2019年11月15日 09:01:03|来源:国际在线|编辑:好医优惠
MANY people have been making the case that Americans have grown fat because they eat too much starch and sugar, and not enough meat, fat and eggs. Recently, the Dietary Guidelines Advisory Committee lifted recommendations that consumption of dietary cholesterol should be restricted, citing research that dietary cholesterol does not have a major effect on blood cholesterol levels. The predictable headlines followed: “Back to Eggs and Bacon?”很多人都说,美国人变得肥胖是因为他们吃了太多淀粉和糖,而没有摄入足够的肉类、脂肪和鸡蛋。近日,美国膳食指南咨询委员会(Dietary Guidelines Advisory Committee)取消了“膳食中的胆固醇消耗应该受到限制”的建议。它援引的一项研究认为,饮食中的胆固醇不会对血液中的胆固醇水平产生重大影响。不出所料,一些媒体打出了这样的大标题:“回归鸡蛋和熏肉?”But, alas, bacon and egg yolks are not health foods.但是,唉,熏肉和蛋黄都不是健康食品。Although people have been told for decades to eat less meat and fat, Americans actually consumed 67 percent more added fat, 39 percent more sugar, and 41 percent more meat in 2000 than they had in 1950 and 24.5 percent more calories than they had in 1970, according to the Agriculture Department. Not surprisingly, we are fatter and unhealthier.虽然这几十年来,人们都被告知要少吃肉类和脂肪,但与1950年相比,美国人在2000年实际消耗的添加脂肪增加了67%,糖分增加了39%,肉类增加了41%,而且比1970年多摄入了24.5%的卡路里。因此毫不奇怪,我们变得更胖了,健康水平也下滑了。The debate is not as simple as low-fat versus low-carb. Research shows that animal protein may significantly increase the risk of premature mortality from all causes, among them cardiovascular disease, cancer and Type 2 diabetes. Heavy consumption of saturated fat and trans fats may double the risk of developing Alzheimer’s disease.这场辩论不是简单地比较低脂肪饮食与低碳水化合物饮食。研究表明,动物蛋白可能会大幅增加各种原因导致的过早死亡风险,这些原因包括心血管疾病、癌症和2型糖尿病。大量摄入饱和脂肪和反式脂肪,可能会让阿尔茨海默氏症的患病风险增加一倍。A study published last March found a 75 percent increase in premature deaths from all causes, and a 400 percent increase in deaths from cancer and Type 2 diabetes, among heavy consumers of animal protein under the age of 65 — those who got 20 percent or more of their calories from animal protein.去年3月公布的一项研究发现,在大量摄入动物蛋白的65岁以下人群中,各种原因导致的过早死亡数量增加了75%,因癌症和2型糖尿病而死亡的人数增加了400%。这些人摄入的的卡路里中,超过20%都来自动物蛋白。Low-carb, high-animal-protein diets promote heart disease via mechanisms other than just their effects on cholesterol levels. Arterial blockages may be caused by animal-protein-induced elevations in free fatty acids and insulin levels and decreased production of endothelial progenitor cells (which help keep arteries clean). Egg yolks and red meat appear to significantly increase the risk of coronary heart disease and cancer due to increased production of trimethylamine N-oxide, or TMAO, a metabolite of meat and egg yolks linked to the clogging of arteries. (Egg whites have neither cholesterol nor TMAO.)低碳水化合物加高动物蛋白的饮食促发心脏疾病,其方式不仅仅是影响胆固醇水平那样简单。在动物蛋白诱导下,游离脂肪酸和胰岛素水平升高,内皮祖细胞(有助于保持动脉清洁)的生成减少,从而可能引起动脉堵塞。蛋黄和红肉似乎明显增加了冠状动脉心脏疾病和癌症的患病风险,因为它增进了三甲胺氧化物(TMAO)的生成。TMAO是肉和蛋黄的代谢物,与动脉堵塞有关。(蛋清既没有胆固醇,也不含TMAO)。Animal protein increases IGF-1, an insulin-like growth hormone, and chronic inflammation, an underlying factor in many chronic diseases. Also, red meat is high in Neu5Gc, a tumor-forming sugar that is linked to chronic inflammation and an increased risk of cancer. A plant-based diet may prolong life by blocking the mTOR protein, which is linked to aging. When fat calories were carefully controlled, patients lost 67 percent more body fat than when carbohydrates were controlled. An optimal diet for preventing disease is a whole-foods, plant-based diet that is naturally low in animal protein, harmful fats and refined carbohydrates. What that means in practice is little or no red meat; mostly vegetables, fruits, whole grains, legumes and soy products in their natural forms; very few simple and refined carbohydrates such as sugar and white flour; and sufficient “good fats” such as fish oil or flax oil, seeds and nuts. A healthful diet should be low in “bad fats,” meaning trans fats, saturated fats and hydrogenated fats. Finally, we need more quality and less quantity.