【甚解小组】【TASK III】原文抄抄炒 FROM coffee

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First
Where Culture Comes In
Feb. 10th

“A chance to cut is a chance to cure.” “Heal with steel.” “Cut well, tie well, get well.” These phrases may simply sound like clever aphorisms(谚语), but they speak to important cultural understandings of surgery.

Prior to the mid-20thcentury, few effective treatments for disease existed(发生). There were no pills forhigh blood pressure(高血压), no antibiotics for infections and no chemotherapy(化疗) forcancer. Radiation therapy(辐射疗法) was just being introduced. Operations, to fix broken bones and to remove tumors(肿瘤) and kidney stones(肾结石), were among the few effective interventions available to physicians.

After World War II, many surgeons who had performed lifesaving operations on the battlefield cameback emboldened(使有勇气) by what they believed that surgery could achieve. Thus, in the1940s and 1950s, tens of thousands of tonsillectomies(扁桃腺切除术) were done for indications ultimately shown to be dubious. In this same era, Dr. Alexander Brunschwig of New York’s Memorial Hospital devised a“brutal and cruel procedure,” pelvic exenteration — the removal of the ovaries,uterus, bladder and even rectum — to treat women with advanced gynecological(妇科的) cancers.

Meanwhile,neurosurgeons(神经外科医生) performed lobotomies(脑白质切断术) to treat schizophrenia(精神分裂症) and other mental illnesses.

The new fascination(魔力)with surgery struck a chord with the public and the media. A 1963 Time magazine cover article was entitled “Surgery: The Best Hope of All.” A tagline read, “If they can operate, you’re lucky.”

Despite its scientific basis, medicine is influenced by the surrounding culture. The acceptance or rejection of various treatments may have less to do with the data than with who is promoting the therapies(疗法), what type of technology is being used and how muchpublicity there is.

Based on what we have learned about cancer in the past several decades — that it spreads early in itscourse — the JAMA study showing that removal of cancerous lymph nodes does not improve survival is not surprising. The question is whether we can incorporate(合并的)these new findings into a cultural environment that has placed so much hope andfaith on cancer surgeons’ ability to “get it all.”

Change can occur. We no longer perform needles stonsillectomies, pelvic exenteration or lobotomies. But it will take time.

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exist  
ex·ist / ɪg`zɪst / verb [intransitive] ***
1 to be real or appear in the real world:
Dragons don't exist.

2 to manage to live, especially under difficult conditions: SURVIVE:
exist on: You can't exist on only 500 calories a day.
exist for: How can I exist for a week without seeing you?
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embolden  
em·bold·en / ɪm`boʊldn / verb [transitive] FORMAL
to give someone more confidence to do something
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fascination  
fas·ci·na·tion / ,fæsɪ`neɪʃn / noun
1 [singular or uncount] the state of being very interested in something or attracted by something:
fascination with: the country's fascination with Western culture
fascination for: He had a childish fascination for battles and revolutions.

2 [singular or uncount] the power to interest or attract people very strongly:
The idealism of the 1960s continues to exert a fascination.
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therapy  
ther·a·py / `θerəpi / noun **
1 [count or uncount] a form of treatment for an illness or medical condition:
Massage is one of the oldest therapies.

2 [uncount] a form of treatment for someone with mental illness or emotional problems that involves talking to them or asking them to do things:
Some of her clients needed intensive therapy.
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incorporate  
in·cor·po·rate / ɪn`kɔrpə,reɪt / verb **
1 [transitive] to add or include something as a part of something else, for example as a part of an arrangement or a document: INCLUDE:
incorporate something into/in something: Congress incorporated this principle into the 1977 clean-air Amendments.

2 [intransitive or transitive] BUSINESS to form a corporation (=a company that can raise money by selling shares):
The company's doing so well, we've decided to incorporate.

