如何解读医生罢工期间死亡率下降？

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如果有人说：“降低医生待遇是不可能的，因为一旦全国医生总罢工，一直吃药的拿不到药，那不知会有多少人很快死亡”，应该能得到不少人的认同。这是大多数人的观点。而真理只掌握在少数人手中。

美国的医生协会并不是靠罢工来得到他们需要的待遇，而是靠庞大的国会游说团让议员们通过他们认同的法案来实现的，比如全国医生招生人数不能跟其它行业比如律师工程师那样由市场决定而非由该学科协会控制。

事实上，包括美国在内，有不少国家曾发生过医生罢工事件，但都是保证急救医生继续开业，比如车祸急救、妇产科难产或产后大出血等急救医生继续上班。

根据当时医学杂志和新闻报道提供的数据，罢工期间死亡率不仅没增加，还减少了很多。总的规律是：医生罢工时间越长，人口死亡率下降越多，虽然不是绝对呈直线关系。

在美国1976年洛杉矶医生短期大罢工期间，全市死亡率下降了18%。在加拿大Manitoba医生罢工两周期间，死亡率下降了20%。在British Columbia 的医生罢工三周期间，死亡率下降了30%。在1976年的哥伦比亚Bogota医生罢工52天期间，该市的死亡率下降了35%。在2000年以色列医生大罢工期间，以色列最大的殡葬场（占处理全国死人总数的55%）在该月收到的死人数占1997, 1998，1999三年该月份平均数的60%，等于一个月的罢工期间死亡率下降了40%。在往前数的1973年，以色列为期一月的全国医生大罢工，该月死亡人数下降了50%。在1983年以色列全国医生大罢工长达85天（另一个资料提供的天数是四个半月。估计全国范围的大罢工是85天，而局部的高达四个半月）的时间里，全国死亡人数比以往同期死亡人数下降了50%。

到目前为止，还没有哪个国家或地区医生罢工超过四个半月的，也就无法推理出医生长期罢工对死亡率的终极影响。但有一点是绝对真理：即使所有的医生都永久罢工，所有的医院都关门，死亡率也不会减少100%，因为人总是要死的。

从以上数据得知医生罢工长度与死亡率下降成正比的趋势非常明显。至于如何解读这样的真实数据，当真是仁者见仁智者见智。下面是当时医学家们的部分猜测。

British Medical Journal 2000;320:1561 ( 10 June )

News
Doctors’ strike in Israel may be good for health
Judy Siegel-Itzkovich, Jerusalem

Industrial action by doctors in Israel seems to be good for their patients’ health. Death rates have dropped considerably in most of the country since physicians in public hospitals implemented a programme of sanctions three months ago, according to a survey of burial societies.

The Israel Medical Association began the action on 9 March to protest against the treasury’s proposed imposition of a new four year wage contract for doctors. Since then, hundreds of thousands of visits to outpatient clinics have been cancelled or postponed along with tens of thousands of elective operations. Public hospitals, which provide the vast majority of secondary and tertiary medical care, have kept their emergency rooms, dialysis units, oncology departments, obstetric and neonatal departments, and other vital facilities working normally during the industrial action.

In the absence of official figures, the Jerusalem Post surveyed non-profit making Jewish burial societies, which perform funerals for the vast majority of Israelis, to find out whether the industrial action was affecting deaths in the country.

“The number of funerals we have performed has fallen drastically,” said Hananya Shahor, the veteran director of Jerusalem’s Kehilat Yerushalayim burial society. “This month, there were only 93 funerals compared with 153 in May 1999, 133 in the same month in 1998, and 139 in May 1997,” he said. The society handles 55% of all deaths in the Jerusalem metropolitan area. Last April, there were only 130 deaths compared with 150 or more in previous Aprils. “I can’t explain why,” said Mr Shahor.

Meir Adler, manager of the Shamgar Funeral Parlour, which buries most other residents of Jerusalem, declared with much more certainty: “There definitely is a connection between the doctors’ sanctions and fewer deaths. We saw the same thing in 1983 [when the Israel Medical Association applied sanctions for four and a half months].”

