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 Academy Award-winning actress and Goop founder appeared in a new – and very funny – ad for Astronomer, the tech firm whose former CEO and human resources chief launched a million memes after being shown on a Jumbotron at a Coldplay concert last week.
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In addition to her other hats, Paltrow, of course, is also the famously “consciously uncoupled” ex-wife of Coldplay frontman Chris Martin, who at a concert in Boston last week inadvertently revealed an intimate moment between two top executives at Astronomer – who were seen embracing but immediately ducked from view – during a performance of Coldplay’s “Jumbotron Song.”
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“Whoa, look at these two,” Martin quipped at the time. “Either they’re having an affair or they’re just very shy.”

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Joshuaapaph (doğrulanmamış) Ct, 02/08/2025 - 04:43

Since India’s independence from Britain in 1947, the status of English in India has been deeply political – entwined with questions of identity, power, and national direction.

Today, English is one of several official languages in India, spoken by about 10% of the population. Hindi is the first language for around 44% of citizens, according to the 2011 census.
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But in recent years, Modi’s BJP has placed particular emphasis on promoting Hindi and reducing the use of English in public life.

The prime minister almost never delivers speeches in English, preferring Hindi for national addresses such as his monthly radio program. His administration has encouraged officials to use Hindi on social media and in government correspondence – though, after criticism from non-Hindi-speaking states, clarified that this was intended mainly for the Hindi belt in the north.
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When India hosted world leaders for the 2023 G20 summit in New Delhi, invitations were sent out from “Bharat” – the Sanskrit or Hindi name for the country – instead of “India,” fueling speculation that the government aims to ultimately phase out the country’s English designation altogether.

Modi’s critics have been quick to note his political motives behind these moves.

With its roots in the Rashtriya Swayamsevak Sangh (RSS), a right-wing organization that advocates Hindu hegemony within India, the BJP’s language policies resonate with many in a country where nearly 80% of people are Hindu.

Analysts say the BJP is seeking to capitalize on this demographic by promoting language policies that strengthen its support base in the north.

According to Rita Kothari, an English professor from Ashoka University, the government “is certainly interested in homogenizing the country and making Hindi more widespread.”

But that policy can also backfire – in part because many regions, such as Marathi-speaking Maharashtra in the west – are staunchly proud of their local language.

The violent clashes in the state’s megacity Mumbai earlier this month were sparked by the regional government’s controversial decision to make Hindi a compulsory third language in public primary schools.

Pushback and protest has also been especially strong in the south, where English and regional languages such as Tamil, Telugu, and Kannada are valued as symbols of local identity and autonomy.

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More than that, the buildings of his childhood were disappearing, replaced by shiny new skyscrapers.

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Initially focusing on industrial landscapes, temporary structures and air conditioning units, he began to notice symmetry in many of the buildings he was photographing, inspiring his current project: facades.

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Mauricefut (doğrulanmamış) Ct, 02/08/2025 - 09:30

When Hussain AlMoosawi arrived home, he didn’t recognize anything.

The Emirati photographer, who had spent eight years studying in Australia, returned to the United Arab Emirates (UAE) in 2013. He’d missed a real estate boom of dizzying proportions: not just new buildings, but new districts.
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More than that, the buildings of his childhood were disappearing, replaced by shiny new skyscrapers.

But for AlMoosawi, these international icons were not the urban fabric of his home: it was the oft-overlooked, mid-century office towers and residential blocks squeezed between new highways and overshadowed by luxury developments that felt most familiar.

It sparked a desire to “understand the urban context of the UAE,” and AlMoosawi set out to meticulously document and capture these underappreciated buildings, “and reimagine the city as if it were the ‘80s, the time when I was born.”
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Initially focusing on industrial landscapes, temporary structures and air conditioning units, he began to notice symmetry in many of the buildings he was photographing, inspiring his current project: facades.

“Facades are like a face,” said AlMoosawi. “It’s something that people connect with.”

His bold, geometric images strip away context to spotlight the character and diversity of everyday buildings. Using a telephoto lens to shoot close-ups from the ground or elevated positions, AlMoosawi carefully frames out distractions and sometimes removes minor obstructions like lampposts in post-processing.

So far, the 41-year-old, who is editor-in-chief for National Geographic AlArabiya Magazine, has photographed over 600 building?s across the UAE, and next year hopes to complete his collection in Abu Dhabi, where he lives.

In the long term, he hopes to turn the “lifetime project” into an interactive archive that both preserves urban heritage and invites viewers to rediscover their own city.

“Our cities aren’t big, in terms of scale, compared to many other cities,” said AlMoosawi. “But then they have a story to tell, they have things between the lines that we don’t see, and my quest is to see these things.”

Jorgestoon (doğrulanmamış) Ct, 02/08/2025 - 09:41

Since India’s independence from Britain in 1947, the status of English in India has been deeply political – entwined with questions of identity, power, and national direction.

Today, English is one of several official languages in India, spoken by about 10% of the population. Hindi is the first language for around 44% of citizens, according to the 2011 census.
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But in recent years, Modi’s BJP has placed particular emphasis on promoting Hindi and reducing the use of English in public life.

