中醫藥對可持續發展的貢獻
– Keynote Address at the International Conference on the Modernization of Traditional Chinese Medicine
——在中醫現代化國際會議上的主旨演講
Dr. Margaret Chan
Director-General of the World Health Organization
世界衛生組織總幹事 陳馮富珍博士
Singapore
23 October 2016
新加坡，2016年10月23日
Honourable ministers
distinguished participants
experts in traditional Chinese medicine
ladies and gentlemen
尊貴的部長們，尊敬的與會者們，中醫藥領域的專家們，女士們，先生們：
Every country in the world
including an advanced nation like Singapore
needs to be concerned about the sustainability of its health services.
世界每個國家，包括像新加坡這樣的先進國家，都需要關註其衛生服務的可持續性問題。
Population ageing is now a universal trend
affecting rich and poor countries in every region of the world. The globalized marketing of unhealthy products has made chronic nonmunicable diseases
like heart disease
cancer
and diabetes
the leading killers worldwide.
人口老齡化是當今壹種普遍趨勢，影響著世界各區域的富國與窮國。不健康產品的全球化營銷已使心臟病、癌癥和糖尿病等慢性非傳染性疾病成為全世界的主要殺手。
Economic growth and modernization
long associated with better health
are now creating conditions that leave more and more people living longer
sicker lives.
經濟增長和現代化長期以來都與更好的健康聯系在壹起，而現在造成的局面是，越來越多的人雖然壽命延長了，卻處於不健康的狀態。
Most technology markets
like those for flat screen TVs and hand-held electronic devices
produce products that are progressively cheaper and easier to use. Not so for pharmaceuticals and medical devices
where new products are nearly always more expensive and more plex to use
often requiring specialized training.
大多數技術市場，如平板電視和手持電子設備市場，生產的產品越來越便宜和易於使用。但藥品和醫療器械市場卻不是這樣，這類市場的新產品幾乎總是更昂貴，使用起來更復雜，通常需要專門培訓。
Even the richest countries in the world cannot afford new treatments for mon conditions like cancer and hepatitis C that cost from $50 000 to $150 000 per patient per year.
即使是世界最富裕的國家也負擔不起用於癌癥和丙型肝炎等常見病癥的新治療方法，這些療法的費用每名患者每年為5萬至15萬美元。
This trend is the opposite of sustainable development.
這種趨勢與可持續發展背道而馳。
At the same time
a growing number of countries are reforming their health systems with the aim of reaching universal health coverage
which is a key target under the Sustainable Development Goal for health.
與此同時，越來越多的國家正在改革其衛生系統，旨在實現全民健康覆蓋，這是可持續發展目標下的壹個主要衛生相關具體目標。
In other words
countries are seeking to expand coverage with essential services at a time when consumer expectations for care are rising
costs are soaring
and most budgets are either stagnant or reduced.
換言之，在各國力求擴大基本服務覆蓋面的同時，消費者對醫護服務的期望在不斷上升，費用在飛漲，而多數預算則停滯或縮減。
Faced with this dilemma
and most especially the costs of treating lifestyle-related chronic diseases
many experts see a need to shift the model for health service delivery away from a strictly biomedical model
focused on individual diseases
towards a more holistic approach.
面對這種困境，特別是鑒於治療與生活方式相關的慢性疾病的費用，許多專家認為，需要將衛生服務的提供模式從註重個體疾病的嚴格生物醫學模式轉向更加全面的方法。
This is an approach that stresses prevention as well as cure
offers integrated services that address the multiple determinants of health
and asks people to take more responsibility for their own health.
這種方法不僅強調治療也強調預防，並且提供綜合服務以解決健康的多重決定因素，要求人們對自己的健康承擔更多責任。
Apart from the need to do more for prevention
some countries are looking for approaches that stop people with minor plaints from flooding waiting rooms at clinics and in emergency wards.
除了需要加強預防外，壹些國家正在尋找辦法，以避免有小病小痛的人蜂擁到診所和急診室。
In Europe
for example
pharmacists are trained to deal with mon aches
pains
sniffles
and other plaints. They focus on symptoms
not diseases
and dispense over-the-counter products
including herbal remedies
to address these symptoms. In other words
they act as gatekeepers.
