By DEEPAK CHOPRA , DEAN ORNISH , RUSTUM ROY and ANDREW WEIL

In mid-February, the Institute of Medicine of the National Academy of Sciences and the Bravewell Collaborative are convening a "Summit on Integrative Medicine and the Health of the Public." This is a watershed in the evolution of integrative medicine, a holistic approach to health care that uses the best of conventional and alternative therapies such as meditation, yoga, acupuncture and herbal remedies. Many of these therapies are now scientifically documented to be not only medically effective but also cost effective.

    在二月中旬，美國國家科學院醫學研究所和布萊威爾整合醫學組織合作召開”中西醫結合與國民健康高峰會"，其所討論的議題為一整合醫學演進上的分水嶺：利用傳統和替代療法，例如禪修、瑜伽、針灸和草藥的優點來截長補短，達到更全面性的醫療保健。許多上述的療法在現有的科學文獻中，已被證實不僅有醫學療效且同時具有成本效益。

President-elect Barack Obama and former Sen. Tom Daschle (the nominee for Secretary of Health and Human Services) understand that if we want to make affordable health care available to the 45 million Americans who do not have health insurance, then we need to address the fundamental causes of health and illness, and provide incentives for healthy ways of living rather than reimbursing only drugs and surgery.

    總統當選人Barack Obama和前參議員湯姆Tom Daschle  (衛生與公共事業部長的被提名人)瞭解--如果想要負擔得起4千5百萬個沒有健康保險的美國人民醫療保健，我們必須提出影響健康和病症的基本原因，並且對健康的生活方式提供誘因和鼓勵，而不只是一昧地對藥物和手術提供補償。

Heart disease, diabetes, prostate cancer, breast cancer and obesity account for 75% of health-care costs, and yet these are largely preventable and even reversible by changing diet and lifestyle. As Mr. Obama states in his health plan, unveiled during his campaign: "This nation is facing a true epidemic of chronic disease. An increasing number of Americans are suffering and dying needlessly from diseases such as obesity, diabetes, heart disease, asthma and HIV/AIDS, all of which can be delayed in onset if not prevented entirely."

    目前心臟病、糖尿病、前列腺癌、乳腺癌和肥胖症佔75%的醫療保健費用，然而，絕大部分的情況都可以藉由改變飲食和生活方式去防止和改善。在Obama的競選期間，他對國民健康政策作了以下的陳述：”這個國家正面臨慢性疾病的蔓延， 越來越多的美國人因為肥胖、糖尿病、心臟病、哮喘和愛滋病遭受不必要的折磨和死亡，即使沒有完全的預防這些慢性疾病，仍可延遲它們發病的時間。”

The latest scientific studies show that our bodies have a remarkable capacity to begin healing, and much more quickly than we had once realized, if we address the lifestyle factors that often cause these chronic diseases. These studies show that integrative medicine can make a powerful difference in our health and well-being, how quickly these changes may occur, and how dynamic these mechanisms can be.

    最新的科學研究顯示：假若我們能夠遠離這些造成慢性疾病的生活型態，身體卓越且迅速的復原能力，將超出我們目前的認知。這些研究也表示出中西醫學結合所能創造出的動態機制為何，以及能夠在多快的時間內，為我們的健康福祉帶來顯著的差異。

Many people tend to think of breakthroughs in medicine as a new drug, laser or high-tech surgical procedure. They often have a hard time believing that the simple choices that we make in our lifestyle -- what we eat, how we respond to stress, whether or not we smoke cigarettes, how much exercise we get, and the quality of our relationships and social support -- can be as powerful as drugs and surgery. But they often are. And in many instances, they're even more powerful.

    多數人傾向於相信醫學上的突破來自於新的藥物研發、雷射、或者是高科技手術療程， 而很難去認同—只要我們在生活中作一些簡單的改變，就能達到像藥物和手術的效用，舉例而言：我們吃什麼、我們如何處理生活上的壓力、是否有抽菸的習慣、花了多少時間健身、以及人際關係的好壞和能夠取得的社會支援等；甚至有許多實例顯示，這些生活上的改變，可以帶來更強而有力的影響力。

These studies often used high-tech, state-of-the-art measures to prove the power of simple, low-tech, and low-cost interventions. Integrative medicine approaches such as plant-based diets, yoga, meditation and psychosocial support may stop or even reverse the progression of coronary heart disease, diabetes, hypertension, prostate cancer, obesity, hypercholesterolemia and other chronic conditions.

