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Barbara Natterson-Horowitz 談醫生不瞭解的獸醫知識

Barbara Natterson-Horowitz: What veterinarians know that physicians don't

 

Photo of three lions hunting on the Serengeti.

講者:Barbara Natterson-Horowitz

2014年9月攝於TEDMED 2014

 

翻譯:洪曉慧

編輯:朱學恒

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後制:洪曉慧

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關於這場演講

你如何稱呼只會治療一個物種的獸醫?醫生。在這場引人入勝的演講中,Barbara Natterson-Horowitz分享為何藉由跨物種觀點能改善人類醫療方式-尤其是涉及心理健康時。

 

關於Barbara Natterson-Horowitz

UCLA醫學院心臟科教授Barbara Natterson-Horowitz提出一項特殊觀點:如何藉由瞭解動物健康來改善人類健康,包括心理健康。

 

為什麼要聽她演講

Barbara Natterson-Horowitz是心臟學家,她的病患包括猩猩、獅子、袋鼠和人類。她的巡診有時在洛杉磯動物園,也可能在UCLA雷根醫學中心與獸醫討論人類健康,但始終與達爾文的觀點相通。身為UCLA心臟科及生態與進化生物系教授,Natterson-Horowitz的醫學專業是心臟影像技術-但她在學術上熱衷於人類與動物身心之間的進化關聯。2012年,她合著之書籍《共病時代:醫師、獸醫師、生態學家如何合力對抗新世代的健康難題》,推崇「共同健康」之醫療方式。她創立「人獸共病」會議,使獸醫與醫生共同進行「跨物種」之辯論與合作。

 

Barbara Natterson-Horowitz的英語網上資料

Conference: Zoobiquity

 

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Barbara Natterson-Horowitz 談醫生不瞭解的獸醫知識

 

十年前我接到一通改變我一生的電話,當時我是UCLA(加州大學洛杉磯分校)心臟病學家,專攻心臟影像技術。這通電話來自洛杉磯動物園一位獸醫。一隻高齡母黑猩猩睡醒時臉部下垂,獸醫擔心她中風,他們詢問我是否能前來動物園拍攝這隻動物的心臟影像,尋找可能病因。

 

先說明一下,北美動物園雇用的都是高水準、經認證的獸醫,替動物病患提供相當棒的照顧,但他們偶爾會涉足人類醫學範疇,尤其是針對專科諮詢。我是受邀提供協助的幸運醫生之一,我有機會替這隻黑猩猩排除中風危機,確保這隻大猩猩的主動脈不會破裂;檢測這隻金剛鸚鵡的心音;確保這隻加州海獅的心包沒有發炎。這張照片中,我正在替一隻獅子做心臟聽診。在獸醫與醫生共同進行的一次急救之後,我們從這隻獅子的心包中導出700 cc液體,這與我曾經在許多人類患者身上施行過的步驟完全相同,除了這裡的爪子和尾巴。

 

大多數時候我都在UCLA醫學中心與醫生共事,探討人類患者的症狀、診斷和療法,但有時我會在洛杉磯動物園與獸醫合作,探討動物患者的症狀、診斷和療法。有時在同一天當中,我會在UCLA醫學中心和洛杉磯動物園之間來回奔波,這就是我開始有所領悟的契機。醫生和獸醫本質上處理的是發生在人類與動物患者身上相同的問題:充血性心臟衰竭、腦瘤、白血病、糖尿病、關節炎、ALS(肌萎縮性偏側硬化症)、乳癌,甚至精神症狀,例如憂鬱、焦慮、強迫症、飲食障礙、自殘等。

 

現在我必須做個自白。儘管我大學時讀過比較生理學和進化生物學,甚至畢業論文主題與達爾文理論有關,瞭解動物與人類疾病之間存在明顯的交集對我來說彷彿及時敲響警鐘,因此我開始思考,既然有如此多的交集,為何我不曾想過請教獸醫或查閱獸醫方面的文獻,藉此瞭解人類患者的疾病?為何我本身以及所有我請教過的醫生朋友和同事都不曾參加過獸醫學會議?鑒於這個原因-這有什麼好讓人驚訝的?我是指,試想,每位醫生都同意動物和人類之間存在某種生物學上的聯繫,我們所開的每一種藥,無論是自己使用或家人使用的藥都先在動物身上試驗過。

