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Drug Shortages Create Ethics Issue


PBS NewsHour - January 29, 2016 处方药短缺迫使医生做出困难的限额配给决定。 Prescription drug shortages force doctors to make difficult rationing decisions.

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Hari Sreenivasan, Anchor, PBS NewsHour: Now, how some shortages of some prescription drugs are forcing doctors to make difficult [and] often ethically-fraught decisions. In some cases, choosing one patient over another to receive a much-needed drug, or splitting a single dose between two [or] even three patients. For a look at what's behind the rationing [and] how doctors and their patients are coping and what might be done to correct the problem, we turn to Sheri Fink of The New York Times, who's been reporting on this story. In addition to being a reporter, she is also a medical doctor. Dr. Fink, what's interesting is [that] you're talking about some of the best hospitals in the country that are going through this, not a small, faraway hospital where you might expect that there'd be a shortage. Paint us a picture of how widespread this issue is.
Sheri Fink, Reporter, The New York Times: The shortages are affecting all types of hospitals [and] clinics [and] a broad range of medical specialities. It has touched in recent years - this problem - has touched just about everywhere in America.
HS: So, why is it happening? Is it specific types of drugs? Is it specific companies?
SF: It has to do with some of the drugs often are made by only one manufacturer, so if something goes wrong in a quality sense, for example, and they have to shut down production, that could leave the market not having enough. It could be that there's not an economic incentive for a lot of drug companies to get into this. It could be that manufacturing chains in the factories are running all the time, and if one goes down, it can affect lots of different drugs. So, there are economic reasons, there are regulatory reasons, there are all sorts of reasons, and these shortages are becoming a fact of life. They have increased. In recent years, the number of new shortages increased. New federal law requiring manufacturers to tell the FDA (Food and Drug Administration) if they see something like this on the horizon, have decreased the number of new shortages, but the number of existing shortages is quite high, and it, again, it's affecting all different parts of medicine.
HS: All right. So, there's a hospital facing a tough choice, saying, "We have," let's say, "five patients that need this drug, [but] we only have enough drugs for two patients." What do they do?
SF: This is the part that we don't see, because of course, the doctors don't want to make patients feel less trustful of their treatment. And these are these tough ethical decisions, as you said. How do you make these choices? These are not purely medical choices. They have ethical overtones. They have overtones of values. For example, some of the doctors were describing to me about in some cases a drug is used for children and adults, and maybe children need less of it, so could you treat two children with the same amount of drug that you treat one adult? How do you make that value judgment between lives? It's very difficult.
HS: So, if they're using age as a factor, do they use weight as a factor? Do they use the existing condition of the patient as a factor?
SF: All of the above. And, the point of my investigation - and I've been looking at this for a few years - is that it is being done all sorts of ways. There is no one way. There are very few guidelines. Today, a group of children's cancer doctors actually published rationing guidelines, because children's cancer, of all the compelling parts of our medical system, that has been hit by shortages in recent years, and these doctors were so worried, and they had so little ethical guidance, that they said, "Let's get together for a few years, work this through, get ethicists involved, get patient representatives involved, and come out with some strategies to offer to doctors who have to make these decisions, or who may have to make them."
HS: One of the quotes you have in your story is, "We've been forced into what we think is a highly unethical corner." I mean, you actually profile, one of the characters in your story is somebody that is essentially working on inventory in the basement of the Cleveland hospital (sic), and he is in a position to decide which one of his clinics, and which doctors, and eventually, which patients will get these drugs.
SF: Yeah, that quote was from Peter Adamson - Dr. Peter Adamson - [of] the Children's Oncology Group (COG), which is the group that came out with these guidelines in the journal of the National Cancer Institute (NCI). And, the person you're speaking about is Chris Snyder. So, the Cleveland Clinic has been unusually proactive. They have hired a full-time pharmacist, pretty much just to deal with these shortages in recent years. And so, Chris Snyder is scurrying around the basement of the Cleveland Clinic, staying on top of these drug shortages and trying...the first step, of course, is to conserve, it's to wipe out any waste that you might have in your system, and to maximize, so that you don't have to make those tragic choices. But ultimately, sometimes they have had to put restrictions on which uses, which groups of patients would get a drug and which wouldn't.
HS: So, what about the patients in all this? You're saying that oftentimes, they don't even know that the medicine is being rationed toward or away from them.
