【英语语言学习】大麻的药用价值
时间：2019-01-24 作者：英语课 分类：英语语言学习
英语课
Norman Swan: Hello, and welcome to the Health Report with me, Norman Swan. Today, your heart and your genes 1. Most people think of congenital heart disease as heart abnormalities which affect babies. But in fact it's a bigger problem for adults and many issues don't emerge till you're older. A fascinating study using massive data to do some genetic 2 detective work.
Plus, speaking of detective work, a map of autism spectrum 3 disorder 4 in children which tells us a lot about genes and the environment.
And cannabis and the push to have it legalised for medical uses. It's got the support of the Prime Minister and most states and NSW is leading a trial.
Given all the advocacy going on you'd think that there's heaps of evidence that cannabis works for things like pain and nausea 5, but a recent review suggests that may not be the case. One of the authors is Professor Mike Farrell who's director of the National Drug and Alcohol Research Centre at the University of NSW, and he's with me in the studio now. Welcome to the Health Report.
Michael Farrell: Hello.
Norman Swan: What worries you about this, Michael?
Michael Farrell: Well, I think what we need to do is we need a balanced and measured approach to the evidence around treatment efficacy. So one of the things that worries me is when we've got this discussion that we are not actually looking hard enough at the evidence. One of the problems is that some of these conditions are hard to research and measure, for instance pain is a very subjective 6 thing, so actually getting very good measures of pain and understanding where the effects are can be quite complicated.
Norman Swan: I mean, we haven't even studied Panadol properly.
Michael Farrell: We have all sorts of problems with chronic 7 pain, even understanding the nature of pain and why we should medicate it or what we should do and what's best is a very broad discussion.
Norman Swan: So let's go through the evidence and let's start with pain. What is the evidence that cannabis has any effect on pain?
Michael Farrell: Well, the evidence is conflictual. There are a number of studies that show positive effects and there's a number of studies that show really…if you want to summarise 8 it, the evidence at the moment is quite modest for pain. Probably the best evidence is around multiple sclerosis and using it for spasm 9 and some of the spasm pain in multiple sclerosis, and that's where the cannabis type medications have in quite a number of countries been authorised for medical use.
Norman Swan: A lot of people don't realise there have been cannabis type medications authorised for use for over 30 years. The United States has got one and Europe and Britain have got others. We don't have any here I don't think.
Michael Farrell: No, dronabinol has never really…which was one of the first ones to be a synthetic 10 cannabinoid that was authorised, but it has never really been put to great use, it has never been shown to be…whereas some of the newer ones like nabiximol which is actually derived 11 directly from the plant THC and CBD is probably more user-friendly and more acceptable from a patient user point of view.
Norman Swan: So that's pain. The jury is out on pain. It doesn't look as if…if there is an effect it's going to be relatively 12 small. What about nausea and vomiting 13? Because I think that was the first indication for cannabis or a cannabis derived compound almost 30 years ago.
Michael Farrell: That's right, and that's where dronabinol and these ones came in. One of the complexities 14 of it is when you look…you are actually not just looking for efficacy, you are looking at comparative efficacy. And some of the other medication for nausea in the cancer field has come on in great leaps and bounds in the last 30 years, so actually it's putting really cannabis on the back foot from that point of view…
Norman Swan: Meaning they are more effective with fewer side effects.
Michael Farrell: Yes, that's one of the issues, is that you are having more effective medications. So from that point of view where cannabis now fits in in comparison to years ago is far more…again the jury is out on it.
Norman Swan: Another area of use, because you get the munchies, proverbially, if you smoke marijuana or consume marijuana therefore you eat more, was appetite stimulation 15, particularly in weight loss conditions like when you've got established AIDS.
Michael Farrell: Yes, and there was great interest in that and there's been a number of studies done, but of course it is again confounded by the introduction of AZT, which is actually a very effective treatment for HIV.
Norman Swan: So when the antiretrovirals came in, people put on weight.
Michael Farrell: That's right, so then the potential role of something like cannabis really moved into the back seat, and there hasn't been a lot more work advanced on it, primarily because of the effectiveness of AZT.
