「事業仕分け」で漢方薬を保険適用外とする結論について
事業仕分けで漢方薬を保険適応外にしろという議論が出た.あったまにきた.おれがみている患者さんたちに,死ね,といっていることだからだ.MRIC 医療ガバナンス学会に投稿した.こちらにも転送しておく.
もう一歩先,にいきたいとき,漢方薬はとても便利.救われない,救うことができない,とされたひとたちを救うことができる.それを,やめろと.人殺しの結論は,撤回していただきたい.
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▽「事業仕分け」で漢方薬を保険適用外とする結論 ▽
佐久総合病院附属小海診療所 後期研修医
小池宙
2009年11月22日 MRIC by 医療ガバナンス学会 http://medg.jp
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『内閣府の行政刷新会議が実施した「事業仕分け」を受け、漢方薬等の市販品類似薬を保険適用外とする方向性で結論が下された』
ニュースを読んだとき、眼を疑った。次に患者さんたちの顔が浮かび、そして怒りと
悲しさがわいてきた。
自分はまだ医者として4年目、漢方薬を少しずつ使い始めて2年目程度。しかしその
短い経験の中でも、漢方薬を使わなければなくなられてきた方を私は何人も見てきた。
たとえば先週CVポート(高濃度の栄養剤を点滴するための器具)を抜去した患者さ
んも、そんなひとり。
大腸穿孔の手術後に大きく衰弱、その後も絞扼性イレウスで小腸を半分以上切除、そ
の後重度の食欲不振となりほんとんど食事を取れない状態で、CVポートからの連日の
点滴という状態で在宅診療導入となった。毎日の点滴がつらく、ほとんど食べれないの
に点滴をはずしたいとよくおっしゃっていた。何とかしたく、六君子湯と大建中湯をそ
れぞれ1包ずつ内服とした。その数日後電話すると、飲むとおなかが痛くなるからやめ
た、とのこと。仕方がないなとしばらくみていたところ、娘から強く勧められてしぶし
ぶのむようにしたところ徐々に食欲回復、毎日三食、小さな茶碗に1杯ずつ食べれるな
っていた。そんな状態で、ポートが感染し、点滴をすると発熱するようになった。食事
を取れるようになっていたので問題なく抜去することができた。もし、この患者さんに
漢方薬を使わなければこの方の食欲は回復することはなく、食事が取れなければポート
を抜くことが難しかった。なにより、漢方薬にて食事のおいしさをまた味わうことがで
きるようになったのは、診療させていただいていてとてもうれしかった。
他にも漢方薬で元気になったいろいろな患者さんをみた。たとえば、膵臓癌手術後の
重度の食欲不振、胃がないので腸ろうを作成し栄養剤投与していても吸収せず、蛋白質
の低下から全身浮腫と胸水進行し入院となった患者さんも印象的だった。利尿剤でも改
善しなかった全身浮腫が真武湯で改善。その後も血中の蛋白質が増えなかったため人参
養栄湯を使ったところ、徐々に蛋白質増加し状態安定。念願の家に帰ることができた。
重度の心・腎不全で点滴での治療をどうしてもやめることができず退院することがで
きなかった患者さんで、牛車腎気丸を使ったところ、浮腫が取れ点滴から離脱できた方
を、2例みた。
老衰による食欲低下で状態悪化しているひとで、六君子湯を飲んだところまた食べる
ようになった人を何人もみた。
進行乳がん、乳房は崩れ肺にまで癌が進行したがホルモン療法でなんとか進行を抑え
ることができた方も記憶に強く残っている。癌は抑えることはできても全身衰弱強度。
ベッドに起き上がるのがやっとお風呂すら介助なしには入れない状態で家に帰り、在宅
診療が始まった。六君子湯と当帰芍薬散を使ったところ徐々に元気になり散歩もできる
ようになったため、半年後の今は私の外来に歩いて通ってきている。
今自分は在宅診療を中心に仕事をしている。在宅にはいろいろな意味で限界の状態で
生活されている患者さんばかりだ。がん患者さんも多い。そういった方たちには漢方を
上手に使うと、元気にまた生きて行けるひとが多くいる。漢方を保険からはずすことは、
本来生きることができるひとたちを殺すこと。先に示した患者さんたちを殺す決定。そ
んな決定には、患者さんたちのの元気を望む医者として認めることはできない。再検討
いただきたい。
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今回の記事は転送歓迎します。その際にはMRICの記事である旨ご紹介いただけましたら幸いです。
MRIC by 医療ガバナンス学会
http://medg.jp
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