Those of you who have seen the film "Moneyball," or have read the book by Michael Lewis, will be familiar with the story of Billy Beane. Billy was supposed to be a tremendous ballplayer; all the scouts told him so. They told his parents that they predicted that he was going to be a star.
在座看过电影“点球成金”的 又或者读过麦克·路易斯的书的, 会对比利·比恩的故事很熟悉。 比利应该是一个非常好的球员;所以的球探都这么跟他说。 他们告诉他的父母, 他们预测他会变成一个明星。
But what actually happened when he signed the contract -- and by the way, he didn't want to sign that contract, he wanted to go to college -- which is what my mother, who actually does love me, said that I should do too, and I did -- well, he didn't do very well. He struggled mightily. He got traded a couple of times, he ended up in the Minors for most of his career, and he actually ended up in management. He ended up as a General Manager of the Oakland A's.
但事实上当他签约后 -- 其实他并不想 签约,他想去上大学 -- 而这是真的爱我的母亲 说我应该做的,而我也这么做了 -- 但其实他没做多好。他挣扎着去适应。 他被交易了几次,并在小联盟打了他大部分的职业球赛, 最终来到了管理层。它做了奥克兰运动家球队 的总经理。
Now for many of you in this room, ending up in management, which is also what I've done, is seen as a success. I can assure you that for a kid trying to make it in the Bigs, going into management ain't no success story. It's a failure.
对于在座的大多数人来说,像我一样成为管理层的一部分 会被看做是成功。 我可以向你保证,对于一个试图在大联盟打出名声的孩子来说, 进入管理层不是一个成功的故事。它是一种失败。
And what I want to talk to you about today, and share with you, is that our healthcare system, our medical system, is just as bad at predicting what happens to people in it -- patients, others -- as those scouts were at predicting what would happen to Billy Beane. And yet, every day thousands of people in this country are diagnosed with preconditions.
而我今天想和你说的,便是 我们的医保系统,医疗系统,在对于预测 将发生在人身上的事情也很差 -- 病患,其他的 -- 就像那些预测比利·比恩会成功的球探一样。 但每一天 在这个国家里仍然有上千个人 被诊断出疾病前兆。
We hear about pre-hypertension, we hear about pre-dementia, we hear about pre-anxiety, and I'm pretty sure that I diagnosed myself with that in the green room.
我们听到高血压前兆,痴呆症前兆, 焦虑症前兆,而我确定我在那绿色的房间里 给了自己这个诊断。
We also refer to subclinical conditions. There's subclinical atherosclerosis, subclinical hardening of the arteries, obviously linked to heart attacks, potentially. One of my favorites is called subclinical acne. If you look up subclinical acne, you may find a website, which I did, which says that this is the easiest type of acne to treat. You don't have the pustules or the redness and inflammation. Maybe that's because you don't actually have acne.
同样的,我们也提到亚临床症状。 我们有亚临床动脉硬化, 潜在的联系到心力衰竭。 我最喜欢的叫做亚临床粉刺。 如果你搜索亚临床粉刺,你可能会像我一样找到一个网站, 上面说这种粉刺最容易被治疗。 你不会有脓包,红肿或炎症。 但这也有可能是因为你并没有粉刺。
I have a name for all of these conditions, it's another precondition: I call them preposterous. In baseball, the game follows the pre-game. Season follows the pre-season. But with a lot of these conditions, that actually isn't the case, or at least it isn't the case all the time. It's as if there's a rain delay, every single time in many cases.
我给这些病症起了个名字,它也是一种前兆症: 我叫它们 ”荒谬绝伦“。 在棒球中,正式比赛在热身赛后开始。 赛季在赛前季后。 但对于这些疾病来说,这大多数情况 并不成立。在很多病例中它就像在球赛被下雨取消了一般。
We have pre-cancerous lesions, which often don't turn into cancer. And yet, if you take, for example, subclinical osteoporosis, a bone thinning disease, the precondition, otherwise known as osteopenia, you would have to treat 270 women for three years in order to prevent one broken bone. That's an awful lot of women when you multiply by the number of women who were diagnosed with this osteopenia.