动物蛋白增加了胰岛素样生长激素IGF-1和慢性炎症,后者是很多慢性疾病的潜在成因。另外,红肉含有很高的Neu5Gc,这是一种导致肿瘤的糖分,可能会引起慢性炎症,增加患癌风险。以植物为主的饮食则可以延年益寿,因为它可以阻断引起衰老的mTOR蛋白质。与控制碳水化合物时相比,当脂肪热量受到严格控制时,患者减去了67%的额外身体脂肪。预防疾病的最佳饮食,是基于植物的全面膳食,其中动物蛋白、对人体有害脂肪,以及精制的碳水化合物含量天然就比较低。这意味着在日常生活中少吃或不吃红肉;主要吃未经深加工的蔬菜、水果、全谷类,豆类和豆制品;像糖和白面粉这种单纯和精制碳水化合物,只消耗极少量;要摄入足够的“好脂肪”,比如鱼油或亚麻籽油,种子和坚果。少吃“坏脂肪”,即反式脂肪、饱和脂肪和氢化脂肪。最后,我们还需要提高质量,减少数量。My colleagues and I at the nonprofit Preventive Medicine Research Institute and the University of California, San Francisco, have conducted clinical research proving the many benefits of a whole-foods, plant-based diet on reversing chronic diseases, not just on reducing risk factors such as cholesterol. Our interventions also included stress management techniques, moderate exercise like walking and social support.我和非营利机构预防医学研究院(Preventive Medicine Research Institute)及加州大学旧金山分校(University of California, San Francisco)的同事们进行过临床研究,明基于植物的全面膳食在逆转慢性疾病方面有着众多好处,而不只是降低胆固醇等风险因素。我们的干预措施还包括压力管理技巧、散步这样的适度运动,以及社交持。We showed in randomized, controlled trials that these diet and lifestyle changes can reverse the progression of even severe coronary heart disease. Episodes of chest pain decreased by 91 percent after only a few weeks. After five years there were 2.5 times fewer cardiac events. Blood flow to the heart improved by over 300 percent.我们的随机对照试验研究显示,在改变饮食习惯和生活方式之后,就连严重的冠状动脉心脏疾病发展都可以逆转。仅仅几周后,患者胸痛发作次数就减少了91%。五年之后,心脏事件减少了2.5倍。流向心脏的血液改善了300%。Other physicians, including Dr. Kim A. Williams, the president of the American College of Cardiology, are also finding that these diet and lifestyle changes can reduce the need for a lifetime of medications and transform people’s lives. These changes may also slow, stop or even reverse the progression of early-stage prostate cancer, judging from results in a randomized controlled trial.美国心脏病学会(American College of Cardiology)会长金·A·威廉斯(Kim A. Williams)士等其他医生还发现,改变饮食习惯和生活方式可以减少终生用药的需要,可以让人们的生活焕然一新。从随机对照试验的结果来看,这些改变还有可能减缓、中止甚至逆转早期前列腺癌症的发展。These changes may also alter your genes, turning on genes that keep you healthy, and turning off genes that promote disease. They may even lengthen telomeres, the ends of our chromosomes that control aging.这些改变也可能会转变你的基因,启动让你健康的基因,关闭促发疾病的基因。它们甚至可能延长端粒;它是染色体的末端,作用是控制衰老。The more people adhered to these recommendations (including reducing the amount of fat and cholesterol they consumed), the more improvement we measured — at any age. But for reversing disease, a whole-foods, plant-based diet seems to be necessary.无论属于哪个年龄阶段,人们越是遵循这些建议(包括减少脂肪和胆固醇摄入),我们测量到的改善也就越大。但对于逆转疾病而言,基于植物的全面膳食似乎是必不可少。In addition, what’s good for you is good for our planet. Livestock production causes more disruption of the climate than all forms of transportation combined. And because it takes as much as 10 times more grain to produce the same amount of calories through livestock as through direct grain consumption, eating a plant-based diet could free up resources for the hungry.此外,有利于你的东西对我们的星球也有好处。畜牧业对气候变化的影响,超过了所有运输工具的总和。而且,与直接消耗粮食相比,需要多达10倍以上的粮食,才能通过牲畜产生同样多的卡路里,所以,以植物为主的饮食习惯有助于腾出资源来救助饥民。What you gain is so much more than what you give up.与你放弃的东西相比,你的所得远远更大。 /201503/367303