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上文源自辩题：“Are Doctors Too Quick to Cut?“

核心是：”Doesthe American medical culture rely too heavily on surgical treatments?“

作者：Barron H. Lerner （professor of medicine and public health atColumbia University Medical Center）

Issue:
184. We learn through direct experience; to accept a theory without experiencing it is to learn nothing at all.
我们通过直接经验来学习，如果没有通过体验来接受一个理论就等于根本没学。
文章第三段关于实践的重要性，正是因为二战期间给了外科医生们足够多的实践经验，才使得医学界对于外科手术有了充分的信心。

68. Technologies not only influence but actually determine social customs and ethics.
技术不仅仅影响而且实际上是决定了社会传统和道德规范。
技术的发展向我们证实了癌症是可以治好的。医学是没有性别的。

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First
The Do-Something Mentality
Feb. 10th

It is human nature towant a cancerous node removed or a coronary blockage cleared — it is ingrained(根深蒂固的)into our fundamental notions about treatment — but much of the time these notions are wrong.

As we have learned in recent years, many surgeries that have been standard medical practice — spinalfusion(脊椎融合术), hysterectomies(子宫切除)and, now, armpit lymph-node dissection for many breast cancers — offer little or no benefit. Intuition(直觉) is a poor substitute(替代) for data.

Surgical research is finally beginning to come of age, upending longstanding dogma. This is no small feat. Surgical research is hard to do. It isn’t easy to enroll patients inrandomized trials, investigators cannot be blinded, and doctors often refuse to participate. As Denise Grady reports in her Times article on the lymph node study, a number of experts thought it was unethical(不道德的) to randomly select patients for treatment that did not include complete dissection.

But even as hard-won knowledge becomes available, surgical practice changes slowly. For example,cardiologists(心脏病专家) continue to implant stents(心脏搭桥) in patients with chronic(慢性的) stable chest pains, even after a landmark study in 2009 showed that for many patients, perhaps amajority, the procedure offers little advantage over drug therapy. It’s been estimated that up to a third of surgeries in this country are unnecessary. If the definition is broadened to include procedures of “equivocal(模棱两可的)” efficacy, therate increases to two-thirds.


So much of what we do as doctors is based oninstinct(本能，直觉) and faith, not hard evidence. To help our patients, we need more data, especially in surgical specialties, but we must also learn to embrace the knowledge we generate. One cannot underestimate the power of entrenched interests to resist change, even in medicine.

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ingrained  
in·grained / ɪn`greɪnd / adjective
1 an ingrained attitude, belief, or habit has existed for a long time and cannot easily be changed

2 ingrained dirt is under the surface, so that it is difficult to remove
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intuition  
in·tu·i·tion / ,ɪntu`ɪʃn / noun [count or uncount]
an ability to know or understand something through your feelings, instead of by considering facts or evidence:
Archaeologists often use their intuition to decide where to dig.
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substitute 1  
sub·sti·tute1 / `sʌbstɪ,tut / verb **
1 [transitive] to use something new or different instead of what is normally used:
Instead of using silicon, they have substituted a more flexible material.

2 [transitive] to remove one thing and put something else in its place:
substitute something for something: Police investigators substituted Palmer's bag for a similar one, then followed him to his hideout.
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substitute 2  
sub·sti·tute2 / `sʌbstɪ,tut / noun [count] *
something that is used instead of something else:
We couldn't get cream, so we used yogurt as a substitute.
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unethical  
un·eth·i·cal / ʌn`eθɪkl / adjective
morally wrong or against accepted standards of behavior, especially in a particular profession:
unethical business practices
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chronic  
chron·ic / `krɑnɪk / adjective *
1 a chronic illness or pain is serious and lasts for a long time. A serious illness or pain that lasts only for a short time is described as acute:
chronic back pain

2 a chronic problem is always happening or returning and is very difficult to solve:
a chronic shortage of food/money/resources