SF: That's right. Sometimes they're not being told. A lot of times they're not being told. Doctors told me that they don't want to worry a patient. There is a patient I wrote about - her name is Bev - and she has Crohn's disease, and she relies on intravenous nutrition. So, she can't eat like you and I do. And, they cut...during a shortage period that affected many elements of her nutrition, she wasn't told she wasn't getting zinc, and she came up with a horrible rash, ended up in the hospital, and then found out that this was a classic symptom of zinc deficiency. And, she said, "Why didn't anybody tell me?" So, this is just one example of people finding out after. There are many cases where patients just aren't being told, and this is another ethical dimension is: Should patients be told? At what point? And, how does a doctor explain the relative risks of a substitute drug versus the standard drug? It's all very complicated...(HS: Sheri Fink of The New York Times, thanks so much.)...Thank you.

  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    (sic) (原文如此)◆〈拉丁语〉sic erat scriptum (thus was it written)
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    administration 【名词】1. 管理,经营;行政 2. 行政机关,局[处、署];(A- 主美)政府; 3. 给与;施行; 4. 给药,(药的)服法; 5. 【军事】后方勤务; 6. 【法律】施行,执行
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    affected lot 被感染的批号
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    aging 老化【及物动词】衰老,老龄化,时效,老龄,增龄,陈酿,老年
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    all the compelling parts of our medical system 我们医疗体系的所有引人注目的部分
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    anchor 【名词】1. 锚;新闻主播 2. 桩; 支架; 依靠; 【不及物动词】1. 抛锚; 2. 停泊;固定; 【及物动词】1. 抛锚泊(船); 2. 把…固定住
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    broad range of medical specialities 范围广泛的医学专科
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    cancer 癌症【名词】1. 癌症;癌(瘤),肿瘤; 2. 弊病;社会恶习; 3. (the C-)【天文学】巨蟹座;巨蟹宫
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    cancer doctor 癌症医生; 肿瘤科医生
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    cancer institute 癌症研究所
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    character 字符【名词】性格,品格,人物,特征,角色,个性,特性,性质,点,字
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    classic symptom 典型症状
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    Cleveland Clinic 克利夫兰诊所
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    clinic 诊所【名词】1. 临床讲授;临床实习课; 2. 诊所;门诊部; 3. 特殊病例分析;会诊
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    compelling 令人信服的;迫切的【及物动词】强迫;协迫;使不得不;迫使(服从、沉默等)
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    complicate 【动词】使复杂; 使麻烦
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    conditioning 调理
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    conserve 节约;保存
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    cope 应对【不及物动词】1. 竞争,抗衡,对抗; 2. 对付,应付;克服,善处(困难等); 3. 【古】接触; 【及物动词】1. (英口)应付; 2. (废语)遇见,接触; 【及物动词】1. 给…穿上教士罩袍; 2. 加盖于,覆盖,给…砌上顶盖[墙帽]; 3. 【铸】修型; 【不及物动词】突出如墙帽
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    correct the problem 改正问题
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    Crohn's disease 克罗恩氏病,节段性回肠炎
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    cutting 切割【名词】1. 切断,切下;切片;【园艺】扦插,插条;(英国)剪裁,(报纸等的)剪辑;(宝石等的)加工,琢磨,开凿; 2. 大贱卖;剧烈的竞争; 3. 【林业】采伐;【畜牧】剪毛; 4. (马的)互踢; 5. 【机械工程】切削; 【形容词】1. 切得动的,锐利的; 2. 像刀割似的;刺骨的; 3. 讽刺的,尖酸刻薄的; 4. (目光)炯炯的,敏锐的; 5. (俚语)卖得贱的
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    deficiency 缺乏【名词】1. 缺乏,不足,短缺; 2. 缺陷; 3. 不足额;亏空
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    difficult and often ethically-fraught decisions 困难且经常充斥伦理道德的决策
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    disease 【名词】1. 病,疾病;【植物】病害 2. (精神等的)病态,弊病 3. (酒等的)变质;(食物等的)腐败
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    dose 剂量【名词】1. (药的)一服,一剂;药量,剂量; 2. 苦药,讨厌的东西; 3. (酒中的)配料,增味剂; 4. (处罚等)一回,一次,一番; 5. (美俚)花柳病,梅毒; 6. 【物理学】放射[辐射]剂量
  • drug administration 药品监督管理; 给药; 服药
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    drug company 制药公司
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    drug shortage 药物短缺
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    drugged 【及物动词】用药麻醉;使服药;使服毒品
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    economic incentive 经济刺激;经济诱因
  • economic reason 经济原因
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    economics 经济学【名词】1. 经济学; 2. (国家的)经济(状况);经济
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    ending up 结果是;最终; 终止于
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    ending up in the hospital 结果入了医院