Anita Chanko could not sleep. At 4 a.m., on an August night in 2012, she settled onto the couch in her Yorkville living room with her dog, Daisy, and her parrot, Elliott, and flipped on the DVR. On came the prior night’s episode of “NY Med,” the popular real-life medical series set at NewYork-Presbyterian Hospital, starring Dr. Mehmet Oz. Mrs. Chanko, 75, was a fan of the show and others like it.2012年8月的一天夜里,安妮塔·钱科(Anita Chanko)失眠了。凌晨4点,她窝在自己位于约克维尔的家中客厅里的沙发上,在宠物黛西(Daisy)和鹦鹉埃利奥特(Elliott)的陪伴下,打开了DVR(数字视频录像机)。电视上播放的是前一晚的《纽约医务组》(“NY Med”),这是一部大受欢迎的医务纪实系列片,拍摄地点是纽约长老会医院(NewYork-Presbyterian Hospital),领衔主角是穆罕默德·奥兹(Mehmet Oz)医生。75岁的钱科女士是这部片子的忠实观众,十分喜欢看。“It starts off, there’s a woman with stomach cancer and her family, and then there’s somebody with a problem with their baby, I think it was a heart,” she remembered. “And then I see the doctor that treated my husband.”“片子开始了,先是一个患有胃癌的女子和她的家人,然后是某人和他们生病的孩子,我想是心脏的毛病吧,”她回忆道。“再然后,我看到了曾经抢救过我丈夫的那名医生。”Mark Chanko, her husband, died 16 months earlier, in April 2011, after being struck by a sanitation truck while crossing a street near his home. The doctors and nurses at NewYork-Presbyterian Hospital/Weill Cornell Medical Center tried in vain to save his life.16个月前的2011年4月,她的丈夫马克·钱科(Mark Chanko)在他们家附近过马路时被环卫车撞了,纽约长老会医院/威尔康奈尔医学中心(Weill Cornell Medical Center)的医生和护士们竭尽全力想要挽救他的生命,却没能成功。马克最后还是因为这起事故去世。On the TV screen, she saw a chief surgery resident, Sebastian Schubl, responding to an emergency in which a man is hit by a vehicle. “And then I see, even with the blurred picture, you could tell it was him,” she said. “You could hear his speech pattern. I hear my husband say, ‘Does my wife know I’m here?’ ”电视屏幕上,外科总住院医师塞巴斯蒂安·舒布尔(Sebastian Schubl)正在应对一起急诊,一名男子被车撞了。“接着我就看到了我的丈夫,尽管画面经过了模糊处理,但仍足以分辨出那就是他,”钱科太太说。“你可以听出他说话的方式。我听到他说:‘我妻子知道我在这里么?’ ”There was no doubt in her mind: The blurred-out man moaning in pain was her husband of almost 46 years, the Korean War veteran she met in a support group for parents without partners.至此她的心中再无疑问:这个影像模糊、痛苦呻吟的男子,正是与自己相伴近46年的丈夫,那个她当初在单身父母(parents without partners)后援小组里遇到的韩战退伍军人。“I hear them saying his blood pressure is falling. I hear them getting out the paddles and then I hear them saying, ‘O.K., are you y to pronounce him?’ ”“我听到他们说他的血压正在下降,听到他们拿出心脏除颤器,然后有人说:‘就这样吧,准备好宣布死亡了吗?’ ”She clenched her fists so tightly that “the palms of my hands almost looked like stigmata” and her mouth got so dry that her tongue stuck to the roof “as if I had just eaten a whole jar of peanut butter.”她不由攥紧了拳头,以至于“手掌上都是红色斑痕”;她感到口干舌燥,舌头粘在上颚,“就好像刚刚吃下了一整罐花生酱。”“I saw my husband die before my eyes.”“我看着我的丈夫在我眼前死去。”No one in the Chanko family had given “NY Med” permission to film Mr. Chanko’s treatment at the hospital or to broadcast the moments leading up to his death.钱科一家从未许可《纽约医务组》拍摄钱科先生在医院的治疗过程,或是向公众播放他去世前的情形。Such moments — indeed, all of the intimate details of a person’s health — are supposed to be shared only with a patient and whomever they designate, under a federal law known as Hipaa.根据联邦法律HIPAA(《健康保险隐私及责任法案》)的规定,这样的时刻——事实上,应该说是所有关乎个人健康的私密细节——应该仅限于伤患及其指定的人选才有权了解。In the 18 years since the law was passed, doctors and hospitals have put in place an ever-expanding list of rules meant to protect patient privacy. Yet even in the face of this growing sensitivity, real-life shows like “NY Med” have proliferated, piggybacking off fictional counterparts like “E.R.,” “Grey’s Anatomy” and “House.”自这项法律通过18年以来,医生和医院建立起了越来越多的规则,旨在保护伤患的隐私。然而,即使在人们正变得更加敏感的情况下,借着《急诊室的故事》(“E.R.”)、《实习医生格蕾》(“Grey’s Anatomy”)和《豪斯医生》(“House”)等虚构医务剧的热播之势,《纽约医务组》之类的医务纪实片也层出不穷。Medical ethicists and groups like the American Medical Association worry that these shows exploit patients’ pain for public consumption, but their makers argue that they educate viewers and inspire people to choose careers in medicine.美国医学协会(American Medical Association)等团体和医疗伦理学家担心这些节目是在利用伤患的痛苦供大众消费,但这些节目的制作人则辩解他们是在教育观众,并激励人们选择医学相关的职业。