3 [usually before noun] doing something again and again, especially something harmful that you are unable or unwilling to stop doing:
a chronic liar/smoker/workaholic
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equivocal  
e·quiv·o·cal / ɪ`kwɪvəkl / adjective FORMAL
1 with more than one possible meaning, in order to avoid making a clear statement: NON-COMMITTAL:
an equivocal answer/response

2 not clearly showing the real situation or providing a definite result: INCONCLUSIVE:
Despite extensive research, the evidence remains equivocal.
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instinct  
in·stinct / `ɪnstɪŋkt / noun [count or uncount] **
1 a natural tendency to behave in a particular way that people and animals are born with and that they obey without knowing why. For example the maternal instinct is a woman's natural tendency to behave like a mother:
the instinct of ducklings to follow their mother

2 a natural ability to know what to do in a particular situation:
instinct tells/warns you: Instinct tells me that it would be unwise to return home.

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上文源自辩题：“Are Doctors Too Quick to Cut?“

核心是：”Doesthe American medical culture rely too heavily on surgical treatments?“

作者：Pauline W. Chen （a surgeon and the authorof “Final Exam: A Surgeon’s Reflections onMortality.”）


相同的论题，不同的视角。

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Second
Balancing Freedom With Discipline
Feb. 11th

Teaching in a college with a sizable population of Jewish, Indian and other ethnic(种族的) groups, I can identify attitudinal(态度的) traits that can only be loosely termed “Chinese.” The idea that Chinese mothers have some special or "superior" parenting styleis at best a misconception(误解), and at worse, nonsense.

But if we want some sort of explanation, we can look to the Chinese culture for some clue. In China, the strong emphasis on striving in education comes from a long history of Confucian teachings and a tradition of grooming the best and brightest for the formidable(强大的，艰难的)imperial exams.

In contemporary times, strict and result-oriented parenting also has to do with anxieties created by a ubiquitous(普遍存在的) testing environment. In China, it is exacerbated(恶化) by the one-child policy. The
college entrance exam, for example, has even been known to push students to suicide. Concerns over academic competition and professional opportunities have fueled demand for education and skill attainment by Chinese parents for their children.

There are decided benefits to a rigorous(严格的) parenting style. Persistent drilling of skills can help children acquire proficiency in certain areas. Offering direction about career paths can help lead students toward more employable fields. But increasingly, Chinese and Asian Americans are paying attention to the downsides of this type of parenting. What often gets lost are individuality, creativity and leadership skills.

We worry about the paucity(少数) of Nobel laureates in the sciences in China, despite outstanding international test scores from Chinese students. We lament the gap between Chinese/Asian Americans’ academic achievements and the relatively few who reach top management ranks in the United  States.

Chinese parents everywhere are changing. My family is a case in point. We find a combination of demanding and encouraging styles the ideal model. We never had a piano in ourhome because we did not understand why every Asian kid seems to play the piano.We let our kids choose their extracurricular(课余的) activities, although the math team takes precedence over sports teams, which in turn comes before saxophone lessons. We may be disappointed that our older son may not major in physics, but at our suggestion, he wants to combine his economics major with mathematics. And yes, they should strive for A’s, but they will not be taken to task for lower grades as long as they make earnest efforts.

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ethnic
eth·nic1 / `eθnɪk / adjective **
1 relating to a group of people who have the same culture and traditions:
The country's population consists of three main ethnic groups.

2 ethnic clothing, food, music, etc. comes from countries outside Western Europe and North America:
ethnic restaurants
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attitudinal  
at·ti·tu·di·nal / ,ætɪ`tudɪnl / adjective FORMAL
relating to or affected by what someone feels about something
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misconception  
mis·con·cep·tion / ,mɪskən`sepʃən / noun [count or uncount]
a wrong belief or opinion as a result of not understanding something:
The question is open to misconception.
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formidable  
for·mi·da·ble / `fɔrmɪdəbl,   fər`mɪdəbl / adjective
very impressive in size, power, or skill and therefore deserving respect and often difficult to deal with:
Meeting the energy demands of a big city is a formidable task.
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ubiquitous  
u·biq·ui·tous / ju`bɪkwɪtəs / adjective FORMAL
present everywhere:
Their HQ comprises miles of lunch rooms with their ubiquitous coffee machines.
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ex·ac·er·bate    v.