我们有癌前病变, 但它们经常不会转化为癌症。 然而, 如果你拿亚临床骨质疏松症做例子, 它的前兆症状, 被称为骨质减少, 你必须为270个女人提供长达3年的治疗, 来防止一个断裂的骨头。 当你用时间乘以被诊断为骨质减少的 女人人数时, 这个数字是相当庞大的。
And so is it any wonder, given all of the costs and the side effects of the drugs that we're using to treat these preconditions, that every year we're spending more than two trillion dollars on healthcare and yet 100,000 people a year -- and that's a conservative estimate -- are dying not because of the conditions they have, but because of the treatments that we're giving them and the complications of those treatments?
所以,看看每年 我们花费在这些病症前兆上的 药物的费用以及它们导致的副作用, 我们每年都要在医保上花费2万亿美元以上的钱, 但每年仍然有10万人 死亡-- 而这只是一个保守的估计, 不是因为他们所有的病症, 而是因为我们所给他们的疗程以及这些疗程带来的并发症。
We've medicalized everything in this country. Women in the audience, I have some pretty bad news that you already know, and that's that every aspect of your life
我们医疗化了这个国家 的一切。 在座的女性们,我有一些 你已经知道的坏消息, 那就是你们生活的每一部分
has been medicalized. Strike one is when you hit puberty. You now have something that happens to you once a month that has been medicalized. It's a condition; it has to be treated. Strike two is if you get pregnant. That's been medicalized as well. You have to have a high-tech experience of pregnancy, otherwise something might go wrong.
都被医疗化了。 第一次是当你来到青春期。 你现在有了一个被医疗化的,每月都发作一次的东西。 它变成了一个病症; 它必须被治疗。第二次是 当你怀孕的时候。 那也被医疗化了。 你必须使用高科技 来保护孕期,不然有些地方可能会出错。
Strike three is menopause. We all know what happened when millions of women were given hormone replacement therapy for menopausal symptoms for decades until all of a sudden we realized, because a study came out, a big one, NIH-funded. It said, actually, a lot of that hormone replacement therapy may be doing more harm than good for many of those women.
第三次是更年期。 我们都知道,几十年来我们给了几百万的女人激素取代疗法 来治疗更年期症状, 直到我们突然明白了一个由国家卫生研究所 (NIH)资助的研究 得出来的结果。 研究说, 其实太多的激素取代疗法对于很多女人来说 坏处可能多于好处。
Just in case, I don't want to leave the men out -- I am one, after all -- I have really bad news for all of you in this room, and for everyone listening and watching elsewhere: You all have a universally fatal condition. So, just take a moment. It's called pre-death. Every single one of you has it, because you have the risk factor for it, which is being alive.
为了以防万一, 我不想把男人置身事外 -- 毕竟我也是其中一份子 -- 对于在座的给位以及正在收听和 收看的观众, 我有很坏的消息: 你们都有 一个普遍的致命病症。 所以,请深呼吸一下。 他叫死亡前兆。 你们每个人都有,因为你们都有它的危险因素, 那就是活着。
But I have some good news for you, because I'm a journalist, I like to end things in a happy way or a forward-thinking way. And that good news is that if you can survive to the end of my talk, which we'll see if that happens for everyone, you will be a pre-vivor.
但我也有些好消息,因为我是 一个新闻记者,我喜欢以一种开心和积极的心态来结尾。 这个好的信息便是,如果你可以成功的活到我的演讲的结束, 这点我相信大家都可以, 你会是一个前存者 (pre-vivor)。
I made up pre-death. If I used someone else's pre-death, I apologize, I think I made it up. I didn't make up pre-vivor. Pre-vivor is what a particular cancer advocacy group would like everyone who just has a risk factor, but hasn't actually had that cancer, to call themselves. You are a pre-vivor.