    這些研究通常是使用尖端科技的測量方法去證明低科技且低成本中繼處理方式的功效。中西醫結合包括：草本天然的飲食、瑜伽、禪修和社會心理社會的支持，這些方法或許能夠阻止、甚至徹底轉變冠狀動脈心臟病、糖尿病、高血壓、前列腺癌、肥胖病、高膽固醇和其他慢性病的蔓延。

A recent study published in the Proceedings of the National Academy of Sciences found that these approaches may even change gene expression in hundreds of genes in only a few months. Genes associated with cancer, heart disease and inflammation were downregulated or "turned off" whereas protective genes were upregulated or "turned on." A study published in The Lancet Oncology reported that these changes increase telomerase, the enzyme that lengthens telomeres, the ends of our chromosomes that control how long we live. Even drugs have not been shown to do this.

    國家科學研究院學報刊登了最新的相關研究：上述的方法甚至可能在幾個月內改變數百個基因基因表現表達的型態，基因與癌症和心臟病都有關連性，當有防禦性的基因被上調或啟動，就能使病症的發炎反應情況下調或抑制。在《柳葉刀—腫瘤學》雜誌上發表的一篇研究報告也指出：這些變動會使端粒酶的數量增加，即能使位於我們的染色體末端、控制壽命長短的端粒長度增加；然而，即便是依靠藥物，也無法做到如此。

Our "health-care system" is primarily a disease-care system. Last year, $2.1 trillion was spent in the U.S. on medical care, or 16.5% of the gross national product. Of these trillions, 95 cents of every dollar was spent to treat disease after it had already occurred. At least 75% of these costs were spent on treating chronic diseases, such as heart disease and diabetes, that are preventable or even reversible.

    就本質上來說，我們的" 醫療保健系統" 是疾病照護系統。 美國在去年花了$2.1兆，或者說是16.5%的GNP在藥物治療上；在這龐大的金額裡，每一塊美元，即有95分是用在已發生的疾病治療上，且至少有75%的成本是花費在那些可以被阻止、甚至是徹底杜絕的心臟病、糖尿病等慢性疾病上。

The choices are especially clear in cardiology. In 2006, for example, according to data provided by the American Heart Association, 1.3 million coronary angioplasty procedures were performed at an average cost of $48,399 each, or more than $60 billion; and 448,000 coronary bypass operations were performed at a cost of $99,743 each, or more than $44 billion. In other words, Americans spent more than $100 billion in 2006 for these two procedures alone.

    就以心臟方面的手術來舉例最為清楚，根據美國心臟協會提供的數據，在2006年中，執行 1.3百萬個氣球擴張術的平均成本為$48,399，或者說是超過$600億，而448,000個冠狀動脈搭橋手術的平均成本為$99,743，或者說是超過$440億。換句話說，在2006年裡，美國人在這兩個手術上，花費了超過$1000億。

Despite these costs, a randomized controlled trial published in April 2007 in The New England Journal of Medicine found that angioplasties and stents do not prolong life or even prevent heart attacks in stable patients (i.e., 95% of those who receive them). Coronary bypass surgery prolongs life in less than 3% of patients who receive it. So, Medicare and other insurers and individuals pay billions for surgical procedures like angioplasty and bypass surgery that are usually dangerous, invasive, expensive and largely ineffective. Yet they pay very little -- if any money at all -- for integrative medicine approaches that have been proven to reverse and prevent most chronic diseases that account for at least 75% of health-care costs. The INTERHEART study, published in September 2004 in The Lancet, followed 30,000 men and women on six continents and found that changing lifestyle could prevent at least 90% of all heart disease.

     根據2007年四月出版的新英格蘭醫學期刊中，一隨機對照試驗的結果可發現：儘管已投入了大量成本，血管修復術和支架置放術並不能延長患者的壽命，甚至不能阻止心臟病在緩解期間發作(95%接受該手術的病患)。而冠狀動脈搭橋手術，亦僅能延長不到3%的患者壽命。

    因此，醫療保險、其他保險業者和個人支付億萬元在像修復術和搭橋手術等的外科手術，通常是危險、侵入、昂貴且近乎無效的。假若他們是選擇將金錢支付在那些至少佔了75%醫療保健成本、但已被證明出能過改善和阻止大部分慢性疾病的綜合醫學上，只需很少的花費。2004年9月出版的《柳葉刀》雜誌中，國際心臟病研究報告指出，在追蹤遍佈六大洲的3萬名男女性後，可以發現改變生活方式，能夠阻止至少90%的心臟疾病發生。

That bears repeating: The disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable simply by changing diet and lifestyle. And the same lifestyle changes that can prevent or even reverse heart disease also help prevent or reverse many other chronic diseases as well. Chronic pain is one of the major sources of worker's compensation claims costs, yet studies show that it is often susceptible to acupuncture and Qi Gong. Herbs usually have far fewer side effects than pharmaceuticals.

