How Many Pills Are Too Many?
吞多少藥丸才算太多？
By Austin Frakt

The point of prescription drugs is to help us get or feel well. Yet so many Americans take multiple medications that doctors are being encouraged to pause before prescribing and think about “deprescribing” as well.
處方藥的用意是幫助我們康復或感覺好些。然而卻有太多美國人同時服用多種藥物，以致醫師被鼓勵在開處方簽之前先暫停一下，也想想是否該拿掉一些藥。

The idea of dropping unnecessary medications started cropping up in the medical literature a decade ago. In recent years, evidence has mounted about the dangers of taking multiple, perhaps unnecessary, medications.
減少不必要用藥的想法10年前開始在醫學文獻中突然出現。最近幾年，有關服用多種、也許不必要的藥物有危險的證據也增加了。

Deprescribing will work only if patients also get involved in the process. Only they can report adverse effects that they sense but that are not apparent to clinicians. And they need to be comfortable weaning from or dropping drugs that they are accustomed to and believe to be helpful.
唯有在病患也參與的情況下，減開處方藥才行得通。只有病人才能陳述他們感覺到，但臨床醫師看不出來的副作用。必須讓他們對斷掉或停用他們習慣且認為有幫助的藥感覺自在。

Yet an increasing number of Americans – typically older ones with multiple chronic conditions – are taking drugs and supplements they don’t need, or so many of them that those substances are interacting with one another in harmful ways. Studies show that some patients can improve their health with fewer drugs.
但愈來愈多美國人，通常是有不只一種慢性病的年長者，正在服用他們不需要的藥物和保健品，或是服用太多種，以致這些物質以有害的方式相互作用。研究顯示，一些病人在藥物減量後健康改善。

Though many prescription drugs are highly valuable, taking them can also be dangerous, particularly taking a lot of them at once. The vast majority of higher-quality studies summarized in a systematic review on polypharmacy – the taking of multiple medications – found an association with a bad health event, like a fall, hospitalization or death.
雖然許多處方藥有很高的價值，服用卻也可能有危險，特別是一次服用很多。在一項有關多重用藥的系統性文獻整理回顧中，概述了絕大多數較高品質的研究，發現服用多種藥物，與不幸的健康事件有關，像是跌倒、住院或死亡。

About one-third of adverse events in hospitalizations include a drug-related harm, leading to longer hospital stays and greater expense. The Institute of Medicine estimated that there are 400,000 preventable adverse drug events in hospitals each year, costing $3.5 billion. One-fifth of patients discharged from the hospital have a drug-related complication after returning home, many of which are preventable.
約1/3的住院醫療不良事件包含與藥物有關的傷害，導致住院時間更長和費用更高。醫學研究院估計，醫院每年有40萬件可預防的藥物不良反應事件，耗費35億美元。出院的病人有1/5在返家後出現與藥物有關的併發症，而許多是可預防的。

Not every adverse drug event means a patient has been prescribed an unnecessary and harmful drug. But older patients are at greater risk because they tend to have more chronic conditions and take a multiplicity of medications for them. Two-thirds of Medicare beneficiaries have two or more chronic conditions, and almost half take five or more medications. Over a year, almost 20 percent take 10 or more drugs or supplements.
不是每一件藥物反應不良事件都意味對病人開了不需要和有害的藥。不過，較年長的病人有較大風險，因為他們傾向有更多慢性病，並為這些病服用多種藥物。聯邦醫療保險的受益人有2/3有兩種或多種慢性病，近半服用5種或更多藥。在一年中，近20%服用10種或更多藥和保健品。

Some are unnecessary. At least 1 in 5 older patients are on an inappropriate medication – one that they can do without or that can be switched to a different, safer drug. One study found that 44 percent of frail, older patients were prescribed at least one drug unnecessarily.
有些是不需要的。至少1/5的年長病患正在服用一種不適合的藥，他們可以不服用，或是可以換一種不同、更安全的藥。一項研究發現年邁體衰的病人，有44%被開了至少一種不必要的藥。

原文參照：
https://www.nytimes.com/2017/04/10/upshot/how-many-pills-are-too-many.html

2017-04-30．聯合報．D4．紐約時報賞析 田思怡

說文解字看新聞 田思怡

本文的主題是deprescribing（停止或減少開處方藥），處方藥的英文是prescription drugs，動詞是prescribe（開處方藥），deprescribe就是停止或減少開處方藥。例如，When patients take too many pills, doctors deprescribe.（病人服用太多藥，醫師就少開處方藥）

第6段提到adverse events指的是醫療不良事件，adverse events in hospitalization就是住院醫療不良事件，反而導致病人住院更久。adverse drug events是藥物不良事件，包括用錯藥（medication errors）、藥物不良反應（adverse drug reactions）、過敏反應（allergic reactions）以及藥物過量（overdoses）。

