tag:blogger.com,1999:blog-10473901351021572362024-03-14T02:59:33.938-07:00巷仔口沒有精神醫學Ross Limhttp://www.blogger.com/profile/04834324679210414893noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-1047390135102157236.post-12304741651337994502017-09-02T02:22:00.000-07:002017-09-05T06:40:50.130-07:00醫師,加辣嗎?<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">林子勤/中山醫學大學附設醫院 精神科醫師</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">東森綜合台【醫師好辣】節目,在8/16播出主題為「醫界娘子軍崛起!男醫師慘兮兮?!」的內容,企劃標題則顯示為「特別企劃!男女醫師來PK,誰才是醫界TOP1」(1)。</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img alt="2017-09-02_142526.jpg" height="138" src="https://lh4.googleusercontent.com/U_ay_r2yE4oyECL_jjKfkV2diisOZkF9AOEDSqHdeJnCLrckAmQBJ4gGwcvWx1nHirQHop5CW7HvLU_tjmrfTu2wTXeTHfaNtSEMdZ7JzYZegNUMgYWQvyLEGhkFEICsbVhMKJJS" style="border: none; transform: rotate(0rad);" width="248" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">該集節目播出後,8/29一篇屬名「一群女醫師」的觀點投書刊登於風傳媒,標題為「女醫師對無稽之談的怒吼」,內文針對當天鄭丞傑醫師在節目上的發言提出反駁與抗議(2)。緊接著在8/31台灣女醫師協會於臉書發表聲明,同樣是對鄭丞傑醫師的發言提出抗議(3)。在9/2於該則聲明下方的留言處,則可看到名稱顯示為鄭丞傑的臉書帳號留言表示致歉(4)。</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span><br />
<a name='more'></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">沒有醫師是局外醫師</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">若沒有「一群女醫師」與「台灣女醫師協會」的抗議,該集節目的內容與鄭醫師的言論,或許就不會引起更大的注意。不過,該集節目播完之後,除了電視台重播之外,Youtube還可以無限次重播,很可能在接下來的數月數年裡,持續影響著任何看到該集節目的觀眾。</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> 令人擔心的是,若只有「一群女醫師」或「台灣女醫師協會」對該集節目中的鄭醫師表示抗議,那就無意中又重現、延續了「男女醫師來PK」的對立,讓討論的焦點持續鎖定在「男女二分」的競逐與對立之中。在相關文章下方的留言裡,也果真可以看到這樣的戰場被延續,持續進行男女PK的辯論,而且發言的主體也不限於醫師而已,連路過的網民也紛紛發表起他們的就醫經驗,辯論了起來。</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> 由此可以看出,這樣的節目企劃確實有其影響力。如果認為「那只是個綜藝節目,看看就好」或者「跟這樣的節目認真就輸了」,恐怕是低估了該類型節目的影響力。</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">打開電視看醫生</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">事實上,除了【醫師好辣】以外,在相同的時段轉台一下,你會看到更多的醫師坐在電視機裡面與你相見(例如:【健康好生活】、【醫定要知道】、【健康No.1】、【媽媽好神】等節目)。這樣的現象如何理解?也許每個人有不同看法。但令人好奇的是,醫師的養成教育中,是否曾經教過「如何在電視或媒體發言」呢?無論是否有教過,目前醫師在公共媒體或自媒體的發言顯然越來越重要,這一點可以從近年開設給醫師上的「個人品牌經營」及「簡報製作」課程越來越多可以略窺一二(5)。</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">社群媒體時代的醫病溝通</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b><br class="kix-line-break" /></b></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> 進入社群媒體的大平台時代之後,醫師跟大多數的公民一樣,也與患者一樣,一同進入一個隨時都在分享、隨時都在發言的年代。過去僅發生在診間、病房、社區等空間的醫病溝通,事實上已漸漸轉移到臉書、LINE、Instagram等等的平台上了。醫病之間的互動逐漸從face to face轉變成facebook to facebook。在這樣的大敘事年代中,醫師公開發言的機會與需求增加了,甚至有更多樣的機會與患者互動:無論是開「粉絲專頁」、開「直播」,或者像【醫師好辣】這個節目一樣開「粉絲見面會」(6)。</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> 這樣的互動,自然開啟了過去不曾有過的機會,但也衍生不少新現象。例如:在醫療糾紛發生時,醫師與患者相繼透過臉書公開發文回應對方;或者患者在自己的臉書或「爆料X社」等平台公開發表不愉快的就醫經驗,隨後引起醫療人員或路過的網民發表評論等等。無論是醫師或患者,可能都已習於透過大平台發表自己的難受想哭。這些現象都已超越社群媒體出現之前,那些傳統「醫病溝通」理論所能想像或理解之事。</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">藏在道歉啟事中的細節</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">若觀察近年醫師的公開發言,曾有一些在發言之後因各種狀況而必須道歉的例子。在那些道歉啟事中,往往可以看到一些細節,說明了一開始的發言在哪個環節出了問題。</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> 舉例而言,在2016年8月,心容中醫診所的洪心容醫師對於文章中寫到「十全大補湯簡直是旗艦版的肌瘤催生工具」而道歉,在洪醫師後來的道歉聲明中,提到了幾個環節(7):</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1. 這是衛教文章</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">2. 是個人的臨床觀點</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">3. 用了比較口語的誇飾文字</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">4. 加上部分媒體的斷章取義</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">5. 以致於造成各界困擾</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">6. 而我的本意是....</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> 在這份道歉聲明中,可以窺見在社群媒體時代醫師公開發言須注意的幾個重要環節,也恰好與社群媒體時代訊息流動的特質相互呼應。例如,在社群媒體時代的衛教文章,越來越強調口語化、親民化,甚至有「懶人包」、「扁平化的圖像」更好。為了加深印象,搭配「特殊的」或「罕見的」個人經驗或患者故事也是必備的要素;而為了與大量簡短的訊息競逐讀者觀眾的注意力,使用一些誇飾文字更是不可缺乏。最後,一旦文章或發言公開,被擷取部分內容再次分享傳播,也是無法避免的結果。至於文章或作者一開始的本意,自然就可能因以上問題而被模糊或必須重新澄清。</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">醫師,加辣嗎?</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">同樣地,此次鄭醫師在【醫師好辣】節目中的發言引起爭議,除了將關注焦點放在鄭醫師個人身上之外,更重要的也許是鄭醫師為何在那樣的節目中說出那些的話。只有他個人的因素嗎?或者還有其他因素?</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">用該節目的名稱來比喻:如果鄭醫師當天的發言很辣,是鄭醫師本來的意見就很辣,還是有被加辣呢?如果有加辣的話,那是小辣、中辣、還是大辣?</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">若說在「台灣女醫師協會」文章下方的留言確實是鄭醫師親自寫的道歉聲明(8),可以找找看有無相關細節,其中提到:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1. 由於求「節目效果」,包括我在內的所有的來賓都力求灰諧幽默。</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">2. 我和幾位男醫師扯到女住院醫師易不服指導、經前症候群容易情緒失控、體力較低⋯想製造誇大笑果</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">3. 加上我過度簡略舉例, 發言不夠審慎精確</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">似乎可以解讀,鄭醫師當天的言論是有加辣的,其中一個原因是求「節目效果」。</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">又一次,幾乎可以確認該節目的企劃是有影響力的。在主題設定好之後,上節目的鄭醫師就力求節目效果。而那一集要的效果是甚麼?再看一次該節目在Youtube的縮圖畫面,然後對比製作單位後來的說明(9):
</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">「對此《醫師好辣》節目製作單位也做出聲明,表示本集節目中是來賓們各自分享其經歷,討論男女醫師面對的各種狀況和甘苦,並透過對談來打破性別之偏見。而節目來賓們於節目中也一再強調所述為個人經歷及見聞,為個案或特例,並非醫界通則,實無任何性別歧視或不敬之意。」</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">儘管事後澄清並無此意,但在引起抗議之後,聯合報的報導標題為「婦科名醫性別玩笑開過火? 女醫師氣瘋了」(10)。這樣的標題會出現,應該是在該節目設定好要「男女PK」的主軸後,就註定會出現的結果了。</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> 這樣的節目追求的是甚麼樣的效果呢?在節目上發言的醫師追求的又是甚麼效果呢?兩者一致嗎?或者不一致?
</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>到底是誰加的辣?
