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.
在場看過電影「魔球」 或者看過麥可.路易斯書的人 對比利.比恩的故事並不陌生吧 所有的球探都告訴比利他原本會是個傑出的球員 他們告訴他的父母 他們預測比利將成為明日之星
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.
但當他簽了合約後的事實是- 順帶一提,他並不想要簽那個合約,他想上大學 這就是為什麼愛我的媽媽 說我也應該去上大學,然後我去了- 嗯…他沒有做得很好,而且做得非常辛苦。 他被交易了幾次,他的職業生涯大多在小聯盟裡 最終他成為了球隊經理 他擔任了奧克蘭運動家隊的的經理
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.
回到在座的各位來說,和我一樣以管理階層的身份離開 被認為是成功的 我能向你保證對於那些想打進大聯盟的孩子們來說 進入到管理階層並不是成功的故事,那是失敗。
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.
而我今天想跟你們分享的是 我們的保健、醫藥系統 對於預測人們或是病人發生了什麼事 就和球探們預測比利.比恩的未來一樣不準 然後,每一天 這個國家裡有成千上萬的人 被診斷出生病的前兆
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.
我們到到有高血壓的前兆、痴呆的前兆 焦慮症的前兆 我非常確定在那個綠色的房間裡 我認為我患了焦慮症
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.
我們也被暗示有症狀不顯著的病症 可能是症狀不顯著的動脈粥樣硬化、動脈硬化 明顯地被聯結為潛在的心臟病 我最愛的一種稱為症狀不顯著的粉刺 如果你查詢這個症狀,你會和我一樣發現一個網站 裡頭提到了這是最容易治療的粉刺種類 你沒有膿皰、紅腫或發炎 或許這是因為你其實根本就沒有粉刺
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.
我為這些病症取了一個名字,這又是另一個前兆了: 我稱它為荒唐病 在棒球裡,正式比賽在熱身賽之後 球季在賽前季之後 但是在許多情況中根本不會有病 至少是大部份的時候都不會有病 那就好像隨時隨地都有遇雨停賽的可能
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.
我們有癌症的徵兆 但是最終通常都不會變成癌症 還有 以症狀不顯著的骨質疏鬆症為例 這是一種骨質薄化的病症 如果你將它視為骨質減少 你必須在三年內治療270位女性 以免其中一位跌斷了骨頭 當你計算有多少女性 被診斷為骨質減少時 所得到的數字 將會非常驚人
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?
是否有人懷疑過 花費這些錢 還有為了治療這些徵兆而服用的藥物所帶來的副作用 我們已在健康管理上花費超過兩萬億美元 而且保守估計每年還有十萬人面臨死亡 他們不是因為有了什麼疾病 而是因為我們給他的治療所產生的併發症 讓他面臨死亡
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
在這個國家 我們一直用醫藥的方式來處理每件事 在場的女性朋友 有幾個壞消息是您已經知道的 那就是您生命中的每一個面向
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.
都已被醫藥化了 第一個階段是在你年輕的時候 有一個東西是每個月出現一次 那也已經被醫藥化了 這是一種已經被治療的症狀 第二個階段是 如果你懷孕了 這件事也被醫藥化了 你必須要經歷高科技的懷孕過程 否則可能會有問題
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.
第三個階段是更年期 我們都知道幾十年來上百萬位婦女 被以荷爾蒙替代療法來治療更年期的症狀 直到某一刻國家衛生研究所發表了一篇研究 我們才突然驚醒 這份研究報告指出 事實上,對許多婦女來說 荷爾蒙替代療法可能造成更多的傷害
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.
遠多於它所帶來的幫助 比方說 我不想讓男人離開 畢竟我也是個男人 我有一個壞消息要告訴在座的男性 以及在任何地方的觀眾朋友 你們都有 致命的病症 因此,請深呼吸片刻 這叫作死亡前兆 每一個人都有這個病症 因為你們都有一個可能致死的危險因子 那就是活著
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.
