医学进步
1.Re-visit the Mecca which produced you; you'll be surprised that what you consider a holy grail has become anachronistic.
【译文】重访曾经孕育你的（圣地）麦加，你会惊奇地发现，曾被视为圣杯的圣物已经过时。
【点评】没有一成不变的真理，任何事物都在发展，都在前进。
2.… Many pints of fluid were used to wash out the abdominal cavity.Some surgeons appeared to attribute their successful results to the thoroughness of their washing-out.It did not take many years, however, to find out that this prolonged washing-out was quite unnecessary in the case of perforated ulcer, and very harmful in the case of a perforated appendix.Yet it was some time before the custom was entirely dropped.It was a common custom when first l begun my medical studies.
—— Zachary Cope, 1881——1974
【译文】……用大量的液体冲洗腹腔。不少外科医生似乎把良好的治疗效果归因于这种彻底的清洗。然而，没过多少年，就发现这种长时间的冲洗对于溃疡穿孔是完全没有必要的，而对阑尾穿孔甚至非常有害。但又过了好一段时间，这一习惯才完全废止。这是我刚开始学医时很普遍的一个习惯。
3.First it was the abolition of acid reductive operations for peptic ulcers, then it was not operating on diverticular disease, then not operating on knobby goiters,but investigating them, and now it's this stunting outrage.Our surgical parents had to put up with the abolition of the superior mesenteric artery syndrome, and colectomy for constipation in low spirited ladies, and sympathectomy for just about every form of vascular disease, and phrenic nerve crush for asthma.There is a sustained assault on the livelihood of surgeons, but happily they can invent operations faster than they are found out to be useless.Laparoscopy is re-finding old operations and is working on new ones by some form of laparoscopic hitching,stapling or removing for bloating, queasiness, gluttony, or general lowness of spirit.
—— David Dent
【译文】首先废除的是消化性溃疡的减酸手术，然后是治疗憩室病的手术、结节性甲状腺肿的手术，但后者还在继续研究。现在是支架植入的暴行。我们的外科前辈还废除了肠系膜上动脉综合征（手术），为情绪低落的女性便秘患者做结肠切除，为几乎所有血管疾病患者进行交感神经切除以及为哮喘患者进行膈神经压榨等等手术。由此给外科医生的生计带来持续冲击，但令人高兴的是，他们发明新手术的速度快于证明这些手术无用的速度。腹腔镜正在重启某些过去的手术，并通过在腹腔镜下以某种栓套、钉合或切除的新手段——来治疗腹胀、恶心、暴食或一般的精神萎靡。
【点评】读完这段话，让我心里堵得慌。说完全是在诋毁外科医生吧，但这种种手术方式的确是真真切切存在过，甚至有些还一度非常盛行。说全盘接受吧，又觉得太冤。其实问题的关键在于是为了创新手术方式而创新，还是为了以最小的创伤、最大限度地减轻患者的疾苦去创新手术方式。
4.That which is new at this time will one day be ancient; as what is ancient was once new.It is not the length of time which gives value to things, it is their own excellency.
—— Augustine Belloste, 1645——1730
【译文】此刻的新东西终有一天会成为古董，就像古董也曾经是新东西一样。赋予事物价值的不是时间的长短，而是其自身的优势。
5.The real problem with medical advances is that they are practiced indiscriminately.
—— Moshe Schein
【译文】医学进步的真正问题是不加区别地将其付诸实践。
【点评】将医学进步选择性地付诸实践是可以的，但必须要有科学、严谨的证据，否则有可能将许多医学进步扼杀于襁褓中。
6.There are fashions in surgery just as there are in morals, millinery, religion,and war boats.They are just as transitory and often just as bizarre.
—— Chalmers Da Costa, 1863——1933
【译文】正如道德、宗教和战船等一样，外科手术也有时尚，其共同特征是怪诞，难以长久。
7.If you are too fond of new remedies, first you will not cure your patients;secondly, you will have no patients to cure.
—— Astley Paston Cooper, 1768——1841
【译文】如果你过分喜欢新疗法，首先你就治不好患者，其次你也没有患者可治了。
8.It usually requires a considerable time to determine with certainty the virtues of a new method of treatment and usually still longer to ascertain the harmful effects.
—— Alfred Blalock, 1899——1964
【译文】确定一种新疗法的优点通常需要相当长的时间，而确定其有害性则需要更长时间。
9.In general, if a technique has been adequately reported in a major journal,but was then not persistently followed up by its creators with a succession of papers confirming the original success, and was not picked up by others, the conclusion may safely be drawn that the procedure was defective or unattractive, and had probably been tried by others, who found it wanting, perhaps without bothering even to publish.There are exceptions to this.