</b></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> 鄭丞傑醫師在「台灣女醫師協會」粉絲專頁留言致歉後,仍有網友希望鄭醫師透過該節目致歉。不過,根據「鄭丞傑」帳號回覆如下(11):
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「</span><span style="font-family: "arial";"><span style="font-size: 14.6667px; white-space: pre-wrap;">事實上我已經多次向節目製作團隊反應希望有機會在節目上表示歉意
但是她們認為那一集絕大多數的觀眾反應都很好
因此目前仍未同意我的建議
很抱歉我沒有能力改變她們的看法</span></span><span style="font-family: "arial"; font-size: 11pt; white-space: pre-wrap;">」
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4C38mEzMp1UHAapYmKz1EIl7v2C_t4ywaCJ1yN6BuS2WX85uNrWguCO9pNsdy1e3pzY1v02E_fASL3lrHSDW-aOnNBPHx2Kad_bxhPAE0HSPsteVAELQVQmROhjdjGjMH_MgAhMh1nSd5/s1600/2017-09-05_205939.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="131" data-original-width="544" height="77" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4C38mEzMp1UHAapYmKz1EIl7v2C_t4ywaCJ1yN6BuS2WX85uNrWguCO9pNsdy1e3pzY1v02E_fASL3lrHSDW-aOnNBPHx2Kad_bxhPAE0HSPsteVAELQVQmROhjdjGjMH_MgAhMh1nSd5/s320/2017-09-05_205939.jpg" width="320" /></a></div>
<span id="docs-internal-guid-6c102a87-5237-a520-07cc-b0e264330e13"><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">若此留言說明的狀況為真,就有幾點值得注意:</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> 1. 該節目認為大多數的觀眾反應都很好</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> 2. 鄭丞傑醫師無法改變節目的看法</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> 這個狀況凸顯了,醫師的公開發言除受個人因素影響以外,可能也受各種情境(節目效果)或結構因素(製播權力)而影響其發言內容的自由度。 </span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> 醫師好辣,究竟是醫師自己加的辣?還是被迫加的辣?或者其實顧客本來就很愛吃辣?</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span></span><br />
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">--</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(1) 醫界娘子軍崛起!男醫師慘兮兮?!醫師好辣2017.08.16</span><a href="https://youtu.be/aHaOLCT4WLA" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">https://youtu.be/aHaOLCT4WLA</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(2) 觀點投書:女醫師對無稽之談的怒吼 </span><a href="http://www.storm.mg/article/322210" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">http://www.storm.mg/article/322210</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(3) 台灣女醫師協會鄭重聲明 </span><a href="https://www.facebook.com/permalink.php?story_fbid=1924470117810942&id=1544208442503780" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">https://www.facebook.com/permalink.php?story_fbid=1924470117810942&id=1544208442503780</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(4) 「鄭丞傑」回覆<a href="https://www.facebook.com/permalink.php?story_fbid=1924470117810942&id=1544208442503780&comment_id=1925328634391757&comment_tracking=%7B%22tn%22%3A%22R9%22%7D">https://www.facebook.com/permalink.php?story_fbid=1924470117810942&id=1544208442503780&comment_id=1925328634391757&comment_tracking=%7B%22tn%22%3A%22R9%22%7D</a></span><br />
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(5) 網路時代之個人品牌工作坊 http://pati2015.innovarad.tw/</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(6) 醫師好辣 回饋粉絲見面會 </span><a href="http://blog.ebc.net.tw/apps/hellodocto/article.aspx?id=10773" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">http://blog.ebc.net.tw/apps/hellodocto/article.aspx?id=10773</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(7) 重申暨道歉聲明 </span><a href="https://www.facebook.com/HsinJung.TMC/posts/589136627913538:0" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">https://www.facebook.com/HsinJung.TMC/posts/589136627913538:0</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(8) 網路時代公開發言的另一議題是如何確定發言者的身分</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(9) 名醫爆料女醫勾男師上床 醫師協會不滿痛批歧視</span><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><a href="http://ent.ltn.com.tw/news/breakingnews/2181180" style="text-decoration: none;">http://ent.ltn.com.tw/news/breakingnews/2181180</a></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(10) 婦科名醫性別玩笑開過火? 女醫師氣瘋了 https://udn.com/news/story/7266/2675896
(11) 「鄭丞傑」回覆 <a href="https://www.facebook.com/permalink.php?story_fbid=1924470117810942&id=1544208442503780&comment_id=1924835571107730&reply_comment_id=1925723854352235&comment_tracking=%7B%22tn%22%3A%22R%22%7D">https://www.facebook.com/permalink.php?story_fbid=1924470117810942&id=1544208442503780&comment_id=1924835571107730&reply_comment_id=1925723854352235&comment_tracking=%7B%22tn%22%3A%22R%22%7D</a></span><br />
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Ross Limhttp://www.blogger.com/profile/04834324679210414893noreply@blogger.comtag:blogger.com,1999:blog-1047390135102157236.post-12600143158104302592017-03-19T01:19:00.001-07:002017-03-19T01:27:06.085-07:00ADHD藥物治療與骨折風險<b>ADHD藥物治療與骨折風險的關聯性:以台灣兒童青少年為主的全國性研究 </b><br />
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林子勤醫師/中山醫學大學附設醫院 精神科<br />
<blockquote class="tr_bq">
<b>究竟ADHD的藥物會為這些患者帶來傷害?還是降低這些患者受傷的機率?更重要的是,藥物治療的時間長短/持續度,是否是降低受傷風險的關鍵?</b></blockquote>
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注意力不足/過動症(ADHD)是一種牽涉神經系統異常之疾患,患者的核心症狀涵蓋了過動、衝動、以及認知功能異常[1]。這些症狀通常出現在兒童及青少年時期,但也有將近一至三成的患者,成年之後仍有症狀[2, 3]。此症全球平均之終生盛行率約為5.3%[4]。這些患者通常有一定程度之功能異常:例如在學業、社會、或人際關係方面的困難[5-7]。</div>
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除此之外,有<b>越來越多的證據顯示,這些患者比一般人更容易發生意外。無論是交通意外或者腦部創傷,皆有國際相關研究指出,這群患者因此受傷的風險比一般人來得高[8-12]。</b>此症的核心症狀-注意力不足、分心、以及衝動-也許可以解釋為何這個族群較一般人更容易受傷[13]。</div>
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<b> ADHD治療藥物對這些意外傷害風險的影響也逐漸受到全球注意。</b>荷蘭學者van den Ban等人在2014年發表的研究指出:接受ADHD藥物治療後,患者受到身體傷害的發生率降低了[14]。2015年另一則德國研究則發現ADHD藥物對於腦部創傷有保護效果(降低了34%的風險)[15]。這些研究陸續嘗試探查ADHD藥物對於各類身體傷害風險的影響。 </div>
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在這些意外傷害中,骨折又是其中相當常見,而且可能帶來許多後續問題的一種傷害[16-20]。<b>近年台灣已有兩個研究顯示,ADHD與骨折有高度關聯[21, 22]。</b> 關於ADHD與意外傷害的關聯性已有不少研究,但其治療藥物是否會改變發生意外傷害的風險?目前相關的研究並不多。</div>
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<b>究竟ADHD的藥物會為這些患者帶來傷害?還是降低這些患者受傷的機率?更重要的是,藥物治療的時間長短/持續度,是否是降低受傷風險的關鍵?</b>這皆是過去研究尚未解答的問題。 </div>
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儘管ADHD藥物之療效已有充分之實證 [23],但因藥物使用持續度不足導致療效不佳,在臨床上仍是相當常見之狀況[24-26]。高淑芬教授等人統計台灣的臨床資料發現,越無法規則使用藥物的患者,相較於規則服藥的患者,其ADHD的症狀也較為嚴重[27]。因此,<b>非常需要釐清的是,規則使用或持續使用ADHD藥物是否能帶給這些患者明確的保護效果。 </b></div>
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因此,本研究試圖藉由台灣健保資料庫去釐清的是:ADHD藥物治療是否會改變此族群的骨折風險?以及藥物治療持續時間的長短,是否影響了此族群發生骨折的風險? </div>
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經分析統計發現,相<b>較於從未接受藥物治療的患者,接受藥物治療超過180天的ADHD族群,其骨折風險顯著較低,低了將近23%。更值得注意的是,有接受藥物治療,但總期間不超過180天的患者,其骨折風險與未接受藥物的族群比較起來並無明顯差異-凸顯了藥物治療持續時間的影響。</b></div>
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此結果顯示:ADHD藥物治療與較低的骨折風險有關,但此關聯僅存在於治療超過180天的族群。在治療時間小於180天的族群,其骨折風險與未接受藥物治療的族群沒有差異。</div>
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在本研究中更發現,所有ADHD患者中,<b>接受藥物治療超過180天的患者,僅占所有ADHD患者的29.6%。顯見目前台灣ADHD患者接受藥物治療的比例仍然偏低。對臨床醫師而言,應向患者及家屬傳達-持續藥物治療對於減少身體傷害有其重要性。</b></div>
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<b><u><a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0173762" target="_blank">原始研究</a></u></b><br />
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Chen VC-H, Yang Y-H, Liao Y-T, Kuo T-Y, Liang H-Y, Huang K-Y, et al. (2017) The association between methylphenidate treatment and the risk for fracture among young ADHD patients: A nationwide population-based study in Taiwan. PLoS ONE 12(3): e0173762. doi:10.1371/journal.pone.0173762<br />
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<b><u>參考文獻</u></b><br />
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1.<span class="Apple-tab-span" style="white-space: pre;"> </span>Sadock, B.J., V.A. Sadock, and P. Ruiz, Attention Deficit/Hyperactivity Disorder. KAPLAN & SADOCK'S Synopsis of Psychiatry, 11th edition, 2015.<br />
2.<span class="Apple-tab-span" style="white-space: pre;"> </span>Kessler, R.C., et al., The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry, 2006. 163(4): p. 716-23.<br />
3.<span class="Apple-tab-span" style="white-space: pre;"> </span>Huang, C.L., et al., Epidemiology of treated attention-deficit/hyperactivity disorder (ADHD) across the lifespan in Taiwan: a nationwide population-based longitudinal study. PLoS One, 2014. 9(4): p. e95014.<br />
4.<span class="Apple-tab-span" style="white-space: pre;"> </span>Polanczyk, G., et al., The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry, 2007. 164(6): p. 942-8.<br />
5.<span class="Apple-tab-span" style="white-space: pre;"> </span>Nijmeijer, J.S., et al., Attention-deficit/hyperactivity disorder and social dysfunctioning. Clin Psychol Rev, 2008. 28(4): p. 692-708.<br />
6.<span class="Apple-tab-span" style="white-space: pre;"> </span>Rogers, M., et al., Inattention, working memory, and academic achievement in adolescents referred for attention deficit/hyperactivity disorder (ADHD). Child Neuropsychol, 2011. 17(5): p. 444-58.<br />
7.<span class="Apple-tab-span" style="white-space: pre;"> </span>Barkley, R.A., et al., Young adult outcome of hyperactive children: adaptive functioning in major life activities. J Am Acad Child Adolesc Psychiatry, 2006. 45(2): p. 192-202.<br />
