David Casarett: A doctor's case for medical marijuana
大衛·卡薩雷特: 一位醫生對藥用大麻的探討
David Casarett asks: What if mainstream health care operated more like a medical marijuana dispensary? Full bio
Double-click the English transcript below to play the video.
在我擔任臨終關懷治療師的時候,
about the most embarrassing thing
of working as a palliative care physician.
擔任她的醫療顧問──
to see a woman in her 70s --
罹患胰腺癌。
who had pancreatic cancer.
疼痛、噁心、想吐......
she had pain, nausea, vomiting ...
we talked about those symptoms
我們談論了這些症狀;
that medical marijuana might help her.
藥用大麻能幫助到她。
關於藥用大麻的知識;
about medical marijuana,
because I had learned absolutely nothing.
任何藥用大麻的知識。
並沒有什麼用處。
had no benefits whatsoever.
然後從床邊的提袋裡,
into the handbag next to the bed,
隨機對照試驗報告,
randomized controlled trials
噁心、疼痛、焦慮等症狀。
marijuana has benefits
and pain and anxiety.
before offering an opinion ...
再發表意見......醫生。」
and found a bunch more.
there is some evidence
支持大麻具有醫療效果;
really was interested,
如果她真的有意願的話,
retired English professor?
about six months ago.
才發現這個東西,它棒極了。」
to discover this stuff. It's amazing."
about medical marijuana
in medical school
開始和研究人員交流,
I started talking to researchers,
I started listening to patients.
我開始傾聽患者的聲音。
based on those conversations,
「意料之外」的事件為中心──
around three surprises --
to medical marijuana.
as huge or as stunning
所希望我們相信的──
of medical marijuana
as huge and as scary
想讓我們相信的程度,
marijuana would have us believe,
that was most ...
of the patients I talked with
marijuana for help,
because of its benefits
那是一種特效藥,
it was a wonder drug,
對疾病的控制感,
control over their illness.
let me tell you about another patient.
讓我來聊聊另一位患者。
like she was in her late 60s.
類風濕性關節炎的折磨,
for the last 20 years,
on a wheelchair to get around.
cognitively, psychologically,
people I've ever met.
一間藥用大麻藥局裡,
in Northern California
to medical marijuana,
from many patients before.
she slept better.
我卻從來沒聽過:
that I'd never heard before,
control over her life
that worked for her.
then she could make changes.
anybody else's permission --
不需要醫生的處方,
not a doctor's prescription,
for somebody with chronic illness,
這是一件小事嗎?
狼瘡、癌症、糖尿病
or lupus or cancer or diabetes,
而不是用「如果」。
都要面對嚴重的慢性病,
will face a chronic serious illness
有的人還會經歷智力衰退,
some of us will see our cognition decline,
to care for ourselves,
我們失去了控制權。
也就是臨終關懷患者交流時,
my palliative care patients,
正面臨將奪走他們生命的疾病,
that will end their lives,
constipation, fatigue,
more than anything else
是可能在某個時候,
control of their health,
dependent on others,
that patients like Robin,
some semblance of control.
一些表面上的控制權。
marijuana dispensaries --
back the sort of control that they need?
medical hospitals and clinics,
一間破破的診所,
in Venice Beach in California
to be a medical marijuana patient.
藥用大麻的病患。
that would let me buy medical marijuana.
能讓我購買藥用大麻。
a resident of California --
of recommendation to make a purchase,
那份同意書購買大麻,
美國緝毒局的調查員的──
用這份同意書進行購買,
make a purchase though,
because it let me be a patient.
因為它讓我成為一名患者,
像羅繽這樣的患者所經歷的,
what patients like Robin experience
所得到的經驗。
marijuana dispensary.
of people like Robin --
每天都在經歷的──
診所和藥局的那一刻起,
many of these clinics and dispensaries,
at the outset about who I am,
他們會詢問一些問題,
for a medical marijuana prescription,
what my preferences are,
我期望帶來什麼幫助?
this might help me,
get asked all the time.
that make me confident
是從內心關注我的利益,
really has my best interests at heart
in those clinics
behind the counter,
from folks in the waiting room.
