Genç hekimin Soner Yalçın'a mektubu üzerine

medikritik Çar, 27/11/2019 - 10:31

Eren Öztürk’ün “Kara Kutu” ile ilgili Soner Yalçın eleştirisini okuyunca insanın zayıflamış umutları depreşiyor. Bilimsel ve sosyal konularda pek çok akademisyenin ilgi ve bilgi düzeyini gördükçe, bir tıp öğrencisinden böyle nitelikli bir yazı okumak sevindirici bir şey. Yalnızca ilgi, bilgi ve duyarlılık yok, aynı zamanda dili ve kurgusuyla da iyi bir makale. 

Aşılar konusundan başlarsak: Önce son 100-120 yıldır insanın yaşam süresi neden bu kadar devrimsel oranda uzadı sorusunu sormak gerekir. Bunu birçok başka kitap dışında özellikle Dr. Akif Akalın’ın çevirdiği ve yazdığı “toplumcu tıp” kitaplarından öğreniyoruz. İnsan yaşamının uzamasında ilk büyük sıçramayı yaratan şey, tıpla doğrudan bağlı görülmeyecek, ama göbekten bağlı bir gelişmedir. İngiltere ve Batı Avrupa’da geniş yoksul kesimlerin yaşadığı semtlere temiz su ve kanalizasyon götürülmesi! O mahallerin ve o evlerin en temel düzeyde sağlıklı hale getirilmesi… 

İnsanın ortalama yaşamında devrimsel oranda sıçrama yaratan öteki iki şey ise 1- Antibiyotikler, 2- Aşılardır. İşte Soner Yalçın’ın bilerek ya da bilmeden saldırdığı iki şey sosyal tıbbın ya da halk sağlığının en büyük iki silahıdır. 

Soner Yalçın’ın antibiyotikler hakkında söylediği birçok şey gerçi doğru. Son elli yıldır leblebi çekirdek gibi tüketilmesi, gerek vatandaşın, gerekse doktor ve eczacıların aşırı ve kötüye kullanımları ciddi sorunlar yaratmakta. Ancak zaten o konuda, beğenmediğimiz devlet bile ciddi önlemler alıyor. Sayın Soner Yalçın her konuda olduğu gibi bu konuda da bazı temel doğrularla birtakım kulaktan dolma yanlış bilgileri ve şehir efsanelerini harmanlayarak ilgi uyandırmayı seçiyor. Ne var ki bu taktik o bahsettiği doğruları itibarsızlaştırıyor.  Birtakım ilaçların yan etkilerinden dolayı sonradan yasaklanması, ilaç şirketlerinin aşırı kâr hırsıyla insan sağlığını riske atması, yaşanan gerçekler. Fakat tüm bunlar uyanıklığı, sorguyu, sosyalist bir tıp anlayışını doğurmalı. İlaçlara karşı genel bir güvensizliğe, tüm antibiyotiklerin “tu-kaka” ilan edilmesine yol açmamalı. Bilimin sorunları o bilim ne kadar yolundan sapsa da bilim içinde çözülmeli. 

Eren Öztürk’ün “modern tıbbın sorunlarının” “modern tıp dışı yöntemlerle” nasıl çözüldüğüne, daha doğrusu çözülemediğine dair yaklaşımı ve örnekleri gayet yerinde. 

Aşı muhalifliği ise bu çözümsüzlüğün en uç, en sorumsuz noktası. Fakat elbette aşılar da bilimsel anlamda tartışılmalı, onun da aşırı ve kötüye kullanımları önlenmeli. Ne var ki özellikle bizim gibi ülkelerde bu konu kişisel inisiyatiflere asla bırakılmamalı. Çünkü salgın hastalıklar kişisel ve özel karar alanları değildir. Öztürk’ün belirttiği gibi aşıları daha önce yapabildiğimiz gibi kendimiz üretmeliyiz. Sadece aşıları değil mevcut ilaçları ve yeni bulacağımız ilaçları da ülke olarak kendimiz üretebilmeliyiz. Soner Yalçın’ın da uyarısı doğrultusunda ilaç kalitelerini sürekli denetleyebilmeliyiz. Tüm bunlar hem doğrudan ölüm-kalım meselesidir, hem maliyet hesapları, ilaca ulaşılabilirlik ve ülke bağımsızlığı ile ilgili temel sorunlardır. 