8.<span class="Apple-tab-span" style="white-space: pre;"> </span>Altun, C., et al., Dental injuries and attention-deficit/hyperactivity disorder in children. Spec Care Dentist, 2012. 32(5): p. 184-9.<br />
9.<span class="Apple-tab-span" style="white-space: pre;"> </span>Merrill, R.M., et al., Attention deficit hyperactivity disorder and increased risk of injury. Adv Med Sci, 2009. 54(1): p. 20-6.<br />
10.<span class="Apple-tab-span" style="white-space: pre;"> </span>Sobanski, E., Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci, 2006. 256 Suppl 1: p. i26-31.<br />
11.<span class="Apple-tab-span" style="white-space: pre;"> </span>Ertan, C., O.O. Ozcan, and M.S. Pepele, Paediatric trauma patients and attention deficit hyperactivity disorder: correlation and significance. Emerg Med J, 2012. 29(11): p. 911-4.<br />
12.<span class="Apple-tab-span" style="white-space: pre;"> </span>Tai, Y.M., S.S. Gau, and C.S. Gau, Injury-proneness of youth with attention-deficit hyperactivity disorder: a national clinical data analysis in Taiwan. Res Dev Disabil, 2013. 34(3): p. 1100-8.<br />
13.<span class="Apple-tab-span" style="white-space: pre;"> </span>Cairney, J., Deficits in attention, motor control, and perception and increased risk of injury in children. Dev Med Child Neurol, 2014. 56(11): p. 1040-1.<br />
14.<span class="Apple-tab-span" style="white-space: pre;"> </span>van den Ban, E., et al., Association between ADHD drug use and injuries among children and adolescents. Eur Child Adolesc Psychiatry, 2014. 23(2): p. 95-102.<br />
15.<span class="Apple-tab-span" style="white-space: pre;"> </span>Mikolajczyk, R., et al., Injury prevention by medication among children with attention-deficit/hyperactivity disorder: a case-only study. JAMA Pediatr, 2015. 169(4): p. 391-5.<br />
16.<span class="Apple-tab-span" style="white-space: pre;"> </span>Erdogan, M., et al., Is attention deficit and hyperactivity disorder a risk factor for sustaining fractures of proximal humerus? Acta Chir Orthop Traumatol Cech, 2014. 81(3): p. 221-6.<br />
17.<span class="Apple-tab-span" style="white-space: pre;"> </span>Ozer, K., et al., Psychiatric risk factors in pediatric hand fractures. J Pediatr Orthop, 2010. 30(4): p. 324-7.<br />
18.<span class="Apple-tab-span" style="white-space: pre;"> </span>Uslu, M.M. and R. Uslu, Extremity fracture characteristics in children with impulsive/hyperactive behavior. Arch Orthop Trauma Surg, 2008. 128(4): p. 417-21.<br />
19.<span class="Apple-tab-span" style="white-space: pre;"> </span>Uslu, M., et al., Children with fractures show higher levels of impulsive-hyperactive behavior. Clin Orthop Relat Res, 2007. 460: p. 192-5.<br />
20.<span class="Apple-tab-span" style="white-space: pre;"> </span>Nakaniida, A., K. Sakuraba, and E.L. Hurwitz, Pediatric orthopaedic injuries requiring hospitalization: epidemiology and economics. J Orthop Trauma, 2014. 28(3): p. 167-72.<br />
21.<span class="Apple-tab-span" style="white-space: pre;"> </span>Chou, I.C., et al., Attention-deficit-hyperactivity disorder increases risk of bone fracture: a population-based cohort study. Dev Med Child Neurol, 2014. 56(11): p. 1111-6.<br />
22.<span class="Apple-tab-span" style="white-space: pre;"> </span>Guo, N.W., et al., Fracture risk and correlating factors of a pediatric population with attention deficit hyperactivity disorder: a nationwide matched study. J Pediatr Orthop B, 2015.<br />
23.<span class="Apple-tab-span" style="white-space: pre;"> </span>Vaughan, B. and C.J. Kratochvil, Pharmacotherapy of pediatric attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am, 2012. 21(4): p. 941-55.<br />
24.<span class="Apple-tab-span" style="white-space: pre;"> </span>Adler, L.D. and A.A. Nierenberg, Review of medication adherence in children and adults with ADHD. Postgrad Med, 2010. 122(1): p. 184-91.<br />
25.<span class="Apple-tab-span" style="white-space: pre;"> </span>Charach, A. and R. Fernandez, Enhancing ADHD medication adherence: challenges and opportunities. Curr Psychiatry Rep, 2013. 15(7): p. 371.<br />
26.<span class="Apple-tab-span" style="white-space: pre;"> </span>Childress, A.C. and F.R. Sallee, Attention-deficit/hyperactivity disorder with inadequate response to stimulants: approaches to management. CNS Drugs, 2014. 28(2): p. 121-9.<br />
27.<span class="Apple-tab-span" style="white-space: pre;"> </span>Gau, S.S., et al., National survey of adherence, efficacy, and side effects of methylphenidate in children with attention-deficit/hyperactivity disorder in Taiwan. J Clin Psychiatry, 2008. 69(1): p. 131-40.<br />
<br />Ross Limhttp://www.blogger.com/profile/04834324679210414893noreply@blogger.comtag:blogger.com,1999:blog-1047390135102157236.post-16355322616231028002017-02-05T04:55:00.001-08:002017-02-08T19:02:19.417-08:00故事與知識的真實交會 <div class="MsoNormal">
<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;">林子勤/中山醫學大學附設醫院 精神科醫師<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;">對我而言,<span lang="EN-US">2016</span>年是與心動家族特別有緣的一年。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: inherit; font-size: large;"><b><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">陪同心動家族家長代表出席立院公聽會</span></b><span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"> 2016</span><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">年<span lang="EN-US">7</span>月<span lang="EN-US">28</span>日,劉建國立委在立法院召開<span lang="EN-US">ADHD</span>議題之公聽會,我有緣陪同幾位家族的家長代表一同出席。當天的公聽會,家長代表以清晰而堅定的口吻分享了經驗<span lang="EN-US">(</span></span><span lang="EN-US"><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><a href="https://goo.gl/ZR1iX0" target="_blank">1</a></span><span id="goog_1016193354"></span><span id="goog_1016193355"></span><a href="https://www.blogger.com/"></a></span><span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">)</span><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">,不僅令我感佩,也慶幸自己有機會能陪同他們一起出席。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">事實上,在劉建國委員召開公聽會的那一陣子,部分立委對於<span lang="EN-US">ADHD</span>的治療方式發表了一些極端意見,例如「除非所有醫師皆同意用藥,否則反對投藥」這種將醫療簡化為舉手投票的意見。當時我寫了一篇文章投稿媒體<span lang="EN-US">(</span></span><span lang="EN-US"><a href="https://goo.gl/xISmwv"><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">2</span></a></span><span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">)</span><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">,說明此類極端意見將可能使某些族群連「一次用藥的機會」都不可得。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;"> <span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;"> <span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">11/19</span><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">這場研討會上,心動家族集結了醫師、心理師、職能治療師、學校老師、以及<span lang="EN-US">ADHD</span>學童家長,分享過去八年來凝結的寶貴經驗<span lang="EN-US">(</span></span><span lang="EN-US"><a href="https://goo.gl/GH12eC"><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">4</span></a></span><span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">)</span><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">。這樣的組合與互動,似乎正是心動家族過去八年不斷嘗試、修正、再嘗試的縮影。理事長陳錦宏醫師-也是我的老師-在會中發表了「注意力不足過動症ADHD的第三條路」
<span lang="EN-US">(</span></span><span lang="EN-US"><a href="https://goo.gl/d2IFHc"><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">5</span></a></span><span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">) </span><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">的演說,呈現了過去媒體報導中常描述的兩條路,也提出心動家族過去八年嘗試的第三條路-以家庭為中心的照護模式。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<b><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;">在那場研討會上,雖然出席的人來自各界,但談論「誰該負責?」的時間並不多。更多的討論反而是:各種專業與家長之間如何彼此協助?<span lang="EN-US"><o:p></o:p></span></span></span></b></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">因為就在研討會過後幾天,我在另一個臉書的專頁看見一篇文章<span lang="EN-US">(</span></span><span lang="EN-US"><a href="https://goo.gl/2RivMc"><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">7</span></a></span><span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">)</span><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">,作者是跟我同校但不同系的老師。在那篇文章中,我看到一些對於<span lang="EN-US">ADHD</span>診斷與分析的簡化與偏誤,文章中多次談論「責任」歸屬的問題,更直指「藥物治療作為集體卸責的社會處方」。令我感嘆的是,那篇文章在短短兩天內,已有<span lang="EN-US">160</span>次的臉書分享。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">出於一種憂心與焦慮,我寫了另一篇文章嘗試指出該文的簡化<span lang="EN-US">ADHD</span>問題的風險所在<span lang="EN-US">(</span></span><span lang="EN-US"><a href="https://goo.gl/eZGPI8"><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">8</span></a></span><span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">)</span><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: inherit; font-size: large;"><b><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">與醫師面對面談話</span></b><span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;"> <span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;">心動家族定期舉辦的「與醫師面對面談話 」活動,讓家長與醫師在診間以外有面對面談話的機會。更重要的是,家族的其他家長、成員,也都能一起參與,一起對話。我有緣與慈濟醫院蕭亦伶醫師一起參加了<span lang="EN-US">12/3</span>這一場,在家長的提問、陳錦宏醫師、蕭醫師與聽眾的互動之中,我得到許多過去在醫院裡或診間沒有的經驗。在現有的醫療時空之下,這樣「面對面」的互動經驗,對醫師或有困擾想求助的家長而言,是非常重要的「真實」經驗。