Norman Swan: What other uses to which has it been put?
Michael Farrell: Well, there's discussion about, for instance might it be used in dementia for cognitive 16 protection. There is no great evidence that it does that but…
Norman Swan: I thought it caused cognitive decline.
Michael Farrell: Well, that's what some people would think, but then other people are arguing that maybe the CBD component 17 might be neuroprotective.
Norman Swan: CBD?
Michael Farrell: It's the other component besides THC of cannabis, and it's the one that doesn't actually have psychotic properties, so there's a lot of interest in it.
Norman Swan: We'll come to side-effects in a moment, but some of the people who say, well, you know the evidence isn't strong because you're testing the wrong compound, and if you smoke cannabis then you are getting the whole natural compound and the things that work, whereas when you synthesise it you are not necessarily getting the things that work.
Michael Farrell: Yes, that's where the THC and CBD, the medications derived from the plants themselves, may have a benefit, but it has to be said that there are studies and…
Norman Swan: Well, people say the other way around, that smoking has more benefit than synthetic…
Michael Farrell: Well, they do, but there's one very authoritative 18 systematic 19 review just published as the American College of Pain Guidelines, and basically…smoked cannabis comes out worse of all the different varieties in relation to evidence for benefit.
Norman Swan: Even with its powerful placebo 20 effect? Because obviously there is a huge placebo in the whole business of taking it.
Michael Farrell: Well, I suspect that may be different for people with…one of the things we probably need to distinguish is people who have had experience taking cannabis as compared to people who would be taking cannabis for the first time as a medication.
Norman Swan: So what are the issues around that?
Michael Farrell: Well, the issues around that are the psychoactive effects, you know, that somebody who has acquainted themselves with cannabis may see as desirable, but if you've never had them you may not actually want any of these psychoactive effects, and that you may experience them as very unpleasant and adverse 21. And that could be either a slight euphoria, it could be anxiety, or it could be nausea even. You know, there's a range of different things. Or it could be more a sense of derealisation. There's a range of effects that you can have with cannabis.
Norman Swan: So what’s the risk of psychosis if you're 65, you are told you've got a year to live with your cancer and you think, what the heck, I'm going to take cannabis?
Michael Farrell: That's probably way down the list of risks from that point of view. The risk is pretty…the risk of psychosis with cannabis we know is pretty modest anyway. It's not so modest if you actually have a strong family history of psychosis, but without that the risk is pretty modest. You're probably more concerned about other side-effects, like anxiety, mood disorders 22 and potentially getting subjective effects, that you feel out of control, and they're just decidedly unpleasant unless you've had previous experience.
Norman Swan: One thing I was wondering about is you get this amotivational syndrome 23 where you are not really motivated to do stuff, whether that's an adolescent issue in cannabis I don't know, but whether or not you…you know, if you're undergoing cancer care and you start smoking dope, whether you think, oh well, I don't really need to have my chemo anymore, and you could be denying yourself treatment.
Michael Farrell: Well, one of the concerns around people using it for MS is that it may be associated with cognitive decline in MS. So that's one of the potential adverse effects of using it with MS. But that has to be offset 24 with the benefits of pain and spasm reduction.
Norman Swan: And if you're 40 and got chronic pain and you are going to be taking it long-term, and smoking it, what are the risks to your lungs?
Michael Farrell: Well, at 40 probably modest. You may not have to smoke it. There are…you could take nabiximols, like what we call Sativex, which is now licensed 25 in Australia, it's primarily licensed for multiple sclerosis, but there may be the opportunity to use it off-licence for particular individuals. And I think the risks are far more around anxiety, mood disorders and the more common mental disorders and other subjective side-effects rather than psychosis or that.
Norman Swan: So New South Wales is leading a trial for the other state governments. I think the ACT has come on board, Victoria is supportive, and I think people at Monash University are advising on this trial. Is it going to answer any questions in terms of how well it works?
Michael Farrell: Well, it possibly could. The message we think clearly is that we need more research to see where the efficacy lies, and if well designed trials are put in place, along with other international trials that are rigorous and really properly…modern designed trials, they will add to the body of evidence. And one of the things we need is a good body of evidence so that we've got less of this sort of either exaggerated claims of benefit or exaggerated negative claims about the harmful effects, and just trying to find a real middle way between that.
