Читать онлайн книгу «Медицина для умных. Современные аспекты доказательной медицины для думающих пациентов» автора А. Д. Парамонова 📚. Простая регистрация на сайте ✔. Термин Healthhacking означает применение достижений медицинской науки для долгой и комфортной жизни. В России чаще говорят «доказательная медицина», имея в виду, что предложенные схемы и методы лечения прошли плацебо-контролируемые когортные исследования. Книгу, которую вы держите в руках, написа…

Without kewood

БЕЗГРАНИЧНО РАЗУМНЫМ ПОСВЯЩАЕТСЯ

Авторы заявляют отсутствие конфликта интересов: данная книга не имеет сторонних источников финансирования.

© Парамонов А., Бутрий С., Штабницкий В. и соавт., текст, 2021

© ООО «Издательство «Эксмо», 2021

Dear reader!

Авторы этой книги – практикующие врачи, со многими из которых я знаком годы и даже десятки лет.

У книги необычный для обращенной к пациенту литературы формат – она в большей степени направлена на выявление и контроль факторов риска и раннюю диагностику тех заболеваний, где ранняя диагностика может принести пользу, – к сожалению, еще не при всех болезнях медицина способна остановить болезнь.

Кратко содержание книги можно описать так: что делать, пока негативное событие еще не случилось и чтобы не случилось в будущем? Современная медицина не может гарантировать благополучного будущего, но может оценивать его в вероятностных категориях и также с определенной вероятностью предотвращать нежелательные события.

Книга дает пациенту знания, когда нужно обратиться к врачу и что нужно делать, чтобы такая потребность возникала реже. Профилактика заболеваний уже сотни лет декларируется врачами как приоритет, но в лечении мы пока преуспели гораздо больше. Пусть эта книга станет малым вкладом в большое дело профилактики.

Здоровья вам и долгих продуктивных лет жизни.

Введение: как сохранить здоровье и не утратить желания жить?

Term Healthhacking придуман не нами, но его пока нельзя назвать общепринятым. Мы и некоторые наши единомышленники в разных концах света вкладываем сюда следующий смысл: использование достижений медицинской науки для долгой и комфортной жизни с применением только проверенных в исследованиях методов.

Более распространенная практика биохакинга (Biohacking) могла бы показаться, на первый взгляд, в чем-то похожей, но мы ее считаем, скорее, антиподом научной медицины и ее принципов. Биохакинг – движение, призывающее использовать плохо исследованные «новейшие» технологии для продления жизни и получения суперспособностей (необычных памяти, скорости мышления, остроты зрения, слуха и т. д.). Биохакеры «спешат жить». Вчера газеты написали об успешном исследовании нового препарата на крысах, а сегодня биохакеры его добывают любыми средствами, не всегда законными, и принимают.Doctors who have participated in clinical trials look at this practice with a sad smile, because they know how often success in one model is not confirmed in another. What helps rats can be deadly for humans. Biohackers take dozens of supplements containing vitamins, selenium, taurine, tryptophan, inject themselves with sex hormones, use psychostimulants and antidepressants, memory enhancers, and much more. Biohackers have one thing in common – with a serious theoretical basis for "life extension systems", they have no experimental confirmation. They conduct the experiment on themselves, so they are not surprised by press reports about the sudden death of the 28-year-old founder of a biohacking company. In our opinion, the first biohacker was Michael Jackson, who, by visiting the pressure chamber and disinfecting everything around, planned to live for 150 years. We know the result.

The book you are holding in your hands was written by a team of physicians working on the principles Evidence Based Medicine (medicine based on evidence, or evidence-based medicine). There will be no recommendations that we could not explain and refer to the source – the study where the data was obtained. This is the main, but not the only principle that formed the basis of this book.

Another principle is that the recipes that we offer should either prolong life or improve its quality. Abstract recommendations, the value that cannot be assessed, such as “improving cerebral circulation” or “cleansing blood vessels from toxins”, you will not find here.

The third principle is that recommendations should be feasible and feasible. It is known that there are many centenarians among the rural inhabitants of poor mountain regions. There, people do not eat too many calories, eat a lot of plant foods, they have regular physical activity. But we will not offer to move to a mountain village: we think that few of you will agree. If we make recommendations that require you to make a known effort, such as quitting smoking, we will also tell you the most effective and realistic ways to achieve this goal.

The concept of compliance, that is, adherence to these recommendations, also follows from the third principle. If we offer you "burdens that are heavy and unbearable," you will not have to hope for a long time to carry them. In this book, special attention is paid to easy-to-implement recipes that bring obvious results.