Motti Yeshuvayov of Tel Aviv’s only burial society said that he had noticed the same trend in the Tel Aviv metropolitan area in the past two months. The only exception to the trend of decreasing deaths has been in the Haifa area.

The coastal city of Netanya has only one hospital, and it has been spared the industrial action because staff have to sign a no strike clause with their contract. Netanya’s burial society, headed by Shlomo Stieglitz, reported 87 funerals last month, the same number as in May 1999. It reported 97 in April compared with 122 in April 1999, and 99 in March as compared with 119 in March 1999. Mr Stieglitz said that his burial society services not only Netanya but also other cities, including Hadera and Kfar Sava, where hospital doctors have joined the sanctions.

Avi Yisraeli, director general of the Hadassah Medical Organization, which owns two university hospitals in the capital, offered his own explanation. “Mortality is not the only measure of harm to health. Lack of medical intervention can lead to disability, pain, and reduced functioning. Elective surgery can bring about a great improvement in a patient’s condition, but it can also mean disability and death in the weakest patients. And patients who do not undergo diagnosis or surgery now could decline or die in a few months due to the postponement.”

During the months of the strike, patients “have been going more to their family doctor and to hospital emergency rooms, which have not been affected by sanctions,” Professor Yisraeli said.

 

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Excerpt from: Confessions of A Medical Heretic

By Robert S. Mendelsohn, M.D. Chicago: Contemporary Books, 1979, p. 114

(Note: By “Church” he is referring to the medical establishment, which he says is far more a religion than a science)

“How truly deadly the Church is comes into stark relief whenever there’s a doctor’s strike. In 1976 in Bogota, Columbia, there was a fifty-two day period in which doctors disappeared altogether except for emergency care. The “National Catholic Reporter” described “a string of unusual side-effects” from the strike. The death rate went down 35%. A spokesman for the National Morticians Association said, “It might be a coincidence but it is a fact.” An 18% drop in the death rate occurred in Los Angeles County in 1976 when doctors there went on strike [note: it was a work slowdown] to protest soaring malpractice insurance premiums…. When the strike ended and the medical machines started grinding again, the death rate went right back up to where it had been before the strike.

“The same thing happened in Israel in 1973 when the doctors reduced their daily patient contact from 65,000 to 7,000. The strike lasted a month. According to the Jerusalem Burial Society, the Israeli death rate dropped 50% during that month. There had not been such a profound decrease in mortality since the last doctors’ strike twenty years before!
“I’ve been saying right along that what we need is a perpetual doctors’ “strike.” If doctors reduced their involvement with people by ninety percent and attended only emergencies, there’s no doubt in my mind that we’d be better off.”

*************************************************************************************************************************Extract from: Medical Journal of Australia 1999; 170: 404-405

Editorial

The human element of adverse events
Is a certain level of error inevitable in healthcare?
Quality in Australian Health Care Study (QAHCS) (1) together with the Harvard study on which it was based (2), were groundbreaking studies that for the first time systematically revealed the nature and scale of iatrogenic injury in healthcare.
Morbidity due to healthcare appears to be a major public health problem, and it is very unlikely that this problem is confined to Australia and the United States. The QAHCS revealed particularly high levels of adverse events (AEs), in part because it took a broader, quality-of-care approach rather than one focused on negligence and compensation…..

….The findings from the QAHCS (5 years ago) suggested that each year 50 000 Australians suffer permanent disability and 18 000 die at least in part as a result of their healthcare. Further evidence emerged in 1997 with the publication of AE rates in Victorian hospitals (3). Since then, thousands more Australians have presumably been injured or died through deficiencies in the healthcare system. Furthermore, the QAHCS found that AEs lost Australia over three million bed-days per annum. In its interim report, the National Expert Advisory Group pointed out that the extrapolated potential saving from preventable AEs in 1995-96 would be $4.17 billion (4). AEs also lead to increased disability benefits and time lost off work, which all impact on the Australian economy.