Norman Swan: Now, just signalling that I'm going to be talking about this on the Health Report today I've already got my email bag and people are saying I'm just a tool of the pharmaceutical 26 industry, this is a plot to deny people a natural medication that's going to help them enormously.
Michael Farrell: Well, the complication of it is what is a natural product that can be consumed for recreational purposes and what then is an agent, a medication with defined efficacy, are two different questions. So people wishing to use this as adjunctive usage for subjective sense of betterment is one thing, but actually it being a clearly defined therapeutic 27 agent needs far closer scrutiny 28 before those claims can be made.
Norman Swan: So beware of the bandwagon. Michael Farrell, thank you very much indeed.
Michael Farrell: Thank you.
Norman Swan: Mike Farrell is director of the National Drug and Alcohol Research Centre at the University of NSW.
Plus, speaking of detective work, a map of autism spectrum 3 disorder 4 in children which tells us a lot about genes and the environment.
And cannabis and the push to have it legalised for medical uses. It's got the support of the Prime Minister and most states and NSW is leading a trial.
Given all the advocacy going on you'd think that there's heaps of evidence that cannabis works for things like pain and nausea 5, but a recent review suggests that may not be the case. One of the authors is Professor Mike Farrell who's director of the National Drug and Alcohol Research Centre at the University of NSW, and he's with me in the studio now. Welcome to the Health Report.
Michael Farrell: Hello.
Norman Swan: What worries you about this, Michael?
Michael Farrell: Well, I think what we need to do is we need a balanced and measured approach to the evidence around treatment efficacy. So one of the things that worries me is when we've got this discussion that we are not actually looking hard enough at the evidence. One of the problems is that some of these conditions are hard to research and measure, for instance pain is a very subjective 6 thing, so actually getting very good measures of pain and understanding where the effects are can be quite complicated.
Norman Swan: I mean, we haven't even studied Panadol properly.
Michael Farrell: We have all sorts of problems with chronic 7 pain, even understanding the nature of pain and why we should medicate it or what we should do and what's best is a very broad discussion.
Norman Swan: So let's go through the evidence and let's start with pain. What is the evidence that cannabis has any effect on pain?
Michael Farrell: Well, the evidence is conflictual. There are a number of studies that show positive effects and there's a number of studies that show really…if you want to summarise 8 it, the evidence at the moment is quite modest for pain. Probably the best evidence is around multiple sclerosis and using it for spasm 9 and some of the spasm pain in multiple sclerosis, and that's where the cannabis type medications have in quite a number of countries been authorised for medical use.
Norman Swan: A lot of people don't realise there have been cannabis type medications authorised for use for over 30 years. The United States has got one and Europe and Britain have got others. We don't have any here I don't think.
Michael Farrell: No, dronabinol has never really…which was one of the first ones to be a synthetic 10 cannabinoid that was authorised, but it has never really been put to great use, it has never been shown to be…whereas some of the newer ones like nabiximol which is actually derived 11 directly from the plant THC and CBD is probably more user-friendly and more acceptable from a patient user point of view.
Norman Swan: So that's pain. The jury is out on pain. It doesn't look as if…if there is an effect it's going to be relatively 12 small. What about nausea and vomiting 13? Because I think that was the first indication for cannabis or a cannabis derived compound almost 30 years ago.
Michael Farrell: That's right, and that's where dronabinol and these ones came in. One of the complexities 14 of it is when you look…you are actually not just looking for efficacy, you are looking at comparative efficacy. And some of the other medication for nausea in the cancer field has come on in great leaps and bounds in the last 30 years, so actually it's putting really cannabis on the back foot from that point of view…
Norman Swan: Meaning they are more effective with fewer side effects.
Michael Farrell: Yes, that's one of the issues, is that you are having more effective medications. So from that point of view where cannabis now fits in in comparison to years ago is far more…again the jury is out on it.