例如，在歐洲，藥劑師經過培訓可以治療常見的各種疼痛、感冒和其它小病。他們關註的是癥狀，而不是疾病，並分發非處方產品，包括草藥，來治療這些癥狀。換句話說，他們充當守門人的角色。
This is one way to reduce the burden on health services. Traditional Chinese medicine is another.
這是減少衛生服務機構負擔的壹種方法。另壹種方法是中醫藥。
The World Health Organization weles this landmark conference on the modernization of traditional Chinese medicine. You seek
in particular
to give traditional medicine an evidence-based place within a health care system where mainstream modern medicine dominates.
世界衛生組織歡迎這次具有裏程碑意義的中醫藥現代化會議。妳們特別希望在主流現代醫學占主導地位的衛生保健系統中為傳統醫學提供壹個有證據基礎的位置。
Your agenda says many things. You are looking at China’s experiences in clinics and hospitals where traditional and modern medicine offer integrated services
at the role of health services and policy research
and the use of biomedical knowledge to modernize traditional Chinese medicine.
此次會議議程的內容很多。妳們要研究中國診所和醫院在提供中西醫結合服務方面的經驗，要審視衛生服務和政策研究的作用，並要討論如何利用生物醫學知識推動中醫藥現代化。
You are considering how more rigorous testing can meet the scientific standards needed for international recognition and acceptance. You are looking at the absolutely critical issue of safety
as demonstrated in well-designed clinical trials.
妳們要考慮如何通過更嚴格的檢測來滿足為獲得國際認可和接受所必須的科學標準。從精心設計的臨牀試驗可以看出，妳們在考慮極其重要的安全性問題。
You are also looking at the performance of traditional Chinese medicine for specific indications
including digestive disorders
and giving attention to the o forms of traditional medicine most often used in modern health systems
namely acupuncture and herbal remedies.
妳們還要查看中醫藥對特定適應癥（包括消化系統疾病）的效果，並關註針灸和草藥這兩種現代衛生系統中最常用的傳統醫學形式。
All of these approaches can contribute to the modernization of traditional Chinese medicine.
所有這些方法都可推動中醫藥現代化。
I am Chinese
and I have used traditional Chinese medicine throughout my lifetime. I have no doubt that these preparations soothe
treat many mon ailments
and relieve pain.
作為中國人，我壹直都使用傳統中藥。我毫不懷疑這些藥劑能緩解、治療許多常見疾病，並減輕疼痛。
But if I have a bad toothache
I go to the dentist.
但如果我牙痛難忍，我會去看牙醫。
Ladies and gentlemen
女士們，先生們，
One approach when exploring the modernization of traditional Chinese medicine is to look at the shortings of modern medicine
both real and perceived. Paradoxically
these shortings have created a situation where traditional medicine meets a perceived need
yet earns a bad name at the same time.
在探討中醫藥現代化問題時，可以審視壹下現代醫學的缺點，不論是真實的還是察覺到的。但奇怪的是，這些不足卻導致了壹種局面，就是傳統醫學滿足了壹種被很多人認可的需求，卻得了個壞名聲。
In wealthy countries
the public often reacts in a negative way to health care that is seen as over-medicalized and over-specialized
with the patient treated like a collection of specialized body-parts on an assembly line
instead of a whole person.
在富裕國家，公眾往往對過度醫療化和過度專業化的衛生保健有種消極反應，因為這類保健將患者當作裝配線上壹種專門身體部位的集合體而非壹個完整的人來對待。
People want more control over what is done to their bodies. They want to self-regulate their own health.
人們希望能更多地掌控對其身體所作的治療。他們希望對自己的健康進行自我調節。
As seen in the movement of vaccine refusal
science is often mistrusted
sometimes even vilified. Rumours spread via social media can carry more weight than hundreds of well-designed peer-reviewed research studies.
