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| Somatic 薬／医学 乱用s psychiatry |
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| — and neglects causal 研究 |
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| by Per Dalén |
| (på svenska) |
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THERE ARE MANY INDICATIONS that the 人気 of modern 薬／医学 is 拒絶する／低下するing. Doctors are 直面するing さまざまな problems that seem to be growing, such as 懐疑的な and inquisitive 患者s who tend to 捜し出す （警察などへの）密告，告訴（状） and help outside 従来の 薬／医学. In Sweden at least, the professional 審議 shows rather plainly that many doctors are adapting いっそう少なく than cheerfully to what is going on, and often tend to 反応する with 失望／欲求不満 when their professional 当局 is not 存在 fully 尊敬（する）・点d. 伝統的な values such as "science", and "証拠-based 薬／医学" are 存在 defended. 代案／選択肢 and complementary methods are beyond the pale. In many other Western countries 内科医s are now 率直に 調査するing such methods, but in Sweden this is a deviation that is not 許容できる in licensed practitioners. There is hardly any opinion の中で 医療の professionals against these 制限s.[1]
On the other 手渡す, there is a 主題 that not only 生き残るs inside the 医療の culture in spite of an almost total 欠如（する） of 科学の support, but 現実に 栄えるs there 予定 to the support given by 主要な circles. This is the use of psychological theories as a means of reclassifying bodily symptoms as mental problems in 事例／患者s where 従来の 薬／医学 is at a loss for an explanation, 特に 患者s with いわゆる new 診断するs. 患者s often feel 侮辱d by this 行為／法令／行動する of reclassification, which is often …を伴ってd by 調印するs of impatience on the part of the doctor. Many health professionals tend to be 刺激するd by 患者s who themselves 示唆する a diagnosis that lies outside the 従来の 医療の world-見解（をとる）. If a doctor should begin to 受託する that electrosensitivity and amalgam illness do in fact "存在する", this puts his/her 評判 in jeopardy and may (in Sweden) even lead to 疑惑s of possible malpractice. In some 事例／患者s the 国家の Board of Health and 福利事業 may feel called upon to start an 調査.
”Since I am a psychiatrist, I have for a long time been intrigued by the 驚くべき／特命の／臨時の use of psychiatric causal explanations for illnesses that not only go with predominantly somatic symptoms, but also 欠如（する） any basic similarity to known mental disorders.”
Since I am a psychiatrist, I have for a long time been intrigued by the 驚くべき／特命の／臨時の use of psychiatric causal explanations for illnesses that not only go with predominantly somatic symptoms, but also 欠如（する） any basic similarity to known mental disorders. Are 患者s 存在 helped by this peculiar way of 解釈する／通訳するing their illnesses? No, it would be a 甚だしい／１２ダース exaggeration to 持続する this, at least when there are pronounced （民事の）告訴s of some かなりの duration. On the other 手渡す there is no 否定するing that 確かな 利益／興味d parties outside 薬／医学 are 存在 helped, for instance the electric and electronic 産業s, 同様に as those who are 責任がある the continued use of 水銀柱，温度計 in dentistry. I cannot 除外する the 可能性 that psychiatry is 存在 乱用d ーするために sweep 確かな 極度の慎重さを要する problems under the carpet.
We have here a possible 倫理的な problem. If 内科医s in general were in the habit of thinking 独立して and, in appropriate circumstances, were willing to show civil disobedience, problems like these would never have to arise. Earlier examples of 乱用 of psychiatry in Nazi Germany and the Soviet Union unfortunately show that 内科医s are no more upright than others in the 直面する of signals from people they regard as their superiors. The herd instinct may even be stronger in my 同僚s than の中で people in general.
Starting from the background 輪郭（を描く）d above I should like to discuss different 面s of 医療の 態度s to questions that somehow 伴う／関わる all those people who have been unfortunate enough to 落ちる 犠牲者 to illnesses that are 公式に counted as probably 非，不，無-existent.
医療の science has a really weak 味方する that is not 存在 discussed very often. 研究 into 原因（となる）s is making no 進歩 in important areas, which gives a hollow （犯罪の）一味 to all this proud talk of 予防の work. It would be at least partly 訂正する to say that there is no real 研究 into 原因（となる）s, but that this has been 取って代わるd by a search for "機械装置s". The 原因（となる）s are 推定する／予想するd to 落ちる into our （競技場の）トラック一周s like 熟した fruits when enough 詳細（に述べる）s about the 機械装置s of a 病気 have become known. Going straight for the 原因（となる） is regarded as something that adventurers may be dreaming about, but real scientists are not supposed to do things like this. From the point of 見解（をとる） of your career it would be very unwise to について言及する that you hope to be able to search for unknown 原因（となる）s of 病気. Everybody "knows" that this is far too difficult, and that you will have to be a pretentious fool to be talking 率直に of such goals for your 科学の 成果／努力s.
On closer 分析 the uses of the word "原因（となる）" are far from unambiguous, even in 科学の discourse. いつかs 機械装置s of 病気 are called 原因（となる）s. For example, antibodies directed against our own tissues may be said to 原因（となる） autoimmune 病気s, such as 多重の sclerosis. Instead of 試みる／企てるing some 肉親，親類d of philosophical 分析, I shall stick to a simple 鮮明度／定義 in this article. The basis is the 仮定／引き受けること that we are 普通は in a 明言する／公表する of health. 原因（となる）s of 病気 are such 外部の things that either 始める, or 与える／捧げる 大幅に to the 出現 of a 明言する／公表する of illness, and will then 持続する this 異常な 明言する／公表する until the 団体／死体 manages to 回復する normality, with or without outside help.
Autoimmunity does not arise from nothing, but unfortunately we know very little about its 原因（となる）s. 予防 and 治療 are 貧しく developed. In these days of enthusiasm for molecular biology many scientists are dreaming of 麻薬s that are tailored for a 明確な／細部 目的, such as 封鎖するing the autoimmune 機械装置 before it has led to manifest symptoms. This will probably be a difficult approach, fraught with 失敗s. There is first of all a かなりの 危険 that serious 逆の 影響s will occur when 化学製品 介入s are 存在 made in central parts of this delicate apparatus which has 発展させるd through millions of years. We should rather look for something altogether different, すなわち an 外部の 乱すing factor (含むing nutritional 欠陥／不足s) which enters the chain of events at an earlier 行う／開催する／段階, and which we might 除去する. But unfortunately very little 研究 is going on that can be 推定する／予想するd to 達成する this goal.
If there are several possible 原因（となる）s, ありふれた sense will tell us that we had better concentrate on those that we can in fact hope to do something about with reasonable, and preferably 害のない means. Today this is no longer self-evident, since the mapping of genetic 機械装置s at the molecular level seems to open 完全に new 視野s. But here we 危険 losing our way because of a simple 誤解.
Our 遺伝子s have also been 実験（する）d during millions of years, and with rare exceptions they serve us exceedingly 井戸／弁護士席 as long as the 環境 keeps within reasonable 限界s. 医療の genetics used to を取り引きする rare 病気s in which a 遺伝子 is in fact 異常な in such a way that a 病気 will arise even in a perfectly normal 環境. Such "faults in the construction" are 予定 to 突然変異s, which may in some 事例／患者s escape 排除／予選 by natural 選択. It is いつかs possible to 限界 the 伝達／伝染 of such 遺伝子s if those who carry them 差し控える from having children of their own. This approach becomes more problematic if compulsory 対策 are 存在 considered, 特に if such 計画（する）s are 存在 guided by pseudo-科学の genetics, as was the 事例／患者 during the first half of the 20th century. During this period schizophrenia and several other mental disorders and anomalies were regarded as 明白に hereditary in many countries. As we know, this belief was the "科学の" underpinning for eugenic 法律制定 in which compulsory sterilization was an important part, not only in Nazi Germany. Today it is obvious that the "hereditary background" that was taken for 認めるd in these 事例／患者s was not at all of the 肉親，親類d where 異常な 遺伝子s could be 除去するd by sterilization. The 関連した facts were known already in the 1930s, but this 批評 was 抑えるd for political 推論する／理由s, and for 推論する／理由s of prestige.