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;"> <span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;">隨著社群媒體興起,醫療現場的溝通變得更複雜了。在過去,醫師面對求助者時,可能會一併面臨求助者從家人或鄰居聽來的經驗,於是會聽到<b>:「我聽家人說...」或「我聽鄰居說...」</b>,醫師除了面對求助者,還要面對沒有出席的家人與鄰居;然而在社群媒體(如臉書)讓所有人都變成鄰居之後,求助者帶進診間的訊息跟經驗就更多了。醫師聽到的就變成:<b>「我看網路一篇文章說...」或「我聽網路一位專家說...」</b>了。醫師在診間裡要面對的,又多了無數看不見臉孔的「專家」和摸不著邊際的廣泛意見。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;"> <span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;">這樣的互動累積起來,恐怕都將逐漸影響雙方的信任感。在互動還沒有發生以前,雙方就已帶著某些他人的經驗或資訊來想像對方。這是為什麼我說,<b>「面對面」的互動經驗,反而是現今寶貴且重要的「真實」感受。因為只有那樣的互動,才能讓求助者的故事與助人者的知識有真實的交會,而非只停留在想像與假設。<span lang="EN-US"><o:p></o:p></span></b></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">12/3</span><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">當天的「面對面談話」活動尾聲,陳醫師給我機會對參與的家長說幾句話。我說:「雖然我不是兒童青少年精神科醫師,但在<span lang="EN-US">ADHD</span>的議題裡,我看見兒青醫師的辛苦與挑戰。在現今這個環境之下,他們面臨許多期待與要求,卻也面臨許多質疑。所以,我其實想呼籲,如果各位遇上了一位值得你信任的兒童青少年精神科專科醫師,一定要好好珍惜。否則,我其實很擔心,兒童青少年精神科專科醫師會因為這些艱難的處境,而變得更為更稀有、更難找到。」<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">參加完活動的那個下午,我在<span lang="EN-US">ADHD</span>現代知識專頁發表我個人關於<span lang="EN-US">ADHD</span>的第三篇文章<span lang="EN-US">(</span></span><span lang="EN-US"><a href="https://goo.gl/QVEKgu"><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">9</span></a></span><span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">)</span><span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">,談的是過去曾被錯誤解讀的一篇<span lang="EN-US">ADHD</span>研究,近期又被台灣部分人士提出來,重新用錯誤的方式在網路上解讀與宣傳了一次。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;">***<o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;">回顧<span lang="EN-US">2016</span>年,我與心動家族有數次難得的緣分。這些在診間以外面對面的互動經驗,對我個人而言是真實且寶貴的,感謝家族讓我學習了許多。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;"> <span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;">在我有限的診間經驗裡,家長常提到:關於<span lang="EN-US">ADHD</span>的故事與知識,他們總是在網路上搜尋到好幾種說法跟版本。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;">是否有完全正確或一體適用的答案呢?我個人的答案是沒有。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;"> <span lang="EN-US"> <o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-family: inherit; font-size: large;">無論是故事或知識,最大的危險就是被「簡化」或「去脈絡化」(沒頭沒尾)。偏偏這也是社群媒體傳播訊息常見的兩大陷阱。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: inherit; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;"><span style="font-size: large;">因此我的建議是,在參考網路資訊以外,務必要有實際的互動與溝通,讓求助者的故事與助人者的知識有真實的交會,那才是這個時代最值得珍視的經驗。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<b><span style="font-family: inherit; mso-bidi-font-family: 新細明體; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt;">引用文章<span lang="EN-US"><o:p></o:p></span></span></b></div>
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Ross Limhttp://www.blogger.com/profile/04834324679210414893noreply@blogger.comtag:blogger.com,1999:blog-1047390135102157236.post-14032442804126728412016-12-16T08:42:00.000-08:002017-02-08T19:02:35.826-08:00別坐在少林寺藏經樓門口看武俠小說<div class="MsoNormal" style="background: white; mso-pagination: widow-orphan;">
<span style="font-family: inherit;"><span style="color: #1d2129; font-size: 13.5pt;">(中山醫學大學附設醫院 精神科/林子勤醫師)<br /><br />來科內實習的醫學生,在跟診時,略帶不好意思地說:</span><span style="color: #1d2129; font-size: 13.5pt;"> <span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: inherit;"><b><span style="color: #1d2129; font-size: 13.5pt;">醫師,我發覺,我好像</span></b><b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;">...</span></b><b><span style="color: #1d2129; font-size: 13.5pt;">還是不太能接受精神科的邏輯</span></b><b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;">...</span></b><b><span style="color: #1d2129; font-size: 13.5pt;">跟診斷</span></b><b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;">...</span></b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span style="color: #1d2129; font-size: 13.5pt;"> 我請他試著說清楚一些,同學進一步說,<b>他感覺這一科跟他之前其他科學的太不一樣了,客觀的東西不多,相當多仰賴的是主觀的觀察與判斷。他無法想像如果是自己坐在精神科醫師那個位置上,可以用那樣的方式診斷或者是互動。還有就是,</b></span><b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;">DSM</span></b><b><span style="color: #1d2129; font-size: 13.5pt;">那些診斷</span></b><b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;">...</span></b><b><span style="color: #1d2129; font-size: 13.5pt;">好像不如其他科的診斷標準那麼客觀</span></b><b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;">...</span></b><b><span style="color: #1d2129; font-size: 13.5pt;">令人有些無法信服</span></b><b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;">...</span></b><b><span style="color: #1d2129; font-size: 13.5pt;">還是得靠主觀的判斷</span></b><b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;">...<o:p></o:p></span></b></span></div>
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<span style="font-family: inherit;"><span style="color: #1d2129; font-size: 13.5pt;"> 聽了之後我說:<b>這是好事啊!如果你去一個科學習,發現跟你原來想的或知道的都完全一樣,那又何必去呢?</b></span><b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: inherit;"><span style="color: #1d2129; font-size: 13.5pt;"> 而且你應該要利用這個衝擊,去好好了解為何精神科會是這個樣子?為何會與你之前去過的那些科這麼不一樣。</span><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span style="color: #1d2129; font-size: 13.5pt;"> 至於</span><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;">DSM</span><span style="color: #1d2129; font-size: 13.5pt;">或診斷,在沒有來到臨床時,你有理由和一般民眾一樣,靠著看文字去想像患者或求診者的樣貌。<b>但你既然來到臨床前線了,你就沒有理由只用這個方式理解它了。你要記得求診者的樣貌,嘗試感受他們的感受,了解他們為何而來,還有觀察在那個過程之中精神科醫師/精神醫療體系如何與他們互動。然後,再回頭去思考</b></span><b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;">DSM</span></b><b><span style="color: #1d2129; font-size: 13.5pt;">與診斷。那才有機會讓你與一般民眾或者沒有來過精神科的人有所不同。</span></b><b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: inherit;"><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;"> DSM</span><span style="color: #1d2129; font-size: 13.5pt;">診斷的不完美、不夠科學、不夠客觀,在離開臨床前線之後,你可以有很多機會與時間去反思、批評、研究。但在討論出結果之前,站在前線的人每一天都仍然要去面對那些來求助的人,他們不會等到你反思/批評/研究完,才走進來的。換個方式說,如果沒有那些持續進行中的實踐,又如何知道反思/批評/研究要朝哪一個方向呢?持續更新中的知識與做法,不也是如此累積滾動而來的嗎?</span><span style="color: #1d2129; font-size: 13.5pt;"> </span><span style="color: #1d2129; font-size: 13.5pt;"> </span><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span style="color: #1d2129; font-size: 13.5pt;"> 而主觀與客觀的問題,我提醒同學,未來到了其他科學習,也要持續去觀察醫療的能與不能、作用與副作用。<b>精神科相較於其他科有更多主觀的判斷,但不代表那裡面沒有醫學的邏輯與精神。</b>同樣的,如果你自己認為、或者你過去的教育告訴你:醫學追求的是全然的客觀,那你也要再好好觀察看看、想看看這件事情。</span><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span style="color: #1d2129; font-size: 13.5pt;"> 至於,覺得「自己無法像精神科醫師那樣」這件事,就更重要了。<b>首先你應該要知道,並沒有人規定你要像誰一樣。</b>醫師這個工作有一些約束與阻力,例如健保、法律、道德。但你也不要忘了,在那之外,就是每個人各自發揮、各自成長的空間。</span><b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;">DSM</span></b><b><span style="color: #1d2129; font-size: 13.5pt;">診斷寫在那裡,但不代表所有精神科醫師的診斷與互動都只有</span></b><b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;">DSM</span></b><b><span style="color: #1d2129; font-size: 13.5pt;">,或者都長得一模一樣。就好像你未來去到其他科,你會觀察到每個醫師都還是有自己的風格跟邏輯一樣。你遇過的老師/醫師那樣,不代表你未來就要這樣。否則,未來就交給電腦或機器看診即可。</span></b><b><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: inherit;"><span style="color: #1d2129; font-size: 13.5pt;"> 然後也不要忘了,對於疾病或苦難,從來就不只有醫學這個觀點。不只是精神醫學,在你未來經歷的其他醫學領域,都要留心這件事情。</span><span lang="EN-US" style="color: #1d2129; font-size: 13.5pt;"><o:p></o:p></span></span></div>
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<span style="color: #1d2129; font-family: inherit; font-size: 13.5pt;">最後,我語重心長地說:<b>希望你能記得這兩周的經驗,也希望未來有一天,當你站在你自己的前線時,要記得自己的觀點曾經跟精神科醫師這麼不一樣,然後要進一步提醒那時的自己,別人的觀點可能也跟你很不一樣。</b></span><span lang="EN-US" style="color: #1d2129; font-family: "georgia" , "serif"; font-size: 13.5pt;"><o:p></o:p></span></div>
Ross Limhttp://www.blogger.com/profile/04834324679210414893noreply@blogger.comtag:blogger.com,1999:blog-1047390135102157236.post-89101333609239340302016-12-03T00:51:00.000-08:002017-02-08T19:02:47.916-08:00從BBC的道歉啟事談起-ADHD研究結果被扭曲的過去與現在<div class="MsoNormal">
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<span style="font-family: inherit; font-size: large;"><span lang="EN-US">2010</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,英國醫學期刊(</span><span lang="EN-US">BMJ, British Medical Journal</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)刊登了一則新聞。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: inherit;">〈<span lang="EN-US">BBC </span>的專題報導扭曲了注意力不足過動症<span lang="EN-US">(ADHD)</span>研究的結果〉</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<b><span style="font-family: inherit; font-size: x-large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">故事的開端</span></b></h3>
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<b><span style="font-family: inherit; font-size: x-large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