The prime minister almost never delivers speeches in English, preferring Hindi for national addresses such as his monthly radio program. His administration has encouraged officials to use Hindi on social media and in government correspondence – though, after criticism from non-Hindi-speaking states, clarified that this was intended mainly for the Hindi belt in the north.
https://trip-scan.biz
трип скан
When India hosted world leaders for the 2023 G20 summit in New Delhi, invitations were sent out from “Bharat” – the Sanskrit or Hindi name for the country – instead of “India,” fueling speculation that the government aims to ultimately phase out the country’s English designation altogether.

Modi’s critics have been quick to note his political motives behind these moves.

With its roots in the Rashtriya Swayamsevak Sangh (RSS), a right-wing organization that advocates Hindu hegemony within India, the BJP’s language policies resonate with many in a country where nearly 80% of people are Hindu.

Analysts say the BJP is seeking to capitalize on this demographic by promoting language policies that strengthen its support base in the north.

According to Rita Kothari, an English professor from Ashoka University, the government “is certainly interested in homogenizing the country and making Hindi more widespread.”

But that policy can also backfire – in part because many regions, such as Marathi-speaking Maharashtra in the west – are staunchly proud of their local language.

The violent clashes in the state’s megacity Mumbai earlier this month were sparked by the regional government’s controversial decision to make Hindi a compulsory third language in public primary schools.

Pushback and protest has also been especially strong in the south, where English and regional languages such as Tamil, Telugu, and Kannada are valued as symbols of local identity and autonomy.

Bryanfug (doğrulanmamış) Ct, 02/08/2025 - 14:22

When Hussain AlMoosawi arrived home, he didn’t recognize anything.

The Emirati photographer, who had spent eight years studying in Australia, returned to the United Arab Emirates (UAE) in 2013. He’d missed a real estate boom of dizzying proportions: not just new buildings, but new districts.
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More than that, the buildings of his childhood were disappearing, replaced by shiny new skyscrapers.

But for AlMoosawi, these international icons were not the urban fabric of his home: it was the oft-overlooked, mid-century office towers and residential blocks squeezed between new highways and overshadowed by luxury developments that felt most familiar.

It sparked a desire to “understand the urban context of the UAE,” and AlMoosawi set out to meticulously document and capture these underappreciated buildings, “and reimagine the city as if it were the ‘80s, the time when I was born.”
https://tripscan36.org
трипскан сайт
Initially focusing on industrial landscapes, temporary structures and air conditioning units, he began to notice symmetry in many of the buildings he was photographing, inspiring his current project: facades.

“Facades are like a face,” said AlMoosawi. “It’s something that people connect with.”

His bold, geometric images strip away context to spotlight the character and diversity of everyday buildings. Using a telephoto lens to shoot close-ups from the ground or elevated positions, AlMoosawi carefully frames out distractions and sometimes removes minor obstructions like lampposts in post-processing.

So far, the 41-year-old, who is editor-in-chief for National Geographic AlArabiya Magazine, has photographed over 600 building?s across the UAE, and next year hopes to complete his collection in Abu Dhabi, where he lives.

In the long term, he hopes to turn the “lifetime project” into an interactive archive that both preserves urban heritage and invites viewers to rediscover their own city.

“Our cities aren’t big, in terms of scale, compared to many other cities,” said AlMoosawi. “But then they have a story to tell, they have things between the lines that we don’t see, and my quest is to see these things.”

Jamesgum (doğrulanmamış) Ct, 02/08/2025 - 14:40

Since India’s independence from Britain in 1947, the status of English in India has been deeply political – entwined with questions of identity, power, and national direction.

Today, English is one of several official languages in India, spoken by about 10% of the population. Hindi is the first language for around 44% of citizens, according to the 2011 census.
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But in recent years, Modi’s BJP has placed particular emphasis on promoting Hindi and reducing the use of English in public life.

The prime minister almost never delivers speeches in English, preferring Hindi for national addresses such as his monthly radio program. His administration has encouraged officials to use Hindi on social media and in government correspondence – though, after criticism from non-Hindi-speaking states, clarified that this was intended mainly for the Hindi belt in the north.
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When India hosted world leaders for the 2023 G20 summit in New Delhi, invitations were sent out from “Bharat” – the Sanskrit or Hindi name for the country – instead of “India,” fueling speculation that the government aims to ultimately phase out the country’s English designation altogether.

Modi’s critics have been quick to note his political motives behind these moves.

With its roots in the Rashtriya Swayamsevak Sangh (RSS), a right-wing organization that advocates Hindu hegemony within India, the BJP’s language policies resonate with many in a country where nearly 80% of people are Hindu.

Analysts say the BJP is seeking to capitalize on this demographic by promoting language policies that strengthen its support base in the north.

According to Rita Kothari, an English professor from Ashoka University, the government “is certainly interested in homogenizing the country and making Hindi more widespread.”

But that policy can also backfire – in part because many regions, such as Marathi-speaking Maharashtra in the west – are staunchly proud of their local language.

The violent clashes in the state’s megacity Mumbai earlier this month were sparked by the regional government’s controversial decision to make Hindi a compulsory third language in public primary schools.

Pushback and protest has also been especially strong in the south, where English and regional languages such as Tamil, Telugu, and Kannada are valued as symbols of local identity and autonomy.

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