The important 誤解 that 生き残るs even today is that a "hereditary background" to a 病気 means an 関与 of 遺伝子s that are 異常な, and therefore should be "修理d" if it is impossible to 除去する them from the 全住民. But this is rarely the 事例／患者. It is やめる 平易な to show that many important and 普及した 病気s are to some extent controlled by genetic factors, but it has to be assumed that this is a question of コンビナート／複合体 and diffuse 出資／貢献s from several 遺伝子s, each of which are in themselves 機能（する）／行事ing 普通は. 予定 to chance, some of us have more than an 普通の／平均（する） endowment of 遺伝子s that 増加する the 危険 of developing 病気s like obesity, アレルギー, cardiovascular 病気, or 糖尿病. Even so, most of the facts point に向かって the 環境 as 決定的な in these 事例／患者s. If the incidence of a 病気 is 増加するing 速く in the 全住民, this 増加する cannot be 予定 to a sudden change in the frequency of 確かな 遺伝子s. 非難するing 遺伝 can often become an evasive argument, 特に so in 医療の science, with its lamentably poor 記録，記録的な／記録する of 研究 into 原因（となる）s, 特に where 環境の factors are 関心d.
”Genetic 研究 is now enjoying an unparalleled にわか景気, with 広大な／多数の／重要な 期待s of 未来 sales of knowledge. It is not in the 利益／興味s of geneticists to 削減（する） the hype and the 誤解s 負かす／撃墜する to size as long as their 計画（する）s for the 未来 are supported by those popular beliefs.”
Take it with a pinch of salt if you are told that your illness may have a genetic background! Your doctor will be 説 so with the best 意向s, but such a piece of （警察などへの）密告，告訴（状） will rarely be helpful in your 成果／努力s to 回復する your health. To the doctor this is also a way of 確認するing his belief that our 遺伝子s are a 肉親，親類d of ultimate basis for all that happens in our 団体／死体s, in health 同様に as in 病気. Thoughts like this are 高度に contagious. Genetic 研究 is now enjoying an unparalleled にわか景気, with 広大な／多数の／重要な 期待s of 未来 sales of knowledge. It is not in the 利益／興味s of geneticists to 削減（する） the hype and the 誤解s 負かす／撃墜する to size as long as their 計画（する）s for the 未来 are supported by those popular beliefs. And the いっそう少なく we talk about the 環境, the better for the 商売／仕事 事業／計画（する）s of the geneticists.
In the 未来, 研究室／実験室 methods of genetic diagnosis will become 一般に 利用できる for 決まりきった仕事 use. They will show whether a person carries a 確かな 遺伝子, and may for instance guide the choice of 麻薬 治療s in particular 状況／情勢s. It remains to be seen whether this will become 事実上 useful, but today it is still in the pipeline, like so many other 使用／適用s of modern genetics.
 I am sure my 声明 above that 薬／医学 has no real 研究 into 原因（となる）s will already have given rise to 反対s from some readers. Genetics is regarded as a solid basis for 未来 insights into 原因（となる）s, but in reality it is still only of use in 関係 with 確かな rare 病気s. Epidemiology is another specialty that is という評判の to carry the 重要なs to 原因（となる）s of 病気. 初めは this was the science of the occurrence of (infective) 病気s in 全住民s. Now it has developed into a versatile discipline, which uses 統計（学） as its basis. の中で other things, epidemiologists 診察する correlations between the incidence of 病気s and さまざまな 環境の factors, hoping to 位置／汚点／見つけ出す causal factors. Epidemiology has almost acquired the status of a basic science in 薬／医学. Much of its 評判 茎・取り除くs from the successful 解答 of the problem of smoking and 肺 癌 by Austin Bradford Hill and Richard Doll in Britain during the 1950s. At that time 90 % of all British men were smokers. The 緊張する of World War II certainly 与える／捧げるd to this 極端に high prevalence of the smoking habit. 肺 癌 was 増加するing at an alarming 率, but 最初 even those who solved the problem 設立する it hard to believe that smoking was the 原因（となる）: "cigarette smoking was such a normal thing", as Doll said in a 1991 interview. Doll also felt that モーター exhausts, or かもしれない the tarring of roads were more likely 候補者s — see "The Rise and 落ちる of Modern 薬／医学" by James Le Fanu.[2] Thus the 研究員s were 取引，協定ing with a true 集まり （危険などに）さらす, which meant that it was difficult to find 十分な numbers of 非，不，無-smoking 支配（する）／統制するs. Bradford Hill and Doll were successful, but their 熟考する／考慮するs had to be made very large in spite of the fact that 肺 癌 is a 際立った 病気 that is easily 診断するd. In many other 状況／情勢s of 集まり （危険などに）さらす the 条件s are いっそう少なく favourable. The picture of the 嫌疑者，容疑者／疑うd 逆の 影響s is often 複雑にするd by いわゆる "unspecific symptoms", which makes it harder to define and delimit the problem. In such 状況／情勢s epidemiology is often （判決などを）下すd useless because of a sharp 拒絶する／低下する in the sensitivity of the methods. 集まり （危険などに）さらす thus 減ずるs the chances of （悪事，秘密などを）発見するing 逆の 影響s that are 比較して weak, or occur at a low 率. This is その上の 悪化させるd if there are also problems of 分類 or 鮮明度／定義. Epidemiology 作品 best under ideal circumstances. There is nothing remarkable about this, but it would be better if the 証拠不十分s were 宣言するd 率直に, so that 期待s might become more 現実主義の. After nearly 50 years epidemiology has still not より勝るd its 早期に feats in タバコ 研究. This is not 予定 to a 欠如（する） of 資源s, but the problem of the frequently low sensitivity of the methods used has become a major hindrance. Many 試みる／企てるs have ended in 不確定 about the meaning of the findings. What is 設立する are of course 統計に基づく 協会s, not causal links. A 病気 may thus be somewhat more ありふれた in a group of people who are exposed above the 普通の／平均（する） level for the general 全住民 to some factor that might be harmful. Such 協会s are often 設立する, but there are almost always 反対s to the hypothesis that this might 代表する a real causal link. For さまざまな 推論する／理由s the epidemiologists themselves will usually not be in a position to bring the 事柄 その上の by doing other 肉親，親類d of 研究 on the problem in question. As a result a 広大な／多数の／重要な number of ありふれた factors in our food and our 環境 will be entered on a 名簿（に載せる）／表（にあげる） of 嫌疑者，容疑者／疑うs. Science is then often unable to pass a final 裁判／判断 in many of these 事例／患者s. An example that most people will be familiar with is that of the health 影響s of a small intake of alcohol, say a glass of ワイン per day. 科学の opinion seems to 転換 continually. At 現在の such a dose is predominantly good for you, but this is sure to change, as it has been doing in the past. The （人命などを）奪う，主張する that science is superior to politics for 扱うing such problems will quickly lose its 信用性 if no reliable 指導／手引 is 利用できる in a question like this. There are unfortunately other 類似の examples of 広大な／多数の／重要な importance for everybody. I am thinking of さまざまな dietary 指導基準s, 特に 関心ing fat, where different 専門家 opinions have appeared in succession during １０年間s.