İKİ İTİRAZIM VAR

Fakat değerli Öztürk’e iki noktada itirazım var. Biri gebelerde şeker yükleme testi ile ilgili. Epey bir süredir bu konuyu tartışıyoruz, “şeker yüklemeci” doktor arkadaşlar henüz beni ikna edebilmiş, sorularıma tatmin edici bir cevap vermiş değiller. Bilimsel iddiadaki argümanları şu: Gebelerde diyabet ortaya çıkacaksa kritik bir 5-6 haftalık dönemde çıkma olasılığı yüksekmiş. İşte o dönemde yapılan şeker yükleme testi ile erken tanı sağlanabiliyormuş. Gebenin ve ceninin sağlığı bu şekilde korunuyormuş. Peki bu kritik 5-6 haftalık dönemin son gününü nasıl saptayıp o günde test yapıyorlar? Hiç de öyle bir şey yapmıyor, herhangi bir günde yapıyorlar. O halde test yapıldıktan sonraki günlerde, haftalarda diyabet ortaya çıkarsa ne olacak? Üstelik diyabet illa o en yüksek olasılıklı dönemde çıkmayabilir, sonraki haftalarda da çıkabilir. Şeker yüklemesi negatif çıkan gebe bu yöntemle demek ki kendini sağlıklı sayacak ve aylarca diyabetle birlikte yaşayacak. Oysa bunun yerine önerdiğimiz şey son derece ucuz bir seçenek olarak açlık kan şekeri düzeyi ölçümünün gebelik boyunca birkaç haftada bir yinelenmesi. Ayda bir de hemoglobin A-1c ölçümü yapılırsa iş taçlanır. Ancak sadece şeker ölçümü bile yeterli. Uygulanırsa çok daha iyi sonuçlar alınabilir. 

Testte verilen ve o “az” denen şeker miktarı hiç de az değil ve kadın doğum uzmanlarının vermeyi pek sevdiği “bir dilim pasta” örneği yanıltıcı. Miktar hem fazla ve hem de bir dilim pastadan çok farklı bir içerik söz konusu. Üstelik bu test sıkça gördüğümüz gibi bir kez değil, birçok kez de yapılabiliyor. Yüklemeyle diyabeti gösteren miktar neden kendi başına diyabeti tetiklemesin? Modern tıbbın başta radyolojik tetkikler olmak üzere sıklıkla kötüye kullandığı tüm agresif tetkik yöntemleri sorgulanmalı. 

Bazı ülkeler bu yöntemi uygulamıyor. Örneğin toplum sağlığında örnek ülke Küba’da sadece riskli gebelere uygulanıyor ve o bile tartışılıyor. 

İkinci itiraz noktam ise değerli Öztürk’ün şu sözüne: “Emin olun, ilaç endüstrisi en çok sağlık camiasında eleştiriliyor.” Keşke öyle olsaydı. Bizler “Tıp Bu Değil” kitaplarının yazarları olarak bu konuları yıllardır gündeme getirmeye çalıştığımız halde üstünü en çok örten, en çok görmezden gelen, gargaraya getirmeye çalışan doktorlar ve sağlıkçılar oldu. Doğrudur, birtakım siyasi bildirilerde, TTB’nin kimi söylemlerinde yoğun bir anti-kapitalizm var gibi… Ama sadece “gibi”. Biz on yıllardır mücadele ediyoruz, hekimler hem de “muhalif” hekimler arasında ne aşırı tetkike, ne aşırı teşhise, ne aşırı tedaviye hevesi önleyebildik ne de koruyucu hekimliğe, sosyal tıbba bir eğilim yaratabildik. 

Çok ağır ve neredeyse hakarete varan eleştirilerimize karşın hala medikal şirketler sponsorluğunda kongreler dışında “bilimsel kongre” yok gibi… Ve hekimler bireysel olarak ve de örgütsel anlamda uzmanlık dernekleri ve onlardan aidat alan TTB vasıtasıyla bundan nemalanmaya devam ediyorlar. Böyle bir ortamda bilim ve bilimsel tartışma ne derece güçlenebilir? 

Hüsnüniyetin (iyiye yorma ve yorumlamanın) karşılığını gerçekte bulmasını elbette tüm kalbimizle dileriz. Konuya bu yaşta Eren Öztürk gibi nitelikli bakanların sayısı arttıkça belki o günleri göreceğiz. O konuda genç sağlıkçılara, doktorlara büyük iş düşüyor. 

