medicine (2) : 死 - 2 QALY

Va'esse deireádh aep eigean, va'esse eigh faidh'ar

上篇留底咗兩個 key notes

1. QALY - Quality-Adjusted-Life-Years
2. //對於死，到底你有乜野睇法？上面講嘅只係肉體嘅死，另一種departure嘅表達。//

如果你唔係讀health science, 可能會對QALY有啲陌生。

QALYs are calculated by multiplying length of time spent in a given health state by the utility associated with state.

QALY 嘅ideoloy https://www.researchgate.net/publication/302485082_The_Limitations_of_QALY_A_Literature_Review

 

簡而言之，做人慘過做狗，個QALY就會低。

咁點解QALY咁重要？我舉個例子，香港買樓冇四五百萬唔駛諗，所以畀完首期之後接落黎嗰幾十年就係用黎供樓。當你供完層樓之後，你會發現到幾樣野

1. 你唔再候生
2. 你身邊嘅朋友唔係走曬就係死咗
3. 周身病痛 e.g. hypertension, hypercholestrolaemia, glaucoma, cognitive declination, depression, diabetes, occupational injuries (e.g. plantar fasciitis), anxiety, insomnia ...etc

from google

當然呢個例子好撚pessimistic，但換個角度睇，好多野都會受到physical 嘅局限而發揮唔到。亦都因為咁，我唔介意你係到包拗頸：

1. 識新朋友
2. 改變自己諗法
3. etc

林林總總嘅說法都係非常之stoic, 但係你會想老咗之後過住經常改變嘅環境，定係咁個地方抖下就算？可能候生有動力嗰陣唔介意去再適應，去experience新嘅野。但係到老嗰陣乜撚野動力都冇曬，到時點樣再去adopt 新嘅環境？（所以係呢度我好撚同情時下被稱為廢老嘅人 i.e. 低學歷，patriotic, 低socio-economic status ...etc。subliminally, 人地唔係為咗你年輕/意見不同想反你，純粹係時日無多，搞咁撚多野最終都係搞到佢。）

係呢個咁瘋狂嘅時代出世，你有冇問過自己生存嘅意義？可能QALY只係能夠用係健康&壽命嘅association, 不過諗下冇錢睇醫生搞到健康差又短命，咁multidimensional如果有其他parameters 去量度"QALY"真係唔出奇。

講返QALY嘅計法，我諗你都聽講生不如死/慘過食兩舊屎嘅講法，以下係個例子

...The appropriateness of the QALY arithmetical operation is compromised by the essence of the utility scale: while life-years are expressed in a ratio scale with a true zero, the utility is an interval scale where 0 is an arbitrary value for death ...

The possibility of combining quantity and quality of life in a single index can be combined is based on the idea that the quality of life can be quantified by applying the concept of "utility" [8], a concept rooted in the school of political philosophy known as utilitarianism. Consumer Choice Theory likewise describes how consumers decide what to buy on the basis of two fundamental elements: their budget constraints and their preferences. Consumer preferences for different consumables are also often represented by the concept of "utility"...  - PMC317370

當年有人問個prof. utility 有冇可能係負數。As mentioned above, 當你人生慘過死嘅時候就會係負數。

亦都因為咁，你問我打成世工然後等死係唔係慘過死，我可以答你好多野都係好subjective. 

• 愛可以大過一切
• 食 (re: 雞翼魚蛋湯)
  
  
  嫌母煮雞翼魚蛋湯10 歲女圖跳樓, apple daily
• 事業
• foreseeability
• 平凡
• Democracy
• Shared belief
• etc

你點value, 最後都係好depends on 你個background/ personal experience... 

既然係講死，點解要講生存？你唔覺得呢對concept係好of dualism架咩？我曾經做過一個clinical intervention, 關於一個八張野嘅阿婆長期食proton pump inhibitor (e.g. Nexium)。當然求祈都嗡到long term side-effects e.g. 唔夠Vitamin B12, osteopenia, Clostridium difficile–associated diarrhea ... 但同時個醫生又係硬頸到仆街，之前metformin/diclofenac O.D. 都要屌返我轉頭。所以我嗰陣只可以advise 病人拎張info 質個醫生。

不過諗返：成八十幾歲人，又做埋full-hip replacement, 行又行唔到，又周身病痛，你問我佢仲剩返幾耐時間？當然唔建議佢日日食PPI, 不過食唔食都係嗰頭近，點解唔畀佢食？起碼做到symptomatic relief. 

所以你問我medicine 嘅出現係件好事定壞事？有辣有唔辣，不過有時我諗：吊住條命，我覺得真係慘過去死。

//對於死，到底你有乜野睇法？上面講嘅只係肉體嘅死，另一種departure嘅表達。//

下篇先再講啦