 

但使動物進行藥物試驗或罹患人類疾病,以及動物本身罹患充血性心臟衰竭、糖尿病或乳癌之間存在很大的差異,但也許其中令人訝異之處源於城鄉之間日漸擴大的隔閡。你知道,我們聽過一些城市裡的孩子認為羊毛長在樹上,或乳酪來自植物。現今人類醫院逐漸轉變成閃耀的科技殿堂,使得在醫院進行治療的人類患者與生活在海洋、田野和叢林中的動物患者之間產生心理上的距離。但我認為還有一個更深層的原因。對於醫生與科學家而言,我們理智上承認人類這個物種不過是一個物種,不比其他物種獨特,但我們內心並不完全這麼認為;當我聆聽莫札特,或在MacBook上觀看火星探測器傳回的照片時這麼思索。我感到人類特殊論的氛圍,即使我意識到將人類視為獨立且與眾不同的高等物種所付出的科學代價。如今我正努力改變。當我看見人類病患時總會自問,獸醫對於這個問題會有什麼我不瞭解的認知?如果我將人類患者視為「人類動物患者」,是否能給予他們更好的治療?

 

以下是幾個例子,說明這種想法所產生的令人振奮的關聯。恐懼誘發心臟衰竭:在2000年左右,人類心臟學家「發現」情緒誘導的心臟衰竭。這種情況發生在一位嗜賭成性的父親身上,當他因為一把骰子失去畢生積蓄後;也發生在一位被遺棄的新娘身上。但事實上這種「新」人類疾病既不新奇,也非人類獨有,獸醫早已對動物的情緒誘發症狀進行診斷、治療,甚至預防,對象包括猴子、紅鶴、鹿和兔子。從1970年代開始,多少人的生命將獲得拯救,如果這個獸醫學知識能被急診室醫生與心臟病學家運用?

 

自殘:有些人類病人會傷害自己,有些會扯下成把頭髮,有些甚至會割傷自己。有些動物患者也會自我傷害。有些鳥會拔掉自己的羽毛,有些馬會不斷啃咬自己的側腹,直到流血。但獸醫有相當具體且有效的方法治療甚至預防動物這種自我傷害的行為,難道這種獸醫學知識不應傳授給深受自殘行為困擾的心理醫生、父母和病人嗎?

 

產後憂鬱和產後精神病:有時在生產後不久,有些女性會出現憂鬱症狀,有時會變成嚴重憂鬱,甚至精神病。她們或許會忽視新生兒,在某些極端病例中,甚至會傷害孩子。馬科獸醫也知道,有時母馬在生產後不久會忽視小馬,拒絕哺育。在某些例子中會踢小馬,甚至踢死牠們。但獸醫設計出處理這種抗拒新生兒症狀的干預療法,就是增加母馬體內的催產素。催產素是一種連結荷爾蒙,能促使母馬對小馬重新產生興趣。難道這種知識不應傳授給婦產科醫生、家庭醫生及飽受產後憂鬱和精神病困擾的患者嗎?

 

儘管擁有如此多的益處,不幸的是,不同領域之間的鴻溝依然存在。為了解釋這一點,恐怕我得揭露一些黑暗面。有些醫生根本瞧不起沒有醫學博士文憑的醫生,我是指牙醫、驗光師和心理醫生。但也許對獸醫來說更是如此。當然,絕大多數醫生不瞭解,現在進入獸醫學院比進入醫學院還難。當我們就讀醫學院,我們學習的是關於一個物種-人類-的所有知識,但獸醫需要學習哺乳類、兩棲類、爬蟲類、魚類和鳥類之健康與疾病等知識,因此我不會責怪獸醫對醫生的優越感和無知感到厭惡。但獸醫當中有個說法:你如何稱呼只會治療一個物種的獸醫?醫生。(笑聲)

 

縮小鴻溝成了我渴望實現的目標,我正藉由一些項目進行,例如UCLA的達爾文巡診(Darwin on Rounds)計畫。我們將動物專家和進化生物學家安插到我們的醫療團隊中,與實習醫生及住院醫生一起工作。藉由「人獸共病」(Zoobiquity)會議,我們使醫學院和獸醫學院齊聚一堂,共同討論動物與人類病患共有的疾病和失調。在「人獸共病」會議中,與會者學習到治療老虎的乳癌如何幫助我們對一名幼稚園老師的乳癌進行更佳的治療;荷士登乳牛的多囊卵巢症如何幫助我們對一名舞蹈老師的經痛症狀進行更佳處理;深入瞭解治療喜樂蒂牧羊犬的分離性焦慮如何幫助第一天上學感到焦慮的兒童。