The publication can be useful to people of any age, but first of all it is aimed at readers of the middle age category, when risk factors are already appearing, but the disease is either not yet, or it has not become irreversible. Therefore, in the "cardiology" section there will be no information on how to treat angina pectoris, we will write how to prevent its development. In "gastroenterology" we do not write how to treat a stomach ulcer, but we will write how to minimize its risk and the risk of developing stomach and colon cancer.

Since the book is aimed at people of the most active age, special attention is paid to the preservation of men's and women's health, recovery after pregnancy, and medical risks that travel a lot.

The most important chapter here is brief but sufficient information about the scope of the preventive check-up examination, which is reasonable to take depending on your gender and age.

Happy reading, dear future centenarians!

Section 1
Cardiology

Author: Olga Sokolova, cardiologist, candidate of medical sciences

What does the layperson need to know about cardiovascular disease prevention?

Over the past hundred years, the world has changed a lot, and people have learned to resist the threats that had previously successfully killed them for many centuries. But for some reason the golden age did not come. Since people, at least in developed countries, learned not to die at a young age from hunger and infections and began to live longer on average, it turned out that the palm among the causes of death belongs to cardiovascular diseases. Since heart attacks and strokes tend to kill people suddenly, often at a completely active age, and those who survive significantly spoil the quality of life, it is quite understandable that humanity spends quite a lot of effort and other resources in order to avoid this scourge. It should be recognized that we have learned a lot in this area and know a lot. We are humanity as a whole, and every random passer-by on the street, and every specific reader of this book. Yes, yes, now people, as a rule, are much more informed on this issue than their parents, and even more so grandparents, even if they are not at all interested in a healthy lifestyle. “Healthy lifestyle” sounds now, as they say, from every iron, and every schoolchild has long known that “salt / sugar / unnecessary cross out – white death”. Even the number of jokes and anecdotes that immediately pop up in the head of any of us at the thought of a healthy lifestyle and active longevity (“a smoking mother will never become a father”, “whoever does not smoke or drink will die healthy”, etc. .), indicates that the topic has long and firmly taken root in the public mind.

On the other hand, since scientific research in any field always goes through a series of errors and misconceptions, and new information often refutes the previous one, there is considerable confusion in the public mind about what exactly should and should not be done so as not to die of a heart attack or become disabled. as a result of a stroke, without having completed all his life plans. In this chapter, we will try to sort out all this confusion, focusing on the scientific information in the field of preventive cardiology that exists at the moment.At the same time, it should be taken into account that the development of this direction continues, and it is quite possible that in a year or two this text will need to be substantially revised.

Where did preventive cardiology come from? Roosevelt and the Framingham Study

So. Start over. Now it is already hard to believe, but quite recently there was no preventive cardiology yet. Back in the 30s and 40s of the 20th century – there are people living among us who remember this time – humanity did not know very many things that are now known even to schoolchildren. And the doctors of that time considered a lot of things that we have long been accustomed to fear, for example, an increase in cholesterol levels or blood pressure, as natural manifestations of normal aging. Moreover, in those days, the only risk that smoking was associated with in the mass consciousness was damage to the family budget. And so it would have continued further if not for the 32nd President of the United States, Franklin Delano Roosevelt. Yes, we owe him the appearance of preventive cardiology, but not as a politician, but as a patient.

In 1932, during his election campaign, Franklin Roosevelt made public, as is customary now, his medical data. At that time, his blood pressure was 140/100 mmHg. Art., and this was not at all considered then a reason for any intervention. After Roosevelt became president, he chose an otolaryngologist as his personal physician because the most common medical problem during that period of his life was sinusitis. By 1941, the president's blood pressure was already 188/105 mm Hg. Art., but this was also considered quite normal for a man of his age. Despite the fact that the president looked frankly bad, and this began to catch the eye of others, the then medicine recognized the problem only in 1944, when Roosevelt had already developed heart failure. However, there were no effective drugs for either high blood pressure or heart failure, and Franklin Delano Roosevelt died of a cerebral hemorrhage in April 1945. He was 63 years old and had a blood pressure of 300/190 mmHg at the time of the stroke. . Art. So President Roosevelt shared the fate of very many of his compatriots, since, according to the then statistics, cardiovascular diseases were already the most common cause of death in the country. At that time, it was already clear to everyone that this was a problem, and the most serious problem, but there was still practically no scientific information about what reasons underlie the current situation. It was clear that serious research was needed to find these reasons, which would require serious money. It was only in 1948 that the next US President, Harry Truman, succeeded in obtaining the consent of Congress to finance such research, and it was the fate of his predecessor that served as a decisive argument.