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When the cure is not worth the cost
Thanks to research by the National Institutes of Health and academic scientists during the last three decades, we now have proven treatments for depression, addiction and other mental disorders. But all too often clinicians do not use them. Without financial incentives to provide treatments that are known to work, many mental health professionals stick with what they know, or pick up on the latest fad, or even introduce their own untested innovations-which in turn are spread by testimonials and credulous news media coverage. Take the well-known approach featured on the cable TV reality show "Intervention" aimed at getting addicts and alcoholics into treatment. Here, the family and sometimes the employer gather with a counselor, confront the addict and threaten to shun him or fire him if he doesn’t enter a rehabilitation center. A 1999 study compared this style of intervention -which can backfire and lead to broken families-to a less confrontational approach known as "community reinforcement and family training," which is aimed at helping the family nurture the addict’s own motivation. More than twice as many families succeeded in getting their loved ones into treatment (64 percent) with the gentler approach than with standard intervention (30 percent). But no reality shows push the less dramatic method, and it is difficult to find clinicians who use it. Similarly, one of the most common approaches to alcoholism treatment involves having counselors and fellow alcoholics confront patients and force them to identify themselves as alcoholics. But research finds that the more a counselor confronts, the more a patient drinks and the more likely he is to drop out of treatment. And no association between accepting the label "alcoholic" and quitting drinking has been found. Counselor empathy-not confrontation-is connected with recovery. According to a review by the Institute of Medicine in 2006, only 10.5 percent of alcoholics received "care consistent with scientific knowledge" of the disorder; similarly, 43 percent of children in psychiatric hospitals are given antipsychotic medication despite not suffering from psychosis. Tough boot camps for troubled teenagers-which have been proven to be ineffective and potentially harmful-thrive, while "multisystemic family therapy," which effectively treats teenagers at home, is available only through the juvenile justice system. If we want to provide genuine help for the 33 million Americans with mental health and drug problems, giving more no-strings-attached money to providers via insurance mandates is not the answer. It is dangerous to blindly bolster useless and even harmful treatments while failing to support proven therapies. Coverage must be tied to outcomes and evidence. And payment should be dependent, at least in part, on health improvements, not just services received. We need parity in evidence-based treatment, not just in coverage. 