    再次覆述：那些造成美國人民早逝的疾病，遠遠超過能夠藉由改變飲食和生活型態而預防的病症。改變後的生活方式不只能夠阻止或徹底轉變心臟疾病，對於其他慢性病也有同樣的效果。慢性病所帶來的痛苦，是工作者的費用索賠成本的主要來源之ㄧ，然而，研究指出，這些痛苦經常能夠透過針灸和氣功改善，且草藥帶來的副作用通常遠少於合成的西藥。

Joy, pleasure and freedom are sustainable, deprivation and austerity are not. When you eat a healthier diet, quit smoking, exercise, meditate and have more love in your life, then your brain receives more blood and oxygen, so you think more clearly, have more energy, need less sleep. Your brain may grow so many new neurons that it could get measurably bigger in only a few months. Your face gets more blood flow, so your skin glows more and wrinkles less. Your heart gets more blood flow, so you have more stamina and can even begin to reverse heart disease. Your sexual organs receive more blood flow, so you may become more potent -- similar to the way that circulation-increasing drugs like Viagra work. For many people, these are choices worth making -- not just to live longer, but also to live better.

    喜悅、樂趣和自由是能更維持且支持身心在一個良好的狀態；但剝奪和嚴酷並不能。當你的生活中，開始有健康的飲食、放棄抽菸、健身鍛鍊、禪修靜思，擁有更多的愛的時候，大腦就會接受更多的血液和氧氣，因此思路變得更加地清晰、身體也有更多地精力和能量，也就不需要太多的睡眠。僅在短短的幾個月內，大腦會產生更多的神經元連結，由於血液更加地順暢，臉孔得到更多的血流，因此皮膚變得容光煥發，且較少皺紋；心臟得到更多血流，因此有更多毅力和抵抗力，甚至能徹底扭轉心臟疾病的發生；性器官接受更多的血流，因此可以變得更加”有力”--相似於使用威而鋼增加循環的效能。對許多人來說，這些改變和選擇都是值得的—不只是為了活得更久，同時有能夠活得更有品質。

It's time to move past the debate of alternative medicine versus traditional medicine, and to focus on what works, what doesn't, for whom, and under which circumstances. It will take serious government funding to find out, but these findings may help reduce costs and increase health.

現在，我們應該拋開替代療法和傳統療法間的爭論，並針對在哪種情況下，對哪些疾病、哪些人，是有療效或沒有療效來作觀察。這將需要大量的政府基金去研究和發現，但其結果將有助於減少成本和增進健康。

Integrative medicine approaches bring together those in red states and blue states, liberals and conservatives, Democrats and Republicans, because these are human issues. They are both medically effective and, important in our current economic climate, cost effective. These approaches emphasize both personal responsibility and the opportunity to make affordable, quality health care available to those who most need it. Mr. Obama should make them an integral part of his health plan as soon as possible.

    因為中西醫結合是屬於人民的議題，因此它使得民主黨與共和黨凝聚在一起。中醫和西醫都有他們在醫學上的療效，且對我們當前的經濟環境同樣重要，皆具有其成本效益。這些方法強調以下兩個重點：一為使個人有責任和機會去負擔；二為使有需要的人，都可以得到有品質的健康照護。質量醫療保健可利用對多數需要它的那些人。Mr. Obama應該儘快將中西醫結合的方式，納入其醫療計畫的一部份。

Dr. Chopra, the author of more than 50 books on the mind, body and spirit, is guest faculty at Beth Israel Hospital/Harvard Medical School. Dr. Ornish is clinical professor of medicine at the University of California, San Francisco. Mr. Roy is professor emeritus of materials science at Pennsylvania State University. Dr. Weil is director of the University of Arizona Center for Integrative Medicine.

Dr. Chopra，超過50本身、心、靈相關書籍的作者，也是Beth Israel Hospital/Harvard Medical School的客座醫師。Dr. Ornish是舊金山－加州大學的臨床教授。Mr. Roy 是賓州大學裡，材料科學的榮譽退休教授。Dr. Weil 是亞利桑那大學綜合醫學中心的主任。

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