 

在美國和全世界的「人獸共病」會議中,醫生和獸醫拋下本身的態度和成見,以同事、同行、醫生的身分齊聚一堂。畢竟人類也是動物,讓醫生接受患者及人類本身的動物本質,參考獸醫的觀點,以跨物種的視角來看待醫療。

 

因為事實證明,一些最棒、最適用於人類的醫療方式正由治療非人類患者的醫生所使用。治療人類患者最好的方式之一,就是密切關注地球上其他病患如何生活、生長、生病及痊癒。

 

謝謝。(掌聲)

 

以下為系統擷取之英文原文

About this Talk

What do you call a veterinarian who can only take care of one species? A physician. In a fascinating talk, Barbara Natterson-Horowitz shares how a species-spanning approach to health can improve medical care of the human animal — particularly when it comes to mental health.

About the Speaker

Barbara Natterson-Horowitz, Professor of Medicine in the Division of Cardiology at UCLA Medical School, provides a unique perspective on how human well-being, including mental health, can be improved by insights into animal health. Full bio

Transcript

Ten years ago, I got a phone call that changed my life. At the time, I was cardiologist at UCLA, specializing in cardiac imaging techniques. The call came from a veterinarian at the Los Angeles Zoo. An elderly female chimpanzee had woken up with a facial droop and the veterinarians were worried that she'd had a stroke. They asked if I'd come to the zoo and image the animal's heart to look for a possible cardiac cause.

Now, to be clear, North American zoos are staffed by highly qualified, board-certified veterinarians who take outstanding care of their animal patients. But occasionally, they do reach into the human medical community, particularly for some speciality consultation, and I was one of the lucky physicians who was invited in to help. I had a chance to rule out a stroke in this chimpanzee and make sure that this gorilla didn't have a torn aorta, evaluate this macaw for a heart murmur, make sure that this California sea lion's paricardium wasn't inflamed, and in this picture, I'm listening to the heart of a lion after a lifesaving, collaborative procedure with veterinarians and physicians where we drained 700 cc's of fluid from the sac in which this lion's heart was contained. And this procedure, which I have done on many human patients, was identical, with the exception of that paw and that tail.

Now most of the time, I was working at UCLA Medical Center with physicians, discussing symptoms and diagnoses and treatments for my human patients, but some of the time, I was working at the Los Angeles Zoo with veterinarians, discussing symptoms and diagnoses and treatments for their animal patients. And occasionally, on the very same day, I went on rounds at UCLA Medical Center and at the Los Angeles Zoo. And here's what started coming into very clear focus for me. Physicians and veterinarians were essentially taking care of the same disorders in their animal and human patients: congestive heart failure, brain tumors, leukemia, diabetes, arthritis, ALS, breast cancer, even psychiatric syndromes like depression, anxiety, compulsions, eating disorders and self-injury.

Now, I've got a confession to make. Even though I studied comparative physiology and evolutionary biology as an undergrad -- I had even written my senior thesis on Darwinian theory -- learning about the significant overlap between the disorders of animals and humans, it came as a much needed wake-up call for me. So I started wondering, with all of these overlaps, how was it that I had never thought to ask a veterinarian, or consult the veterinary literature, for insights into one of my human patients? Why had I never, nor had any of my physician friends and colleagues whom I asked, ever attended a veterinary conference? For that matter, why was any of this a surprise? I mean, look, every single physician accepts some biological connection between animals and humans. Every medication that we prescribe or that we've taken ourselves or we've given to our families has first been tested on an animal.

But there's something very different about giving an animal a medication or a human disease and the animal developing congestive heart failure or diabetes or breast cancer on their own. Now, maybe some of the surprise comes from the increasing separation in our world between the urban and the nonurban. You know, we hear about these city kids who think that wool grows on trees or that cheese comes from a plant. Well, today's human hospitals, increasingly, are turning into these gleaming cathedrals of technology. And this creates a psychological distance between the human patients who are being treated there and animal patients who are living in oceans and farms and jungles.