1. Wilson RM, Runciman WB, Gibberd RW, et al. The Quality in Australian Health Care Study. Med J Aust 1995; 163: 458-471.
2. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. N Engl J Med 1991; 324: 370-376.
3. O’Hara D, Carson NJ. Reporting of adverse events in hospitals in Victoria 1994-1995. Med J Aust 1997; 166: 460-463.
4. National Expert Advisory Group on Safety and Quality in Australian Health Care. Interim report – Commitment to quality enhancement. July 1998.

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Metro, May 11, 2005

Prescription Drugs ‘kill 15,000 a year’

Thousands of people are killed each year by common prescription drugs, scientists revealed yesterday.

They suffer heart attacks because the medication disrupts the electrical activity controlling their heartbeat.

Seven drugs are said to present a danger, including the antibiotics erythromycin and clarithromycin.

The others are domperidone and cisapride, for gastro-intestinal disorders, and anti-psychotic drugs pimozide, haloperidol and chlorpromazine.

Dr Bruno Stricker said: ‘Sudden cardiac death can be attributed to these drugs in around 9,000 people in Europe and 6,000 in the US.’
Researchers studied 775 cases of sudden heart deaths and found the seven drugs were responsible for 320.

They calculated this worked out to about 15,000 deaths each year across Europe and America.

The chances of someone in the West dying from sudden cardiac arrest is normally one or two in a thousand.

The risk for those taking the drugs was found to be up to three times higher – about three in a thousand. Patients who had been on the drugs for less than about 90 days were said to be in the greatest danger…”

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Prescription drug reactions kill more than 100,000 a year
By BRENDA C. COLEMAN
April 15, 1998
Associated Press

CHICAGO ¯ Bad reactions to prescription and over-the-counter medicines kill more than 100,000 Americans and seriously injure an additional 2.1 million every year ¯ far more than most people realize, researchers say.

Such reactions, which do not include prescribing errors or drug abuse, rank at least sixth among U.S. causes of death ¯behind heart disease, cancer, lung disease, strokes and accidents, says a report based on an analysis of existing studies.

“We’re not saying, ‘Don’t take drugs.’ They have wonderful benefits,” said Dr. Bruce H. Pomeranz, principal investigator and a neuroscience professor at the University of Toronto.
“But what we’re arguing is that there should be increased awareness also of side effects, which until now have not been too well understood.”

The harm may range from an allergic reaction to an antibiotic to stomach bleeding from frequent doses of aspirin, Pomeranz said. The study, by Pomeranz and two colleagues at his school, Jason Lazarou and Paul N. Corey, did not explore which medications or illnesses were involved.

The authors analyzed 39 studies of hospital patients from 1966 to 1996. Serious drug reactions affected 6.7 percent of patients overall and fatal drug reactions 0.32 percent, the authors reported in Wednesday’s Journal of the American Medical Association.
In the study, serious injury was defined as being hospitalized, having to extend a hospital stay or suffering permanent disability.

The most surprising result was the large number of deaths, the authors said. They found adverse drug reactions ranked between fourth and sixth among leading causes of death, depending on whether they used their most conservative or a more liberal estimate.
In 1994, between 76,000 and 137,000 U.S. hospital patients died, and the “ballpark estimate” is 106,000, Pomeranz said. The low estimate, 76,000 deaths, would put drug reactions sixth. The ballpark estimate would put them fourth, he said.

An additional 1.6 million to 2.6 million patients were seriously injured, with the ballpark estimate 2.1 million, he said.

More than two-thirds of the cases involved reactions outside hospitals rather than in hospitals, the authors reported.

Experts commended the study but disagreed whether the estimates are on target.
Dr. David W. Bates of Partners Healthcare Systems and Brigham and Women’s Hospital in Boston said the estimates may be high. One reason, he said, is that they may overrepresent large medical centers, which treat sicker than average patients, who are more prone to reactions.

“Nonetheless, these data are important, and even if the true incidence of adverse drug reactions is somewhat lower than that reported … it is still high, and much higher than generally recognized,” he said.

Dr. Sidney M. Wolfe, director of the consumer advocacy Public Citizen Health Research Group, said he believes the numbers are on target.