“We have heard many stories of people who were inspired to go to medical school, to become nurses or paramedics, or to head into particular specialties like trauma or transplant surgery after watching our show,” Terence Wrong, executive producer of “NY Med,” said in an email. (He declined to discuss Mr. Chanko’s case or to be interviewed for this article.)《纽约医务组》的执行制片人特伦斯·朗(Terence Wrong)在电子邮件中写道:“我们已经听说过很多这样的事例:人们受我们节目的启发,考取了医学院,成为护士或医务辅助人员,或是钻研起创伤或外科移植手术等特殊专业。”(他拒绝谈论钱科先生的案例,也不愿意就本文接受采访。)Hospitals like NewYork-Presbyterian, meanwhile, have seized upon such programs as a way to showcase themselves, vying to allow TV crews to film their staff and patients — even emergency-room patients sometimes in no condition to give permission. When the first season of “NY Med” was broadcast on A in 2012, the hospital’s vice president of public affairs at the time, Myrna Manners, told PR Week, “You can’t buy this kind of publicity, an eight-part series on a major broadcast network.” (A second season, also based at the hospital, ran over the summer and garnered more viewers than the first. A has not announced whether another season is planned.)另一方面,纽约长老会医院等医疗机构也想要以此类节目作为展示自己的窗口,忙不迭地许可电视台的摄制组来拍摄自己的工作人员和伤患——甚至有时还涉及急诊室接诊的情况危重、根本无法自己表示是否许可拍摄的伤患。2012年,“纽约医学”的第一季在美国广播公司(A)播出,该医院当时主管公众事务的副院长米尔纳·曼纳斯(Myrna Manners)告诉《公关周刊》(PR Week):“在主流传媒网络上播放的八集系列片,这可是花钱也买不到的宣传。”(该剧的第二季在夏季播出,它也是在这家医院拍摄的,并吸引了比第一季更多的观众。A尚未宣布是否计划制作第三季。)For the Chankos, the episode of “NY Med” added a coda of anger to more than a year of grief. Their daughter, Pamela Chanko, 46, said seeing the specifics of her father’s injuries and his death on TV sent her spiraling back into clinical depression. “It just sent me straight back to square one,” she said.但对于钱科一家,这一集《纽约医务组》却是给他们一年多来的悲伤加上了个愤怒的尾声。他们的女儿,46岁的帕梅拉·钱科(Pamela Chanko)表示,因为从电视上看到父亲受伤和死亡的细节,她的临床抑郁症复发了。她说:“这就好像直接把我丢回了原点。”Kenneth Chanko, 57, Mr. Chanko’s son, filed complaints with the hospital, the New York State Department of Health, A, a hospital accrediting group and the ed StatesDepartment of Health and Human Services’ civil rights office.钱科先生的儿子,57岁的肯尼思·钱科(Kenneth Chanko)向纽约长老会医院、纽约州卫生署(New York State Department of Health)、A、一个医院评定组织以及美国卫生与公众务局民权办公室(ed States Department of Health and Human Services’ civil rights office)提交了投诉。The show had caused him “great emotional distress and psychological harm,” he wrote in a complaint to the hospital. “I had to unnecessarily relive my father’s death at your hospital a second time, while knowing that the public at large was able to — and continues to be able to — watch my father’s passing, for the purposes of what can only be described as drive-by voyeuristic ‘entertainment.’ ”这节目给他造成了“巨大的精神痛苦和心理伤害”,他在给医院的投诉信中写道。“我不得不毫无必要地重温我的父亲在贵院去世的情景,而我也知道,广大公众能够——并继续观看我父亲的过世,只是出于一种唯有被称为偷窥癖的性目的。”A quickly removed the segment involving Mr. Chanko from its website, DVDs and future viewings (although not from the promotional blurb for the episode, which still says, “Sebastian Schubl, a Dr. McDreamy-like young trauma surgeon, tries to save the day when a critically injured pedestrian struck by a vehicle is brought to the E.R.”). In 2013, the state cited the hospital for violating Mr. Chanko’s rights.A迅速从其网站、DVD和未来的节目安排中删除了与钱科先生有关的片段(但该集的宣传简介中仍然写道:“塞巴斯蒂安·舒布尔,一名像美梦先生(Dr. McDreamy,《实习医生格蕾》中的男一号)一样的年轻的创伤外科医生,试图挽救被车辆撞成重伤送往急诊部的行人。”)。在2013年,纽约州因长老会医院侵犯了钱科先生的权利而对其进行传讯。That was not enough for the Chankos, who sued A, NewYork-Presbyterian and Dr. Schubl for damages. An appellate panel recently dismissed the case, but the family has asked for that decision to be reviewed. Dr. Schubl and the hospital declined to comment for this article, citing the continuing litigation. A referred a reporter to Mr. Wrong’s statement.但这对于钱科一家来说还远不够,他们又起诉了A、纽约长老会医院和舒布尔医生,要求他们赔偿损失。日前,受理上诉的小组驳回了此案,但钱科一家已要求对该决定进行复审。舒布尔医生和医院均以诉讼仍在继续为由拒绝了本文的置评请求。