Pronunciation:	ig-'za-sər-ˌbāt
Function:	transitive verb
Inflected Form:	-bat·ed ; -bat·ing
Etymology:	Latin exacerbatus, past participle of exacerbare, from ex- + acerbus harsh, bitter, from acer sharp ― more at EDGE
Date:	1660

: to make more violent, bitter, or severe <the proposed shutdown…would exacerbate unemployment problems
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rigorous  
rig·or·ous / `rɪgərəs / adjective *
1 thorough and careful:
rigorous safety checks

2 strict or severe:
rigorous enforcement of the law
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paucity  
pau·ci·ty / `pɔsəti / noun [singular] FORMAL
paucity of a small amount of something that is not enough:
There's a paucity of quality leaders.
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extracurricular  
ex·tra·cur·ric·u·lar / ,ekstrəkə`rɪkjələr / adjective
1 extracurricular activities are things that you do at school or college that are not part of your program of study

2 HUMOROUS outside the usual range of activities or behavior expected in a job or a marriage

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上文源自辩题：“Is Extreme Parenting Effective?”

核心：“Does strict control of a child's life lead to greater success or can it be counterproductive?”

作者：Yan Sun（professor of political science at the City University of New York）

由中国教育模式为例子，对孩子的培养究竟是兴趣教育还是普遍教育进行了阐释。

Issue:


39. Too much emphasis is placed on role models. Instead of copying others, people should learn to think and act independently and thus make the choices that are best for them.
太多的注意力被放在了模式化方面。与其模仿别人，人们还不如学习独立思考和做出最合适自己的选择。
文章最后一段，作者给出了观点，最适合自己的才是最好的

31. Education will be truly effective only when it is specifically designed to meet the individual needs and interests of each student.
教育只有被专门设计来满足每一个学生需求和兴趣的时候才是真正有效率的。

35. Competition for high grades seriously limits the quality of learning at all levels of education.
追求高分严重的限制了教育各阶段的学习质量。
中国式教育

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Reconsider Attitudes about Success
Feb. 12th

Even “Race to Nowhere,” with its poignant(伤心的) depictions of the emotional cost of traditional schooling, doesn’t tell the whole story. For one thing, students suffer intellectually as well as psychologically because the pressure to succeed academically leaves little room for exploring ideas. (Achieving is very different from learning.) For another thing, this destructive pattern doesn’t stop when kids get to college.

The solution, I think, is twofold: Reconsider our attitudes about success (and long-term goals for ourchildren); and change the school policies that create or exacerbate(加重) the problem.

Many parents push their kids with the best of intentions, but some are so busy basking in the reflected glory of their children’s accomplishments that they overlook the damage being done by the pressure to live up to(不辜负...的期望) their expectations. “Fewparents,” said the psychoanalyst Erich Fromm, “have the courage and independence to care more for their children’s happiness than for their success.”

Whole childhoods are sometimes sacrificed(牺牲) in a relentless(无情的) regimen of preparing kids for Harvard, aprocess I’ve come to call “Preparation H.” Gambling their mental health andlove of learning in the hopes of acceptance at an extremely selective college isa bet that no caring, rational(理性的) parent should take.

Ultimately, though, educators (with parental support) must be willing to change the entrenched educational practices that are turning so many teens into basket cases.

Gratuitous(无理由的) competition teaches students that everyone else is an obstacle(障碍) to their own success.(Awards and class rank could be eliminated tomorrow without jeopardizing(危及) admission to college.)

Absurd(荒谬的) quantities of mostly pointless homework force students to work a second shift after having spent all day in school. (Happily, I’ve heard from many teachers who rarely or never assign homework and report fabulous results.)