Behind every 製品 on the 名簿（に載せる）／表（にあげる） of 嫌疑者，容疑者／疑うs there is at least one worried 支店 of 産業. The タバコ 産業 learned 早期に on how to 扱う epidemiology by （種を）蒔くing 疑問 about the meaning of the findings, which is a very useful method of "損失 支配（する）／統制する". Epidemiology 現実に 申し込む／申し出s obvious 適切な時期s for 突き破るing off 制限s. When modern PR 顧問s are trying to （疑いを）晴らす an 産業の 製品 from 疑惑s they take it for 認めるd that only epidemiology can produce final proof in such 事柄s. And the 医療の 設立 will nod approvingly without giving much thought to the problem. 医療の professionals are still impressed by the fact that smoking could be shown to be the 犯人 in the 事例／患者 of 肺 癌, and they are not likely to 耐える in mind that many other 医療の problems have been 手渡すd over to epidemiology without ever 存在 solved. Doctors are even いっそう少なく likely to see how 産業の 利益／興味s are 活発に 影響（力）ing the course of what is 表面上は a 科学の discussion. When science, unassisted, is unable to fully answer important 議論の的になる questions, other parties will 徐々に take 支配（する）／統制する of the 状況／情勢. First of all, of course, any 産業s 伴う／関わるd, then public 当局 and political 議会s. This 存在 so, it is やめる natural to 雇う the 予防の 原則 in some form or other, ーするために make it possible to take important 決定／判定勝ち（する）s even before the scientists have reached 合意, which may take a very long time. It is hardly reasonable to put public health in jeopardy when a 支店 of 産業 is …に反対するing 制限s and manages to 持続する 疑問 and 不一致 の中で scientists. The 巧みな操作s of the タバコ 産業 have been 完全に exposed, and there is no 推論する／理由 どれでも to assume that this is a unique example. Epidemiology is thus open to 批評 because its methods 生成する many 協会s that tend to worry the general public, 協会s that will tend to ぐずぐず残る 無期限に／不明確に without science always 存在 able to decide the 事柄 one way or the other. What is 欠如（する）ing is often その上の 状況証拠 of a different 肉親，親類d from 統計（学）. Epidemiologists are first of all statisticians, and many do in fact 欠如（する） an ordinary 医療の education and experience from 臨床の work with 患者s. They can 評価する 統計に基づく 協会s and see whether these are 存在 影響（力）d by いわゆる confounding factors, which is often the 事例／患者. But their opinions on causal 関係s must often be taken with a pinch of salt, 特に when it is a question of 否定するing a 関係 on 純粋に 統計に基づく or theoretical grounds.
”What makes an individual human 存在 ill cannot be 決定するd by 統計（学）.”
What makes an individual human 存在 ill cannot be 決定するd by 統計（学）. This has long been 受託するd in the 熟考する／考慮する of unusual 味方する 影響s of 麻薬s, where 事例／患者 報告（する）／憶測s are 絶対 necessary ーするために acquire any knowledge. 要求するing 統計に基づく proof is an absurdity if a given 味方する 影響 occurs in one 事例／患者 per thousand 扱う／治療するd or even more rarely. Each 麻薬 also has a number of different 味方する 影響s that may be rare. Nobody will be ready to 財政／金融 the 抱擁する epidemiological 熟考する／考慮するs that might かもしれない be able to 取って代わる 事例／患者 報告（する）／憶測s. If sponsors from the 産業 could have their way, epidemiologists would produce even more of いわゆる "消極的な 熟考する／考慮するs", which in other words do not show an 影響 of the factor 熟考する／考慮するd. They should of course be 正式に 訂正する in all 詳細（に述べる）s, and will then have the 広大な／多数の／重要な advantage of not 反映するing 不正に on any 製品. It used to be ありふれた knowledge の中で scientists that such 熟考する／考慮するs don't 証明する anything at all, and 定期刊行物 editors were not 特に keen on publishing them. This has changed, perhaps 予定 to the ロビーing 成果／努力s of the タバコ 産業 in this area. There are many possible 推論する／理由s why an epidemiological 熟考する／考慮する 産する／生じるs a "消極的な" result. The 協会 that was looked for might in fact be 非，不，無-existent. If there is a weak or 穏健な causal 関係 there are 確かな 必要物／必要条件s that must be 実行するd ーするために get a 重要な 統計に基づく 協会. First of all, the 熟考する／考慮する 構成要素 must be of a 確かな 最小限 size. Even if the dimensions are 十分に large, さまざまな confounding factors 同様に as 証拠不十分s of design and defects in the observational 構成要素 may still lower the sensitivity under the level where it is possible to get a 肯定的な result. It is as a 支配する expensive to 成し遂げる epidemiological 熟考する／考慮するs that are of high 質 and large enough, and therefore a 確かな 割合 of 熟考する／考慮するs will turn out to be 消極的な even though there is a causal 関係. If the problem under 熟考する／考慮する is not new and unknown, an experienced epidemiologist should be able to 査定する／（税金などを）課す beforehand what the chances are of a 肯定的な 結果. Many of the people who order 熟考する／考慮するs are also likely to have a flair for this. A 広大な／多数の／重要な 取引，協定 of experience will have 蓄積するd in the タバコ and the 化学製品 産業s. It is thus やめる possible to 計画（する） for a 消極的な 熟考する／考慮する, though we will rarely know whether this 現実に happened in a 明確な／細部 事例／患者. Epidemiology is of course 危険ing its 評判 by having too much to do with 研究 that cannot 証明する anything. On the other 手渡す there are strong 期待s from many ４半期/4分の1s that somebody should be able to tell us which things are harmful, and which are innocuous の中で all that we are exposed to more or いっそう少なく collectively in our food and our 環境. At 現在の it is 一般に believed that epidemiology has this competence, but it is 平易な to show that this is not the 事例／患者. 明白に, therefore, the 予防の 原則 連合させるd with ありふれた sense should guide us in any 決定／判定勝ち（する）s in this tricky area.