考研詞匯： depression[diˈpreʃən] n.①沮喪，消沉;②(經(jīng)濟(jì))蕭條，不景氣 [真題例句] Failing hips can be replaced, clinical depression (①) controlled, cataracts removed in a 30-minute surgical procedure.[2003年閱讀4] [例句精譯] 髖骨不行了可以更換，臨床憂郁癥得到了控制，白內(nèi)障僅用30分鐘手術(shù)便可以切除。 [真題例句] Even so, that gain adds up to only 11.4 percent, lowest in American annual records except for the Depression (②) years.[1998年閱讀4] [例句精譯] 即使如此，人口總數(shù)也只增加了11.4%，除了大蕭條時(shí)期，這是美國年度記錄最低的增長率。 credulous[ˈkredjuləs] adj.輕信的，易受騙的 shun[ ʃʌn] vt.避開, 避免 intervention[ˌintəˈvenʃən] n.干涉 [真題例句] In any case, all such interventions are heavily dependent on scientific advice and also scientific and technological manpower of all kinds.[2000年翻譯] [例句精譯] 無論如何，所有這些干預(yù)都非常依賴于科學(xué)的建議，也依賴于各類科技人才的力量。 therapy[ˈθerəpi] n.治療，理療 [真題例句] The profession is taking steps to require young doctors to train in hospices, to test knowledge of aggressive pain management therapies, to develop a Medicare billing code for hospital-based care, and to develop new standards for assessing and treating pain at the end of life.[2002年閱讀4] [例句精譯] 醫(yī)療行業(yè)采取步驟，讓年輕醫(yī)生去晚期病人休養(yǎng)所培訓(xùn)，對(duì)各種大膽的鎮(zhèn)痛療法方面的知識(shí)進(jìn)行評(píng)估，為醫(yī)院護(hù)理制定一份符合美國醫(yī)療保障方案的付款條例，以及為評(píng)估和治療臨終痛苦制定新的標(biāo)準(zhǔn)。 bolster[[ˈbəulstə] n.墊子v.支持 背景常識(shí)介紹： 家庭和社區(qū)介入治療可以幫助每個(gè)家庭成員認(rèn)識(shí)和解決家庭中的問題，促進(jìn)相互理解、相互幫助，避免患者在治療后又回到一個(gè)病態(tài)家庭中去;也可以幫助患者擺脫依賴，同時(shí)也消除患者給家庭成員造成的心理創(chuàng)傷。 參考譯文： 治療與花費(fèi)之間的不等 多虧了國家健康研究所和學(xué)院科學(xué)家們在過去三十年中的研究，現(xiàn)在我們擁有可以治療抑郁癥、上癮癥以及一些其他精神失常癥狀的方法。但很多時(shí)候臨床醫(yī)師卻不使用這些方法。 沒有金錢動(dòng)力讓他們提供有明確療效的治療方法，很多精神健康從業(yè)人員堅(jiān)持使用他們所知道的方法，或采用最新潮流中提供的方法，甚至使用未經(jīng)檢驗(yàn)過的自創(chuàng)發(fā)明，而這些發(fā)明卻通過證明信和媒體夸張的報(bào)道流傳開來。 以有線電視真實(shí)現(xiàn)場秀"intervention(干預(yù))"中提供的著名方法來說，這個(gè)方法是為了讓癮君子和酗酒者接受治療。節(jié)目中，家人有時(shí)是公司雇主和咨詢師一起面對(duì)上癮者，威脅說如果他不參加康復(fù)治療中心就趕走或開除他。一項(xiàng)1999年的調(diào)查把這種干預(yù)方法和比較溫和的名為"社區(qū)強(qiáng)化和家庭訓(xùn)練"的方法進(jìn)行比較，后者是為了幫助家庭來培養(yǎng)上癮者自己戒掉不良嗜好的動(dòng)力， 而前者可能會(huì)后院起火從而導(dǎo)致家庭破裂。 64%的家庭采用溫和方法成功使得他們所愛的家人接受治療，這是采用常規(guī)干預(yù)方法成功的家庭(30%)的兩倍多。但沒有任何真實(shí)秀節(jié)目推廣這種溫和的方法，也很難找到臨床醫(yī)師使用這種方法。 同樣的，治療酗酒最為普遍的一種方法就是讓咨詢師和其他酗酒者與病人面對(duì)面，強(qiáng)迫這些病人承認(rèn)自己是酗酒者。但研究表明越是和咨詢師接觸，病人反而飲酒量越多，而且退出治療的可能性越大。而且并未發(fā)現(xiàn)接受酗酒者的標(biāo)簽與戒酒有任何聯(lián)系。咨詢師的同情，而非與其接觸，和恢復(fù)正常有關(guān)聯(lián)。 根據(jù)一份2006年醫(yī)藥研究會(huì)的評(píng)論，只有10.5%的酗酒者得到結(jié)合精神失調(diào)相關(guān)的科學(xué)知識(shí)的照顧和治療。同樣，精神病院中43%的兒童獲得不受精神病困擾的治療方法。嚴(yán)厲的青少年勞教營，已證明其對(duì)幫助問題青少年沒有療效甚至有潛在危險(xiǎn)，卻時(shí)興起來;相反，有效的在家中治療青少年的"多系統(tǒng)家庭治療法" 卻只能在青少年犯罪體系中使用。 如果我們想為三千三百萬有精神困擾和毒品困擾的美國人提供真正幫助的話，通過保險(xiǎn)授權(quán)給予更多的金錢并非是答案。盲目的改善無用甚至有害的治療方法卻無法推廣有效的治療方法是很危險(xiǎn)的。報(bào)道應(yīng)與結(jié)果和證據(jù)緊密聯(lián)系。報(bào)酬至少有一部分應(yīng)當(dāng)依據(jù)治療效果而不僅是接受的服務(wù)來付出。我們需要與所付報(bào)酬等價(jià)的治療，這種治療是建立在醫(yī)學(xué)證據(jù)之上而非媒體的報(bào)道。 |
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