正如我們在拒絕疫苗接種的運動中所看到的，科學往往得不到信任，有時甚至遭到詆毀。通過社交媒體傳播的謠言可能比上百份精心編寫並獲得同行審評的研究報告更具影響力。
People are suspicious that powerful new drugs may have side effects that have either not yet been detected or were never honestly disclosed.
人們懷疑效力強大的新藥物可能具有尚未發現或從未誠實披露的副作用。
Some *** ysts attribute this dissatisfaction and mistrust to the system
the infrastructure
the training
the incentives
and the orientation of modern medical care.
壹些分析師將這種不滿和不信任歸因於現代醫療保健的制度、基礎設施、培訓、獎勵措施以及導向。
In many countries
this system dictates that a doctor spend no more than around 20 minutes with each patient. In many outpatient clinics for primary care
the time spent with patients is 5 minutes or less.
在許多國家，現代醫療保健制度要求醫生用於每名患者的時間不得超過20分鐘。而在許多初級保健門診所，用於患者的時間僅5分鐘或更短。
During these few minutes
the doctor is expected to act
not talk
to order medicines
tests
and other interventions. This practice contrasts sharply with the approach used by traditional practitioners.
在這幾分鐘內，醫生要行動，不要說話，要就藥物、化驗以及其它幹預作出處方。這種做法與傳統醫學從業者的方法形成鮮明對比。
Moreover
the number of doctors practicing family medicine continues to shrink dramatically in favour of more
and better-paid
specialists and sub-specialists.
此外，從事家庭醫學的醫生數量繼續大幅減少，而出現了更多報酬更高的專科醫生和亞專科醫生。
Family physicians are a vanishing profession right at the time when the rise of nonmunicable diseases makes their skills essential for prevention and the continuity of sometimes life-long care.
隨著目前非傳染性疾病日益增多，家庭醫生的技能對於這類疾病的預防和有時持續終生的連續護理至關重要，但這壹職業卻正在消失。
The phenomenal rise of the alternative medicine industry responds to some of these shortings in what modern medicine has to offer. In several North American and European countries
the production and sale of herbal medicines
dietary supplements
and other so-called “natural” products have bee a huge and profitable industry
amounting to $32 billion a year in the USA alone.
替代醫學產業的驚人崛起彌補了現代醫學中的壹些不足之處。在若幹北美和歐洲國家，草藥、膳食補充劑以及其它壹些所謂“天然”產品的生產和銷售已成為壹個巨大的賺錢產業。僅在美國，該產業的年業務額便達320億美元。
The industry fiercely defends its territory
its claims
and its profits. Aggressive marketing that makes unsubstantiated claims has antagonized many in the medical establishment.
該產業極力捍衛自己的領域、權利和利潤，通過壹些毫無根據的聲稱展開積極營銷，招致了醫療界中很多人的怨憤。
As medical professionals argue
most alternative medicines are introduced onto the market
via over-the-counter sales or the inter
without any regulatory oversight.
醫療專業人士指出，大多數替代藥物系通過非處方銷售或因特網進入市場，不受任何監管。
These arguments point to the critical contribution regulatory authorities can make to the modernization of traditional Chinese medicine. A drive aimed at licensing and regulatory control can bring legitimacy to traditional remedies
as has been done here in Singapore.
這些論點指出監管機構可以對中醫藥現代化做出重要貢獻。針對許可證發放和監管控制采取行動可以使傳統療法具有合法性，新加坡已經這樣做了。
Singapore has also pioneered some good policies that protect against some perceived dangers of traditional Chinese medicine. For example
patients are referred for traditional treatments
like acupuncture
by doctors trained in Western medicine.
新加坡還開創了壹些良好政策，幫助防止壹些已察覺到的中醫藥危險。例如，將患者轉診給受過西醫培訓的醫生進行針灸等傳統治療。
Having a doctor’s opinion as backup helps protect against the risk that what may seem to be unplicated plaints might actually be the early signals of a more serious condition.
征詢醫生的意見作為支持有助於防範風險，有些看起來似乎不太復雜的小病痛實際上可能是壹個更嚴重病癥的早期信號。