The above-について言及するd 調書をとる／予約する by Le Fanu[2] became a 広大な／多数の／重要な success in 広大な／多数の／重要な Britain, in spite of, or perhaps rather thanks to its 高度に 批判的な 治療 of several 支配的な 傾向s in 薬／医学 of today. He 特に 焦点（を合わせる）s on two phenomena, epidemiology, and the over-率ing of modern genetics. A 引用する will show how 徹底的に the author can summarise his 見解（をとる） of the 事柄: Under the banyan tree nothing grows, and the banyan tree of genetics and epidemiology now casts such long 影をつくる／尾行するs that the fresh green shoots of 医療の 研究 are stifled. Le Fanu convincingly shows how the 広大な／多数の／重要な 今後 strides in 薬／医学 during a few １０年間s after World War II arose from 条件s that were radically different from those 勝つ／広く一帯に広がるing today, in an ますます commercialized 研究 imitating 産業の 生産／産物. Remarkably often it was seemingly chance that showed individual 研究員s outside the 設立s a way that led to important 進歩. At 現在の there is an obvious 危険 that we may 簡単に be looking in the wrong places and fail to see novel and unexplored 可能性s that are coming our way. All large-規模 企業s have difficulties with adaptations at short notice. No new knowledge can be 設立する 会社にする／組み込むd in long-称する，呼ぶ／期間／用語 planning, only 使用／適用s of things we already believe we know! This 状況／情勢 may look paradoxical, but this is hardly a 訂正する description of the 状況／情勢. Since really new knowledge is always more or いっそう少なく surprising, it cannot in fact be planned into 存在. A leader of 研究 who has managed to acquire 支配（する）／統制する of large 経済的な 資源s is likely to be 懐疑的な of 比較して unplanned, spontaneous activities. This is not the 肉親，親類d of thing that will 勝利，勝つ the 信用／信任 of sponsors, nor will it 保証（人） a stable 職業 状況／情勢 for 従業員s who are 扶養家族 on their 主要な／長／主犯's ability to make long-称する，呼ぶ／期間／用語 計画（する）s. How 平易な, then, to 可決する・採択する the 見解（をとる） that it must be possible to run 研究 によれば the same 原則s as 産業の 開発 work. It may take years to discover that this method is sterile — even those around this 豊富な 会・原則 will be 納得させるd that 研究 is a question of large 投資s and a rather slow "生産／産物". Science has become something of a 後継者 of 宗教 to many people today thanks to the fact that it has 拡大するd our knowledge in such a marvellous way in many important areas. Today we have 高度に developed theories on 医療の problems that were either unknown not very long ago, or were partly in the 手渡すs of charlatans, quacks, and 代表者／国会議員s of folk 薬／医学. For such 推論する／理由s 研究 has long been favoured in the 競争 for 経済的な 資源s. The number of scientists active today far より勝るs the 蓄積するd number of those who have lived earlier during the history of mankind. 投資s often 産する／生じる a very good return, but this is true 特に of technical and 適用するd 研究. This is where it is possible to solve problems by a 大規模な 動員 of 資源s. Once you have 設立する out how to make a car, or a computer, the thing is to 改善する the 製品 all the time, and this does not 要求する too many 完全に new 発見s. The 状況／情勢 is very different if for instance the 仕事 is to do something about 未解決の 医療の problems, where so much is unknown that there is no basis for a 幅の広い 開発 事業／計画（する） on an 産業の 規模. We have seen that Richard Nixon's "宣言 of war" against 癌 in 1971 did not lead to any 広大な／多数の／重要な 打開s. It is easier to land people on the moon than "solving the riddle of 癌". Why? 井戸／弁護士席, the 根底となるs of how to solve the problems of space flights have long been known, but when it comes to 癌 we are still 単に scratching the surface. One could also say that the 原因（となる）s of why this or that will happen when you are trying to 飛行機で行く to the moon are 大部分は known — the problem is to invent technical 解答s and 実験（する） them. It is hardly surprising that we are better at developing or 修理ing machines that we have 建設するd ourselves! The simplest thought model for understanding and discussing living organisms is to regard them as 複雑にするd machines. Up to a point this is an 完全に natural and purposeful approach. We do in fact find it difficult to think in any other way, even when we realize that something better is needed. As a 支配する psychological theories also have a 基本的に mechanistic structure, which is somewhat いっそう少なく evident. What might work better than this thought model? "Holistic 薬／医学" has long been a 肯定的な catch-phrase, and can be seen as a 警告 against one-sidedness and "reductionism". It is never a good idea to oversimplify, acquiring only parts of 利用できる knowledge and then 適用するing this in a 削減（する）-and-乾燥した，日照りのd way. It is of course better to be able to consider several different mechanistic models 同時に and intuitively 適用する the one that seems best in an individual 事例／患者. This will introduce intuition as a 道具, which is perhaps not regarded as "科学の" enough. The result may be excellent, but the method is not やめる 両立できる with today's 医療の culture.
The question of reductionism vs. holistic 薬／医学 would be いっそう少なく of a problem to a 内科医 in 臨床の work if the gaps in our mechanistic knowledge were more manageable. 欠如（する） of knowledge is 現実に a かなりの 障害（者）, 特に in the 治療 of chronic 病気s. Many 患者s are aware of this and turn to 代案／選択肢 practitioners. How does 薬／医学 扱う this last-について言及するd problem? 公式に, 設立するd 薬／医学 is the place where only methods of proven value are 存在 used. It is いつかs obvious that a 治療 作品, for example when 行政 of an 抗生物質 is すぐに followed by 改良 of a 厳しい 感染, and it was known from a 研究室／実験室 実験（する） that the particular infective スパイ／執行官 is 極度の慎重さを要する to the 麻薬. さもなければ a method should in 原則 have been proven superior to placebo in 裁判，公判s に引き続いて 確かな 支配するs. 麻薬s are usually not difficult to 実験（する） in this way, but it may be much harder with other 肉親，親類d of 治療 of which acupuncture is one example. 影響s that take some かなりの time to develop are of course also harder to 実験（する） under "二塁打-blind" 条件s. An 介入 should preferably have a 誘発する and 際立った 影響 ーするために 避ける problems of telling what is likely to be 予定 to the 治療, and what might be a result of the natural and いつかs 予測できない course of the 病気. 代案／選択肢 methods may accordingly qualify for a place の中で 設立するd 治療s. This does not happen very often, 大部分は 予定 to the fact that 広大な／多数の／重要な 経済的な 資源s are 要求するd ーするために 成し遂げる a 訂正する 裁判，公判 that is large enough to make a 肯定的な result likely. In many 事例／患者s it is also impossible to 工夫する a 信頼できる placebo, and then the 患者s cannot be kept in the dark about whether they are receiving active or sham 治療. Two examples of 麻薬s from 代案／選択肢 薬／医学 that have recently become more or いっそう少なく 受託するd are St. John's Wort for 不景気, and glucosamine for 確かな 共同の 病気s. Such 麻薬s cannot be 特許d, and are therefore not 特に 利益／興味ing to the 製薬の 巨大（な）s. If we are not 許すd to have a "解放する／自由な 部門", 確かな 価値のある 麻薬s will therefore disappear from the market. 治療s should in 原則 be chosen によれば diagnosis, both in 従来の 薬／医学 and in 代案／選択肢 practices, but the methods of diagnosis may 異なる かなり between these two. In such 事例／患者s the diagnostic system of 設立するd 薬／医学 usually takes 優先, which is a その上の difficulty. 代案／選択肢 methods rarely carry the 公式の／役人 stamp of 是認, but in spite of this more and more people are turning to this 部門 for help. This is of course a 事柄 of 関心 to 設立するd 薬／医学, which has no ready explanation why its 株 of the market is 減らすing. The idea that some 代案／選択肢 methods 現実に 産する／生じる good results is mostly 避けるd. Instead 頼みの綱 is had to a seemingly obvious explanation, すなわち that all the 肯定的な 影響s （人命などを）奪う，主張するd to have resulted from 代案／選択肢 治療s are 簡単に placebo 影響s. Here 確かな 支配するs that have become 設立するd since the middle of the 20th century are 存在 偉業／利用するd. It is regarded as self-evident that a method of 治療 should be demonstrably better than placebo (or on a par with already 受託するd methods) ーするために become 公式に 認可するd. 臨床の 裁判／判断 or other informal ways of 精査するing 証拠 are not 受託するd. From this point of 見解（をとる） 代案／選択肢 methods that have not been 支配するd to the 定める／命ずるd 実験（する）s 簡単に 欠如（する） 長所s, and might hypothetically work only because 患者s believe in them. Whether 予定 to prudence or not, the 分析 is usually not carried その上の than this. It might いつかs be the 事例／患者 that a 確かな method has a 肯定的な 影響 of long duration, while placebo 影響s are by their nature short-lived. やめる often 代案／選択肢 治療s are given to people with chronic （民事の）告訴s that 設立するd 薬／医学 has 全く failed to relieve. If so, it has a hollow （犯罪の）一味, to say the least, if a favourable result of an 代案／選択肢 治療 is a priori せいにするd to some more or いっそう少なく undefined charismatic 質 of the therapist. Still this 肉親，親類d of 直面する-saving 推論する／理由ing is often 存在 used without hesitation.
”The さもなければ so meticulously 批判的な 医療の community has accordingly been living for １０年間s with a picture of reality that has not at all been checked. Why? Could the 推論する／理由 perhaps be that this story was too useful in its 初めの form?”