A则让一名记者引述了朗先生的声明。In court filings, the hospital and A do not dispute that they did not have consent from Mr. Chanko or his family, but they say the patient is not identifiable to the public. The network has asserted that because “NY Med” is produced by its news division, it is protected by the First Amendment. Lawyers for NewYork-Presbyterian have argued that the state does not recognize a common law right to privacy and that any privacy right Mr. Chanko did have ended upon his death. They say that the Chankos themselves are responsible for their loss of privacy.在法庭文件中,医院和A均不否认他们未征得钱科先生及其家属的同意,但他们声称他们已经对片子进行过处理,使普通公众无法辨认出伤患身份。此外,A坚称,《纽约医务组》由其新闻部门制作出品,受《宪法第一修正案》(First Amendment)的保护。纽约长老会医院的律师也主张,该州并未确立承认隐私权的普通法,且在钱科先生死亡后,他的所有隐私权也已随之终结。他们认为,会丧失隐私权是钱科一家自己的责任。“There would today still be no identification of the patient or his family but for the latter’s publication via this lawsuit,” a brief for the hospital says.简言之,该医院认为:“如果不是后来因为这场官司造成的内情披露,直到今天普通观众也不会知道伤患或其家属的身份。”The day Mr. Chanko was hit by a private garbage truck had been entirely forgettable, his wife said. “If I had a diary, I’d leave the page blank.”钱科太太说,她一直刻意遗忘丈夫被私营垃圾车撞倒的那一天。“如果我写日记的话,我会把那一页留白。”They arrived home past 11 p.m. after spending a few days at their second home in Goshen, Conn., in Litchfield County. As they unloaded their luggage, Mr. Chanko looked in the refrigerator and noticed they were out of milk and bananas. He decided to run across York Avenue, in the Yorkville section of Manhattan, to a deli.那天他们离开逗留数日的位于康涅狄格州利奇菲尔德县歌珊地市的另一处住宅,回到家时已经超过晚上11点了。待放下行李之后,钱科先生看了看冰箱,发现牛奶和香蕉都吃光了,于是他决定穿过曼哈顿约克维尔区的约克大道到一家熟食店去。After Mr. Chanko had been gone a few minutes, the building doorman buzzed up and asked Mrs. Chanko to come downstairs. Not understanding the urgency, she said she would be down in a bit.钱科先生出门后才几分钟,大楼的门卫就通过蜂鸣器呼叫钱科太太,叫她下楼一趟。当时她完全没意识到事情有多紧迫,随口回答说自己一会儿就下去。The doorman buzzed again. Moments later, the doorbell rang. When she answered, a longtime neighbor grabbed her arm. “Anita, you have to come with me,” she recalled the neighbor as saying. “Mark needs you. He’s been hurt.”门卫再次呼叫了她。不久,门铃也响了。她过去应门,一个老邻居一把抓住了她的胳膊。“安妮塔,快跟我来,”她记得那位邻居这样说道。“马克需要你。他受伤了。”When she got downstairs and walked outside, Mrs. Chanko saw an ambulance and her 83-year-old husband on a gurney, his head bandaged. The neighbor drove her to NewYork-Presbyterian. There, she watched as the medical team hurriedly pushed the gurney carrying her husband near the emergency room.她下楼走了出去,看到一辆救护车,她83岁的丈夫躺在轮床上,头部缠着绷带。邻居开车将她送到了纽约长老会医院。在那里,她看着医务人员急匆匆地将载着她丈夫的轮床推到急诊室附近。“I rushed up because I wanted to run alongside him and just hold his hand and reassure him and say, ‘You’ll be OK,’ ” she said. The doctor said no. “That would have been my last chance to even say something to him.”“我冲了上去,因为我想要跟在他身边,握着他的手,安慰他说:‘你会没事的,’ ”钱科太太说。但医生不许。“这是我最后一次有机会跟我的丈夫说话。”Mr. Chanko was initially alert and awake, and able to respond to questions, medical records show. But he was in bad shape: His pelvis had been broken in several places, as had his left femur. The skin was ripped off his right leg.病历显示,钱科先生起初还是警觉和清醒的,并能对问题做出反应。但他的情况确实很糟:骨盆和左股骨都有多处骨折。右腿的皮肤也被撕剥开来。Outside the operating room, doctors and nurses could not detect Mr. Chanko’s pulse and resuscitated him. In the operating room, he became more unstable, medical records show. Twice more they tried to bring him back. He was pronounced dead at 1:17 a.m.手术室外,医生和护士检测不到钱科先生的脉搏,对他实施了心肺复苏。病历显示,进入手术室后,他的状态变得更加不稳定了。他们多次试图将他抢救回来。但钱科先生还是在凌晨1:17被宣布死亡。Dr. Schubl and a social worker walked into the conference room, where the family was waiting, and shut the door.舒布尔医生和一名社工一起走进了家属们一直等候着的会议室,关上了门。“I did everything I possibly could,” Dr. Schubl told them. “Unfortunately, he did not survive. I am sorry.”