Yine de tıp ve sağlık işleri sadece doktorların konuşacağı bir tabu değildir. Öztürk belirtmiş: Toplum da bilinçlenmeli ve bilinçli hastalar istiyoruz. Akalın’ın sık yinelediği gibi: “Sağlık sadece doktorlara bırakılamayacak kadar ciddi bir konudur.” Toplum, halk bilinçlenmeli, örgütlenmeli, kendi sağlığı için baskı gücü oluşturmalı. Devlete karşı, politikacılara karşı ve tabii doktorlara karşı da bir baskı gücü oluşturmalı. Örneğin güçlü biçimde şu sesi yükseltebilmeli: “Sigaraya karşı büyük kampanyalar ve devamlı bir karşı propaganda yapıyorsunuz. Güzel ve doğru. Ama o konuda gerçekten samimiyseniz fabrikaların baca filtresiz çalışmasına nasıl izin veriyorsunuz?” 

Bunu diyecek kitle Soner Yalçın kitaplarıyla oluşmaz. Aksine oluşacağı varsa da oluşmaz. 

Kaan Arslanoğlu

http://www.medikritik.com/haberler/tip-fakultesi-ogrencisinden-soner-ya…

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Darrellavoiz (doğrulanmamış) Per, 19/06/2025 - 00:00

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Derekuneta (doğrulanmamış) Per, 19/06/2025 - 14:46

Trailer trucks queue to cross into the United States at the Otay Mesa Port of Entry, in Tijuana, Mexico, November 27, 2024. Jorge Duenes/Reuters
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Since President Donald Trump won the election in November, businesses across the globe have been bracing for higher tariffs — a key Day One promise the president made.

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That could change, come 11:59 p.m. ET on Saturday — the deadline Trump set for when he says he will slap 25% tariffs on all Mexican and Canadian goods and a 10% tariff on all Chinese goods.

The tariffs, he said, will be imposed as a way of punishing the three nations, which Trump claims are responsible for helping people enter the country illegally and supplying fentanyl consumed in the US.

Speaking to reporters from the Oval Office on Thursday, Trump said he meant business, especially with his tariff threats on Mexico and Canada. White House Press Secretary Karoline Leavitt also confirmed on Friday that Trump will levy the 10% tariff on China on Saturday.
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Should these threats be believed? Yes and no, said Trump’s former Commerce Secretary Wilbur Ross.
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The threat of blanket tariffs is likely being overstated, Ross said in an interview with CNN. “There probably will be exclusions, because there are some goods that just are not made here, will not be made here, and therefore, there’s no particular point putting tariffs on.”

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Robertopag (doğrulanmamış) Cu, 20/06/2025 - 13:05

Jan Beutel was half-watching a live stream of Kleines Nesthorn, a mountain peak in the Swiss Alps, when he realized its cacophony of creaks and rumbles was getting louder. He dropped his work, turned up the sound and found himself unable to look away.
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“The whole screen exploded,” he said.

Beutel, a computer engineer specializing in mountain monitoring, had just witnessed a glacier collapse. On May 28, an avalanche of millions of tons of ice and rock barreled down the slope, burying Blatten, a centuries-old village nestled in the valley below.

Local authorities had already evacuated the village after parts of the mountain had crumbled onto the glacier; a 64-year old man believed to have stayed remains missing.

But no one expected an event of this magnitude.

Successive rock avalanches onto the glacier increased the pressure on the ice, causing it to melt faster and the glacier to accelerate, eventually destabilizing it and pushing it from its bed. The collapse was sudden, violent and catastrophic. “This one just left no moment to catch a breath,” Beutel said.
The underlying causes will take time to unravel. A collapse of this magnitude would have been set in motion by geological factors going back decades at least, said Matthias Huss, a glaciologist at the Swiss university ETH Zurich.

But it’s “likely climate change is involved,” he said, as warming temperatures melt the ice that holds mountains together. It’s a problem affecting mountains across the planet.

People have long been fascinated with mountains for their dramatic beauty. Some make their homes beneath them — around 1 billion live in mountain communities — others are drawn by adventure, the challenge of conquering peaks.

These majestic landscapes have always been dangerous, but as the world warms, they are becoming much more unpredictable and much deadlier.

“We do not fully understand the hazard at the moment, nor how the dangers are changing with climate change,” said David Petley, an Earth scientist at the University of Hull in England.

JamesClalt (doğrulanmamış) Cu, 20/06/2025 - 16:44

Jan Beutel was half-watching a live stream of Kleines Nesthorn, a mountain peak in the Swiss Alps, when he realized its cacophony of creaks and rumbles was getting louder. He dropped his work, turned up the sound and found himself unable to look away.
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“The whole screen exploded,” he said.

Beutel, a computer engineer specializing in mountain monitoring, had just witnessed a glacier collapse. On May 28, an avalanche of millions of tons of ice and rock barreled down the slope, burying Blatten, a centuries-old village nestled in the valley below.

