我的《信報》文章2024年3月21日A16頁
《「類固醇奧運」與 球賽賭注迭創新高》
刊登後的改良加長版
附加南韓的不合理醫療制度簡評
www1.hkej.com/dailynews/commentary/article/3712589/「類固醇奧運」與球賽賭注迭創新高
許劍昭
南韓民眾健康感知良好的人口佔比約30%，在經合組織(OECD) 2017年33個成員國報告中列榜末(平均 68%，前列的新西蘭88%);健康惡劣的佔比卻最高，為19%(平均9%)。
[Note 1]
其他數據顯示，南韓的胃癌病發率全球第三高，自殺率居世界首位，也是世上最大的烈酒消費國。
[Note 2]
有鑑於數以千計報稱每週工作60至100小時、常常連續40小時不眠工作的南韓醫生自2月20日始罷工抗議，不妨藉兩則與健康相關的新聞，反省為何現代人教育程度提升，還是那麼多民眾生病，並出現重症年青化趨勢。
[Note 3]
首先是服用興奮劑不受限制的「類固醇奧運會」計劃於2025年初舉行。
由PayPal創辦人、全球首富之一提爾(Peter Thiel 1967 - ) 支持的「強化運動會」(Enhanced Games, 被批評者貶稱為Steroid Olympics)在二月初舉行記者會，籌委會(成員包括一位2002年冬奧運動員)發言人指出:「當 44% 的運動員已經使用強化藥物時，是時候慶祝科學了……運動員能自由地參與實驗，追求人類的卓越。」
已獲贊助的參賽者若能打破世界紀錄，更享有獎金100萬(美元，下同) 。賽事迄今有逾 500人報名，包括一位100米自由式兩屆世界冠軍的澳洲前奧運選手。
關於競賽會促使運動員過度服用類固醇致危害長期健康的擔憂，視體育為娛樂(sports-entertainment) 的主辦者的回覆是近期火紅的口號: 「我的身體，我的選擇!」
[Note 4]
另一則新聞是美國博彩協會推算，二月在賭城拉斯維加斯舉行的美式足球超級碗決賽中，約有6800 萬美國人（全國成年人口的四分一）下賭注，較去年增 35%。總投注額約231億元(合法賭注為15億元)。
[Note 5]
據估計，2022年全球合法運動博彩市場(包括足球、網球、板球、籃球、棒球、高爾夫球)規模或高達2354億元;若計算非法投注，總額可能達3萬億元。且由於湧現五花八門的智能手機便利投注科技，包括學生在內的20至30歲群組於未來十年的年增率至少達10%。
[Note 6]
根據協助病態賭徒的前線社工所見所聞及相關學術研究，球賽博彩較傳統賭博具有兩項極具損害健康的特點。
一是賭徒在球賽途中，受其動態發展誘使不斷加注。例如誰是下一個得分的球員或球隊、下一局的比數是多少，其緊張刺激及可預測性導致更容易染上賭癮。
德國有賭博病態的人約455萬 (18歲以上人口中6.5%)，英國則有 736 萬(佔16歲以上人口的16.4%)。賭癮不僅嚴重影響工作、學習，
更逐漸演變為抑鬱及其他精神病。2021 年，英國多達650 例自殺估計與賭博有關。
另一害是這類賭徒大多喜愛群聚式觀看球賽，並同時喝酒精飲料及享用營養少、熱量高的「垃圾食物」;由於近乎每天都有球賽舉行，頻密的劣質飲食導致多種長期頑疾。
[Note 7]
這兩則訊息表明，「用者友善」科技的猛進，被一些圖巨利的缺德商家用作侵蝕規範、迷惑心智的工具，把許多追求卓越或刺激的聰明笨孺變成自病者。
醫學期刊《刺針》三月初發表世衞參與的最新研究顯示，全球有超過10億人肥胖，包括大量青少年， 人數自1990年以來增加四倍。
[Note 8]
2019年刷第十版的大學教科書《健康與疾病社會學》(Peter Conrad 編)多年來詳細論證，先天缺陷、自然老化、病毒傳染引起的疾病佔用醫療服務的比例持續減少。
倒是
生活習慣（如高糖偏食、缺乏運動、濫藥煙酒）引起的生理疾病、
人際關係（如競爭壓力、排斥欺凌、攀比歧視）導致的心理疾病、
經濟活動（如工傷職勞、沉迷賭博、手機成癮）造成的身心創傷，
變成醫療需求的主要來源。
大多數本可毋須就醫的現代病人實質上是「醫療消費者」，而最受害的是草根階層。
[Note 9]
面對海量的病人，歐美採取的便宜之計是，將既能短暫緩解焦慮或憂鬱，亦可止痛的大麻合法化。但當病情繼續惡化，那些無力承擔全覆蓋醫療保險的基層，唯有購買更有效減少各種疼痛的鴉片類藥物，導致目前泛濫全美國的「鴉片流行病」(opioid epidemic) 。
[Note 10]
2018年，南韓認可醫用大麻;但2022年的民調仍有超過八成人反對大麻全面合法化。盲目崇拜美國文化的執政者無奈採取急增醫生數量的手段，但在改善民眾健康政策同樣交白卷。
[Note 11]
要促使大眾達至並維持長期身心健康、減少對醫療服務的需求及對醫療保險的繳費，較實際有效的做法，可考慮更新「醫學社會學」(Medical Sociology)奠基 者之一帕森斯(Talcott Parsons 1902-79)的分析，把「欠缺能力」(incapacity)及「行為偏差」(deviancy)視為現代疾病(俗稱「都市病」)的兩個根源。
[Note 12]
對於前者，政策是讓弱勢社群能改善營養膳食、增加運動意願。例如為了使貧困的基層避免罐頭和垃圾食品，政府可將部分福利金換成增額消費券，讓他們到餐館即時堂食新鮮烹調的飯菜。也可以讓基層兒童免費使用體育設施，且於鍛鍊身體後獲得購買書簿、文具、體育用品的消費券。
至於後者，亦即大量已有健康知識的公民沒有採取相應行動的普遍偏差現象，政府雖然不能強制迫使個別成人改變行為，但在短期內可以採取更具限制性的政策;例如
全面禁煙、
徵酒精稅、
限制銷售任何含糖或鹽量超過一定水平的包裝飲食、
杜絕手機顯示在線賭博應用程式、
嚴懲非法賭博提供者、
約束青少年玩耍網路遊戲的時間等等。
最理想的當然是禁止體育博彩，讓運動競賽回歸古希臘奧林匹克的目標:欣賞人體力量的純潔與美麗。