“我们已经尽力了,”舒布尔医生告诉他们。“不幸的是,他没能撑过来。请节哀顺变。”The family did not know until the episode was broadcast that a camera was focusing on the closed door of the room where they had gathered and that audio of Dr. Schubl was being recorded.直到那期节目播出后,这家人才知道,就在他们齐聚的那个房间里,有个摄像头正对着那扇紧闭的房门,舒布尔医生所说的话都被录了下来。Afterward, on the episode, Dr. Schubl turned to the camera and said: “Rough day. Rough day.”在那一集片子里,后来舒布尔医生将脸转向了摄像头,说道:“真是艰难的一天呐。”“It was the last clip before the commercial,” Mrs. Chanko said, “or as I put it, ‘Watch this man die, now we’re going to sell you some detergent.’ ”“这是播放广告前的最后画面,”钱科太太说,“要让我说,他们这样是想表达,‘看完这男子的惨死,现在我们可以卖给你们洗涤剂了。’ ”According to PR Week, the public affairs staff at NewYork-Presbyterian contacted Mr. Wrong in 2008, eager to bring one of his shows to the hospital. Mr. Wrong had completed two shows based at Johns Hopkins Hospital in Baltimore and was working on another in Boston. After three years of trying, production began in 2011 at two campuses of NewYork-Presbyterian: Weill Cornell on the Upper East Side and Columbia University Medical Center in Washington Heights (some filming also took place at Lutheran Medical Center in Brooklyn). But two months into filming the first season, Mr. Wrong later told The Philadelphia Daily News, “Weill Cornell was just not delivering enough traumas.” To capture more drama and action for “NY Med,” he said he signed contracts with other emergency rooms and began keeping graphers in NewYork-Presbyterian’s emergency room at Weill Cornell 24 hours a day.《公关周刊》称,纽约长老会医院的公共事务人员曾在2008年联络朗先生,希望他能在该院拍摄节目。此前,朗先生已在巴尔的的约翰斯·霍普金斯医院(Johns Hopkins Hospital)拍摄完成了两部节目,当时正在波士顿拍摄另一部。经过三年的努力,2011年,节目终于在纽约长老会医院的两个校区:上东城的威尔康奈尔和华盛顿高地的哥伦比亚大学医学中心(Columbia University Medical Center)开拍(也有部分镜头在布鲁克林的路德会医疗中心[Lutheran Medical Center]拍摄)。但在第一季开拍两个月后,朗先生向《费城每日新闻》(Philadelphia Daily News)透露:“威尔康奈尔接诊的伤病不够多。”他说,为了给《纽约医务组》寻找更多剧情,自己已经与其他急诊室签约,并开始对纽约长老会医院在威尔康奈尔的急诊室进行每天24小时不间断的连续摄像。Mr. Wrong ended up with thousands of hours of footage, and the luxury of cutting any example that was not perfect, he told Capital New York last year. “You can be shut out of a critical moment that the case lacks emotional resonance without,” he said. “I will give you one of those: the ‘goodbye’ moment, it is the moment where a family says goodbye to their loved one going into surgery. If you don’t capture that moment, because a nurse shut the door on your camera’s face, you kill that piece. “朗先生告诉网络媒体Capital New York,去年他总共录制了数千小时的素材,但有幸剪出来的样片也都不理想。“如果你在关键时刻被拒之门外,案例就失去了情感上的共鸣,”他说。“举个例子:‘告别’时刻,也就是家属对他们将要上手术台的心爱之人说再见的时刻。如果护士把你的摄像机拒之门外,你就捕捉不到那一刻,整个案例就毁掉了。”Some of the patients and families captured by Mr. Wrong’s cameras have no complaints. “I think they were honest in their portrayal of our family and the love that we had and the concerns that any average family would go through when faced with this type of surgery,” said Dara van Dijk, whose mother’s heart valve operation was featured on the same episode as Mr. Chanko’s death. Ms. van Dijk did have one quibble: She was shown falling off a chair while meeting Dr. Oz in the episode. “In a million years, I didn’t think that they would show that,” she said.也有部分被朗先生的摄像机拍到的伤患和家属并无怨言。在录下钱科先生死亡的那一集节目中,还介绍了一位女士的心脏瓣膜手术,这位患者的女儿达拉·范戴克(Dara van Dijk)说:“我认为他们只是诚实地记录下了我们的家庭,我们的爱与忧虑,而这些是面对这种手术的任何普通家庭都要经历的。”不过,范戴克女士也不是完全没有牢骚:那一集有个镜头是她见到奥兹医生时从椅子上摔了下来。“我万万没想到他们会把这个片段也播了出来,”她说。Typically, hospitals have not received money in return for allowing medical reality shows to set up shop, and NewYork-Presbyterian is no exception, an A spokeswoman said in an email.A的女发言人在一封电子邮件中表示,通常情况下,医院不会因允许医务纪实片在本院拍摄而收到金钱报酬,纽约长老会医院也不例外。