“I’ve read most of these studies, and they represent large hospitals, small hospitals … a heterogeneous sample of the kinds of hospitals in this country, and include a whole range,” Wolfe said by telephone Tuesday from Washington.

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Prescription drugs put more than 250,000 in UK hospitals every year

More than a quarter of a million people are admitted to UK hospitals every year after suffering a serious reaction to a prescription drug, a new survey has found.

The drugs that are most likely to cause a serious reaction are aspirin, diuretics, warfarin, and the NSAIDs (non steroidal, anti-inflammatory drugs).

The figure is a rough calculation based on the number of people who had been admitted to a group of hospitals with drug reactions over a six-month period in 2004.

But the total is probably a gross under-estimate of the damage caused by pharmaceuticals. Hospital doctors are notoriously bad at reporting drug side effects, and so it’s quite possible that many admissions have not been registered as such.

The survey also only attempts to measure those reactions that required hospital care. Many, many others suffer at home – and may not even know that the drug is to blame.

The heart of the problem is the way that drug adverse reactions are captured. Doctors are supposed to report all reactions on a ‘yellow card’ system that was introduced in 1964. Its pioneer, Dr Bill Inman, once told WDDTY that he estimated only 12 to 20 per cent of all reactions are reported. If this is so, the true level of admissions to UK hospitals from drug reactions may be closer to our own estimates of 1.2 million people a year.

And they wanted to ban vitamins?
(Source: WHAT DOCTORS DON’T TELL YOU – E-news broadcast. 258 – 18 May 2006, which in turn referenced BMJ 2006;332:1109 (http://bmj.bmjjournals.com/cgi/content/extract/332/7550/1109).)

上面的英文原文我就不翻译了，因为绝大多数海外读者都懂英文（在日本的网友，很抱歉。）。即使不在说英语国家的网友，如果在医学领域，也应该看得懂英文专业资料。

在十几年前，这是热门话题，甚至一些不在医学领域里的大众也知道了“医生罢工医院关门的结果是人口死亡率下降”的报道。大家都知道李大师也听说了这些报道才告诉他的学员们有病别去看医生（然而，我大胆猜测，他本人有病会偷偷去看医生）。

当然，这不是说你有了病就真的不该去看医生，而是要对医生的处理方案反复考虑，如果吃药的话要清楚副作用是什么。如果副作用太大，就要告诉医生。

如果你问我对“医生罢工医院关门导致死亡率下降”的原因有何看法，我认为除了上面英文里边提到的处方药物副作用导致美国每年高达10万人死亡200万人受伤害的原因外，医生罢工医院关门期间死亡率的高速下跌可能有生活方式改变与心理作用的原因。比如，一直吃药的病人由于对药物的崇拜便不抑制自己的懒惰或贪婪行为，可突然间听到医生罢工了，没有处方买不到药了，便吓坏了，不敢躺在床上看电视了，而是想补救，比如下床走路锻炼身体，比如不敢多吃油腻的东西了，等等。这些生活方式的改变激活了身体的某信息系统。最终结果是延长了寿命。

心理作用也许不可忽视。比如，突然间的不利消息引发某种系统（作用类似于Heat shock Protein）的信息变化而导致免疫系统提高了效率。美国杜克大学的医学家把病毒注入脑癌患者的大脑，突然间病毒进入，立刻激活了免疫系统，免疫系统就把癌细胞杀死（请Google搜索新闻报道）。对于心理作用如何诱发生理生化反应，医学界还没有搞清楚。我们知道，人很怕死，听到震惊的消息便坚强了起来，巨大的心理反应便可引发战胜困难的激情。一直吃药，突然间药停了，没有医生开方买不到了，“那还得了！我不能死！ 我要活下去！”这样主动的活下去的心理便战胜了过去被动地依赖药物心理而导致寿命延长了。

还有一个因素必须考虑：双盲试验的标准

比如我们现在用的各类降低胆固醇的药物，都是经过双盲试验验证后才批准上市的。但这些双盲试验的标准可能隐含着巨大风险。润涛阎只是根据个人的猜测，这里不是科普，而是饭后的大胆假设，只提供在医学研究领域的网友思考：