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<span style="font-family: inherit;"><span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">美國國家精神衛生研究院(</span><span lang="EN-US">NIMH</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)針對</span><span lang="EN-US">ADHD</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">展開的一項研究,名為「</span></span><span lang="EN-US" style="font-size: large;">ADHD </span><span style="font-family: "新細明體" , "serif"; font-size: large;">孩童之多元模式治療研究」</span><span style="font-family: "新細明體" , "serif"; font-size: large;">(</span><span lang="EN-US" style="font-size: large;">Multimodal<span style="font-family: , serif;"> </span></span><span lang="EN-US" style="font-size: large;">Treatment Study of Children With ADHD </span><span style="font-family: "新細明體" , "serif"; font-size: large;">),可簡稱為</span><span lang="EN-US" style="font-size: large;"><b>MTA 研究</b></span><span style="font-family: "新細明體" , "serif"; font-size: large;">。</span></span></div>
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<span style="font-family: inherit;"><span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">此研究的重要性在於,其第一期研究(為期</span><span lang="EN-US">14 </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月)是</span><span lang="EN-US">ADHD</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">研究中,少見由國家進行的大規模隨機對照研究。</span><span lang="EN-US">MTA </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">系列的第一期研究結果,發表於西元</span><span lang="EN-US">1999 </span><span style="font-family: , serif;">年</span><span lang="EN-US">[<a href="file:///C:/Users/rossPC/Desktop/%E7%B0%A1%E5%8C%96%E7%B2%BE%E7%A5%9E%E7%A7%91%E8%A8%BA%E6%96%B7/%E5%BE%9EBBC%E7%9A%84%E9%81%93%E6%AD%89%E5%95%9F%E4%BA%8B%E8%AB%87%E8%B5%B7%EF%BC%8DADHD%E7%A0%94%E7%A9%B6%E7%B5%90%E6%9E%9C%E8%A2%AB%E6%89%AD%E6%9B%B2%E7%9A%84%E9%81%8E%E5%8E%BB%E8%88%87%E7%8F%BE%E5%9C%A8.docx#_ENREF_2" title=", 1999 #7340"><span style="color: windowtext; text-decoration: none; text-underline: none;">2</span></a>]</span><span style="font-family: , serif;">。該階段研究採用的方法,是將</span><span lang="EN-US"> ADHD </span><span style="font-family: , serif;">個案隨機分派到四種治療</span><span style="font-family: , serif;">模式(</span><span style="font-family: "calibri" , sans-serif;">嚴謹的</span></span><span style="font-family: , serif;"><span style="font-size: large;">藥物治療、行為治療、藥物加行為治療、社區照護</span></span><span style="font-family: , serif; font-size: large;">),給予定期治療並追蹤</span><span lang="EN-US" style="font-size: large;"> 14 </span><span style="font-family: , serif; font-size: large;">個月,進一步比較不同治療模式之間的差異。</span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">該團隊在</span><span lang="EN-US"> 1999 </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年發表的論文中,結論寫著:</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<b><span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">「對於</span><span lang="EN-US"> ADHD </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">症狀的療效,本研究中的謹慎藥物治療優於行為治療以及一般社區治療;而藥物合併行為治療的方案,並沒有比單獨接受藥物治療來得更好,但卻能改善一些非</span><span lang="EN-US"> ADHD </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的症狀以及功能。」</span></span></b></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipyd8IyG7GSObOW4O0z7u4rwMZa9ZSYkFdZVhQ4pcJftvp7eKK1H10oRhxJcYKF7W1pqXp0gTIMxyLEhTU4OsSSk52NLK0TeVt6AWxOAbflCwBA0ax_zabjJCzylBtIaTh7LgTsR-YDSI/s1600/14month.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="color: black; font-family: inherit;"><img border="0" height="481" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipyd8IyG7GSObOW4O0z7u4rwMZa9ZSYkFdZVhQ4pcJftvp7eKK1H10oRhxJcYKF7W1pqXp0gTIMxyLEhTU4OsSSk52NLK0TeVt6AWxOAbflCwBA0ax_zabjJCzylBtIaTh7LgTsR-YDSI/s640/14month.jpg" width="640" /></span></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;"><span style="font-family: inherit;">出處:https://goo.gl/tjxTsW</span></td></tr>
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<span style="font-family: inherit;"><span style="font-size: large;"><span style="font-family: , serif;">這為期</span><span lang="EN-US">14</span><span style="font-family: , serif;">個月的研究結果顯示:藥物治療(不管有無合併行為治療)對ADHD症狀有明顯幫助(改善幅度較大)。而行為治療則是對親子關係與社交能力有額外的效果。</span></span><span style="font-family: , serif;"><span style="font-size: large;">基於病患權益及研究倫理,研究者不得持續限制受試者只用療效較差的治療方式。於是,此隨機對照研究就在第</span></span><span style="font-size: large;"><span lang="EN-US">14</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月終止了</span><span style="font-family: , serif;">。</span></span></span></div>
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<span style="font-family: inherit;"><span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">也就是說,第</span><span lang="EN-US">14</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月起,無論原來分到哪一組,孩童與家長<b>皆可自由選擇</b>要接受哪一種協助:可以持續或停止原先的治療(包含藥物),也可以轉而嘗試其他治療。</span></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><b><span lang="EN-US" style="font-size: x-large;">14</span></b><b><span style="font-family: "新細明體" , "serif"; font-size: x-large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月之後怎樣?</span><span lang="EN-US"><o:p></o:p></span></b></span></h3>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><b>這是一個極端重要的分水嶺</b>。</span><span lang="EN-US">BBC</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">節目與許多人後來犯的錯誤,都是因為忽略了這個轉折。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">第</span><span lang="EN-US">14</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月之後,研究團隊雖持續追蹤這些個案,但研究性質也轉為無法</span><span style="font-family: , serif;">判斷因果關係的「觀察型研究」(</span><span lang="EN-US">observational study</span><span style="font-family: , serif;">)了-這意味著研究的侷限變多了,尤其是一些干擾因子。</span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">比方說:有些人持續藥物治療,有些人則停止了。背後是甚麼原因?不得而知。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">另外,治療的實際情形也無法像第一階段那樣,可以確實知道頻率與品質了。比方說藥物拿了有沒有規律服用?有沒有規律接受行為治療?都是無法確定的變因。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">嚴格來說,</span><span lang="EN-US">MTA</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">研究最具證據強度的階段已在第</span><span lang="EN-US">14</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月結束。後續研究結果的證據等級降低了,也無法與第一階段比較。<b>若未能掌握此脈絡,後續的判讀就會出錯。</b></span></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><b><span lang="EN-US" style="font-size: x-large;">BBC</span></b><b><span style="font-family: "新細明體" , "serif"; font-size: x-large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">節目出錯的起點</span><span lang="EN-US"><o:p></o:p></span></b></span></h3>
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<span style="font-family: inherit; font-size: large;"><span lang="EN-US">2007</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年</span><span lang="EN-US">8</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月,</span><span lang="EN-US">MTA </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">團隊發表了追蹤這些個案到第三年的「觀察」結果</span><span lang="EN-US">[<span style="color: windowtext; text-decoration: none; text-underline: none;">3</span>]</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">長達</span><span lang="EN-US">14</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">頁的原始論文,結論中寫著:</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<b><span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">「前</span><span lang="EN-US"> 14 </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月有接受藥物治療的個案,療效原本較其他組來得好。進入觀察階段,讓所有個案自由選擇治療模式後,追蹤到第</span><span lang="EN-US"> 36 </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月,先前的療效差異就不明顯了。」</span></span></b></div>
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<span style="font-family: inherit; font-size: large;">1. 前<span lang="EN-US">14</span><span style="font-family: , serif;">個月的研究中,限定個案固定治療模式,發現四組都有改善,而藥物組的改善幅度較大。</span></span></div>
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<span style="font-family: inherit; font-size: large;">2. 第<span lang="EN-US">14</span><span style="font-family: , serif;">到</span><span lang="EN-US">36</span><span style="font-family: , serif;">個月,個案想選擇哪一種模式都可以,四組的症狀相較於第</span><span lang="EN-US">0</span><span style="font-family: , serif;">個月,仍然通通有改善。只不過,四種模式初期的差異,到了第</span><span lang="EN-US">36</span><span style="font-family: , serif;">個月就消失了。</span></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMPt0Jf3zP_41lTye8Xn1lg33vsb3eH2KmY6QJoHKJZGFI8X7qGyPVtLjJdwEAVR30_qW5Dk9d08RotXmgP9SBJFbciKnU5bLVczlVh_Y9ekASFZtuIrJ6cfPaKqAIKsO2cd7F-iNlxRc/s1600/36+month.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="color: black; font-family: inherit;"><img border="0" height="384" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMPt0Jf3zP_41lTye8Xn1lg33vsb3eH2KmY6QJoHKJZGFI8X7qGyPVtLjJdwEAVR30_qW5Dk9d08RotXmgP9SBJFbciKnU5bLVczlVh_Y9ekASFZtuIrJ6cfPaKqAIKsO2cd7F-iNlxRc/s640/36+month.jpg" width="640" /></span></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;"><span style="font-family: inherit;">出處:https://goo.gl/XGwrpn</span></td></tr>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><b>打個比方</b>:前</span><span lang="EN-US">14</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月就像是將學生分成四個班級上課,每一個人都只能在同一個班上課。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span lang="EN-US">14</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月結束時,每一班的平均狀況都改善了。其中又有某一班,改善的幅度比其他班明顯。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">第</span><span lang="EN-US">14</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月之後,每個成員可以自由選擇要去哪一個教室上課,有人留在原班,有人則跑去別班。而且沒有人去管,他們到底有沒有去上課。</span></span></div>
