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本来想放一篇陈光城到华盛顿的东西的,后来怕和谐还是算了 速度
The number of people who are wronglyconvinced they are seriously ill is rising.
'I was living with thisconstant fear that I would be dead in three months," says Mark. The32-year-old from Manchester had a pain in his lungs and immediately suspectedadvanced lung cancer. It became, he says, "an obsession". His GP was certain it wasn't cancer, but Mark couldn't stopthinking about it. He returned to his doctor several times, eventuallypersuading him to arrange a scan at the hospital. This too showed he didn't have the disease.Eventually Mark realised what he was suffering from was not lung cancer, buthealth anxiety.
Catherine O'Neill, servicesmanager at the helpline charity Anxiety UK, says the disorder "is one ofthe things we get most calls about. The common fears are HIV, cancer andillnesses at the more severe end of the spectrum. Quite often, we get people who nursedsomeone through cancer and they become preoccupied with the thoughtthat they have the disease too, or it develops because they have heard or readabout someone with the illness."
Health anxiety is characterisedby the excessive seekingof reassurance, from doctors or from family members. "What we always tellpeople on our helpline is that reassurance doesn't work," says O'Neill. "Ihave seen people who have convinced themselves they have a brain tumour – they go to their GP, they go for scans. When they arereassured they don't have a tumour, they still think what if they missed it?What if it was too small to see? What if this is one of those NHS mistakes?Because the media highlights it so much when things do go wrong, it feeds thefeeling in people with health anxiety that 'I could be the one that it goeswrong for'. People ring up and ask, 'Do you think I've got cancer?' I can'toffer that reassurance because how would I know? But we do know thatreassurance only works in the short term. It isn't long before those fearsreturn."
Another problem, O'Neill says,is that health anxiety – which used to be calledhypochondria – is not taken seriously. "It can be seen as a bit of ajoke, but it can have a serious impact on someone's life."
Mark agrees. "When you'rein the grip of it,it can be terrifying. It affects all aspects of your life – your work, yourrelationships – because you can't think about anything else, and you're livingwith this expectation of impending death."
According to Professor PeterTyrer, head of the centre for mental health at Imperial College London,"about 1-2% of the population have pathological health anxiety", and in people who have already hadtreatment for a condition, it can be around 10%. He thinks the number of peopleaffected is rising.
The internet, he says, is onereason. "Everyone looks up their symptoms, but the internet tells youeverything and nothing." O'Neill agrees: "Type in flu symptoms and you will be able to find a huge range of diseases from acommon cold to the early stages of an HIV infection."
Several studies have shown thatcognitive behavioural therapy (CBT), which aims to change thought patterns andbehaviour, can reduce the symptoms and hospital appointments. But waiting listson the NHS can be long in some areas, and the therapy is not widespread. Tyrer is now leading a study of 448 peoplewith health anxiety who are being treated in five hospitals. Treatment takesplace in hospital clinics that deal with the illness the sufferer feels theyhave - such as cardiology or neurology clinics. "If you say, 'We want you to see a psychologistor psychiatrist' they say, 'I'm physically ill, not mentally ill'. So they aretreated by general nurses who have been trained in this technique."
The study will finish in 2012,but early results look promising. "We have had dozen of letters from thepatients saying how their lives have been turned around," says Tyrer. Hedescribes a patient who had been treated for heart disease who had not been outof his house for a year because he was so terrified of having a heart attack;after a course of CBT, he was able to go on holiday. Tyrer is aiming to provesuch treatment will eventually save the NHS money by reducing the need fortests and emergency hospital admissions.
One CBT technique involvesgetting patients who believe their headaches are a sign of a brain tumour to createa pie chart where they imagine all the people who woke up that day with aheadache, and list the causes for it according to probability: dehydration, a cold, migraine, tiredness, too much caffeine.
"Sometimes this is acomplete revelation to them," says Dr Helen Seivewright, clinical researchfellow at Imperial College, who is also working on the study. "It opens upthis world where not every symptom means the worst diagnosis."
WHITE HOUSE - U.S. PresidentBarack Obama says the leaders of the world’s biggest economies are beginning toagree that more jobs and more growth will help reverse Europe’s economiccrisis. The president spoke Saturday atthe end of the Group of Eight economic summit.
After two days of talks at the Camp Davidpresidential retreat outside Washington, Obama said the eight leadersacknowledge that budget cuts alone will not restore Europe’s economy.
“And there isnow an emerging consensus that more must be done to promote growth and jobcreation right now, in the context of these fiscal and structural reforms,” thepresident said.
A statement from the G8 leaderscalled for a balance between growth and austerity to fight the economic woes.
Obama said the leadersdiscussed the need for the troubled European countries to continue shrinkingtheir deficits while stimulating economic growth.
“Today we agreedthat we must take steps to boost confidence and to promote growth and demandwhile getting our fiscal houses in order," he said. "We agreed uponthe importance of a strong and cohesive Eurozone, and affirmed our interest inGreece staying in the Eurozone while respecting its commitments.”