The real payoff for participating hospitals is distinguishing themselves at a time when other forms of promotion are no longer as effective, said Jennifer Coleman, the senior vice president of marketing and public relations for Baylor Scott amp; White Health, a large hospital system in Texas. Baylor self-produced a reality series about its cancer center and paid to broadcast it on local television. “Advertising is just so saturated right now,” she said. “You put your thumb over anybody’s ad and it’s just the same. That’s what people are trying to break through.” By participating in a major network program, she added, “They get that endorsement.”得克萨斯州的大型医疗机构Baylor Scott amp; White Health的市场营销和公共关系高级副总裁珍妮弗·科尔曼(Jennifer Coleman)指出:医院参与拍摄所能收获的真正回报在于:在这个其他形式的宣传推广都不再有效的时代里仍然能够一举成名。Baylor自己也录制了一系列关于其癌症中心的纪实片,并在当地电视台付费播出。“现在,广告已经严重饱和了,”她说。“如果你用拇指把别家的广告盖住,就会发现各家其实没什么区别,因此人们开始追求脱颖而出。”通过参加大型的网络节目项目,“他们得到了认可,”她补充道。Patients caught up in emergencies are especially vulnerable, posing special issues for reality shows. They may not be conscious or be able to speak for themselves; they may be quite literally exposed, as caregivers work to help them.陷入紧急状况的伤患身体尤其脆弱,这给纪实节目造成了特殊的问题。伤患们很可能已经失去了意识,或者无法表达自己的意见;为了方便医护人员的抢救工作,他们的身体也可能会有大面积的暴露。The American College of Emergency Physicians opposes “the filming for public viewing of emergency department patients or staff members except when they can give full informed consent prior to their participation,” yet show after show returns to the emergency room, drawn by the life-or-death stakes.美国急诊医师学会(American College of Emergency Physicians)反对“在急诊科的伤患和工作人员充分知情同意参与前就对他们进行拍摄并提供给公众观看”,然而,生死关头扣人心弦,驱使着一部又一部节目在急诊室里诞生。The New York Times Co. was sued for invasion of privacy in the early 2000s, by a group of patients in New Jersey who appeared in “Trauma: Life in the E.R.,” a series produced for Discovery’s Learning Channel. One appeals court ruled that the show qualified as news and deserved the same protections under the law. Many of the plaintiffs settled their cases individually, a lawyer for them said.21世纪初,新泽西的一群在探索传播(Discovery)学习频道的系列剧《创伤:急诊室里看人生》(“Trauma: Life in the E.R.”)中出镜的伤患就曾经起诉纽约时报公司(New York Times Co.)侵犯隐私。上诉法院裁定,该节目符合新闻标准,应该得到同样的法律保护。一名原告律师表示,许多原告后来都决定单独解决他们的案件。Mr. Wrong of “NY Med” said by email that he had not been sued over his medical shows before: “We put enormous behind the scenes effort into training our team and working in the medical environment.”《纽约医务组》的朗先生通过电子邮件称自己的医务纪实片此前从未受到起诉:“我们在幕后投入了巨大的努力,培训我们的团队要如何在医疗环境下工作。”Mr. Chanko’s family had aly settled a lawsuit against the private sanitation company whose truck backed over him by the time his widow saw the episode of “NY Med” featuring his case.当钱科太太看到《纽约医务组》中关于自己丈夫的案例那一集之前,钱科一家针对肇事卡车的业主——一家民营环卫公司的诉讼已经结案。A couple of hours after watching her husband die on TV, Mrs. Chanko called her daughter-in-law Barbara, a health care ethicist at the ed States Department of Veterans Affairs in Manhattan. Barbara Chanko, 55, remembers standing up in her office and saying, “If this happened, it’s got to be stopped.” When she watched the episode, she was shocked. “We protect patient privacy in everything we do,” she said. “I feel very betrayed by that medical staff for what they did.”在从电视上看到自己丈夫死亡经过的几小时后,钱科太太打电话给自己的儿媳,位于曼哈顿的美国退伍军人事务部(ed States Department of Veterans Affairs)的医疗伦理学家芭芭拉(Barbara)。55岁的芭芭拉·钱科记得自己当时站在办公室里说:“要是真的发生了这种事,必须加以制止。”在观看那集节目后,她十分震惊。“我们会想尽一切办法来保护伤患的隐私,”她说。“这些医务人员的所作所为让我觉得自己受到了背叛。”The Chankos’ son Eric Chanko, 53, a physician who works at a hospital in Ithaca, N.Y., said he, too, struggled to reconcile what he saw on the air with his own work. “They basically did everything that you’re taught in medical school not to do,” he said.钱科家的儿子,53岁的埃里克·钱科(Eric Chanko)是纽约州伊萨卡市的一名医生,他表示他也很难接受节目中自己同行的做法。