What size are placebo 影響s? This is a very 貧しく 熟考する／考慮するd question, but によれば a 声明 that has been 特記する／引用するd innumerable times since the 1950s a placebo makes the 患者 feel better in about 35 % of 事例／患者s (irrespective of diagnosis!). The source of this 声明 is a very famous 調査する by HK Beecher, "The powerful placebo" (1955)[3]. It would take 40 years before a German 内科医, Gunver Sophia Kienle, exposed this still very often 引用するd paper as 十分な of careless mistakes and misinterpretations. The 35 % 改良 率 is plainly a 甚だしい／１２ダース exaggeration.[4] The さもなければ so meticulously 批判的な 医療の community has accordingly been living for １０年間s with a picture of reality that has not at all been checked. Why? Could the 推論する／理由 perhaps be that this story was too useful in its 初めの form? Today some その上の facts have been 追加するd to Kienle's 明らかにする／漏らすing 分析, and the placebo 影響 has shrunk into something that can only just be shown to 存在する with 利用できる methods. I, for one, believe it does 存在する, but that its importance will have to be 論証するd in each 病気, 分かれて. It would be utterly remarkable if no 広大な／多数の／重要な differences were to be 設立する between different 病気s and 状況／情勢s regarding the 即座の and long-称する，呼ぶ／期間／用語 影響（力） of diffuse psychological factors. Lumping them all together, as has been done for nearly half a century, would 簡単に be intellectually dishonest now that the 明言する／公表する of the Emperor's attire has become 一般に known. In May 2001 an article appeared that challenged the uncritical belief in strong placebo 影響s in a novel way[5] Two 研究員s in Copenhagen had scrutinized all published 熟考する／考慮するs where not only a 無作為に selected group of 患者s had been given placebo, but another group was 含むd where no 治療 had been given. They 設立する 114 熟考する／考慮するs that 満足させるd their 基準. An 影響 of the 患者s' 期待s should only appear in the placebo group. What was 設立する in the 分析 was that placebo was かもしれない somewhat better than no 治療 when 苦痛 was 熟考する／考慮するd, and also in other 状況／情勢s where the 結果 was 概算の by means of some 肉親，親類d of continuous 規模. When 改良 was 手段d as a simple "yes or no" there was no 傾向 for placebo to be more 効果的な than no 治療. This 熟考する／考慮する has 広大な／多数の／重要な 衝撃 because it will be hard to find other data that 否定する the results. There are so few other methods to really 見積（る） the strength of placebo 影響s. The method used here has long been known, but in spite of this it has not been used in any systematic way. Accordingly, placebo is not the strong factor it has long been believed to be, and the 影響s of this 発見 will keep 薬／医学 busy for a number of years to come. やめる a lot of rethinking will be 要求するd in important areas. Placebo theorizing has been built on 公正に／かなり uncritical arguments like the に引き続いて: "since it is possible that psychological factors can 回復する health (just consider the Biblical 奇蹟s!), then we have to assume that this is a 公正に／かなり ありふれた 現象". Beecher's 35 % fits this picture, and has just been 手渡すd over, almost like an 都市の legend. But there is an 平等に unscientific mirror image of this that is very important: "Since it is possible to develop さまざまな symptoms of 病気 経由で psychological 機械装置s (just consider classical hysteria), then this 現象 may very 井戸／弁護士席 be ありふれた enough to underlie all those manifestations of 病気 that 医療の science cannot at 現在の explain in bodily 条件." The starting-point was a 公正に／かなり rare and in several ways extreme illness that was earlier called Briquet's syndrome, or Briquet's Hysteria, a chronic hysterical disorder with a miscellany of predominantly somatic symptoms which usually starts in the teens and is much more ありふれた in women. The に引き続いて 引用する from a long article on sociopathy by a psychologist, Linda Mealey tells us something about how the first-について言及するd 病気 was regarded before it became the 反対する of conscious 拡大: [...] MacMillan and Kofoed (1984) 現在のd a model of male sociopathy based on the 前提 that 性の opportunism and 巧みな操作 are the 重要な features 運動ing both the individual sociopath and the 進化 of sociopathy. Harpending and Sobus (1987) posited a 類似の basis for the 進化 and behavioral manifestations of Briquet's Hysteria in women, 示唆するing that this syndrome of promiscuity, fatalistic dependency, and attention-getting, is the 女性（の） analogue, and homologue, of male sociopathy.[6] Later this 条件 was given a new 指名する, Somatization Disorder, and was subsequently inflated and changed into something that is now （人命などを）奪う，主張するd to be very ありふれた, 特に in the waiting-rooms of general practitioners. Today it is ありふれた to talk about somatization as if this were something that is really understood. It is supposed to be a 条件 with psychological 原因（となる）s, where looking for somatic explanations is useless, or should rather be 避けるd, because it may make the 患者 even more preoccupied with bodily （民事の）告訴s. Briquet's Hysteria is fortunately a rare 運命 of sorts, where many things in life go wrong from an 早期に age and the background is a serious personality disorder that 混乱に陥れる／中断させるs social life. It is 平易な to see that this belongs to the domain of psychiatry. But the label "somatization" covers so very much more, and is only remotely 類似の to the 初めの. In any 事例／患者, Briquet's Hysteria is the supposed "科学の" ancestor, and that this 病気 should have psychological 原因（となる）s is not at all self-evident, and today few psychiatrists are likely to 持続する such a hypothesis. We are その結果 取引，協定ing with a 概念 that is a blend of old and new. It is hardly a natural 部類, but was pieced together and adapted by moving 境界s and stretching earlier 仮定／引き受けることs about what is possible and 考えられる. The result is a rather pretentious thing. Therefore it must be 公式文書，認めるd that there is no proof that it is 正当化するd to 適用する the label of somatization to such diverse 条件s as electrosensitivity, amalgam illness, fibromyalgia, chronic 疲労，（軍の）雑役 syndrome, 多重の 化学製品 sensitivity, and several more illnesses that 設立するd 薬／医学 has so far failed to explain scientifically. There are explanations, to be sure, but 非，不，無 that 満足させるs the exacting 基準s 公式に 適用するd to all 医療の problems! Incidentally, the 境界s of the somatization syndrome 大部分は 同時に起こる／一致する with the 現在の 限界s of received 医療の knowledge. 内科医s are 存在 申し込む／申し出d an 平易な-to-use "沈む", which gives them an 適切な時期 to appear as more knowledgeable than they are and saves them from the 当惑 of 説, "I don't know". When chain saws became ありふれた in forest work a new 肉親，親類d of 騒動 of sensitivity and 血 循環／発行部数 started appearing in the 手渡すs of many lumbermen. Since the 内科医s didn't understand this 現象, they automatically started talking about psychosomatic disorders. But new insights arrived rather quickly, and soon vibration-関係のある 病気s became a 井戸／弁護士席-known 概念. Today the 医療の 欠如（する） of knowledge has come to the fore in other areas. Psychological theories now make it possible for doctors to keep their prestige 損なわれていない in discussions with 患者s who for example 主張する that they get symptoms when exposed to 確かな electromagnetic or other 電気の phenomena, or others who are 納得させるd that their 水銀柱，温度計-含む／封じ込めるing dental fillings have had a detrimental 影響 on their health.
”Somatization and placebo 影響 are in fact two 味方するs of the same coin. Since the belief that placebo is a powerful factor has been 設立する to 欠如（する） support in facts, growing 疑問s can be 推定する／予想するd to appear that somatization is really such a self-evident 機械装置.”