Norman Swan: Another area of use, because you get the munchies, proverbially, if you smoke marijuana or consume marijuana therefore you eat more, was appetite stimulation 15, particularly in weight loss conditions like when you've got established AIDS.
Michael Farrell: Yes, and there was great interest in that and there's been a number of studies done, but of course it is again confounded by the introduction of AZT, which is actually a very effective treatment for HIV.
Norman Swan: So when the antiretrovirals came in, people put on weight.
Michael Farrell: That's right, so then the potential role of something like cannabis really moved into the back seat, and there hasn't been a lot more work advanced on it, primarily because of the effectiveness of AZT.
Norman Swan: What other uses to which has it been put?
Michael Farrell: Well, there's discussion about, for instance might it be used in dementia for cognitive 16 protection. There is no great evidence that it does that but…
Norman Swan: I thought it caused cognitive decline.
Michael Farrell: Well, that's what some people would think, but then other people are arguing that maybe the CBD component 17 might be neuroprotective.
Norman Swan: CBD?
Michael Farrell: It's the other component besides THC of cannabis, and it's the one that doesn't actually have psychotic properties, so there's a lot of interest in it.
Norman Swan: We'll come to side-effects in a moment, but some of the people who say, well, you know the evidence isn't strong because you're testing the wrong compound, and if you smoke cannabis then you are getting the whole natural compound and the things that work, whereas when you synthesise it you are not necessarily getting the things that work.
Michael Farrell: Yes, that's where the THC and CBD, the medications derived from the plants themselves, may have a benefit, but it has to be said that there are studies and…
Norman Swan: Well, people say the other way around, that smoking has more benefit than synthetic…
Michael Farrell: Well, they do, but there's one very authoritative 18 systematic 19 review just published as the American College of Pain Guidelines, and basically…smoked cannabis comes out worse of all the different varieties in relation to evidence for benefit.
Norman Swan: Even with its powerful placebo 20 effect? Because obviously there is a huge placebo in the whole business of taking it.
Michael Farrell: Well, I suspect that may be different for people with…one of the things we probably need to distinguish is people who have had experience taking cannabis as compared to people who would be taking cannabis for the first time as a medication.
Norman Swan: So what are the issues around that?
Michael Farrell: Well, the issues around that are the psychoactive effects, you know, that somebody who has acquainted themselves with cannabis may see as desirable, but if you've never had them you may not actually want any of these psychoactive effects, and that you may experience them as very unpleasant and adverse 21. And that could be either a slight euphoria, it could be anxiety, or it could be nausea even. You know, there's a range of different things. Or it could be more a sense of derealisation. There's a range of effects that you can have with cannabis.
Norman Swan: So what’s the risk of psychosis if you're 65, you are told you've got a year to live with your cancer and you think, what the heck, I'm going to take cannabis?
Michael Farrell: That's probably way down the list of risks from that point of view. The risk is pretty…the risk of psychosis with cannabis we know is pretty modest anyway. It's not so modest if you actually have a strong family history of psychosis, but without that the risk is pretty modest. You're probably more concerned about other side-effects, like anxiety, mood disorders 22 and potentially getting subjective effects, that you feel out of control, and they're just decidedly unpleasant unless you've had previous experience.
Norman Swan: One thing I was wondering about is you get this amotivational syndrome 23 where you are not really motivated to do stuff, whether that's an adolescent issue in cannabis I don't know, but whether or not you…you know, if you're undergoing cancer care and you start smoking dope, whether you think, oh well, I don't really need to have my chemo anymore, and you could be denying yourself treatment.
Michael Farrell: Well, one of the concerns around people using it for MS is that it may be associated with cognitive decline in MS. So that's one of the potential adverse effects of using it with MS. But that has to be offset 24 with the benefits of pain and spasm reduction.
Norman Swan: And if you're 40 and got chronic pain and you are going to be taking it long-term, and smoking it, what are the risks to your lungs?
Michael Farrell: Well, at 40 probably modest. You may not have to smoke it. There are…you could take nabiximols, like what we call Sativex, which is now licensed 25 in Australia, it's primarily licensed for multiple sclerosis, but there may be the opportunity to use it off-licence for particular individuals. And I think the risks are far more around anxiety, mood disorders and the more common mental disorders and other subjective side-effects rather than psychosis or that.