以降低胆固醇的药物为例。凡是经过双盲试验证明能降低胆固醇的药物而且副作用在可以接受的范围内，便可被批准上市。其理论依据为：胆固醇高了会引发血管病。而最近的统计学结果告诉我们：在中年人当中，总胆固醇水平过高或过低都会影响健康。而在高龄老人当中，总胆固醇水平最高的群体，反而会有最长的寿命。总起来说，到了成年后，胆固醇偏高的群体要比胆固醇偏低的群体寿命长。由于我们并不完全了解人体的奥秘，生命科学刚走到盲人摸象的地步而已，我们假设降低胆固醇就可以降低血管病发病几率，也就隐含着降低胆固醇就能延长寿命的推理，便以该新药是否能降低胆固醇作为双盲试验的标准。就好比物理学家必须以地球围绕太阳转为依据来推理天体物理定律，一切以太阳围绕地球转为依据的物理定律都需要重新验证，新药物的双盲试验应该“以该药物对寿命是否延长”为标准。比如，一个新的药物有降血脂的功效，副作用也在可允许的范围内，需要做双盲试验：把该药与“假药”（淀粉制成看上去一样的药片—安慰剂），按年龄按血压把高血脂志愿者分成两拨，他们自己不知道自己吃的是真药（试验组）还是假药（对照组）。经过20年后来统计他们两组的死亡率。这样，就避免了用血脂作为标准而导致寿命反而降低了的可能性。我这里是假设，并不是说市场上有降低血脂而引发寿命缩短的证据。其它任何药物的双盲试验，都应该考虑寿命因素，因为那才是真正的有效指标。一吃药很快就死掉了，不论这药降低了什么具体指标，也不能上市。“一些老人一直吃降低胆固醇的药物，突然间医生罢工了，买不到降低胆固醇的处方药了，他们反而寿命延长了，导致在医生罢工期间没死掉。”这说不定也是一种解释呢（当然这只是假设。科学需要大胆假设小心求证）。

如果按照各次医生罢工导致人口死亡率下降的逻辑，是不是该结论可以延伸？比如除了外伤急救、产妇急救外，所有其他医生都罢工，处方药物都停下来，长达三年，后果会怎样？我们无法得知，因为没有这样的事实在任何国家发生过。如果我们假设这样的长久罢工会导致平均寿命延长了或缩短了，都是猜测，没有任何说服力。只能是信者恒信，不信者恒不信。有趣的是：医生罢工停止后，死亡率回到了罢工前的水平，而没有增加。也就是说，罢工期间少死的人数，没有在罢工结束后补上来。这包括洛杉矶那次医生罢工（罢工期间和罢工结束后的数据统计结果）。

那么，如何解释在现代医学诞生后人的寿命大幅度延长了的事实？

到目前为止，没有人能给出确切的解释，只能是推理，虽然公认的是医学的发展和医院的普及。可是根据医生罢工三个月死亡率下降百分之五十的事实来看，我们有必要从另外的角度审查最近一百年来人类寿命大幅度增加的原因。

第一个原因应该归功于抗生素。抗生素至少在人类进化的短时间内起着巨大的减少胎儿夭折的作用。说人类进化的短时间内，是指也许用不了一千年，抗所有抗生素的超级细菌就会进化出来，而在几千万年的哺乳动物进化过程中，千年只是一瞬。