Advanced Placement courses often just accelerate(促进) the worst sort of lecture-based, textbook-driven,“bunch o’ facts” teaching. (Realizing that harder isn’t always better, a growing number of high schools are eliminating A.P. courses.)

And there’s more. Some 830 colleges and universities have stopped requiring the SAT or ACT. Courageous educators are replacing letter and number grades with less destructive forms of assessment.

One thing is clear: We can’t be content withjust giving kids “coping strategies” that leave the structural problems intact; we have to change the structures themselves.

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poignant  
poign·ant / `pɔɪnjənt / adjective
giving you feelings of sadness:
The roadside crosses are a poignant reminder of the fatal accidents.
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exacerbate  
ex·ac·er·bate / ɪg`zæsər,beɪt / verb [transitive] FORMAL
to make a problem worse
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sacrifice 1  
sac·ri·fice1 / `sækrɪ,faɪs / verb *
1 [transitive] to give up something important or valuable so that you or other people can do or have something else:
sacrifice something to do something: She sacrificed her career to bring up the children.

2 [transitive] to kill a person or animal as part of a ceremony to honor a god or spirit
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sacrifice 2  
sac·ri·fice2 / `sækrɪ,faɪs / noun *
1 [count or uncount] the act of giving up something important or valuable so that you or other people can do or have something else:
Most of the speeches on D-Day will focus on the sacrifice of the World War II generation.

2 [count or uncount] the act of killing a person or animal as part of a ceremony to honor a god or spirit:
Animal sacrifice is an important ritual in this religion.
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relentless  
re·lent·less / rɪ`lentləs / adjective
1 something bad that is relentless never seems to stop or improve:
He seems to be under relentless pressure at work.

2 determined and never stopping your attempts to achieve something:
relentless in: Arnold was relentless in his pursuit of a good news story.
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rational  
ra·tion·al / `ræʃənəl / adjective **
1 based on sensible practical reasons instead of emotions:
There didn't seem to be any rational explanation for his actions.

2 thinking about what you do in a calm way, and making sensible and intelligent decisions:
Let's try to discuss this like rational human beings.
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gratuitous  
gra·tu·i·tous / grə`tuɪtəs / adjective
done or shown without any good reason:
There's too much gratuitous violence in the movie.
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obstacle  
ob·sta·cle / `ɑbstəkl / noun [count] **
a difficulty or problem that prevents you from achieving something:
Disabled people succeed in overcoming many obstacles in everyday life.
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jeopardize  
jeop·ard·ize / `dʒepər,daɪz / verb [transitive]
to risk damaging or destroying something important:
Cuts in funding could jeopardize this vital research work.
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absurd  
ab·surd / əb`sɜrd,   əb`zɜrd / adjective *
1 completely stupid, unreasonable, or impossible to believe: RIDICULOUS:
She makes the most absurd claims about her past achievements.

2 deliberately emphasizing what is silly or stupid about people and society:
She has a wonderfully absurd sense of humor.
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accelerate  
ac·cel·er·ate / ək`selə,reɪt / verb *
1 [intransitive or transitive] to happen or make something happen at a faster rate:
The increased capital could greatly accelerate economic development.

2 [intransitive] if a vehicle accelerates, it moves faster:
Suddenly the truck accelerated and shot forward.

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上文源自：“Stress and the High School Student”
核心辩题：“What can schools -- and parents -- do to relieve some of the résumé-building pressure that young people are feeling?”

作者：Alfie Kohn（the author of a dozen books on education and human behavior）

Issue:

162. It is dangerous to trust only intelligence. 只相信聪明才智是危险的。

80. The pressure to achieve high grades in school seriously limits the quality of learning. An educational environment without grades would promote more genuine intellectual development. 在学校获得高分的压力严重得限制了学习的质量。一个没有分数的教育环境将会促进真正的智力发展。