Norman Swan: So New South Wales is leading a trial for the other state governments. I think the ACT has come on board, Victoria is supportive, and I think people at Monash University are advising on this trial. Is it going to answer any questions in terms of how well it works?
Michael Farrell: Well, it possibly could. The message we think clearly is that we need more research to see where the efficacy lies, and if well designed trials are put in place, along with other international trials that are rigorous and really properly…modern designed trials, they will add to the body of evidence. And one of the things we need is a good body of evidence so that we've got less of this sort of either exaggerated claims of benefit or exaggerated negative claims about the harmful effects, and just trying to find a real middle way between that.
Norman Swan: Now, just signalling that I'm going to be talking about this on the Health Report today I've already got my email bag and people are saying I'm just a tool of the pharmaceutical 26 industry, this is a plot to deny people a natural medication that's going to help them enormously.
Michael Farrell: Well, the complication of it is what is a natural product that can be consumed for recreational purposes and what then is an agent, a medication with defined efficacy, are two different questions. So people wishing to use this as adjunctive usage for subjective sense of betterment is one thing, but actually it being a clearly defined therapeutic 27 agent needs far closer scrutiny 28 before those claims can be made.
Norman Swan: So beware of the bandwagon. Michael Farrell, thank you very much indeed.
Michael Farrell: Thank you.
Norman Swan: Mike Farrell is director of the National Drug and Alcohol Research Centre at the University of NSW.
n.基因( gene的名词复数 )
- You have good genes from your parents, so you should live a long time. 你从父母那儿获得优良的基因，所以能够活得很长。 来自《简明英汉词典》
- Differences will help to reveal the functions of the genes. 它们间的差异将会帮助我们揭开基因多种功能。 来自英汉非文学 - 生命科学 - 生物技术的世纪
adj.遗传的，遗传学的
- It's very difficult to treat genetic diseases.遗传性疾病治疗起来很困难。
- Each daughter cell can receive a full complement of the genetic information.每个子细胞可以收到遗传信息的一个完全补偿物。
n.谱，光谱，频谱；范围，幅度，系列
- This is a kind of atomic spectrum.这是一种原子光谱。
- We have known much of the constitution of the solar spectrum.关于太阳光谱的构成，我们已了解不少。
n.紊乱，混乱；骚动，骚乱；疾病，失调
- When returning back,he discovered the room to be in disorder.回家后，他发现屋子里乱七八糟。
- It contained a vast number of letters in great disorder.里面七零八落地装着许多信件。
n.作呕，恶心；极端的憎恶(或厌恶)
- Early pregnancy is often accompanied by nausea.怀孕期常有恶心的现象。
- He experienced nausea after eating octopus.吃了章鱼后他感到恶心。
a.主观(上)的，个人的
- The way they interpreted their past was highly subjective. 他们解释其过去的方式太主观。
- A literary critic should not be too subjective in his approach. 文学评论家的看法不应太主观。
adj.(疾病)长期未愈的，慢性的；极坏的
- Famine differs from chronic malnutrition.饥荒不同于慢性营养不良。
- Chronic poisoning may lead to death from inanition.慢性中毒也可能由虚弱导致死亡。
vt.概括，总结
- I will summarise what I have done.我将概述我所做的事情。
- Of course,no one article can summarise the complexities of china today.当然，没有哪一篇文章能概括出中国今日的复杂性。
n.痉挛，抽搐；一阵发作