第二个原因应该归功于食物的供应。这是农学家培养出来了各种高产品种以及化学家合成了化肥、农药等增产物质。在这以前，人类基本上处于半饥饿状态。根据欧洲很多科学家的研究发现，人类在身体生长发育的孩童时期如果经历长久的饥饿，这些人的寿命会缩短，哪怕活下来的人群后来不再遇到饥饿，这些人在经历长时间饥饿阶段其DNA会被甲基化其结果是细胞早日进入衰老。科学家已经清楚，细胞衰老、细胞死亡是一个主动过程。更糟糕的是：在精子还没产生之前经历过饥饿的男孩，即使在他们有了生殖能力后不再经历饥饿，他们下一代的孩子照样缩短寿命。该理论早在上世纪初被苏联遗传学家米丘林证明了，这就是那时著名的“获得性遗传学”。当时被西方尤其是美国哥伦比亚大学的西方现代遗传学鼻祖—摩尔根学派斥之为胡言乱语的伪科学。所以，现在西方科学家不用米丘林的“获得性遗传学”而改用“表现遗传学”（epigenetics），其实二者说的是一回事。欧洲科学家的此项研究结果发表后被美国的《时代周刊》2010年第一期作为封面报道过（封面题目是：为何你的DNA不决定你的特征？Why Your DNA Isn’t Your Destiny）。随着大饥荒时代渐行渐远， 后代的寿命也就逐步延长，除非发生新的大饥荒而斩断这一过程。

第三个原因应该归功于战争与社会动荡减少。二战后虽然也有一些战争，但死人的规模与过去比可以忽略不计了。由于法治的发展与警察的增加，各国国内百姓之间被土匪、帮派互殴杀死的人数也越来越少。

第四个原因应该归功于一些外科手术的普及。比如阑尾炎，不做手术的后果大家都清楚，而手术成功率高达九成以上。还有产妇产后大出血的急救等等。

第五个原因应该归功于传统医药的被取代。我们知道，在现代西医流行开以前，几乎各个民族都有自己的“土医生”。中国北边有蒙古大夫，即使没有文字的印第安人也有他们自己一套“土医学”。比如，抽烟的恶习是来自于印第安人。当时的欧洲人看到印第安人在吸烟，由于语言不通，便误以为人人都可以抽烟。而事实上，印第安人的医生用抽烟给患病者治病呢。病好了，就必须戒烟。就拿我们的传统中药来说，几乎大多数中药里都有重金属等毒素，我们的传统医学称之为“以毒攻毒”。由于事实上并不能治病的这些毒素被西药取代后（等于停止服用中药里的毒素），甭管西药是否有延长寿命的作用（抗生素肯定有延长寿命的作用），仅仅取消“以毒攻毒”的毒素进入人体，人口平均寿命就大幅延长了。（这当然是理论推理，因为我们人类历史上没有不看医生的对照组。非但如此，“有病乱投医”是人类的共性。）

第六个原因应该归功于科学知识的普及以及公共卫生条件的改善比如饮水消毒粪便的处理等。这也包括献血输血、体育锻炼、肥胖症或糖尿病控制饮食、食物营养搭配等无数科学知识被发现与被公众接受。

对于内科药物如此广泛的被利用到了极端程度（很多国家65岁以上的人吃药花钱远远超过吃饭的费用），是否对人的寿命延长起了正面作用，尚需探讨研究才能得出结论。美国的医疗总开支平均每人每年朝1万美元跃进，十年前就超过了每人每年7000美元大关。但美国的人均寿命远低于日本香港瑞士，甚至低于古巴，排名在第35位。与美国人吃药太多可能有相关性。如果按照医疗器械的先进程度、医院的高级程度、医生占人口比例、医生水平来说，美国都是一流的，远在古巴之上。

世界人均寿命排名（2011年，数据来自国际卫生组织）
1 日本 83.4
2 香港 82
3 瑞士 82.3
4 澳大利亚 81.9
5 意大利 81.9
6 冰岛 81.8
7 以色列 81.6
8 法国 81.5
9 瑞典 81.4
10 西班牙 81.4
11 挪威 81.1
12 新加坡 81.1
13 加拿大 81
14 奥地利 80.9
15 安道尔 80.9
16 荷兰 80.7
17 新西兰 80.7
18 爱尔兰 80.6
19 韩国 80.6，
20 德国 80.4
21 英国80.2
22 比利时 80
23 芬兰 80
24 卢森堡 80
25 希腊 79.9
26 列支敦士登 79.6
27 塞浦路斯 79.6
28 马耳他 79.6
29 葡萄牙 79.5
30 斯洛文尼亚 79.3
31 哥斯达黎加 79.3
32 智利 79.1
33 古巴 79.1
34 丹麦 78.8
35 美国 78.5