長遠政策則須復興傳統道德觀念、打壓「嫖賭飲吹」四大害，立法規範食品工業，特別是鹽和糖的成分比重及絕對值，並強化大眾的個人自律意識，減少自病者的數量。
「我的身體，我的選擇」此口號隱藏的意義是，熱愛自己，熱愛興奮、熱愛生活，卻厭惡生命(不健康，不生育) ，且不僅厭惡自己的生命，還漠視異鄉人的生命。
〈南韓的不合理醫療制度簡介〉
南韓的醫院是私營的，經營者與政府就病人的收費每年進行談判。
政府為取悅選民壓低收費，而保險公司的回款不足以支付醫療成本。 這些私立醫院因此壓低了初級醫生的薪資，並着重發展不受政府監管的醫療服務，例如美容手術及為外國人提供服務的「醫療旅遊」(包括器官移植，2022年市場規模達18億美元)。只有高級專科醫生才獲得合理的收入。
https://en.wikipedia.org/wiki/Healthcare_in_South_Korea
…Health
finance system in South Korea is characterized as "low premiums, low
medical consultation fees, low pay"…
https://www.linkedin.com/pulse/south-korea-medical-tourism-market-size-industry-share-raghav-arya
The South
Korea medical tourism market size reached US$ 1.8 Billion in 2022. Looking
forward, IMARC Group expects the market to reach US$ 2.5 Billion by 2028,
exhibiting a growth rate (CAGR) of 5.7% during 2023-2028.
Notes
[Note 1]
OECD iLibrary, “OECD Reviews of Public Health: Korea: A Healthier Tomorrow
2017 data”
https://www.oecd-ilibrary.org/sites/6e005d47-en/index.html?itemId=/content/component/6e005d47-en
Nevertheless, while life expectancy is higher than average, these years
are not all spent in good health. Korea has the lowest perceived health status
of all OECD countries, with only a third of people reporting that they are in
good or very good health (see Figure 1.4).
[Note 2]
2017 1031
Berkeley Political Review, “The Scourge of South Korea: Stree and Suicide
in Korean Society”
Korea’s suicide rate, attributable to its high-stress society, is among
the highest in the world.
Suicide is the fourth most common cause of death in South Korea; on
average, 40 people commit suicide every day.
According to Euromonitor International, South Koreans are the world’s
largest consumers of hard liquor, with the average Korean adult taking an
average of 14 shots a week.
World Cancer Research Fund International
Stomach cancer statistics
https://www.wcrf.org/cancer-trends/stomach-cancer-statistics/
3rd South Korea new cases 28,713 per year 27.9 per 100,000 persons
[Note 3]
2024 0229
BBC, “South Korea: Doctors on strike face arrest if they do not return to
work”.
https://www.bbc.com/news/world-asia-68422002
Ryu Ok Hada, a 25-year-old doctor, and his colleagues have not been to
work at the hospital for over a week.
"It feels weird not getting up at 4 a.m.," Ryu joked. The
junior doctor told the BBC he was used to working more than 100 hours a week,
often for 40 hours without sleep. "It's insane how much we work for such
little pay".
