一个问题吗?”虽然有人可能觉得,向你的医生或其他医疗专业人士直接询问:“如果是你自己的孩子,你会选择做甲、乙和丙治疗吗?”之类的问题是不太合理的,但我个人认为提出这个问题在情理之内。我们可以认定,如果这位专业人士不想在自己孩子的身上进行该治疗,那我可能也应该重新考虑!

Be careful, be skeptical. Recently a family member decided to have acupuncture treatment for a very painful hip problem. She had suffered for a week, but found no relief and had to rely on pain medications. As often happens, especially if you’re Asian, she was convinced to go to an acupuncturist and, sure enough, within 12 to 24 hours she was better, and by 48 hours she was back to normal.
要谨慎,要持怀疑态度。最近,我的一个亲戚决定做针灸来治疗很困扰她的腰疼。她的腰已经疼了一个星期,一直没好,只好依靠止痛药。之后发生的事很常见,尤其在亚洲人当中:她被说服去做针灸。果然,在十二个到二十四个小时之内她感到好多了,四十八个小时还没到,她已经恢复正常。

I’m a skeptic about acupuncture, since the scientifically controlled studies that I have read have been somewhat unconvincing. It seems many of them have benefited from the famous placebo effect where if you do something novel, it often seems to get better!
我对针灸是持怀疑态度的,因为我读到过的对照试验比较缺乏说服力。其中很多看起来好像利用了众所周知的安慰剂效应,就是说当尝试一种新的治疗方式时,患者常常会感觉病情有所好转。

However, I’m also open-minded, so while I was impressed this time, I made a suggestion. The next time she had some problem like that, try to make it the control group and do nothing. For example, don’t have acupuncture for 2 weeks, thus going beyond the one week in her first experiment, and see if maybe it’s just the effect of time. If she can tolerate the pain. I don’t think I convinced her.
当然,我也是一个思想开明的人。所以,我虽然这次被打动,但还是提出了一个建议:她下次遇到同样腰疼的问题时,应该什么都不做,来比较一下结果如何。比如说,两周之内不要做针灸,超过她第一次腰疼试验的一周时间,看看是否只是时间的因素使她恢复正常。只要她忍受一下疼痛。不过,我好像没有能成功地说服她按我的方法去试一下。
Skin options. In the last few years, mostly for fun, I experimented on a skin condition I had, called seborrheic keratosis, a kind of a black mole. Iodine is a nutrient and antiseptic. But any foreign agent used too much will often poison what it touches. What if I used it to poison my seborrheic keratosis, since I could easily dab it onto my lesions?
皮肤治疗法的点选。我患有一种名叫脂溢性角化病的皮肤病,类似一种黑痣。近几年,我常拿它来做实验,主要是为了取乐。碘是既可以当营养剂也可以当消毒剂的。可是,任何外来药剂的过度使用通常都会让它接触的东西中毒。那么,因为很容易直接把碘擦在皮肤的病灶上,我是不是可以以毒攻毒用碘来治我的脂溢性角化病呢?

Photos 3A and 3B: Skin has many opportunities to do “controlled” studies. At the minimum you can photograph the course of treatment readily! The differences before and after might be due to an X Factor. (See text). So far, trying to kill moles like this has been only roughly 50% successful. I think I’m giving up on this study.
照片3A和3B:在皮肤上有很多机会可以做“有对照的”研究。最起码你能很方便地把疗程拍摄下来!前后的区别可能是因为X因素(见正文)。目前为止,尝试除掉这种黑痣只得到了50%的成功率。我想我该放弃这项研究了。

To my surprise, it did seem to work, especially when the lesion was just developing. However, as I tested more skin lesions, the results became weaker and weaker. Oh well, that’s why it should be studied!
令我惊讶的是,好像真的有效果,特别是病灶刚开始发展的时候。可是,当我在更多病灶上做试验时,结果却越来越微弱。好吧,这就是为什么我们需要做更多研究!

Plus, I worried that with increasing doses I might poison myself, since any products even on skin might in theory gradually seep into my blood and body! Games of self-medication can indeed be dangerous.
另外,我担心随着剂量逐步增大,我有可能会中毒,因为任何药剂,即使擦在皮肤上,理论上都可能逐渐渗到我的血液和身体里!自行服药的做法确实比较危险。

And, for me, maybe I could even lose my medical license!? Except I don’t really have a license to lose anymore, sorry. (Recently, I sadly and officially handed in my medical license, after many decades).
而且,对我来说,我的做法有可能导致我甚至失去行医执照!?只不过,我已经没有什么执照可以失去了(很可惜,我最近把用了几十年的行医执照正式上交了)。

The X Factor. The X Factor can be described as a variable that could have the most significant impact on outcome. Remember the fantastic healing processes in all parts of our body, to constantly heal it? Otherwise, any little injury or even little germ could literally kill us. This “God Factor” is obviously wonderful, but it is a critical X Factor which needs to be factored into any research. Otherwise, it can ruin your research.
X因素。X因素可以描述为一个对结果最有影响力的变量。你记不记得我们身体的每个部位都有着神奇的愈合机制在不停地运作?否则,任何一个小创伤或者小小的细菌都有可能使人致死。显然,这样一个“上帝因子”很奇妙,但它同时也是一个关键的X因素,在任何研究中都需要被考虑在内。否则的话,这个因子足以毁掉你的研究。

Based on my own intense research background, I am a firm admirer of the classical “randomized controlled trial” of carefully treating half, compared with not treating the other half of any population being studied. Often considered the ultimate gold-standard study, which can help factor out any “God effect”, which in theory should be present in both groups, sort of equally.
基于我自己深厚的科研背景,我是“随机对照试验”的坚定支持者。研究对象种群的一半接受细致的治疗,而另一半不接受任何治疗。这常常被看作研究中的终极黄金标准,有助于把任何“上帝因子”排除在外。因为理论上,“上帝因子”这个因素在两组中出现的几率是一样的。

And next time you scald yourself, just treat only half the scald!
所以,你下次烫着自己时,只治疗一半的烫伤吧!

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