The decisions the leaders makecould have political consequences.
The main advocate of Europeanausterity, German Chancellor Angela Merkel, recently saw her party defeated ina local election.
Former French President NicolasSarkozy, who also favored budget cuts, was voted out of office, in favor ofFrancois Hollande, who offered a pro-growth policy.
Many U.S. political analystssay a stagnant economy, blamed partly on Europe’s economic woes, is the biggestobstacle to Obama’s re-election in November.
“The leadershere understand the stakes," Obama noted. "They know the magnitude of the choices they have to make, and theenormous political, economic and social costs if they do not.”
The G8 leaders also addressedthe possibility of oil shortages when new sanctions against Iran’s oil exportstake effect late next month.
“And in the faceof increasing disruptions in the supply of oil, we agreed that we must closelymonitor global energy markets," Obama said. "Together, we stand ready to call uponthe International Energy Agency to take action to ensure that the market remainsfully and timely supplied.”
The president hosted a meetingof the G8 leaders and the leaders of Benin, Ethiopia, Ghana and Tanzania tohelp improve food security in Africa.
Obama said the G8 is committedto building on its 2009 initiative that led to $22 billion in governmentpledges.
The president said he and hisG8 counterparts made progress on numerous other international issues. Among them were Afghanistan, Syria and NorthKorea.
Most of the leaders have movedon to President Obama’s home city of Chicago for the NATO Summit. Chineseactivist Chen Guangcheng, who has fought against China's one child and forcedabortion policy, has finally arrived in the United States. From New Jersey's Newark InternationalAirport Saturday evening, he was taken to the campus of New York University inManhattan where he will work and live.
越障 Duties, Liabilities, and DamagesSYMPOSIUM BY STEPHEN A. SMITH In this Article I explore two ways ofunderstanding damage awards. The first way, which I call the duty view,supposes that damage awards confirm existing legal duties to pay damages.According to this view, damage awards are structurally similar to awards thatrequire defendants to do things such as deliver contractually promised goods,cease nuisances, or pay contractual debts. Like these awards, damage awards areessentially rubber stamps: they require defendants to do what they should havedone already. In contrast, the second way of understanding damage awards, whichI call the liability view, supposes that insofar as it makes sense to speak atall of legal duties to pay damages, such duties are created — not confirmed —by damage awards. According to this view, damage awards are structurallysimilar to awards that require criminal wrongdoers to pay fines. In Montreal,there is a bylaw stipulating that citizens are liable to be fined a minimum of$300 if they allow their dogs to run unleashed. But there is no rulestipulating that if citizens allow their dogs to run unleashed, they shouldsend the city a check for $300. Errant dog owners have no legal or even moralduty to pay the city prior to being ordered to do so. The liability viewregards damage awards as similar: they are at most duty creating, not dutyaffirming. The Article defends three mainpropositions. First, the best-known contemporary theories of damages —“rights-based theories” and “utilitarian theories” — are committed to the dutyview. Properly understood, the explanations these theories give for why damagesshould be paid — roughly, that there are moral duties to pay damages or thatthe practice of paying damages promotes utility — are in principle bestsatisfied if payment is made immediately after the wrong. If either of thesetheories is correct, the common law should contain a rule stipulating that wrongdoershave duties to pay damages to their victims. Second, the common law contains nosuch rule. Rather than imposing ordinary or even inchoate duties to paydamages, the common law merely imposes liabilities to pay damages. Third andfinally, it follows from the first two propositions that any theory of damageawards focusing on the value of the actions that such awards require — as dorights-based and utilitarian explanations — is bound to fail. The mostimportant feature of damage awards is that they are awards — that is, thatcourts issue them. Like orders to pay fines, their importance liesfundamentally not in what they do, but in what they represent. And what damageawards represent is the law’s recognition that the plaintiff was wronged by thedefendant. Damage awards are the law’s way of vindicating — not enforcing — theplaintiff’s rights. A word on terminology: except whereindicated otherwise, “legal duties” refers to duties that exist because thereis a legal rule — legislative or judge-made — that makes certain behaviorobligatory. This usage is familiar: lawyers say that citizens have legal dutiesto pay their contractual debts because there is a legal rule that contractualdebts ought to be paid. It is not, however, the only usage; in particular,lawyers sometimes talk of legal duties that exist because a court issued ajudicial award. Thus, it is sometimes said that a defendant who has beenordered to pay a sum has a legal duty, arising from the order, to pay themoney. In Part II, I briefly consider whether “court-ordered duties” aredifferent in kind from “rule-based duties” and, more generally, whether theidea of court-ordered duties makes sense at all. In general, however, thisdistinction is unimportant for my purposes. The alleged duties that are thisArticle’s focus are duties that arise upon the commission of a wrong and thatrequire the wrongdoer to pay damages. Such duties are necessarily rule-based. 【632】 |
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