But I think there's an even deeper reason. Physicians and scientists, we accept intellectually that our species, Homo sapiens, is merely one species, no more unique or special than any other. But in our hearts, we don't completely believe that. I feel it myself when I'm listening to Mozart or looking at pictures of the Mars Rover on my MacBook. I feel that tug of human exceptionalism, even as I recognize the scientifically isolating cost of seeing ourselves as a superior species, apart. Well, I'm trying these days. When I see a human patient now, I always ask, what do the animal doctors know about this problem that I don't know? And, might I be taking better care of my human patient if I saw them as a human animal patient?

Here are a few examples of the kind of exciting connections that this kind of thinking has led me to. Fear-induced heart failure. Around the year 2000, human cardiologists "discovered" emotionally induced heart failure. It was described in a gambling father who had lost his life's savings with a roll of the dice, in a bride who'd been left at the alter. But it turns out, this "new" human diagnosis was neither new, nor was it uniquely human. Veterinarians had been diagnosing, treating and even preventing emotionally induced symptoms in animals ranging from monkeys to flamingos, from to deer to rabbits, since the 1970s. How many human lives might have been saved if this veterinary knowledge had been put into the hands of E.R. docs and cardiologists?

Self-injury. Some human patients harm themselves. Some pluck out patches of hair, others actually cut themselves. Some animal patients also harm themselves. There are birds that pluck out feathers. There are stallions that repetitively bite their flanks until they bleed. But veterinarians have very specific and very effective ways of treating and even preventing self-injury in their self-injuring animals. Shouldn't this veterinary knowledge be put into the hands of psychotherapists and parents and patients struggling with self-injury?

Postpartum depression and postpartum psychosis. Sometimes, soon after giving birth, some women become depressed, and sometimes they become seriously depressed and even psychotic. They may neglect their newborn, and in some extreme cases, even harm the child. Equine veterinarians also know that occasionally, a mare, soon after giving birth, will neglect the foal, refusing to nurse, and in some instances, kick the foal, even to death. But veterinarians have devised an intervention to deal with this foal rejection syndrome that involves increasing oxytocin in the mare. Oxytocin is the bonding hormone, and this leads to renewed interest, on the part of the mare, in her foal. Shouldn't this information be put into the hands of ob/gyn's and family doctors and patients who are struggling with postpartum depression and psychosis?

Well, despite all of this promise, unfortunately the gulf between our fields remains large. To explain it, I'm afraid I'm going to have to air some dirty laundry. Some physicians can be real snobs about doctors who are not M.D.'s. I'm talking about dentists and optometrists and psychologists, but maybe especially animal doctors. Of course, most physicians don't realize that it is harder to get into vet school these days than medical school, and that when we go to medical school, we learn everything there is to know about one species, Homo sapiens, but veterinarians need to learn about health and disease in mammals, amphibians, reptiles, fish and birds. So I don't blame the vets for feeling annoyed by my profession's condescension and ignorance. But here's one from the vets: What do you call a veterinarian who can only take care of one species? A physician. (Laughter)

Closing the gap has become a passion for me, and I'm doing this through programs like Darwin on Rounds at UCLA, where we're bringing animal experts and evolutionary biologists and embedding them on our medical teams with our interns and our residents. And through Zoobiquity conferences, where we bring medical schools together with veterinary schools for collabortive discussions of the shared diseases and disorders of animal and human patients. At Zoobiquity conferences, participants learn how treating breast cancer in a tiger can help us better treat breast cancer in a kindergarten teacher; how understanding polycystic overies in a Holstein cow can help us better take care of a dance instructor with painful periods; and how better understanding the treatment of separation anxiety in a high-strung Sheltie can help an anxious young child struggling with his first days of school.

In the United States and now internationally, at Zoobiquity conferences physicians and veterinarians check their attitudes and their preconceptions at the door and come together as colleagues, as peers, as doctors. After all, we humans are animals, too, and it's time for us physicians to embrace our patients' and our own animal natures and join veterinarians in a species-spanning approach to health.

Because it turns out, some of the best and most humanistic medicine is being practiced by doctors whose patients aren't human. And one of the best ways we can take care of the human patient is by paying close attention to how all the other patients on the planet live, grow, get sick and heal.

Thank you.

(Applause).


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