Theories of somatization would probably be hard to disseminate in a 全住民 that is not already 影響（力）d by Freud's teachings on hysteria and other things, but it can be argued that placebo is at least as important as a background. Somatization and placebo 影響 are in fact two 味方するs of the same coin. Since the belief that placebo is a powerful factor has been 設立する to 欠如（する） support in facts, growing 疑問s can be 推定する／予想するd to appear that somatization is really such a self-evident 機械装置. If more and more people start asking for 科学の 証拠, the inflated bladder will soon have been 穴をあけるd. Psychosomatic 病気 was a 井戸／弁護士席-known 概念 long before somatization became 促進するd as a useful notion. For やめる some time peptic ulcer, arterial hypertension, 喘息, ulcerous colitis, migraine, 緊張 頭痛, painful menstruation, and 確かな 肌 病気s were regarded as 高度に 利益／興味ing from a psychosomatic point of 見解（をとる）. For good 推論する／理由s, most of the 病気s enumerated are nowadays 存在 扱う／治療するd with predominantly somatic methods. Somatization is a somewhat diffuse offshoot from the tree of psychosomatics, a rather anomalous field where ordinary somatic diagnostics have been 棚上げにするd for the time 存在. It should be 公式文書，認めるd that somatization is a psychiatric diagnosis, which 内科医s in somatic disciplines are encouraged to 適用する to 患者s with predominantly somatic （民事の）告訴s. Psychiatrists don't usually see "typical" 事例／患者s of somatization, but are still regarded as guarantors of the 概念. It is not contradictory to say that someone has migraine and that this is 予定 to somatization. But we hardly ever hear things like this. Somatization is a label you use when no 従来の diagnosis seems to fit, and then it is usually the "final" diagnosis, no 事柄 which somatic symptoms are 伴う／関わるd. This 大いに 簡単にするs the discussion. Every 従来の somatic diagnosis is connected to さまざまな causal theories and bodily 機械装置s. By 明言する／公表するing as an 申し立てられた／疑わしい fact that the 原因（となる）s are psychological in these 事例／患者s, and making this the basis of a special 肉親，親類d of diagnosis, you will be spared the trouble of considering other possible explanations of those 明白に somatic symptoms. We are 直面するd with a 肉親，親類d of paradox, since 研究 into 原因（となる）s is one of the weakest 支店s in 医療の science, with many embarrassing gaps. It is hard to follow the steps of thought that have led to the abandonment of the 高度に esteemed diagnostic culture of 薬／医学 within a 部門 that is said to be large and important from the point of 見解（をとる） of general practitioners. One 条件 is of course that the 内科医 has tried hard, but failed to fit the 患者 into a 従来の 部類. によれば a logic that is not 正確に／まさに 水晶 （疑いを）晴らす, this leads to the 結論 that there is no somatic illness in this 事例／患者, since the 内科医 has been unable to make an unexceptionable somatic diagnosis. 病気s that are not 設立する in today's 調書をとる／予約する of somatic 診断するs will in other words have to be mental. At once the 内科医 even "knows" what 原因（となる）d all the symptoms, which is more rarely the 事例／患者 in somatic 薬／医学. We should 耐える in mind that a diagnosis is usually a 分類するing label for something of more or いっそう少なく unknown origin. Why should somatization be a scientifically 満足させるing causal explanation of a 広大な／多数の／重要な variety of symptoms? This is a very good question, which is heard all too rarely. Only a few １０年間s ago, borreliosis (Lyme 病気) was a "非，不，無-existent" 病気, and of course many 患者s were then regarded as psychosomatic 事例／患者s, just because of 医療の ignorance. It didn't 事柄 that they often had acutely inflamed 共同のs, 同様に as other indisputably somatic symptoms.[7] The question is what 薬／医学 is doing in this 支援する yard where 欠如（する） of 会社／堅い knowledge is 変えるd into 思索的な 主張s without any 批判的な 発言する／表明するs 存在 heard. Many doctors would never let themselves be caught with woolly ideas about the possible 原因（となる）s of 癌, 多重の sclerosis, or cardiovascular 病気s. But just について言及する the word somatization, and they will feel 解放する／自由な to engage in uncritical 憶測. 供給するd, of course, that no 従来の diagnosis is applicable. Don't hesitate to ask questions about the 科学の 証拠 behind this talk about somatization. Be 執拗な — the 患者 has a 権利 to know, because a diagnosis of somatization is definitely not an innocuous label. It will の近くに さまざまな doors and lead the planning of 治療s into a 跡をつける that usually gets you nowhere. But be 用意が出来ている, "抵抗" against the diagnosis will be taken as 確定／確認 that it is 訂正する! This last-について言及するd oddity is a rather typical 残余 from the heyday of psychoanalysis.
As a psychiatrist, I have to say it is rather 苦しめるing to 証言，証人／目撃する how unconcernedly 確かな 同僚s are 乱用ing psychiatry, 許すing other 利益／興味s than those of the 患者s to take 優先, even though they are not 現実に 存在 軍隊d to do so. There is not even any 肉親，親類d of "科学の necessity" behind the whole thing, since the starting-point is an embarrassingly simple 誤解. If the somatic doctors feel that they cannot find any explanation or 受託するd diagnosis in a given 事例／患者, this certainly does not mean that the 原因（となる）s must やむを得ず be psychological.
”In earlier historical 事例／患者s where psychiatry has been 乱用d it was often 正式に possible for those 伴う／関わるd to excuse themselves on the grounds that they were against the 乱用, but had to obey orders.”
Of course there are psychiatrists who are 納得させるd that they are serving important social 利益／興味s by making a psychiatric diagnosis in 議論の的になる 事例／患者s — perhaps even more so if they have the 特権 of teaching young 内科医s or dentists how to 適用する the same 肉親，親類d of 推論する／理由ing. I know of course that many somatic doctors are looking 負かす／撃墜する upon psychiatrists, but this 肉親，親類d of subservience at the expense of the 患者s will hardly raise the status of the specialty. In earlier historical 事例／患者s where psychiatry has been 乱用d it was often 正式に possible for those 伴う／関わるd to excuse themselves on the grounds that they were against the 乱用, but had to obey orders. This is not the 事例／患者 today. So far modern 内科医s don't see that anything 疑わしい is going on, and nobody is giving them straightforward orders. Only a 少数，小数派 of psychiatrists are 活発に 伴う／関わるd, and most of the 患者s who receive these 診断するs are seen by general practitioners. But some people are 存在 made aware that something must be wrong with the diffuse ideas behind いわゆる somatization. I am thinking first of all of the 患者s who have been 支配するd to a diagnosis of somatization. Many of them have been looking 猛烈に for help during several years for an obscure 病気 that has 奪うd them of their working capacity and made life 哀れな. Such a history is 特に ありふれた の中で 事例／患者s of いわゆる amalgam illness. Mats Hanson[8] gives an excellent description of health problems that may occur if our 団体／死体s are 存在 exposed to 水銀柱，温度計, an 極端に 有毒な metal for which there is no natural 生物学の need. Until some 50 years ago 内科医s 与える／捧げるd to this （危険などに）さらす by using a number of 麻薬s 含む／封じ込めるing 水銀柱，温度計. Today it is only the dentists who are 活発に and 直接／まっすぐに exposing our inner 環境s to this 背信の 毒（薬）. Its many 消極的な 影響s on living organisms have been known for centuries. We are also 存在 exposed to 水銀柱，温度計 from 確かな foodstuffs, but in 持参人払いのs of dental amalgams ("silver fillings"), this latter source is 明確に the most important. Dental amalgam has been in general use for 150 years, and this fact alone may be taken as a 肉親，親類d of proof of its harmlessness. Dental 貿易（する） organizations have been doing their best to 増強する this 見解（をとる）. 批評 has not been 欠如（する）ing, but this has so far been 含む／封じ込めるd within such 限界s that amalgam is still in use all around the world, with only 限られた／立憲的な 制限s. This filling 構成要素 is cheap and 平易な to use, and the 広大な／多数の／重要な 拡大 of dentistry since the middle of the 19th century would have been impossible without it. Today it is no longer 不可欠の, but many older dentists feel uncomfortable with modern 構成要素s. It would be possible today to 段階 out amalgam, but the strategists within the 貿易（する） 恐れる the 雪崩／（抗議などの）殺到 of litigation that would be 始める，決める in 動議 if the 味方する 影響s of amalgam were to be 認めるd. Above all this 適用するs to the U.S.A., where the 公式の／役人 態度s to 水銀柱，温度計-解放する／自由な dentists can be やめる 残虐な. Dentists who make themselves 目だつ by 除去するing amalgam fillings for health 推論する／理由s run the 危険 of 存在 de-licensed, and may in this way be 軍隊d to leave the country. American dentists are 存在 監督するd by 明言する／公表する Dental Boards 乗組員を乗せた with dentists who usually are reliable adherents of the amalgam 政策 of the American Dental 協会 (ADA).