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    ethical 伦理【形容词】道德,伦理学,伦理道德,合乎道德,职业道德
  • ethical decision 道德抉择
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    ethical dimension 伦理道德层面
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    ethical guidance 伦理道德指南
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    ethical overtone 伦理道德的寓意
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    ethicist 伦理学家
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    existing condition 现有条件
  • Extracting Microarray Gene Expression Patterns and Identifying co-expressed Genes 提取微阵列基因表达模式和确认共表达基因◆【略】EPIG
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    fact of life 现实生活
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    factor 因子【名词】因素,因数,要素,系数
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    factory 工厂【名词】出厂,制造厂,厂区,厂家,厂房
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    federal law 联邦法律
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    finding 【名词】1.发现,发现物,调查的结果,研究结果; 2. 裁决,定罪 【动词原形】find
  • fraught 充满
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    full-time pharmacist 全职药剂师
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    guidance 【名词】1.指导,引导 2. 指导物;导航 3. 【机械工程】导槽,导板,导管
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    guideline 准则【名词】指导方针
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    highly unethical corner 非常不道德的角落
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    horrible rash 可怕的皮疹
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    hospital 医院【名词】院,住院
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    incentive 【名词】刺激;鼓励;动机;诱因
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    institute 研究所【名词】1. 协会,学会;学院,专科大学;(学院附设的)研究所; 2. 讲习会;(短期)训练班; 3. 会址,院址,校址,所址; 4. 原则,规则,惯例; 5. (给初学者用的法律、医学等的)浅说,(公认的)基本原理; 【及物动词】1. 设,设立,制定; 2. 实行,创立,开始; 3. 任命,【宗教】授…以圣职
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    interest 利益【名词】兴趣,利息,感兴趣,权益,利率,趣味,关注,关心,爱好
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    intravenous 静脉,静脉内的,静脉注射的◆【略】IV
  • intravenous nutrition 静脉营养◆【略】IV
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    inventory 库存【名词】1. (财产等的)清单,报表;(商品的)目录; 2. 盘存,存货; 【及物动词】编制(商品等的)目录,开清单,盘存
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    investigation 1. 调查研究,调查,研究,调查,审查;2. 研究论文,调查报告
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    judgment 判断【名词】判断力,判决,审判,评判,判定,裁判,裁决,判别
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    manufacture 制造【及物动词】1. (成批)生产,制造,制造业; 2.(文学作品等的)粗制滥造; 【不及物动词】从事制造; 【名词】1. (成批的)制造,制造业; 2. 制造品,产品; 3. (蔑称)(文学上的)滥作
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    manufacturer 【名词】制造商; 生产厂家; 制造者
  • manufacturing chain 制造链
  • maximize 最大化;取…最大值
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    medical journal 医学期刊
  • medical speciality 医学专业
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    medical system 医疗系统
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    much-needed drug 急需的药物
  • National Cancer Institute - Children's Oncology Group 国立癌症研究所 - 儿童肿瘤学小组◆【略】NCI-COG
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    nutrition 营养 【名词】1. 营养(作用),滋养; 2. 营养物,食物;【农业】追肥
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    offering 提供【名词】1. 提议;提供; 2. 贡献;供品,祭品,(给教会的)捐款; 3. 礼物; 4. (上市的)股票,公债;出售物; 5. 课程
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    oftentimes 通常情况下【副词】(古语)屡次,常常
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    on the horizon 在未来
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    oncology 肿瘤学
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    overtones of values 价值的寓意
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    patient representative 患者的代表
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    period 1. 周期,期间 2. 月经期 3. 句号; 结束
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    pharmacist 药剂师;药学家;调剂员
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    prescription 【名词】1. 处方;处方的药;解救方法 2. 命令;规定;法规 3.【法律】(由于长期使用等而)获得权利 【形容词】按处方配制的◆【対】over-the-counter (OTC)
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    prescription drug 处方药
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    proactive 积极主动【形容词】主动,积极,前瞻性,主动性,预见性
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    purely medical choice 纯医学的选择
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    quote 【及物动词】1. 引述(他人文章);引证,举(例); 2. 用引号把…括起来 3. 【商业】喊(价),报(价),开(价);给…估价为; 【名词】1. 引用句,引文; 2. 引号; 3. 报价,估价表