—— Mark M.Ravitch, 1910——1989
【译文】通常，如果一项技术在某一主要期刊上有过一些报道，但后续原创人并未坚持不懈地用一系列论文来证实其当初的成功，也没有被其他人所采用，那么可放心断言，该项技术是有缺陷的或没有吸引力的。或许已经有其他人尝试过，发现了它的缺陷，甚至都不屑于发表其尝试的结果。当然也有例外。(https://www.daowen.com)
10.The great publicity, which certain operative procedures receive...is to be blamed for a good many of the unfortunate results which follow injudicious surgery.They are often demanded in the belief that they are an advance, and the local surgeon is tempted to comply with such demands ...and to perform an operation which is unfamiliar to him——very frequently and with unfortunate results.
—— Max Thorek, 1880——1960
【译文】通过大力宣传接受某些手术操作……常被认为是不明智手术所导致许多不幸结果的罪魁祸首。宣传中，还经常要求人们相信这是一种进步，而当地的外科医生也经不住诱导地顺应了这种宣传……动手做一个他们并不熟悉的手术——此类情况还频频发生，随之而来的是倒霉的后果。
【点评】每个年代、每一个新术式问世之初都有不少这样的典型案例。
11.Never be the first but never be the last to accept change.
—— Angus B.McLachlin, 1908——1987
【译文】永远不要第一个但也不要最后一个接受改变。
【点评】古往今来很多人会恪守这样一个信条，但也总会有第一个吃螃蟹的人。
12.New equipment and new procedures may improve medical care but seldom decrease cost.
—— Mark M.Ravitch, 1910——1989
【译文】新设备和新技术可以改善医疗服务，但很少降低成本。
【点评】有不少新设备、新的手术虽然不直接带来医疗成本的下降，但间接成本是下降的，比如很多的微创手术。
13.We seem to have replaced cheap & effective with expensive & mediocre.
—— Anil Thakur
【译文】我们似乎已经用昂贵与平庸取代了廉价和高效。
【点评】在日趋繁荣的医疗工商业推动下这种现象似乎有愈演愈烈之势。
14.Unfortunately, medicine becomes more and more invasive; lives are saved,lives are being lost; the net results remain the same, but at a much higher price.
—— Moshe Schein
【译文】很不幸，医学变得越来越具有侵略性；生命得以拯救，生命终将会失去；最终结果相同，但代价要高得多。
【点评】从宏观的角度而言，此话不是完全无道理。
15.We in the USA have become an excessively invasive surgical society.Too many Swan-Ganzs, too many coronary angioplasties for MI, and too many PEGS/gastrostomies.The late NY cardiologist Bernard Lown wrote: "the reason for this shift includes a romance with mindless technology, which is embraced largely, to maximize income.Since it is unnecessary to spend much time with patients ...it opens floodgates for endless procedures since".
—— Moshe Schein
【译文】我们美国已经成为一个过度侵入性外科社会。太多的肺动脉漂浮导管，太多的冠状动脉成形术，太多的PEGS（胃造口术）。已故的纽约心脏病专家Bernard Lown曾写道：“带来这种转变的原因是一种对无需动脑思考，重复性机械技术的浪漫，这种技术广受欢迎，让收入最大化。因为不必花太多时间和患者在一起……从而为无尽的这类操作技术开启了泄洪闸。”
【点评】大师从“技术崇拜”和“商业利益”这两个层面剖析了目前过度技术化医疗的成因。
16.The seeming exactness of a mechanical device appeals much more strongly to certain minds than a process of reasoning.
—— James Mackenzie, 1853——1925
【译文】对某些人来说，机械装置表面上的貌似精确比推理过程更具有吸引力。
17.As he picks up his beautiful new tool, however, it is well for the modern biologist to remind himself how subtly and completely a fascination for gadgets can betray sound sense.
—— William T.Salter, 1901——1952
【译文】现代生物学家拿起漂亮的新工具时，最好提醒自己，对这些小玩意的痴迷是如何微妙而彻底地背叛了理智。
18.An increasing worship of instrument for its own sake sometimes leads to enslavement by it.
—— David Seegal
【译文】出于对仪器本身的日益崇拜，有时会导致被仪器所奴役。
19.We do not need a compass to find our way home.
【译文】不需要指南针，我们依然能找到回家的路。
20.A fool with a tool is still a fool.
【译文】拿着工具的笨蛋依然是笨蛋。