The dental profession has long been 伴う／関わるd in a very serious 衝突 of 利益／興味s by taking part in the 科学の discussion of the general health 危険s of amalgam. It is very remarkable that this problem has not yet been 認めるd. This must be a knotty problem for the PR people of ADA and other 貿易（する） organizations. What can be done to 限界 the 損失 once the obvious becomes 一般に known, すなわち that dentists have usually been taken for 客観的な 専門家s for 150 years when they have in fact been defending their own 利益／興味s? によれば the ADA amalgam has 絶対 no 味方する 影響s apart from very rare アレルギーs: In 150 years of use, there have only been 100 文書d 事例／患者s of allergic reactions to amalgam in dental literature.[9] It is of course absurd to （人命などを）奪う，主張する that an implanted 構成要素 is so 極端に 害のない to the human 団体／死体. There are no 製薬の 製品s with as little 味方する 影響s as that, and the 所有物／資産／財産s of 水銀柱，温度計 are definitely such that a whole array of 逆の 影響s should be 推定する／予想するd from chronic （危険などに）さらす. The number of people 世界的な who have received amalgam fillings during 150 years probably far 越えるs one billion. No reliable system for spotting and 報告（する）／憶測ing 味方する 影響s of amalgam has ever 存在するd. The truth is of course that we have no idea of the extent of this problem. 患者s don't 協議する their dentists for symptoms outside the oral area, and 内科医s usually give no attention to their 患者s' dental fillings. Since amalgam is continually 漏れるing 水銀柱，温度計 and other metals, it obvious that it will いつかs give rise to 味方する 影響s. Unfortunately, it is 平等に obvious that dentists don't want to know more about this problem than is 絶対 necessary. When 批評 against the use of amalgam has become too embarrassing, さまざまな countries have 任命するd 公式の／役人 専門家 groups which have written more or いっそう少なく 徹底的な 報告（する）／憶測s. Their 仕事 has been to 熟考する／考慮する whether amalgam gives rise to such 危険s that its use should be stopped. The answers have invariably been in the 消極的な. There is a gap in the logic here, at least in the way the 公式の／役人 報告（する）／憶測s have been 解釈する／通訳するd. 麻薬s have いつかs been 評価するd in a corresponding way, and now and then this has resulted in 撤退s if serious 味方する 影響s have occurred too often. But, the fact that a 麻薬 is 許すd to remain on the market does not mean that it is 解放する／自由な from 味方する 影響s. The 医療の profession (and as a 支配する also the 患者s) are aware that 味方する 影響s do occur, and that a 確かな 危険 is 存在 taken. 製造業者s and 公式の／役人 機関s are 責任がある the 登録 of those 味方する 影響s. It is 全く different with amalgam. The 公式の／役人 answer to the question whether 味方する 影響s occur is in 原則 a 執拗な no, no. It has been like this for 150 years, and therefore it is of course very important to stick to the 策略 of 否定 even now. There is in fact no other choice if you are trying to build up a 弁護 against litigation in the U.S.A.
”You can only acquire 徹底的な knowledge of 味方する 影響s by using 事例／患者 報告（する）／憶測s. If '科学の 証拠' were 要求するd, most of the 観察s on 味方する 影響s in 基準 調書をとる／予約するs like the 内科医s' Desk 言及／関連 would have to be scrapped.”
Those 専門家 groups who are believed to have 公式に 否定するd that amalgam has any 味方する 影響s have as a 支配する had dentists の中で their members or staff. Not surprisingly, findings from "消極的な" epidemiological 熟考する／考慮するs have been 含むd as important 証拠. Toxicologists have 概算の whether 水銀柱，温度計 from amalgams will give rise to 有毒な 集中s in the 団体／死体. 専門家s with a background in work with 報告（する）／憶測s of 味方する 影響s of 麻薬s have not been 伴う／関わるd, as far as I know. This is an obvious problem. It is remarkable that toxicology no longer has very much in ありふれた from a practical point of 見解（をとる） with the science of 味方する 影響s. The methods are やめる different. You can only acquire 徹底的な knowledge of 味方する 影響s by using 事例／患者 報告（する）／憶測s; this now 公式に 無視（する）d method. If "科学の 証拠" were 要求するd, most of the 観察s on 味方する 影響s in 基準 調書をとる／予約するs like the 内科医s' Desk 言及／関連 would have to be scrapped. It has not always been like this. The man who has been called the father of modern toxicology, Louis Lewin (1850-1929) started his career by publishing a 調書をとる／予約する on the 味方する 影響s of 麻薬s in 1881[10] Toxicology was later to 支配する his published work, but for Lewin there never developed a gap between the two 支店s of his 支配する. His famous textbook of toxicology appeared with its fourth 版 in 1929, the year of his death.[11] It has been reprinted 不変の ever since, and is still 利用できる! Lewin's 態度 to amalgam fillings was 明確に 批判的な, see 公式文書，認める for translation.[12] 味方する 影響s typically appear at doses and 集中s that are not 有毒な. Of course 麻薬s should not be given in 有毒な doses, if this can be 避けるd. さもなければ a 大多数 of 患者s would be made ill by the 治療. The peculiar thing with 味方する 影響s is individual sensitivity, which may occur rather seldom, but can be the basis also of very serious reactions. A 麻薬 may have many different, rare 味方する 影響s, and when they are 追加するd together the sum total is a far from trifling problem, which will have to be mapped by means of 事例／患者 報告（する）／憶測s. Since 選び出す／独身 味方する 影響s are often as rare as いっそう少なく than one 事例／患者 per thousand 扱う／治療するd it is 事実上 useless to try and find them with epidemiological methods. What all systems of 報告（する）／憶測ing 味方する 影響s have in ありふれた is that they don't 実行する the 必要物／必要条件s of 厳密に "科学の" proof that are さもなければ the 支配する in 薬／医学. In spite of this all the 存在するing systems 産する／生じる 満足な results in the 麻薬 area. There are international 指導基準s for 査定する／（税金などを）課すing the causal 関係, and an important 成分 in this are 観察s that can be made when a 患者 stops taking a 麻薬. It stands to 推論する／理由 that 見えなくなる of symptoms after the （危険などに）さらす has 中止するd will かなり 強化する 疑惑s of a causal link. In the literature the 称する，呼ぶ／期間／用語 is "dechallenge", and explicit questions about such 観察s are 含むd in the forms to be used to 報告（する）／憶測 味方する 影響s.