- When the spasm passed,it left him weak and sweating.一阵痉挛之后，他虚弱无力，一直冒汗。
- He kicked the chair in a spasm of impatience.他突然变得不耐烦，一脚踢向椅子。
adj.合成的，人工的；综合的；n.人工制品
- We felt the salesman's synthetic friendliness.我们感觉到那位销售员的虚情假意。
- It's a synthetic diamond.这是人造钻石。
vi.起源；由来；衍生；导出v.得到( derive的过去式和过去分词 )；（从…中）得到获得；源于；（从…中）提取
- Many English words are derived from Latin and Greek. 英语很多词源出于拉丁文和希腊文。 来自《简明英汉词典》
- He derived his enthusiasm for literature from his father. 他对文学的爱好是受他父亲的影响。 来自《简明英汉词典》
adv.比较...地，相对地
- The rabbit is a relatively recent introduction in Australia.兔子是相对较新引入澳大利亚的物种。
- The operation was relatively painless.手术相对来说不痛。
吐
- Symptoms include diarrhoea and vomiting. 症状有腹泻和呕吐。
- Especially when I feel seasick, I can't stand watching someone else vomiting." 尤其晕船的时候，看不得人家呕。”
复杂性(complexity的名词复数)； 复杂的事物
- The complexities of life bothered him. 生活的复杂使他困惑。
- The complexities of life bothered me. 生活的杂乱事儿使我心烦。
n.刺激，激励，鼓舞
- The playgroup provides plenty of stimulation for the children.幼儿游戏组给孩子很多启发。
- You don't get any intellectual stimulation in this job.你不能从这份工作中获得任何智力启发。
adj.认知的，认识的，有感知的
- As children grow older,their cognitive processes become sharper.孩子们越长越大，他们的认知过程变得更为敏锐。
- The cognitive psychologist is like the tinker who wants to know how a clock works.认知心理学者倒很像一个需要通晓钟表如何运转的钟表修理匠。
n.组成部分，成分，元件；adj.组成的，合成的
- Each component is carefully checked before assembly.每个零件在装配前都经过仔细检查。
- Blade and handle are the component parts of a knife.刀身和刀柄是一把刀的组成部分。
adj.有权威的，可相信的；命令式的；官方的
- David speaks in an authoritative tone.大卫以命令的口吻说话。
- Her smile was warm but authoritative.她的笑容很和蔼，同时又透着威严。
adj.有系统的，有计划的，有方法的
- The way he works isn't very systematic.他的工作不是很有条理。
- The teacher made a systematic work of teaching.这个教师进行系统的教学工作。
n.安慰剂；宽慰话
- The placebo has been found to work with a lot of different cases.人们已发现安慰剂能在很多不同的病例中发挥作用。
- The placebo effect refers to all the observable behaviors caused by placebo.安慰剂效应是指由安慰剂所引起的可观察的行为。
adj.不利的；有害的；敌对的，不友好的
- He is adverse to going abroad.他反对出国。
- The improper use of medicine could lead to severe adverse reactions.用药不当会产生严重的不良反应。
n.混乱( disorder的名词复数 )；凌乱；骚乱；（身心、机能）失调
- Reports of anorexia and other eating disorders are on the increase. 据报告，厌食症和其他饮食方面的功能紊乱发生率正在不断增长。 来自《简明英汉词典》
- The announcement led to violent civil disorders. 这项宣布引起剧烈的骚乱。 来自《简明英汉词典》
n.综合病症；并存特性
- The Institute says that an unidentified virus is to blame for the syndrome. 该研究所表示,引起这种综合症的是一种尚未确认的病毒。
- Results indicated that 11 fetuses had Down syndrome. 结果表明有11个胎儿患有唐氏综合征。
n.分支，补偿；v.抵消，补偿
- Their wage increases would be offset by higher prices.他们增加的工资会被物价上涨所抵消。
- He put up his prices to offset the increased cost of materials.他提高了售价以补偿材料成本的增加。
adj.得到许可的v.许可，颁发执照(license的过去式和过去分词)
- The new drug has not yet been licensed in the US. 这种新药尚未在美国获得许可。
- Is that gun licensed? 那支枪有持枪执照吗？
adj.药学的，药物的；药用的，药剂师的
- She has donated money to establish a pharmaceutical laboratory.她捐款成立了一个药剂实验室。
- We are engaged in a legal tussle with a large pharmaceutical company.我们正同一家大制药公司闹法律纠纷。
adj.治疗的，起治疗作用的；对身心健康有益的
- Therapeutic measures were selected to fit the patient.选择治疗措施以适应病人的需要。
- When I was sad,music had a therapeutic effect.我悲伤的时候，音乐有治疗效力。