“他们基本上把医学院里教的不该做的事情都做全了,”他说。In the aftermath of the broadcast, a lawyer for NewYork-Presbyterian tried to assure the family that no one could identify them from what was shown on TV. “Please be assured that your father’s and your family members’ images, likeness and other potentially identifying information were completely obscured in the episode,” the hospital’s associate general counsel, Caroline S. Fox, wrote in an emailed response to Kenneth Chanko’s complaint.节目播出一个月后,纽约长老会医院的一名律师向钱科一家保观众们绝对不可能从影片中辨认出他们的身份。该院的副总法律顾问卡罗琳·S·福克斯(Caroline S. Fox)在回复肯尼思·钱科投诉的电子邮件中写道:“请放心,节目对您父亲和您的家人的影像、肖像和其他潜在可能泄露身份的信息全都进行了模糊处理。”Yet a few weeks later, Mrs. Chanko said she received a call from a woman who used to work as a pet sitter for her and her husband. “She said to me, ‘Do you watch “NY Med?” #39; She said, ‘That was Mark, wasn’t it?’ She recognized him.”然而,钱科太太说,没出几周,一个曾担任她家宠物保姆的女子给她打电话。“她对我说:‘你看《纽约医务组》了么?那个不是马克么?’显然她认出了他。”Officials with the state’s health department concluded that NewYork-Presbyterian had violated Mr. Chanko’s rights and, indeed, its own privacy policy. “The patient was unaware and uninformed that he was being filmed and viewed by a camera crew while receiving medical treatment thus his privacy in receiving medical treatment was not ensured,” inspectors wrote in a citation released under New York’s Freedom of Information Law.纽约州卫生部门官员的结论是,纽约长老会医院侵犯了钱科先生的隐私权,实际上,他们还违反了他们自己的隐私政策。调查人员引用纽约的《信息自由法案》(Freedom of Information Law)称:“伤患在接受医护治疗时被摄制组拍摄和观察,未得到通知,也毫不知情,他在此期间的隐私没有保障。”New York regulators did not impose any sanctions on the hospital.纽约的监管机构并未对该医院施加任何制裁。Federal health officials are still reviewing whether NewYork-Presbyterian was obliged to get permission from Mr. Chanko or his family before allowing a TV crew to film him.联邦卫生官员仍在审查纽约长老会医院是否有义务在电视摄制组拍摄钱科先生之前先征得他或家人的许可。A State Supreme Court judge in Manhattan narrowed the Chankos’ lawsuit, but allowed some claims to proceed. In court filings, lawyers for the hospital and Dr. Schubl made the argument that the law prohibits medical professionals from sharing information about a patient only after he has been examined or treated. Because the “NY Med” film crew had shot during Mr. Chanko’s treatment, they claimed, it was legal.位于曼哈顿的纽约州最高法院的法官缩小了钱科一家的诉讼请求,但允许他们继续主张一部分权利。在法庭文件中,医院和舒布尔医生的律师声称,按照法律规定,只有在伤患得到检查或救治之后,才禁止医疗专业人员泄露伤患的信息。由于《纽约医务组》的摄制组是在钱科先生的治疗过程中拍摄的视频,所以完全合法。In November, an appellate panel issued a unanimous order dismissing the case. The conduct “was not so extreme and outrageous” to justify a claim of intentional infliction of emotional distress, the judges wrote. The doctor and hospital, the judges added, did not breach their duty to avoid disclosing personal information “since no such information” was disclosed.11月,受理上诉的小组一致裁定将此案驳回。法官写道,本案中被告的行为并不像原告声称的那样“极端、无耻”地故意导致受害人的情绪困扰。并补充道,医生和医院没有违背其避免泄露伤患个人信息的义务,因为他们并未披露“此类信息”。The family is working on an appeal. “If this ever got in front of a jury, I can’t imagine a jury not thinking a wrong was done to my father and to us,” Kenneth Chanko said. “Morally and ethically it’s not right, and I would also think that legally it can’t possibly be right.”钱科一家仍在努力上诉中。“如果这个案件真的能送到陪审团面前,我无法想象会有陪审团成员认为那些人对我父亲和我们所做的一切都是正当的,”肯尼思·钱科说。“从道义上和道德上这都是不对的,我相信从法律上讲也必将如此。”Asked what she would do if the case fails, Mrs. Chanko said the family would not stop pushing for redress. “If there’s no applicable law, there most certainly should be,” she said. “I’m willing to just pursue it all the way. Why shouldn’t there be a law against this kind of thing?”当被问及如果此案败诉她会怎么做时,钱科太太回答说他们一家不会放弃错误的纠正。“如果没有适用的法律,那么就该制定一部,”她说。“我愿意一直追求这一目标。为什么不该有部法律来防止这种事情的发生呢?” /201501/356000

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