死亡前兆是我编的。 如有雷同,对不起, 但我想这的确是我编的。 但我没有编出前存者 (pre-vivor)。 前存者(其实指癌症高危人群) 是一个癌症宣传组织, 它是指某些人有癌症高发因素, 但却还没发展成癌症 他们就这么称呼他们自己。 你们都是前存者(癌症高危人群)。
We've had HBO here this morning. I'm wondering if Mark Burnett is anywhere in the audience, I'd like to suggest a reality TV show called "Pre-vivor." If you develop a disease, you're off the island.
家庭票房(HBO)今早还在这里。我不知道Mark Burnett(英国著名电视制作人)是否 现在在观众席中。我建议开办一个 叫做“前存者”的真人秀节目。 谁患上了一种疾病,就要从岛上退出。
But the problem is, we have a system that is completely -- basically promoted this. We've selected, at every point in this system, to do what we do, and to give everyone a precondition and then eventually a condition, in some cases. Start with the doctor-patient relationship. Doctors, most of them, are in a fee-for-service system. They are basically incentivized to do more -- procedures, tests, prescribe medications.
但问题是,我们的系统 完完全全的 -- 时时刻刻地在促进它的发生。 我们在这个系统的每个时刻都选择了 我们在做什么,于是它给了每一个人一个前兆 而最终,其中某些前兆转变为病症。 让我们从医患关系说起。大多数医生, 服从一种一次一付的医疗付费系统。越是给的多,他们就做得越多。 比如步骤,检测, 还有开处方。
Patients come to them, they want to do something. We're Americans, we can't just stand there, we have to do something. And so they want a drug. They want a treatment. They want to be told, this is what you have and this is how you treat it. If the doctor doesn't give you that, you go somewhere else. That's not very good for doctors' business. Or even worse, if you are diagnosed with something eventually, and the doctor didn't order that test, you get sued.
病人来找医生, 就是想要到一些东西。我们美国人不能只是傻傻地站在那儿吧, 我们得做些什么啊。他们只是想要药物。 他们只是想要得到治疗。他们想被告知,这就是你得的病, 这就是你的治疗方法。如果医生没能给你这些, 你会到别处就医。 这对医生的生意是很不利的噢。 更坏的是, 如果你最终被诊断出来真的患有某病,而医生当时却没有要求你做相应的检测, 你会起诉他。
We have pharmaceutical companies that are constantly trying to expand the indications, expand the number of people who are eligible for a given treatment, because that obviously helps their bottom line. We have advocacy groups, like the one that's come up with pre-vivor, who want to make more and more people feel they are at risk, or might have a condition, so that they can raise more funds and raise visibility, et cetera.
我们有些制药公司一直在试图扩大用药指征, 好让更多的人有理由接受它的治疗。 因为这样明显会有利于他们盈利。我们有一些宣传组织, 就像刚刚那个想出来前存者的组织, 他们想让越来越多的人觉得自己有高发因素,或是有症状, 好让他们募得更多的资金, 或是提高知名度或获取其他利益。
But this isn't actually, despite what journalists typically do, this isn't actually about blaming particular players. We are all responsible. I'm responsible. I actually root for the Yankees, I mean talk about rooting for the worst possible offender when it comes to doing everything you can do. Thank you. But everyone is responsible.
这其实并不实际, 尽管这是典型的新闻人会干的事,但我其实并不是 在责怪某些人。 我们对此都有责任。 我也要对此负责。 我其实支持Yankee队,我的意思是说 在有能力做任何事情的情况下 支持最可能的罪犯 谢谢。 但是的确人人有责。
I went to medical school, and I didn't have a course called How to Think Skeptically, or How Not to Order Tests. We have this system where that's what you do. And it actually took being a journalist to understand all these incentives. You know, economists like to say, there are no bad people, there are just bad incentives.