[Note 4]
2024
0201
New
York Post, “Billionaire Peter Thiel bankrolling ‘Olympics on steroids’ event
that allows athletes to dope”
2024
0201
The
Olympics prohibits many drugs. Medical professionals say steroid use can have
harmful side effects.
2024
0217
IPD,
“Here Come the Steroid Games”
https://intpolicydigest.org/here-come-the-steroid-games/
As
the site hails, “Backed by the world’s top venture capitalists, the Enhanced
Games is the Olympics of the future. When 44% of athletes already use performance
enhancements, it is time to safely celebrate science.” The project is adamant
in stating, tersely, that, “Sports can be safer without drug testing.” That
leaves the athletes free to partake in experimentation, where science can be
used “for the pursuit of human excellence.”
This
is despite D’Souza’s assertion that athletes are adults with “a right to do
with their body what they wish – my body, my choice; your body, your choice.” The
one-party state becomes substituted by a cadre of investors, doctors, and
advisors, all keen on getting their results from the bodies on show.
Publicity for the events has already seen over 500 registered athletes,
along with a sprinkling of Olympians. Canadian bobsledder Christina Smith, who
participated in the 2002 Winter Games, is a member of the event’s Athlete
Commission.
James Magnussen, an Australian swimmer, Olympian, and two-time world
champion in the 100m freestyle has made a very public declaration that he will
“juice up.” And why not? His brain turned mushy after being told that he was
the golden boy at the London Olympics in 2012. Australian sporting commentators
were convinced that the swimming events he participated in were his, absurdly
declaring him victorious in advance of the events. As things turned out, he was
silvered and bronzed.
[Note 5]
2024 0206
New York Post, “Super Bowl 2024 to see record-breaking $23.1B gambling
explosion — but only a small portion is legal”
https://nypost.com/2024/02/06/sports/super-bowl-2024-to-see-record-23-1-billion-gambling-explosion/
Approximately 68
million Americans — about one in four — will wager on Super Bowl 2024, a 35
percent increase compared to last year, according to projections by the
American Gaming Association.
[Note 6]
https://www.statista.com/topics/1740/sports-betting/
In 2022, the
sports betting and lottery market size worldwide amounted to 235.46 billion
U.S. dollars.
https://afootballreport.com/blog/how-much-money-is-being-bet-on-sports-every-year
Below is an overview of the top-most
gambled sports, how much goes back to bookies as profits and how much is paid
out as wins to players.
OVERALL –$3 TRILLION INDUSTRY
2023 1005
https://www.linkedin.com/pulse/2031-sports-betting-market-size-latest-growing
[Note 7]
2018
National Library of Medicine
“Alcohol Drinking and Low
Nutritional Value Food Eating Behavior of Sports Bettors in Gambling
Advertisments”
https://pubmed.ncbi.nlm.nih.gov/29491768/
2023 0210
The Conversation, “A boon for sports fandom or
a looming mental health crisis? 5 essential reads on the effects of legal
sports betting”
2023 0608
Euronews, “Europe’s betting industry is
thriving: Are we prepared to tackle a rise in gambling addiction?”
[Note 8]
2024
0301
std.stheadline.com/realtime/article/1984290/即時-國際-世衞最新研究顯示-全球逾10億人肥胖
下週一（4日）是世界肥胖日，根據權威醫學期刊《刺針》(The
Lancet)發表世界衞生組織參與的一項最新研究顯示，全球有超過10億人肥胖，其中包括兒童，青少年和成人，
人數自1990年以來增加4倍。
[Note 9]
Peter Conrad and Valerie Leiter (eds.) (2019), “The Sociology of Health
and Illness: Critical Perspectives”, 10th Edition, Los Angeles:
SAGE.
p.672 “medical consumers”
[Note 10]
USA Centers for Disease Control and Prevention
“Understanding the Opioid Overdose Epidemic”
https://www.cdc.gov/opioids/basics/epidemic.html
Wiki, “Opioid epidemic”
https://en.wikipedia.org/wiki/Opioid_epidemic
[Note 11]
wiki, “Cannabis in South Korea”
https://en.wikipedia.org/wiki/Cannabis_in_South_Korea
In November 2018, the country's Narcotics Control Act was amended and use
of medical cannabis became legal …
2023 1109
https://www.statista.com/statistics/1422765/south-korea-cannabis-legalization-more-addicts/
According to a survey conducted in South Korea in late 2022, around 91
percent of respondents stated that they were concerned that legalizing the consumption
of cannabis would lead to an increase in the number of people with addictions
or dependencies. Only 12 percent were in favor of legalizing recreational
marijuana.
[Note 12]
Wiki, “Talcott Parsons”
https://en.wikipedia.org/wiki/Talcott_Parsons
Uta Gerhardt (1989), “Ideas about Illness: An Intellectual and Political History of Medical Sociology”, MacMillan.
p.14 “Two models of Illness”:
The incapacity model
The deviancy model
Wiki, “Medical Sociology”
zh.wikipedia.org/wiki/医学社会学