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<span style="font-family: inherit; font-size: x-large;"><b><span lang="EN-US">BBC</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">隨即推出</span><span lang="EN-US">ADHD</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">紀錄片</span><span lang="EN-US"><o:p></o:p></span></b></span></h3>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">儘管如此,英國廣播公司(</span><span lang="EN-US">BBC</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)仍在這篇論文發表後的幾個月(</span><span lang="EN-US">2007/11/12</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),發布新聞稿表示即將播出一部探討</span><span lang="EN-US">ADHD</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">用藥的紀錄片:〈</span><span lang="EN-US">What Next for Craig</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">〉</span><span lang="EN-US">[<span style="color: windowtext; text-decoration: none; text-underline: none;">4</span>]</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">播出前,</span><span lang="EN-US">BBC</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">新聞網分別以<b>「</b></span><b><span lang="EN-US">ADHD</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">用藥不是解答」</span></b><b><span lang="EN-US">[<a href="file:///C:/Users/rossPC/Desktop/%E7%B0%A1%E5%8C%96%E7%B2%BE%E7%A5%9E%E7%A7%91%E8%A8%BA%E6%96%B7/%E5%BE%9EBBC%E7%9A%84%E9%81%93%E6%AD%89%E5%95%9F%E4%BA%8B%E8%AB%87%E8%B5%B7%EF%BC%8DADHD%E7%A0%94%E7%A9%B6%E7%B5%90%E6%9E%9C%E8%A2%AB%E6%89%AD%E6%9B%B2%E7%9A%84%E9%81%8E%E5%8E%BB%E8%88%87%E7%8F%BE%E5%9C%A8.docx#_ENREF_5" title="NEWS, 2007 #7350"><span style="color: windowtext; text-decoration: none; text-underline: none;">5</span></a>]</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、「</span><span lang="EN-US">ADHD</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">用藥的疑慮」</span></b><b><span lang="EN-US">[<span style="color: windowtext; text-decoration: none; text-underline: none;">6</span>]</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、以及「</span><span lang="EN-US">ADHD</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">用藥沒有好處」</span></b><b><span lang="EN-US">[<span style="color: windowtext; text-decoration: none; text-underline: none;">7</span>]</span></b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">為題,在網站上簡介這部即將播出的紀錄片。文字內容直接寫出,最新研究顯示藥物治療沒有長期效果</span><span lang="EN-US">[<span style="color: windowtext; text-decoration: none; text-underline: none;">7</span>]</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span lang="EN-US">2007/11/12</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">播出的紀錄片,現在已經無法在</span><span lang="EN-US">BBC</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">網站上看到了。原因是兩年多後(</span><span lang="EN-US">2010/2</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月),<b>該片被自家</b></span><b><span lang="EN-US">BBC Trust</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">(內部監管機構)的編輯標準委員會(</span><span lang="EN-US">ESC, Editorial Standards Committee</span></b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><b>)要求改正與道歉,原因是該節目「嚴重違反編輯原則</b>」</span><span lang="EN-US">[<span style="color: windowtext; text-decoration: none; text-underline: none;">8</span>]</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">編輯委員會為此代表</span><span lang="EN-US">BBC</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">致歉,並要求該片不得轉售給其他公司,也不得再次播出,並限</span><span lang="EN-US">BBC</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在</span><span lang="EN-US">5</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">天內將網站上的不當資訊撤下</span><span lang="EN-US">[<span style="color: windowtext; text-decoration: none; text-underline: none;">8</span>]</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">從首播到停播,總共經歷了兩年多的時間。期間有多少人收看過或受到影響,不得而知。事實上,在節目播出後隔天,就已經有觀眾反映該節目針對</span><span lang="EN-US">ADHD</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">應如何治療的報導嚴重不實且失衡,而且可能造成對孩童的傷害</span><span lang="EN-US">[<span style="color: windowtext; text-decoration: none; text-underline: none;">8</span>]</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">五天後,也有精神科醫師發表評論指出,這部紀錄片用</span><span lang="EN-US">30</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">分鐘來呈現如此複雜的議題,是否沒有注意到「平衡報導」的原則呢?(</span><span lang="EN-US">A deficit of attention to impartiality?</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)是否以為觀眾的注意力不足呢?</span><span lang="EN-US">[<span style="color: windowtext; text-decoration: none; text-underline: none;">9</span>]</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">儘管如此,還是要等到兩年多後,</span><span lang="EN-US">BBC</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">才發表道歉聲明與停播。</span></span></div>
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<span style="font-family: inherit;"><b><span lang="EN-US" style="font-size: x-large;">BBC</span></b><b><span style="font-family: "新細明體" , "serif"; font-size: x-large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">為何道歉?</span><span lang="EN-US"><o:p></o:p></span></b></span></h3>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">編輯委員會指出,該節目沒有正確報導</span><span lang="EN-US">MTA</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">研究三年後的觀察結果,應該要增加其他研究者的觀點,而不是僅採用其中一位的說法。更指出該節目在呈現研究結果時,扭曲了一些已知的事實,<b>是嚴重而確實的錯誤</b>。</span><span lang="EN-US">[<span style="color: windowtext; text-decoration: none; text-underline: none;">8</span>]</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">這裡指的是,該紀錄片引用</span><span lang="EN-US">MTA</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">其中一位研究者的話說:「藥物沒有好處、藥物的療效被誇大了」</span><span lang="EN-US">[<span style="color: windowtext; text-decoration: none; text-underline: none;">5</span>]</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。卻沒有清楚說明,該研究本身的設計就有侷限,無法解讀因果關係;而且事實上,經過</span><span lang="EN-US">36</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月,包含藥物治療在內,所有治療組別的症狀相較於一開始皆有所改善。這樣的呈現方式,顯然<b>沒有考慮到觀眾有可能會因此感到擔憂</b></span><span lang="EN-US">[<span style="color: windowtext; text-decoration: none; text-underline: none;">10</span>]</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span style="font-family: "新細明體" , "serif"; font-size: large;">面對委員會的譴責,</span><span lang="EN-US" style="font-size: large;">BBC</span><span style="font-family: "新細明體" , "serif"; font-size: large;">新聞部發言人回應:製作團隊可能誤解了他們掌握的資料,或者只選擇了其中一種詮釋的觀點</span><span lang="EN-US" style="font-size: large;">[<span style="color: windowtext; text-decoration: none; text-underline: none;">8</span>]</span><span style="font-family: "新細明體" , "serif"; font-size: large;">。</span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">這就是文章開頭英國醫學期刊(</span><span lang="EN-US">BMJ</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)那篇新聞裡的事件。</span></span></div>
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<b><span style="font-size: x-large;"><span style="font-family: inherit; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></span></b></h2>
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<span style="font-family: inherit;"><b><span style="font-size: x-large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">六年後的現在,</span><span lang="EN-US">2016</span></span></b><b><span style="font-family: "新細明體" , "serif"; font-size: x-large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年的台灣</span><span lang="EN-US"><o:p></o:p></span></b></span></h3>
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<span style="font-family: inherit; font-size: large;"><span lang="EN-US">BBC</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的道歉距今已六年。民眾現在可以檢視,同樣的現象是否也在台灣上演中。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span lang="EN-US">2016</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年</span><span lang="EN-US">10</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月,美國一位醫藥記者執筆的《精神病大流行》,在台灣開賣了。近一個月內,民眾可以在各類通路看到關於這本書的介紹。中文版的兩位翻譯,一位是心理系畢業,另一位則是醫學系畢業。更值得注意的是,某些網路平台(如【關鍵評論網】)陸續刊載此書的<a href="https://www.thenewslens.com/article/54885" target="_blank">中文導讀</a>以及<a href="https://www.thenewslens.com/article/54396" target="_blank">部分章節</a>。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">此書上市後約一個月(</span><span lang="EN-US">2016/11/22</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),【巷仔口社會學】網站也<a href="https://twstreetcorner.org/2016/11/22/yichun-chen/" target="_blank">登出一篇文章</a>,名為〈誰得了「不專心」的病?注意力缺失症(</span><span lang="EN-US">ADD/ADHD</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的社會學觀察〉。該文作者引用《精神病大流行》一書,寫下關於</span><span lang="EN-US">ADHD</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">藥物治療的文字:</span></span></div>
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<span style="font-family: inherit; font-size: large;">「已有研究顯示,雖然藥物治療初期有效,然而當藥物治療二十四至三十六個月時,患者的注意力不足的症狀卻惡化了。」</span></div>