通过奥巴马的医疗改革后，所有的美国穷人也都可以根据需要看医生、吃处方药了。再过30年后，我们可以回头看，美国的较贫困人口的平均寿命是缩短了还是延长了。也就可以判断出“把药当成饭吃”的习惯对寿命的作用是正的还是负的。

我认为，我们不能把吃药当成宗教信仰一样的依赖，而应该在身体锻炼、注意适当饮食等方面下点功夫。光靠“以预防为主”还不够，还要加上“得病后也要靠锻炼、注意饮食、劳逸结合”来协助药物治疗。

由于医生大罢工后导致人口死亡率下降的结局，使得医生长期罢工成为不可能了（医学协会不会让任何地区的医生大罢工了，因为罢工期间的死亡率大幅下降的事实无法改变。看医生的人少了，医界远期利益的后果不堪设想），也就无法得知医生长期罢工（比如10年，在此期间不能有“土医药”搀和进来）对人口平均寿命的影响是怎样的。我们只知道：地球人摆脱了饥饿后，本代人和下一代人的寿命就长了很多。过去的欧洲和现在非洲的例子非常明显。那些还有大量孩子在发育期常常挨饿的地区，人口寿命都很短。他们的下一代，即使不再有饥饿，寿命照样会短很多。如果有一天有一个国家或民族，除了急救外不再吃药（由于医生长期大罢工）时间长达一代人，我们才会有真正的对照组。在这之前，有病还得看医生。我每年都体检一次，心里有个谱。我也开始吃Metformin降低血糖。效果跟不吃差不多。如果吃药，吃饭猛吃猛喝，不锻炼，效果还不如不吃药但控制饮食外加锻炼身体。可我还是喜欢吃药，可以给自己多吃饭少锻炼壮胆。我试过多次了，凡是自己控制饮食，早晨走路，不吃药，血糖也不高（自己验血糖非常简单，一分钟足够）。如果反过来，猛吃猛喝不锻炼，按时吃药，血糖也高。这让我想起了十几年前的热门话题：医生大罢工无法继续买到处方药后导致死亡率下跌。今天讲这个话题可是地地道道的炒冷饭。那时至少在医学领域的学者们此话题炒得热火朝天。当然，其它领域里的网友未必清楚这事。无论如何，希望网友们尤其是上了年纪的，在体检的前提下，要多锻炼身体，注意健康饮食（当然了，药该吃还得吃）。
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题外话：

除了“没医生结果没想象的那么糟”外，没有政府也差不到哪里去。几年前比利时度过了一年半国家没政府的日子，大家过得都不错。有了政府后，大家也没觉得好到哪里去。“这地球上缺了谁都成”真的不是空话。“没有共产党就没有新中国”是彻头彻尾的欺骗。哪个党学不会整人、学不会腐败？中国要是没政府，老百姓绝对比有政府的日子过得好。只是没办法试验一次而已。有人会说没了政府就会大乱。而事实上，大乱的根源便是有太多的人想当政。如果人人认同不需要政府，没人想当政了，就不会乱。在中国，一开始需要一个会飞的大老虎，谁想当政就飞过去吃掉谁，那就没人想当政了，天下太平。所以，所有的主义里，无政府主义才是最高的理论，是人类社会最后的结局。地球上所有的共产主义试验都是失败的，而比利时的无政府主义试验是成功的。医生罢工，死亡率下跌。要是政府官员罢工不上班也不领工资，百姓的日子就好太多了。什么民主政府啊，专制政府啊，都是伪命题。最好是没有政府。法院监狱也一样。不是先有犯人后有法院（监狱)，而是先有法院(监狱)后有犯人。等到法院监狱去除了，也就没有犯人了。这一点已经有了验证的，比如取消了死刑的国家或地区，死在杀人犯手下的人数立刻减少而非增加。我们需要把被人类颠倒了的思维重新颠倒过来，人类社会才能焕然一新，走向正途。