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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The front of the ship, or the bow, had sunk to the sea floor. But over the weekend, the Nautilus Live expedition from the Ocean Exploration Trust located it in 675 meters (2,214 feet) of water in Iron Bottom Sound in the Solomon Islands.
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Using remotely operated underwater vehicles, scientists and historians observed “details in the ship’s structure, painting, and anchor to positively identify the wreckage as New Orleans,” the expedition’s website said.

On November 30, 1942, New Orleans was struck on its portside bow during the Battle of Tassafaronga, off Guadalcanal island, according to an official Navy report of the incident.
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The torpedo’s explosion ignited ammunition in the New Orleans’ forward ammunition magazine, severing the first 20% of the 588-foot warship and killing more than 180 of its 900 crew members, records state.

The crew worked to close off bulkheads to prevent flooding in the rest of the ship, and it limped into the harbor on the island of Tulagi, where sailors went into the jungle to get repair supplies.

“Camouflaging their ship from air attack, the crew jury-rigged a bow of coconut logs,” a US Navy account states.
With that makeshift bow, the ship steamed – in reverse – some 1,800 miles across the Pacific to Australia for sturdier repairs, according to an account from the National World War II Museum in Louisiana.

Retired US Navy Capt. Carl Schuster described to CNN the remarkable skill involved in sailing a warship backwards for that extended distance.

“‘Difficult’ does not adequately describe the challenge,” Schuster said.

While a ship’s bow is designed to cut through waves, the stern is not, meaning wave action lifts and drops the stern with each trough, he said.

When the stern rises, rudders lose bite in the water, making steering more difficult, Schuster said.

And losing the front portion of the ship changes the ship’s center of maneuverability, or its “pivot point,” he said.

“That affects how the ship responds to sea and wind effects and changes the ship’s response to rudder and propellor actions,” he said.

The New Orleans’ officers would have had to learn – on the go – a whole new set of actions and commands to keep it stable and moving in the right direction, he said.

The ingenuity and adaptiveness that saved the New Orleans at the Battle of Tassafaronga enabled it to be a force later in the war.

Jamestup (doğrulanmamış) Cu, 11/07/2025 - 14:06

Unity and BrightBuilt factory-built homes share an important feature: They are airtight, part of what makes them 60% more efficient than a standard home. GO Logic says its homes are even more efficient, requiring very little energy to keep cool or warm.
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“Everybody wants to be able to build a house that’s going to take less to heat and cool,” said Unity director Mark Hertzler.

Home efficiency has other indirect benefits. The insulation and airtightness – aided by heat pumps and air exchangers – helps manage the movement of heat, air and moisture, which keeps fresh air circulating and mold growth at bay, according to Hertzler.
https://kra34g.cc
кракен ссылка
Buntel, a spring allergy sufferer, said his Somerville home’s air exchange has made a noticeable difference in the amount of pollen in the house. And customers have remarked on how quiet their homes are, due to their insulation.

“I’m from New England, so I’ve always lived in drafty, uncomfortable, older houses,” Buntel said. “This is really amazing to me, how consistent it is throughout the year.”
Some panelized home customers are choosing to build not just to reduce their carbon footprint, but because of the looming threat of a warming planet, and the stronger storms it brings.

Burton DeWilde, a Unity homeowner based in Vermont, wanted to build a home that could withstand increasing climate impacts like severe flooding.

“I think of myself as a preemptive climate refugee, which is maybe a loaded term, but I wasn’t willing to wait around for disaster to strike,” he told CNN.

Sustainability is one of Unity’s founding principles, and the company builds houses with the goal of being all-electric.

“We’re trying to eliminate fossil fuels and the need for fossil fuels,” Hertzler said.

Goodson may drill oil by day, but the only fossil fuel he uses at home is diesel to power the house battery if the sun doesn’t shine for days. Goodson estimated he burned just 30 gallons of diesel last winter – hundreds of gallons less than Maine homeowners who burn oil to stay warm.

“We have no power bill, no fuel bill, all the things that you would have in an on-grid house,” he said. “We pay for internet, and we pay property taxes, and that’s it.”

DarrickUnfib (doğrulanmamış) Cu, 11/07/2025 - 14:09

Today was supposed to be the day that President Donald Trump’s so-called “reciprocal” tariffs on dozens of countries kicked in after a three-month delay, absent trade deals. But their introduction has been postponed, again.