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    rash 【名词】【医学】1. (皮)疹; 2. 同时大量出现的事件; 皮疹【形容词】轻率的,鲁莽的;性急的;过早的,未成熟的
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    rationing 限额配给
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    rationing guidelines 限额配给指南
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    regulatory 管理的;控制的;调整的
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    regulatory reason 监管原因
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    relative risk 相对风险
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    relative risks of a substitute drug versus the standard drug 替代药物相较于标准药物的相对风险
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    relatives 【名词】亲戚,亲属
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    rely on 依靠; 依赖
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    representative 代表【形容词】1. 表示的;表现的,描写的;象征的; 2. 能代表…的;可作…的典型[模范]的; 3. 代理的,代表的,代议制的; 4. 相当[类似](另一种属)的;【名词】1. 代表,代理(人);继任者,继承人;议员;(美国)众议员;驻外代表[大使,公使,领事]; 2. 类似物;样本,标本;典型
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    restriction 限制【名词】1. 限制,限定; 2. 拘束,束缚;自制; 3. 【逻辑学】限定
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    rights [法] 权利;权限;权益 [All rights reserved] 版权所有
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    shortage 短缺【名词】不足,缺少;不足额;(美国)缺点,缺陷
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    shortage period 短缺时期
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    shut down production 停产
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    single dose 单次药量
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    small, faraway hospital 很远的小医院
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    splitting 【形容词】1. 爆裂的; 分裂; 剧痛的 2.极快的; 【名词】【数学】因式分解
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    splitting a single dose 分割单一剂量
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    standard drug 标准药物
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    standards 标准【名词】1. 标准,水准,规格,模范; 2. 旗;军旗,队旗;【徽章】标帜,标记;旗标,象征; 3.【植物;植物学】旗瓣; 4. 金[银]的纯度标准;(硬币的)法定纯度比例; 5. (度量衡的)原基;原器; 6. (英国)(小学的)学年,年级; 7. 直立支柱;灯台;烛台,电杆,垂直的水管(电管)
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    strategy 战略【名词】1. 战略(学); 2. 策略,作战方针
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    substitute 替代【名词】1. 代替者[物],代用品;候补员;后补选手;收入(数); 2.【语法】代用词[语]; 3.【矿物】转接器,短节;【及物动词】以…代替,用…代替;【化学】取代;【不及物动词】作…代理者,(美国)代替;【化学】取代
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    substitute drug 替代药物
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    symptom 症状【名词】征兆,征候;征兆
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    the best hospitals in the country 全国最好的医院
  • The Journal of the National Cancer Institute 《美国国家癌症研究所杂志》◆【略】JNCI
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    the medicine is being rationed toward or away from them 药品是限额配给了他们还是拒之于外
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    the number of existing shortages 现有的短缺数量
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    the number of new shortages 新的短缺数量
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    tough choice 难做取舍
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    tough ethical decision 艰难的道德抉择
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    tragic 悲剧【形容词】悲剧的;悲剧性的,悲惨的
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    tragic choice 悲不幸的选择
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    treatment 【名词】1. 治疗;疗法;疗程 2. 对待;处理 3.评述
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    ultimately 【副词】 最终地 ; 根本地;首要地
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    unethical 不道德
  • United States National Cancer Institute 美国国家癌症研究所◆【略】NCI
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    unusually proactive 异乎寻常地积极主动
  • value judgment 价值判断
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    versus 与【前置词】(拉丁语) 1. (诉讼、运动等中的)对 (= against); 2. 与…相对[相比](略作 v. 或 vs.)
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    very complicated 很复杂的
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    wasting 浪费【名词】浪费;糟蹋;消耗,【医学】虚痨。wasting disease 消耗性疾病(如结核病);痨病;【形容词】消耗性的,渐减的;使荒废的;破坏性的
  • weight 【名词】1. 重量;体重;砝码 2. 负担;重要性 【及物动词】加重量于;使变重
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    widespread 广泛【形容词】普遍,广为流传,普及,广,大规模
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    wipe out 消灭
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    zinc 锌【名词】【化学】锌 (Zn)
  • Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615
    zinc deficiency 缺锌
Sound e31a43d441998f862b764d17930467a5a23de45c433219259bed5eb42e3a7615