Local authorities had already evacuated the village after parts of the mountain had crumbled onto the glacier; a 64-year old man believed to have stayed remains missing.

But no one expected an event of this magnitude.

Successive rock avalanches onto the glacier increased the pressure on the ice, causing it to melt faster and the glacier to accelerate, eventually destabilizing it and pushing it from its bed. The collapse was sudden, violent and catastrophic. “This one just left no moment to catch a breath,” Beutel said.
The underlying causes will take time to unravel. A collapse of this magnitude would have been set in motion by geological factors going back decades at least, said Matthias Huss, a glaciologist at the Swiss university ETH Zurich.

But it’s “likely climate change is involved,” he said, as warming temperatures melt the ice that holds mountains together. It’s a problem affecting mountains across the planet.

People have long been fascinated with mountains for their dramatic beauty. Some make their homes beneath them — around 1 billion live in mountain communities — others are drawn by adventure, the challenge of conquering peaks.

These majestic landscapes have always been dangerous, but as the world warms, they are becoming much more unpredictable and much deadlier.

“We do not fully understand the hazard at the moment, nor how the dangers are changing with climate change,” said David Petley, an Earth scientist at the University of Hull in England.

MartinMof (doğrulanmamış) Cu, 20/06/2025 - 18:09

Jan Beutel was half-watching a live stream of Kleines Nesthorn, a mountain peak in the Swiss Alps, when he realized its cacophony of creaks and rumbles was getting louder. He dropped his work, turned up the sound and found himself unable to look away.
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“The whole screen exploded,” he said.

Beutel, a computer engineer specializing in mountain monitoring, had just witnessed a glacier collapse. On May 28, an avalanche of millions of tons of ice and rock barreled down the slope, burying Blatten, a centuries-old village nestled in the valley below.

Local authorities had already evacuated the village after parts of the mountain had crumbled onto the glacier; a 64-year old man believed to have stayed remains missing.

But no one expected an event of this magnitude.

Successive rock avalanches onto the glacier increased the pressure on the ice, causing it to melt faster and the glacier to accelerate, eventually destabilizing it and pushing it from its bed. The collapse was sudden, violent and catastrophic. “This one just left no moment to catch a breath,” Beutel said.
The underlying causes will take time to unravel. A collapse of this magnitude would have been set in motion by geological factors going back decades at least, said Matthias Huss, a glaciologist at the Swiss university ETH Zurich.

But it’s “likely climate change is involved,” he said, as warming temperatures melt the ice that holds mountains together. It’s a problem affecting mountains across the planet.

People have long been fascinated with mountains for their dramatic beauty. Some make their homes beneath them — around 1 billion live in mountain communities — others are drawn by adventure, the challenge of conquering peaks.

These majestic landscapes have always been dangerous, but as the world warms, they are becoming much more unpredictable and much deadlier.

“We do not fully understand the hazard at the moment, nor how the dangers are changing with climate change,” said David Petley, an Earth scientist at the University of Hull in England.

RobertSmurf (doğrulanmamış) Cu, 20/06/2025 - 19:26

Jan Beutel was half-watching a live stream of Kleines Nesthorn, a mountain peak in the Swiss Alps, when he realized its cacophony of creaks and rumbles was getting louder. He dropped his work, turned up the sound and found himself unable to look away.
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“The whole screen exploded,” he said.

Beutel, a computer engineer specializing in mountain monitoring, had just witnessed a glacier collapse. On May 28, an avalanche of millions of tons of ice and rock barreled down the slope, burying Blatten, a centuries-old village nestled in the valley below.

Local authorities had already evacuated the village after parts of the mountain had crumbled onto the glacier; a 64-year old man believed to have stayed remains missing.

But no one expected an event of this magnitude.

Successive rock avalanches onto the glacier increased the pressure on the ice, causing it to melt faster and the glacier to accelerate, eventually destabilizing it and pushing it from its bed. The collapse was sudden, violent and catastrophic. “This one just left no moment to catch a breath,” Beutel said.
The underlying causes will take time to unravel. A collapse of this magnitude would have been set in motion by geological factors going back decades at least, said Matthias Huss, a glaciologist at the Swiss university ETH Zurich.

But it’s “likely climate change is involved,” he said, as warming temperatures melt the ice that holds mountains together. It’s a problem affecting mountains across the planet.

People have long been fascinated with mountains for their dramatic beauty. Some make their homes beneath them — around 1 billion live in mountain communities — others are drawn by adventure, the challenge of conquering peaks.