[13] More often than not 味方する 影響s of amalgam develop slowly and without any 際立った relation to such things as dental work. In actual practice it is impossible to 蓄積する knowledge of these 味方する 影響s if you have no （警察などへの）密告，告訴（状） on what happens after the amalgam has been 除去するd, in other words what happens after "dechallenge". But what is self-evident when 報告（する）／憶測s are collected on the 味方する 影響s of 麻薬s is unknown or 考えられない when dentists 請け負う to build a registry for 味方する 影響s of dental 構成要素s. Norway was the first country to start such a registry, followed by Sweden a few years later. This Scandinavian 概念 is now 存在 促進するd as a model for the European Union. But there is no question in the forms about what happened after the 嫌疑者，容疑者／疑うd 構成要素 was 除去するd! As far as I know not a 選び出す／独身 事例／患者 of 味方する 影響s (outside the oral 地域, and 非，不，無-allergic) of amalgam has been 受託するd in either country, but they have all been labeled as "unclassifiable". Accordingly, the ADA on the other 味方する of the 大西洋 has not so far had to worry about any possible surprises from their 同僚s in Scandinavia that might upset their 計画（する）s for the 弁護 in the 訴訟s that are now developing. In Sweden odontology may lose 支配（する）／統制する of the 味方する 影響s registry after the 医療の 製品s 機関 took over the 監督 of 医療の 装置s earlier this year. The financially strong ADA has every 推論する／理由 to give 大規模な PR 援助 in the background. The obvious goal would be to 長引かせる the period of 150 years when 組織するd dentistry has had the 特権 of controlling 調査s into the health 影響s of their own activities, 含むing the part that lies outside their competence. After spending my professional life in the 医療の culture I know perfectly 井戸／弁護士席 that much prestige is 大（公）使館員d to the idea that our 科学の 基準s are high. When an insider like myself keeps looking behind the scenes without shunning the contradictions, the glossy 公式の／役人 picture will 徐々に become more cloudy and untenable. I am sure my 同僚s believe they understand science, but still, as we have seen, they may be taken in by 公正に／かなり simple and superficial messages that 明白に serve 純粋に "mundane" goals. The examples discussed here seem to 関心 the 医療の profession's 伝統的な position of 尊敬（する）・点 and 当局 on the one 手渡す, and our ますます important relations to the 力／強力にするs that be in the 経済的な area on the other. Both of these goals cannot be reached at the same time because of 相互の contradictions, but it will take some time before a 大多数 of 内科医s have realized this. I believe it is important for the health-conscious public to become aware of those doubtful points that are 直接／まっすぐに 関連した to the 成果／努力s of individual people to 改善する and 持続する their own health. Today many of us feel that it is necessary to 伸び（る） knowledge that goes far beyond what is 存在 申し込む／申し出d in 設立するd 薬／医学. I have tried to discuss 確かな areas where the 公式の／役人 見解（をとる） 明らかに 欠如（する）s a 会社／堅い 接触する with reality. When all is said and done, reality is the final arbiter, even when we are 取引，協定ing with science. The amalgam question is something of a prime example of how a 宣伝 見解／翻訳／版 of a problem may deceive a group of 高度に educated people who regard themselves as scientifically 警報. At least nine out of ten doctors will believe that it has been scientifically 設立するd that you cannot become ill from amalgam. にもかかわらず every doctor knows that all 麻薬s have 味方する 影響s. When 水銀柱，温度計 was ありふれた in 麻薬s it had 味方する 影響s of course, more than most of the other 麻薬s, as has 繰り返して been 述べるd in the literature. Today's doctors evidently cannot draw the 論理（学）の 結論s of this, but 信用 the absurd 主張 that 水銀柱，温度計 from amalgam is 完全に 解放する／自由な from 味方する 影響s, apart from rare 地元の （民事の）告訴s in the oral cavity. It is useful for you and everybody else to be able to 認める when a 科学の 態度 is 単に a thin varnish, and to make plain that you will not be impressed by specious arguments. In this way we can also help 内科医s to wake up and start doing something about the 状況／情勢.
公式文書，認めるs: 1. However, an 利益／興味ing 主題 問題／発行する of Läkartidningen (the 定期刊行物 of the Swedish 医療の 協会) 14 Nov 2001 (vol 98, no. 46) may be a signal that the Swedish 医療の profession is 長，率いるing に向かって greater 開いていること／寛大 in these 事柄s. [支援する] 2. James Le Fanu, "The Rise and 落ちる of Modern 薬／医学", Little, Brown & Company, London, 1999; page 49 of the paperback 版 (Abacus, 2000). [支援する] 3. 定期刊行物 of the American 医療の 協会 (JAMA) 1955; 159: 1602-6. [支援する] 4. Kienle GS, Der sogenannte Placeboeffekt, Schattauer, Stuttgart och New York, 1995. [支援する] 5. Hrobjartsson A, Gøtzsche PC, Is the placebo 権力のない? — An 分析 of 臨床の 裁判，公判s comparing placebo with no 治療 N Engl J Med 2001; 344: 1594-602. [支援する] 6. See http://cogprints.ecs.soton.ac.uk/bbs/古記録/bbs.mealey.html [支援する] 7. The に引き続いて 要約 is taken from an article by Peter Wahlberg in Nordisk Medicin 1993; 108(5):157-8:
"The message from Lyme[支援する] 8. See Mats Hanson, "A hundred and fifty years of misuse of 水銀柱，温度計 and dental amalgam", The Art 貯蔵所, 2002. [支援する] 9. This 引用する was taken from an ADA News 解放（する） published on the web probably in 1995. In May-June 2001 the ADA website was 支配する to a total 精密検査する (a major 訴訟 関心ing amalgam had been 発表するd), and during this time lots of 利益／興味ing 構成要素s that had been 利用できる for years were 除去するd.See also fact box. [支援する] 10. Louis Lewin, "Die Nebenwirkungen der Arzneimittel", A. Hirschwald, Berlin, 1881. New 版s 1893, 1898 and 1909. All 版s are now やめる expensive in the second-手渡す market. Translations: English 1882 and 1883, ロシアの 1895. In the 1893 版 more than 70 pages are 充てるd to the 味方する 影響s of さまざまな 水銀柱，温度計 構内／化合物s! [支援する] 11. Louis Lewin, "Gifte und Vergiftungen — Lehrbuch der Toxikologie", fourth 版, Stilke, Berlin, 1929. The 肩書を与える of the three first 版s (1885, 1897, 1899) was Lehrbuch der Toxikologie. The 版 that is now in print is the sixth, published by Karl F. Haug, Heidelberg, 1992. [支援する] 12. Below is my translation from Lewin's Gifte und Vergiftungen (1992), page 255:
From amalgam fillings, 特に 巡査 amalgam, the metal may be vaporized into the oral cavity, or may in some 化学製品 form or other pass from the dental cavity to be 吸収するd by the 循環／発行部数, giving rise to a chronic intoxication. Apart from 地元の oral lesions, this manifests itself in a 広大な／多数の／重要な variety of 騒動s of bodily 組織／臓器s, 特に as a loss of normal 機能（する）／行事s of the brain and nervous system. Such 騒動s are not always 予定 to an 増加するd sensitivity to 水銀柱，温度計. Ever since the beginning of this century I have not only taught this in my lectures, but I have drawn the consequences of this knowledge when amalgam-耐えるing people （機の）カム to me with obscure symptoms of nervous illness. I then always recommended the 除去 of such fillings, which resulted in 改良s, even in professors [footnote: I 知らせるd Prof. 在庫／株 about these things, and he 回復するd his health.].[支援する] 13. See その上の 詳細（に述べる）s on the web: http://www.who-umc.org/defs.html, http://www.fda.gov/medwatch/報告（する）／憶測/cberguid/define.htm, http://www.medsafe.govt.nz/Profs/逆の/causality.htm. [支援する]
Copyright © Per Dalén, 2003. (Fact boxes interspersed in the main text were written or 収集するd by the Art 貯蔵所 editor.)
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