第7段提到Medicare（美國聯邦醫療保險），是美國聯邦政府針對65歲以上者、65歲以下的特定殘障者和末期腎衰竭病患的保險。

Edward Enninful Is Named Editor-in-Chief at British Vogue
英版Vogue雜誌 首見男總編輯
By Elizabeth Paton

Edward Enninful, the creative and fashion director of the U.S. magazine W, is set to replace Alexandra Shulman as editor-in-chief of British Vogue, its parent company, Conde Nast, confirmed Monday. The first man and the first black editor to take the helm of Britain’s most powerful fashion publication in its 100-year history, Enninful will begin his new role Aug. 1.
英國版Vogue雜誌的母公司康泰納仕4月10日證實，美國Ｗ雜誌的創意與時尚總監艾德華．恩寧佛將接替亞歷珊卓．舒爾曼，擔任該雜誌總編輯。恩寧佛將在8月1日走馬上任，他將是這個英國最有影響力的時尚刊物創立一百年來，執掌大權的第一位男性，也是第一位黑人總編輯。

A top stylist and acclaimed fashion director who migrated to Britain from Ghana as a child, the 45-year-old Enninful is known for his cheerful demeanor, his legendary fashion covers and for having an army of loyal fans in and out of the fashion business. He received an Order of the British Empire in June for his services to diversity in the fashion industry.
45歲的恩寧佛是頂尖造型師和備受讚譽的時尚總監，他孩童時期從迦納移民英國，以快活的舉止表情、傳奇的時尚雜誌封面，以及在時尚圈內和圈外擁有大批鐵粉聞名。去年6月獲頒大英帝國勳章，表彰他對時尚產業多元化的貢獻。

Conde Nast’s international chairman and chief executive, Jonathan Newhouse, called Enninful “an influential figure in the communities of fashion, Hollywood and music which shape the cultural zeitgeist,” and added that “by virtue of his talent and experience, Edward is supremely prepared to assume the responsibility of British Vogue.”
康泰納仕國際集團董事長兼執行長強納森．紐豪斯說，恩寧佛是「形塑時代思潮的時尚界、好萊塢和音樂界一位具有影響力的人物」，「憑他的才華和經驗，艾德華已為承擔英國版Vogue的責任做好了萬全的準備。」

The appointment comes three months after Newhouse named another man, Emanuele Farneti, to the helm of Italian Vogue, following the death of Franca Sozzani.
在決定這項任命的三個月前，紐豪斯任命了另一位男士艾曼紐爾．法內提出掌義大利版的Vogue，接替去世的法蘭加．索薩妮。

Enninful was an unexpected choice. Born in Ghana, Enninful was raised by his seamstress mother in the Ladbroke Grove area of London, alongside five siblings. At 16, he became a model for the British magazine i-D after being scouted while traveling on the Tube, London’s subway system. He has called modeling his “baptism into fashion.”
恩寧佛是出人意料的人選。他在迦納出生，當裁縫的母親在倫敦蘭僕林區把他和5個兄弟姊妹撫養長大。16歲時，他在搭乘倫敦地鐵時被星探相中，成為英國i-D雜誌的模特兒。他把自己的模特兒經驗稱為「進入時尚界的受洗禮」。

By 17, he was assisting on photography shoots for the publication with the stylists Simon Foxton and Beth Summers. In 1991, at 18, he took over from Summers as i-D fashion editor, making him one of the youngest-ever leaders of a major fashion publication. He also obtained a degree from Goldsmiths, University of London.
到了17歲，他協助造型師西蒙．佛克斯頓和貝絲．桑默斯為這本刊物拍攝照片。1991年18歲時，他取代桑默斯，成為i-D雜誌時尚編輯，使他成為主要時尚刊物有史以來最年輕的主管之一。他並取得倫敦大學金匠學院的文憑。

Although there are a handful of notable exceptions, the fashion industry has a dearth of black power players, and that had been a source of immense frustration for Enninful, who has made a considerable effort to improve things. He has made headlines with accusations of racism, including after he was assigned to sit in the second row at a couture show in Paris in 2013 when white “counterparts” were in the first.
雖然有少數著名的例外，時尚產業極欠缺有權力的黑人，這一直令恩寧佛極感挫折，而他已相當努力以謀求改進。他曾因指控種族歧視而上了大新聞，包括2013年在巴黎一場高級訂製服的秀上，他被指定坐在第二排，而與他「地位相當」的白人坐在第一排。

原文參照：
https://www.nytimes.com/2017/04/10/fashion/edward-enninful-is-named-editor-in-chief-at-british-vogue.html

2017-04-30．聯合報．D4．紐約時報賞析 田思怡