這些人都很高興──
as I was sitting next to them --
為什麼使用藥用大麻?
why they use medical marijuana,
建議和支持的場所。
a hive of interaction, advice and support.
他們非常心甘情願的,
those people were
跟我討論許多細節,
talking me through the nuances
購買任何東西的情況下。
making any purchase whatsoever.
you went to any hospital or clinic
向你詳細解釋,是什麼樣的情況?
explaining those sorts of things to you.
are going to these clinics,
會去這些診所,
of personalized attention
to the healthcare system.
from mainstream medicine,
能給予他們真正需要的。
are giving them what they need.
to the medical establishment,
of my colleagues are either not hearing
physicians in particular,
「哦!我們需要更多證據。
以及更多關於危害的證據。」
we need more evidence about risks."
來證明藥用大麻的成效。
about the benefits of medical marijuana.
把大麻重訂為二類藥物,
to reschedule marijuana to Schedule II,
才能讓研究進行。
to make that research possible.
into medical marijuana's risks.
進行更多研究。
我們了解很多,
the risks of recreational use,
我們幾乎一無所知。
about the risks of medical marijuana.
to make any changes now
aren't seeking out medical marijuana
it's entirely risk-free.
是由於大麻被遞送、發放,
in which it's delivered and administered
對生活的掌控權。
they need over their lives.
we really need to pay attention to.
there are lessons we can learn today
we really should learn.
mom-and-pop operations
一直在為患者提供服務、支持,
and dispensaries are providing services
都做不到的方式──
healthcare systems aren't --
three lessons at least
from those small dispensaries.
to give patients more control
小巧但是重要的方法,
with healthcare providers,
in ways that work for them.
creative and flexible
in using drugs safely
是屬於鴉片類或苯二氮䓬類藥物,
are drugs like opioids or benzodiazepines
患者的意願與需求來使用,
if they're not used in a way
what patients want and need.
if it's delivered safely,
具有非常重要的意義。
for patients and their families.
of those medical marijuana dispensaries
a lot of physician time necessarily,
我們正在用什麼藥物,
about what medications we're using
to learn from each other.
dispensary waiting rooms?
所出現的情境呢?
人們如何彼此分享?
how people share with each other.
把病患放在第一位,
those medical marijuana dispensaries do,
legitimately like what they want,
their fears, their goals and preferences.
期望、恐懼、目標和偏好。
他們想要什麼?擔心什麼?
hoping for and what they're afraid of.
until they're chronically seriously ill,
像我這類的醫師,
until they're seeing a physician like me
提供項目之中。
that healthcare is delivered.
and clinics all across the country
health systems are years behind.
就是放下我們的驕傲──
lots of letters after our name,
一大堆頭銜,
醫療機構裡的主管權力,
of a large healthcare system,
是如何滿足病患的需求。
about how to meet patients' needs.
a few medical marijuana dispensaries.
為什麼很多像羅繽一樣的病人,
why so many patients like Robin
marijuana dispensaries instead.
what their tricks are,
並且我們必須做到的,
and I absolutely think we have to,
都能得到更好的體驗。
will have a much better experience.
ABOUT THE SPEAKER
David Casarett - PhysicianDavid Casarett asks: What if mainstream health care operated more like a medical marijuana dispensary?
Why you should listen
In his third book, Stoned: A Doctor's Case for Medical Marijuana, palliative care physician David Casarett takes a first-person investigative journalist's approach to making sense of marijuana's therapeutic potential and adverse effects. He shares what he's learned about this chronically misunderstood drug -- including the control it gives patients over their health and the educational atmosphere of dispensaries -- and outlines what we still need to do to explore its potential health benefits.
Casarett is a professor of medicine at the Duke University School of Medicine and chief of palliative care for the Duke Health System. He is the author of more than 100 journal articles, numerous magazine articles, and Shocked, another nonfiction book about the science of resuscitation. Casarett's first novel in the Ethical Chiang Mai Detective Agency series, Murder at the House of Rooster Happiness, was published in September 2016. The next installment, The Missing Guests of the Magic Grove Hotel, will be published in the fall of 2017.
David Casarett | Speaker | TED.com