The new, August 1 deadline prolongs uncertainty for businesses but also gives America’s trading partners more time to strike trade deals with the United States, avoiding the hefty levies.
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Mainstream economists would probably cheer that outcome. Most have long disliked tariffs and can point to research showing they harm the countries that impose them, including the workers and consumers in those economies. And although they also recognize the problems free trade can create, high tariffs are rarely seen as the solution.
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Trump’s tariffs so far have not meaningfully boosted US inflation, slowed the economy or hurt jobs growth. Inflation is “the dog that didn’t bark,” Treasury Secretary Scott Bessent likes to say. But economists argue inflation and jobs will have a delayed reaction to tariffs that could start to get ugly toward the end of the year, and that the current calm before the impending storm has provided the administration with a false sense of security.

“The positives (of free trade) outweigh the negatives, even in rich countries,” Antonio Fatas, an economics professor at business school INSEAD, told CNN. “I think in the US, the country has benefited from being open, Europe has benefited from being open.”

Consumers lose out
Tariffs are taxes on imports and their most direct typical effect is to drive up costs for producers and prices for consumers.

Around half of all US imports are purchases of so-called intermediate products, needed to make finished American goods, according to data from the Organisation for Economic Co-operation and Development.

“If you look at a Boeing aircraft, or an automobile manufactured in the US or Canada… it’s really internationally sourced,” Doug Irwin, an economics professor at Dartmouth College, said on the EconTalk podcast in May. And when American businesses have to pay more for imported components, it raises their costs, he added.

Likewise, tariffs raise the cost of finished foreign goods for their American importers.

“Then they have to pass that on to consumers in most instances, because they don’t have deep pockets where they can just absorb a 10 or 20 or 30% tariff,” Irwin said.

Craigkat (doğrulanmamış) Cu, 11/07/2025 - 17:14

Guatemala has pledged a 40% increase in deportation flights carrying Guatemalans and migrants of other nationalities from the United States, President Bernardo Arevalo announced Wednesday during a press conference with US Secretary of State Marco Rubio.
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Guatemala has also agreed to create a task force for border control and protection along the country’s eastern borders. The force, composed of members of the National Police and army, will be tasked with fighting “all forms of transnational crime,” Arevalo said.
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Foreign nationals who arrive in Guatemala through deportation flights will be repatriated to their home countries, Arevalo said, adding that the US and Guatemala would continue to have talks on how the process would work and how the US would cooperate.
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Arevalo also said that Rubio has voiced his support for developing infrastructure projects in the Central American nation. He added that his government would send a delegation to Washington in the coming weeks to negotiate deals for economic investments in Guatemala – which he said would incentivize Guatemalans to stay in their home country and not migrate to the US.

Arevalo said Guatemala has not had any discussions about receiving criminals from the US as El Salvador’s president has offered. He also insisted his country has not reached a “safe third country” agreement with the United States, which would require migrants who pass through Guatemala to apply for asylum there rather than continuing to the US.
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Thomaskek (doğrulanmamış) Cu, 11/07/2025 - 18:52

Today was supposed to be the day that President Donald Trump’s so-called “reciprocal” tariffs on dozens of countries kicked in after a three-month delay, absent trade deals. But their introduction has been postponed, again.

The new, August 1 deadline prolongs uncertainty for businesses but also gives America’s trading partners more time to strike trade deals with the United States, avoiding the hefty levies.
[url=https://kra34g.cc]kraken onion[/url]
Mainstream economists would probably cheer that outcome. Most have long disliked tariffs and can point to research showing they harm the countries that impose them, including the workers and consumers in those economies. And although they also recognize the problems free trade can create, high tariffs are rarely seen as the solution.
https://kra34g.cc
kraken ссылка
Trump’s tariffs so far have not meaningfully boosted US inflation, slowed the economy or hurt jobs growth. Inflation is “the dog that didn’t bark,” Treasury Secretary Scott Bessent likes to say. But economists argue inflation and jobs will have a delayed reaction to tariffs that could start to get ugly toward the end of the year, and that the current calm before the impending storm has provided the administration with a false sense of security.

“The positives (of free trade) outweigh the negatives, even in rich countries,” Antonio Fatas, an economics professor at business school INSEAD, told CNN. “I think in the US, the country has benefited from being open, Europe has benefited from being open.”

Consumers lose out
Tariffs are taxes on imports and their most direct typical effect is to drive up costs for producers and prices for consumers.

Around half of all US imports are purchases of so-called intermediate products, needed to make finished American goods, according to data from the Organisation for Economic Co-operation and Development.

“If you look at a Boeing aircraft, or an automobile manufactured in the US or Canada… it’s really internationally sourced,” Doug Irwin, an economics professor at Dartmouth College, said on the EconTalk podcast in May. And when American businesses have to pay more for imported components, it raises their costs, he added.

Likewise, tariffs raise the cost of finished foreign goods for their American importers.

“Then they have to pass that on to consumers in most instances, because they don’t have deep pockets where they can just absorb a 10 or 20 or 30% tariff,” Irwin said.