我在上医学院的时候, 并没有一门课程叫做“如何抱有怀疑态度地思考” 或是“如何选择检测方法” 我们的这个体制就这样, 你还得继续你应该做的事。 不过好像只有新闻人才懂得这些诱因。 知道吗,经济学家说, 世上本无坏人, 只有坏念头。
And that's actually true. Because what we've created is a sort of Field of Dreams, when it comes to medical technology. So when you put another MRI in every corner, you put a robot in every hospital saying that everyone has to have robotic surgery. Well, we've created a system where if you build it, they will come. But you can actually perversely tell people to come, convince them that they have to come.
这绝对是真理。 因为我们已经创造出了医学界的《梦幻成真》(1989年4月21日在美国上映的一部电影)。 所以当你在每个角落都装备了MRI,却在每个医院又装备机器人 并且说每个人都只能进行机器人手术。 接受现实吧,我们已经创造了这种体制,这些也是不可阻挡的现实。 当然你也可以倔强不屈, 告诉人们将发生什么, 让他们明白这一切是必须发生的。
It was when I became a journalist that I really realized how I was part of this problem, and how we all are part of this problem. I was medicalizing every risk factor, I was writing stories, commissioning stories, every day, that were trying to, not necessarily make people worried, although that was what often happened.
我就是当了新闻人以后才真正意识到我也是这个问题的其中一员, 意识到我们是怎样都和这个问题有关的。 我在医疗化每个危险因素,我在写故事,授权故事, 天天如此,目的就是 不让人们这么焦虑,虽然这通常都不管用。
But, you know, there are ways out. I saw my own internist last week, and he said to me, "You know," and he told me something that everyone in this audience could have told me for free, but I paid him for the privilege, which is that I need to lose some weight. Well, he's right. I've had honest-to-goodness high blood pressure for a dozen years now, same age my father got it, and it's a real disease. It's not pre-hypertension, it's actual hypertension, high blood pressure.
但是知道吗,其实有解决的方法。 上个星期我才见了我的内科医生, 他对我说, “你知道吗”, 这些话在座各位都可以告诉我而不收取任何费用, 而我却付给他钱让他来告诉我, 那就是我需要减肥。 好吧,他是对的。我是如假包换的高血压患者, 已经是老油条了, 患病年龄跟我父亲一样。 这的确是一种疾病,这不是高血压前兆, 这的的确确就是高血压,高血压病。
Well, he's right, but he didn't say to me, well, you have pre-obesity or you have pre-diabetes, or anything like that. He didn't say, better start taking this Statin, you need to lower your cholesterol. No, he said, "Go out and lose some weight. Come back and see me in a bit, or just give me a call and let me know how you're doing."
好吧,他是对的, 但他没有告诉我说, 额,你有肥胖症前兆或是 你有糖尿病前兆或是其他种种,他都没说, 他也没说让我用抑制素来降低胆固醇。 他只是说,‘出去走走,减减肥,回来让我好好看看你。 或者干脆给我打个电话让我知道你在做什么。“
So that's, to me, a way forward. Billy Beane, by the way, learned the same thing. He learned, from watching this kid who he eventually hired, who was really successful for him, that it wasn't swinging for the fences, it wasn't swinging at every pitch like the sluggers do, which is what all the expensive teams like the Yankees like to -- they like to pick up those guys. This kid told him, you know, you gotta watch the guys, and you gotta go out and find the guys who like to walk, because getting on base by a walk is just as good, and in our healthcare system we need to figure out, is that really a good pitch or should we let it go by and not swing at everything? Thanks.
这就是对于我的 一个解决的方法。 同样地,Billy Beane(电影《点球成金》男主角)也学到了这点。 他学会了什么呢? 通过观察他最终雇佣的那个为他赢得巨大成功的孩子, 他学会了要赢得比赛并不仅仅是把球挥出栅栏或是在球场上猛打就可以, 就好比那些富队比如yankees会做的一样使用蛮力, 他们是用心去挑选球员,善用人才。 那孩子告诉他,你要看那些选手,你要到外面去看看, 哪些家伙喜欢走路, 因为步行上垒不失为一种好方法, 而在我们的医保体系里 我们得弄明白 这真的是医疗的一块好球场吗? 或者我们就应该让他维持现状而不去作任何改变? 谢谢。