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<span style="font-family: inherit; font-size: large;"><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">了解</span><span lang="EN-US">ADHD</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">研究脈絡的人不難猜到,這段話引用的文獻,應該就是當初讓</span><span lang="EN-US">BBC</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">犯下嚴重錯誤的那則研究。</span></b><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">翻開《精神病大流行》中文版第</span><span lang="EN-US">290</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">頁,果然是這樣沒錯。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">作者惠特克(</span><span lang="EN-US">Whitaker</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)這樣寫:</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">「使用藥物並非結果有益的重要標記,反而是結果惡化的標記。意思就是,在</span><span lang="EN-US">24</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至</span><span lang="EN-US">36</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月的期間內用藥的受試者,確實在這段期間展現出比未用藥者更多的症狀表現。換句話說,用藥者的注意力不足過動症核心症狀-衝動、注意力不集中、過動,惡化了,至少和未用藥者相比是如此。」</span></span></div>
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<b><span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">惠特克選擇用「惡化」來描述研究結果,而台灣的學者也跟著引用這個說法。</span><span lang="EN-US"><o:p></o:p></span></span></b></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">前面已提過,</span><span lang="EN-US">24</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至</span><span lang="EN-US">36</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月期間的用藥與症狀,僅能判斷相關性,無法判斷因果關係-究竟是症狀比較嚴重所以用藥?還是相反?原始文獻一再說明,無法確定。</span></span></div>
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<span style="font-family: inherit;"><span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">更重要的是,到了第</span><span lang="EN-US">36</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月,症狀相較於第</span><span lang="EN-US">0</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月,仍然有所改善,沒有惡化。</span></span><b><span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">前</span><span lang="EN-US">14</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月接受藥物治療的組別,症狀也從來沒有較其他組嚴重,最多就是一樣的狀態而已。</span></span></b></span></div>
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<b><span style="font-family: inherit; font-size: x-large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></b></h3>
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<b><span style="font-family: inherit; font-size: x-large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">是精神病大流行?還是「超譯精神醫學」正在流行?</span></b></h3>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在《精神病大流行》一書的導讀,<a href="https://www.thenewslens.com/article/54885" target="_blank">〈打開精神醫學的潘朵拉盒子〉</a>一文中,彭榮邦助理教授這樣寫:</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">「如果真是如此,那麼美國主流精神醫學的全球化,就成了一件相當可疑的事情,因為它的整體部署,很難拆解輸出而不改變本質。「精神疾病診斷」及「藥物治療」是最容易<b>跨國輸出</b>的部分,但是構成「精神疾病」整體部署的其他向度,例如社會福利、特殊教育,以及其他接應精神病患的體制和人際網絡,恐怕就很難跨越國界,或至少在速度上遠遠落後。更需要注意的是,這個只有<b>「部分輸出」</b>的精神醫學,很可能改變或遮蔽了某些正在醞釀中的歷史過程。」</span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">此書上市不到兩個月,台灣的民眾與讀者也可以開始觀察,<b>《精神病大流行》為台灣輸入些甚麼呢?</b>更要觀察的是,台灣各界將用甚麼樣的觀點來回應這本書呢?是跨國輸入台灣的學說?還是富含本土脈絡的實證?</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span style="font-family: "新細明體" , "serif"; font-size: large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">這將會是一場重要的社會觀察。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<b><span style="font-family: inherit; font-size: x-large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">沒有守門人的時代</span></b></h3>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">回顧</span><span lang="EN-US">BBC</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的道歉啟事,內部的獨立委員會扮演了守門人(</span><span lang="EN-US">watchdog</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的角色,指出節目內容的錯誤、要求道歉、撤下扭曲的資訊。<b>在</b></span><b><span lang="EN-US">2016</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年的台灣,民眾應該要問-面對那些引用科學文獻支持自身論點,隨手可看、可分享的網路文章-守門人在哪裡?</span></b><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">BBC的</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">道歉儘管來得很遲,但他們至少有勇氣面對。<b>而比道歉更重要其實是,那部紀錄片撤下前對多少人造成了影響。</b></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><b><span lang="EN-US">對比之下,2016</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年的台灣,持續參與傳播類似訊息,扭曲研究結果的-特別是醫師、網路媒體、各類社群、專家學者們-他們接下來的選擇會是甚麼?</span></b><span lang="EN-US"><o:p></o:p></span></span></div>
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<b><span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">又有多少台灣人可能會受到影響?</span><span lang="EN-US"><o:p></o:p></span></span></b></div>
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<b><span style="font-family: inherit; font-size: large;"><span style="font-family: , serif;">民眾在這個過程裡,又能有甚麼選擇?</span> </span></b></div>
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<b><u><span style="font-family: inherit;">參考資料</span></u></b></div>
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<span style="font-family: inherit;"><span lang="EN-US">1. Dyer, C., <i>BBC programme gave distorted facts about ADHD study.</i> BMJ, 2010. <b>340</b>: p. c1894.</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span lang="EN-US">2. <i>A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD.</i> Arch Gen Psychiatry, 1999. <b>56</b>(12): p. 1073-86.</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span lang="EN-US">3. Jensen, P.S., et al., <i>3-year follow-up of the NIMH MTA study.</i> J Am Acad Child Adolesc Psychiatry, 2007. <b>46</b>(8): p. 989-1002.</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span lang="EN-US">4. Jofre, S., <i>What Next for Craig?</i>, 2007, BBC.</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span lang="EN-US">5. NEWS, B. <i>Drugs for ADHD 'not the answer'</i>. 2007; Available from: </span><span lang="EN-US">http://psychrights.org/articles/Drugs4ADHDNotAnswerBBCNov07.htm</span><span lang="EN-US">.</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span lang="EN-US">6. NEWS, B. <i>Questions over drugs for ADHD</i>. 2007; Available from: </span><span lang="EN-US">http://news.bbc.co.uk/2/hi/uk/7090011.stm</span><span lang="EN-US">.</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span lang="EN-US">7. Office, B.P. <i>Panorama: ADHD drugs have "no beneficial effects"</i>. 2007; Available from: </span><span lang="EN-US">http://www.bbc.co.uk/pressoffice/pressreleases/stories/2007/11_november/12/adhd.shtml</span><span lang="EN-US">.</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit;"><span lang="EN-US">8. Deans, J. <i>BBC Trust condemns 'inaccurate' Panorama ADHD episode</i>. 2010; Available from: https://</span><span lang="EN-US">www.theguardian.com/media/2010/feb/24/panorama-bbc-trust-ruling</span><span lang="EN-US">.</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: inherit;">9. McClure, I., <i>A deficit of attention to impartiality?</i> BMJ : British Medical Journal, 2007. <b>335</b>(7628): p. 1047-1047.</span></div>
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<span style="font-family: inherit;"><span lang="EN-US">10. REPORTER, D.M. <i>BBC's Panorama 'distorted facts' in documentary about ADHD</i>. 2010; Available from: </span><span lang="EN-US">http://www.dailymail.co.uk/news/article-1253480/BBCs-Panorama-distorted-facts-documentary-ADHD.html</span><span lang="EN-US">.</span></span><br />
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<span lang="EN-US">*本文於2016/12/3刊於<a href="http://adhdknow.blogspot.tw/2016/12/bbcadhd.html" target="_blank">ADHD現代知識專頁</a></span></span></div>
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Ross Limhttp://www.blogger.com/profile/04834324679210414893noreply@blogger.comtag:blogger.com,1999:blog-1047390135102157236.post-15351984634358176272016-11-25T06:29:00.000-08:002017-02-08T19:03:01.201-08:00社會學觀察或研究不應簡化精神科診斷標準<div class="MsoNormal">
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<span style="font-size: large;"><span style="font-family: inherit; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 我是精神科醫師,平日參與實習醫師與住院醫師的精神科診斷教學與訓練。雖不是兒童青少年精神科專科醫師,但也有與孩童、家長在診間互動的經驗與訓練。</span></span><br />
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<span style="font-family: , serif; font-size: large;"> </span><span style="font-family: , serif; font-size: large;">在文章的一開始必須先聲明,</span><span style="font-family: , serif; font-size: large;">以下見解仍僅從我過去工作和受訓的經驗出發,可能有其觀點上的侷限,</span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 幾天前,「巷仔口社會學」網站及其臉書專頁,發表了一篇題為『<b>誰得了「不專心」的病?注意力缺失症(</b></span><b><span lang="EN-US">ADD/ADHD</span></b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的社會學觀察<b>』</b>的<a href="https://twstreetcorner.org/2016/11/22/yichun-chen/" target="_blank">文章</a></span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,作者是我的母校醫學社會暨社會工作學系的陳逸淳。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 這篇文章名為社會學觀察,好幾次針對「弔詭現象」指出疑問,更引用了法國學者傅科的論述,凸顯了社會學不斷提問、具批判性、關注體制的特色。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 文中數次提及醫療與醫學:例如「注意力問題被醫療化」、「醫療體系傾向於採用藥物來進行長期治療」、「藥物治療卻愈來愈被醫療機構與衛生部門視為治療的重要選項」、「診斷的目的是為了治療」、「當我們將社會化過程中所發生的問題,透過建立起診斷標準轉化為醫療問題的時候,也許正如傅柯所言,正是一種精神醫學普遍化的展現。」</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 還有最顯眼的結論:「不專心的問題不應為醫療語言所壟斷」。以及「任由醫療語言片面壟斷對個體生命的解釋權」。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 此外也有一些用字的選擇引人注意:例如「各式各樣干擾上課的行為就『都成了醫療問題』」,『濫用』注意力缺失症,『十成』的孩子都符合患病標準了」(引他人之文字);「診斷與研究卻是『徹底』『歸咎』於個體的」;「『所有』的診斷都將注意力缺失的問題認定為個人的問題,卻『從未』考慮人們的不專心是否與制度、規範等集體事實有關」;「如此『推理』的話,成人確診數量理應遠遠高於兒童。」;「截至目前為止,試圖辨認過動症兒童之特定神經化學失衡的努力結果,『一直都是』令人失望的。」