ArmandoTwerm (doğrulanmamış) Cu, 11/07/2025 - 18:52

The bow of a US Navy cruiser damaged in a World War II battle in the Pacific has shone new light on one of the most remarkable stories in the service’s history.

More than 80 years ago, the crew of the USS New Orleans, having been hit by a Japanese torpedo and losing scores of sailors, performed hasty repairs with coconut logs, before a 1,800-mile voyage across the Pacific in reverse.

The front of the ship, or the bow, had sunk to the sea floor. But over the weekend, the Nautilus Live expedition from the Ocean Exploration Trust located it in 675 meters (2,214 feet) of water in Iron Bottom Sound in the Solomon Islands.
[url=https://kra34g.cc]кракен ссылка[/url]
Using remotely operated underwater vehicles, scientists and historians observed “details in the ship’s structure, painting, and anchor to positively identify the wreckage as New Orleans,” the expedition’s website said.

On November 30, 1942, New Orleans was struck on its portside bow during the Battle of Tassafaronga, off Guadalcanal island, according to an official Navy report of the incident.
https://kra34g.cc
kra cc
The torpedo’s explosion ignited ammunition in the New Orleans’ forward ammunition magazine, severing the first 20% of the 588-foot warship and killing more than 180 of its 900 crew members, records state.

The crew worked to close off bulkheads to prevent flooding in the rest of the ship, and it limped into the harbor on the island of Tulagi, where sailors went into the jungle to get repair supplies.

“Camouflaging their ship from air attack, the crew jury-rigged a bow of coconut logs,” a US Navy account states.
With that makeshift bow, the ship steamed – in reverse – some 1,800 miles across the Pacific to Australia for sturdier repairs, according to an account from the National World War II Museum in Louisiana.

Retired US Navy Capt. Carl Schuster described to CNN the remarkable skill involved in sailing a warship backwards for that extended distance.

“‘Difficult’ does not adequately describe the challenge,” Schuster said.

While a ship’s bow is designed to cut through waves, the stern is not, meaning wave action lifts and drops the stern with each trough, he said.

When the stern rises, rudders lose bite in the water, making steering more difficult, Schuster said.

And losing the front portion of the ship changes the ship’s center of maneuverability, or its “pivot point,” he said.

“That affects how the ship responds to sea and wind effects and changes the ship’s response to rudder and propellor actions,” he said.

The New Orleans’ officers would have had to learn – on the go – a whole new set of actions and commands to keep it stable and moving in the right direction, he said.

The ingenuity and adaptiveness that saved the New Orleans at the Battle of Tassafaronga enabled it to be a force later in the war.

ClintonTautt (doğrulanmamış) Cu, 11/07/2025 - 19:04

Unity and BrightBuilt factory-built homes share an important feature: They are airtight, part of what makes them 60% more efficient than a standard home. GO Logic says its homes are even more efficient, requiring very little energy to keep cool or warm.
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“Everybody wants to be able to build a house that’s going to take less to heat and cool,” said Unity director Mark Hertzler.

Home efficiency has other indirect benefits. The insulation and airtightness – aided by heat pumps and air exchangers – helps manage the movement of heat, air and moisture, which keeps fresh air circulating and mold growth at bay, according to Hertzler.
https://kra34g.cc
kraken ссылка
Buntel, a spring allergy sufferer, said his Somerville home’s air exchange has made a noticeable difference in the amount of pollen in the house. And customers have remarked on how quiet their homes are, due to their insulation.

“I’m from New England, so I’ve always lived in drafty, uncomfortable, older houses,” Buntel said. “This is really amazing to me, how consistent it is throughout the year.”
Some panelized home customers are choosing to build not just to reduce their carbon footprint, but because of the looming threat of a warming planet, and the stronger storms it brings.

Burton DeWilde, a Unity homeowner based in Vermont, wanted to build a home that could withstand increasing climate impacts like severe flooding.

“I think of myself as a preemptive climate refugee, which is maybe a loaded term, but I wasn’t willing to wait around for disaster to strike,” he told CNN.

Sustainability is one of Unity’s founding principles, and the company builds houses with the goal of being all-electric.

“We’re trying to eliminate fossil fuels and the need for fossil fuels,” Hertzler said.

Goodson may drill oil by day, but the only fossil fuel he uses at home is diesel to power the house battery if the sun doesn’t shine for days. Goodson estimated he burned just 30 gallons of diesel last winter – hundreds of gallons less than Maine homeowners who burn oil to stay warm.

“We have no power bill, no fuel bill, all the things that you would have in an on-grid house,” he said. “We pay for internet, and we pay property taxes, and that’s it.”

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