These majestic landscapes have always been dangerous, but as the world warms, they are becoming much more unpredictable and much deadlier.

“We do not fully understand the hazard at the moment, nor how the dangers are changing with climate change,” said David Petley, an Earth scientist at the University of Hull in England.

TimothyteP (doğrulanmamış) Cu, 20/06/2025 - 20:42

Jan Beutel was half-watching a live stream of Kleines Nesthorn, a mountain peak in the Swiss Alps, when he realized its cacophony of creaks and rumbles was getting louder. He dropped his work, turned up the sound and found himself unable to look away.
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“The whole screen exploded,” he said.

Beutel, a computer engineer specializing in mountain monitoring, had just witnessed a glacier collapse. On May 28, an avalanche of millions of tons of ice and rock barreled down the slope, burying Blatten, a centuries-old village nestled in the valley below.

Local authorities had already evacuated the village after parts of the mountain had crumbled onto the glacier; a 64-year old man believed to have stayed remains missing.

But no one expected an event of this magnitude.

Successive rock avalanches onto the glacier increased the pressure on the ice, causing it to melt faster and the glacier to accelerate, eventually destabilizing it and pushing it from its bed. The collapse was sudden, violent and catastrophic. “This one just left no moment to catch a breath,” Beutel said.
The underlying causes will take time to unravel. A collapse of this magnitude would have been set in motion by geological factors going back decades at least, said Matthias Huss, a glaciologist at the Swiss university ETH Zurich.

But it’s “likely climate change is involved,” he said, as warming temperatures melt the ice that holds mountains together. It’s a problem affecting mountains across the planet.

People have long been fascinated with mountains for their dramatic beauty. Some make their homes beneath them — around 1 billion live in mountain communities — others are drawn by adventure, the challenge of conquering peaks.

These majestic landscapes have always been dangerous, but as the world warms, they are becoming much more unpredictable and much deadlier.

“We do not fully understand the hazard at the moment, nor how the dangers are changing with climate change,” said David Petley, an Earth scientist at the University of Hull in England.

JamesIdiop (doğrulanmamış) Ct, 21/06/2025 - 07:21

Tree-covered mountains rise behind a pile of trash, children run through the orange haze of a dust storm, and a billboard standing on parched earth indicates where the seashore used to be before desertification took hold. These striking images, exhibited as part of the Right Here, Right Now Global Climate Summit, show the devastating effects of climate change.
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The summit, held at the University of Oxford in the UK and supported by UN Human Rights (OHCHR), aims to reframe climate change as a human rights crisis and spotlight climate solutions. It works with everyone from policymakers to artists to get the message across.

“Photographers document the human rights impacts of climate change, helping to inform the public and hold governments and businesses accountable,” said Volker Turk, UN High Commissioner for the OHCHR, via email. “The Right Here, Right Now Global Climate Summit shows the power of collective action — uniting storytellers, scientists, indigenous leaders, and others to advance climate solutions rooted in human rights.”

Coinciding with World Environment Day on June 5, the exhibition — titled “Photography 4 Humanity: A Lens on Climate Justice” — features the work of 31 photographers from across the globe, all documenting the effects of global warming and environmental pollution on their own communities.

Climate change disproportionately affects vulnerable populations around the world. Despite emitting far fewer greenhouse gases, low-income nations are suffering the most from extreme weather events and have fewer resources to adapt or recover.
Photographs at the exhibition show the effects of desertification, flooding and plastic pollution. A black and white image shows the ruins of a house in West Bengal, India, sloping towards the Ganges River, with the owner sitting alongside. Riverbank erosion is degrading the environment and displacing communities in the area. Photographer Masood Sarwer said in a press release that the photo depicts the “slow violence” of climate change: “These are not sudden disasters, but slow-moving, relentless ones — shaping a new category of environmental refugees.”

Another photo, taken by Aung Chan Thar, shows children fishing for trash in Inle Lake, Myanmar. The lake was once a pristine natural wonder but now faces the growing threat of plastic pollution. “This image of children cleaning the water symbolizes the importance of education and collective action in preserving our environment for a sustainable future,” he said.

Organizers hope that the exhibition will help to humanize the climate crisis. “Our mission is to inspire new perspectives through photography,” said Pauline Benthede, global vice president of artistic direction and exhibitions at Fotografiska, the museum of photography, art and culture that is curating the exhibition at the summit. “It draws attention to the human rights issue at the heart of global warming, which affects both the world’s landscapes and the people that live within them.”

“Photography is the most influential and inclusive art form of our times and has the power to foster understanding and inspire action,” she added.

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