</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 儘管有以上這些描述與字眼,身為一名精神科醫師,我仍不至於也不應將此文看成是對精神醫學的敵視。否則,我的發言或情緒就可能讓人覺得,精神醫學或精神科醫師,就是不具反思性、不可被批判、也不可能改變的。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> <b>不過,有一點仍是無法忽視,必須加以澄清的。那就是「巷仔口社會學」粉絲專頁與該文章數次簡化了精神醫學的診斷。</b></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 該文要談的似乎是<b>「注意力不足過動症」</b>,<b>但文章標題及內文混用「不專心」、「注意力缺失」來討論、推理、以及詮釋「注意力不足過動症」的診斷、研究、與用藥</b>。此為第一種簡化,背後的風險是令讀者認為此症只有注意力的症狀,研究及診斷也僅只涵蓋於此。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 接著,在<a href="https://www.facebook.com/twstreetcorner/posts/732046273609688">「巷仔口社會學」粉絲專頁登出此文</a>時,<b>引文用了三個封閉式的問句加上一句警語:</b></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCmjqYZlMHsPuV0DuWCJ-eFp_2EwDraqox1mZBBKaAt-Q73j7P6tbokK2A-1if9DbMMfPb68daHdsWJFEbfHQFAia9aXkvg4CGZltBHTBpbt3sdcxzJbPNNCV-Ir3aZQa7xOM1L_-1sTv_/s1600/2016-11-25_223954.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: inherit;"><img border="0" height="124" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCmjqYZlMHsPuV0DuWCJ-eFp_2EwDraqox1mZBBKaAt-Q73j7P6tbokK2A-1if9DbMMfPb68daHdsWJFEbfHQFAia9aXkvg4CGZltBHTBpbt3sdcxzJbPNNCV-Ir3aZQa7xOM1L_-1sTv_/s320/2016-11-25_223954.jpg" width="320" /></span></a></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 「你是不是經常逃避、討厭或不願從事需要持久心力的工作?或經常遺失工作或活動所需的東西?還是在日常生活中常忘東忘西?小心,你可能得了「注意力不足過動症」(</span><span lang="EN-US">ADHD</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)」</span><span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><b> 此處為對於精神科診斷的第二種簡化,背後的風險是令讀者認為精神科醫師是以封閉式問句做診斷。</b>必須聲明的是,精神醫學的診斷,從一開始的訓練就不是這樣教的,也不應該是這樣開場的。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> <b>最後,最重要也最令人擔心的風險是,內文對於注意力不足過動症診斷的描述,是嚴重的簡化。作者僅引述</b></span><b><span lang="EN-US">DSM-5</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">診斷準則中的</span><span lang="EN-US">A</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">條款,而且,連</span><span lang="EN-US">A</span></b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><b>條款都未引述完整。</b>或許有人會說,作者應該是引述自己覺得重要的部分吧,讀者如果要看全部的診斷,自行上網查詢即可啊。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><b> 然而,作者所省略之處,正是此診斷在臨床訓練中最關鍵也最需注意的部分。例如:</b></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><b><span lang="EN-US">A</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">條款一開頭即說明這些症狀必須干擾功能或發展,才能算是符合;</span><span lang="EN-US"><o:p></o:p></span></b></span></div>
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<span style="font-family: inherit; font-size: large;"><b><span lang="EN-US">B</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">條款則限制了症狀初次發生的年齡必須在</span><span lang="EN-US">12</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲以前;</span><span lang="EN-US"><o:p></o:p></span></b></span></div>
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<span style="font-family: inherit; font-size: large;"><b><span lang="EN-US">C</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">條款剛好呼應作者想強調的,必須考慮情境因素,若症狀只在某一種情境(例如學校)出現,不得診斷;</span><span lang="EN-US"><o:p></o:p></span></b></span></div>
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<span style="font-family: inherit; font-size: large;"><b><span lang="EN-US">D條款</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">更重要:要求有明顯的證據顯示症狀干擾或降低社會、學業、或職業功能的品質。請注意此處定義的是「干擾」與「降低」功能的品質,基準是個案本身的功能品質,而不是作者所簡化的「與他人有所差異」、或者傅柯在多年前指涉的「不符成人的標準」。</span><span lang="EN-US"><o:p></o:p></span></b></span></div>
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<span style="font-family: inherit; font-size: large;"><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">最後,</span><span lang="EN-US">E條款</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">更要求確認注意力不足、過動、衝動等症狀,並不是其他精神病症所可以解釋的。</span><span lang="EN-US"><o:p></o:p></span></b></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 以上重點,是精神醫學訓練必教、必學之處。該文不僅省去不談,更在照抄前</span><span lang="EN-US">9</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">項症狀之後,緊接著問讀者<b>:「看完上述列表,有沒有覺得好幾項目似曾相似,好像自己也常常如此?」此處的風險是讀者再次留下印象,精神科診斷是單從字面意義即可理解或操作。</b></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: inherit; font-size: large;">**</span></div>
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<span style="font-family: inherit; font-size: large;"><span lang="EN-US"> DSM-5</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">診斷系統並不完美,也有其限制。<b>但那些條文並非法律,也不是自我診斷用的核對表</b></span><span lang="EN-US"><b>(checklist)</b></span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><b>。</b></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 若有人一方面暗示</span><span lang="EN-US">DSM-5</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">診斷像法律,具有強制性或可能會因診斷而被精神醫療霸權支配;另一方面又暗示讀完這些條文即可自行診斷,<b>這就不只是簡化了,而是進一步影響民眾對此診斷系統的印象與理解。</b></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 綜合以上考量與觀察,我提出以上澄清並呼籲:</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<b><span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 「社會學觀察或研究不應簡化精神科診斷標準」。</span><span lang="EN-US"><o:p></o:p></span></span></b></div>
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<span style="font-family: inherit; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 社會學有其理想、關懷、與格局,企圖看見人們不易察覺之問題。不過,若在提問的過程中,簡化了精神診斷或精神醫療原有的複雜度與脈絡,這樣的做法不僅有風險,更令人難以分辨社會學與山達基或公民人權協會的立場/脈絡是否有別。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd2bu4CcVQIger38c_iEY2ERlVQCXYd7cej1nvw3VtJwUPSqGod_jTC-MMGLYBpT3CCiX3Fu0qa4UwycyeC8QQgwFdRx7s5dYETpEiy4fouP94DrliDhGnD6ykke3ZdQ1MlEs3EqrgasTe/s1600/2016-11-25_224528.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: inherit;"><img border="0" height="137" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd2bu4CcVQIger38c_iEY2ERlVQCXYd7cej1nvw3VtJwUPSqGod_jTC-MMGLYBpT3CCiX3Fu0qa4UwycyeC8QQgwFdRx7s5dYETpEiy4fouP94DrliDhGnD6ykke3ZdQ1MlEs3EqrgasTe/s400/2016-11-25_224528.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: inherit;">公民人權協會也在詮釋原因</span></td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUTQxydkcgAU0SFBbTL1OQz7rGMbHUzjOSyjqX6l1ZgP_MlA87At5TEUhiEIcsN45aUOM-HYn2UuHp8zbv587lk1MauXONGlmg9kPozc5NfcN9OOQ0C7tTosbF8YGL5VLXlBIbjvVDLhuZ/s1600/2016-11-25_224823.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: inherit;"><img border="0" height="282" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUTQxydkcgAU0SFBbTL1OQz7rGMbHUzjOSyjqX6l1ZgP_MlA87At5TEUhiEIcsN45aUOM-HYn2UuHp8zbv587lk1MauXONGlmg9kPozc5NfcN9OOQ0C7tTosbF8YGL5VLXlBIbjvVDLhuZ/s400/2016-11-25_224823.jpg" width="400" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: inherit;">公民人權協會也覺得DSM是將行為疾病化</span></td></tr>
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Ross Limhttp://www.blogger.com/profile/04834324679210414893noreply@blogger.comtag:blogger.com,1999:blog-1047390135102157236.post-57098483102690560682016-05-30T01:00:00.000-07:002017-02-08T19:05:31.793-08:00一次用藥的機會 <div style="background-color: white; color: #222222;">
<span style="font-family: inherit; font-size: large;">林子勤/精神科醫師</span></div>
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<span style="font-family: inherit; font-size: large;">近來若干立委針對注意力不足過動症(<span lang="EN-US">ADHD</span>)<wbr></wbr>藥物治療的極端看法,令人相當不安。<span lang="EN-US"></span></span></div>
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<span style="font-family: inherit; font-size: large;">更有立委喊出:「除非所有醫師皆同意用藥,否則反對投藥」-<wbr></wbr>這種將醫療視為舉手投票的意見。</span></div>
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<span style="font-family: inherit;"><span style="font-size: large;">長期以來,精神科藥物存在著許多負面的形象,例如副作用、成癮、</span><wbr style="font-size: x-large;"></wbr><span style="font-size: large;">依賴性等等。許多人在醫師還沒有開口建議藥物治療之前,</span><wbr style="font-size: x-large;"></wbr><span style="font-size: large;">心中就對藥物存在相當程度的恐懼,最終錯過治療的機會。</span></span><br />
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<span style="font-family: inherit; font-size: large;"><b>藥物不是精神科治療的唯一選項;但對許多人而言,<wbr></wbr>藥物是非常重要的一個選項。精神科醫師必須努力建立醫病關係,<wbr></wbr>甚至得串聯好幾個支持系統,才能讓這些人得到藥物治療的幫助。</b><span lang="EN-US"></span></span></div>
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<span style="font-family: inherit; font-size: large;">在注意力不足過動症的議題上,部分立委將藥物治療與「毒品」、「<wbr></wbr>副作用嚴重」、「草率用藥」等形象畫上等號-<wbr></wbr>如此將精神科用藥的副作用極大化,將精神科醫師的專業極小化,<wbr></wbr>結果將是國人對所有精神用藥與治療的態度極端化。<wbr></wbr>對某些需要藥物治療的人而言,可能連「一次用藥的機會」<wbr></wbr>都不可得。<span lang="EN-US"></span></span></div>
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<span style="font-family: inherit; font-size: large;">經歷數個悲劇之後,<wbr></wbr>輿論與政治人物突然發現精神醫療的是社會安全網的一環,<wbr></wbr>更有許多聲音大力疾呼要「補破網」。言猶在耳,<wbr></wbr>某些民代卻開始做相反的事。<span lang="EN-US"></span></span></div>
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<span style="font-family: inherit; font-size: large;">下一個社會事件發生後,媒體又會去分析背後的原因。<wbr></wbr>到時也許會有人說:「他曾有過一次用藥(治療)的機會...」</span></div>
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<span style="font-family: inherit; font-size: large;">*本文投稿於蘋果即時論壇,<a href="http://www.appledaily.com.tw/realtimenews/article/forum/20160531/874655/1/" target="_blank">刊登</a>時標題與內文有所修改</span></div>
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Ross Limhttp://www.blogger.com/profile/04834324679210414893noreply@blogger.com