但是我有一個好消息要告訴你 因為我是個新聞工作者 我喜歡讓事情以快樂或是正向思考的方式來作結 這個好消息是如果你能夠在我的演講後倖存 稍後見分曉 你就會是一位有「倖存前兆」的人
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.
我虛構了死亡前兆這個詞 如果我用了某個人創造的這個詞 如有雷同,純屬巧合 我並沒有虛構倖存前兆者 倖存前兆者是一個多麼特殊的癌症提倡團體 希望每個人都有危險因子 但是事實上 他們連這個癌症的名字都沒有 你是一個倖存前兆者
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.
我們今早在這裡看了HBO電影台 我很好奇如果馬克伯內特在場 我會建議他拍一場叫「倖存前兆者」的實鏡電視秀 如果你生了病,你就得離開這座島
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.
但是問題是 我們有一種非常徹底且基本的宣傳機制 我們是被選出來的 在這個機制的每一分一毫都被安排好了 我們要做的事、給每個人一個前兆 接著其中一部份則成了病症 以醫病關係來作說明 大部份的醫生都在收費服務的機制裡 基本上他們樂於做更多手續、測驗 開立處方箋
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.
病人前來就醫 他們想要某種東西 我們是美國人,我們不會只是站在那裡 我們需要做點什麼 因此他們得到了藥物與治療 他們想要聽到這是你目前可以用的藥 以及你如何治療病症 如果醫生沒有給你這些東西 你就會另外找一家醫院 這對醫生的生意來說不太好 更糟的可能是 如果最後你被診斷出某種疾病 而之前的醫生沒有做那些檢驗,你就會告他
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.
我們有不斷嘗試開發出適用各種病症藥品的製藥廠 擴展能夠得到合適處方藥物的病人 因為那很顯然的滿足了最基本的需求 我們有像「倖存前兆者」的提倡團體 試著想要讓更多人覺得他們身處危機、患有病症 因此他們可以得到更多的贊助 提升能見度等等
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.
然而這並非屬實 不管新聞工作者怎麼做 都不是在責備特別的球員 我們都很盡責 我也很盡責 其實我支持洋基隊 我的意思是當你可以做任何事情的時候 支持最有可能的罪犯 謝謝 但是每個人都是負責任的
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.
我曾去過醫學院 卻沒有一堂叫做「如何保持懷疑態度的思考」 或是「如何避免做檢驗」 我們的體制如此 而你只能在其中做該做的事 這其實讓身為記者的我了解所有這些動機 你知道經濟學者可能會說 世界上沒有不好的人 只有不好的動機
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.
確實如此 因為我們創造了一種醫學界的《夢幻成真》 當你在每一個角落擺一台核磁共振儀器 就等於你在每一間醫院放了一個機器人 他會告訴每個人都需要機器手術 我們已經建立了一個機制 一旦建立了,事情就會順其而行 但是你也可以倔將地告訴人們 說服他們 一定要這麼做
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.
一直到我當了記者後 我才理解到原來我也是問題的一部份 而且我們大家都是這個問題的一部份 過去我醫藥化每一個風險因子 我每天都寫了很多故事且授權故事 目的是不讓人們感到如此焦慮 雖然這種事很常發生
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.
但是你知道 事情總有解決的辦法 上個星期我去見了我的內科醫生 他告訴我 「你知道的,你該減肥了。」 每一個在場的觀眾都可以免費告訴我這件事 但是我卻得花錢請他跟我說 那就是我該減肥了 好吧,他是對的 我確實是好幾十年的高血壓患者 我父親在我這個年紀的時候也一樣 而且這是一個真的疾病,這不是前兆而已 這是真的高血壓
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,他是對的 但是他沒有告訴我 嘿,你有肥胖的前兆 或是你糖尿病的前兆,或是那之類的病症 他一點也沒有說 他用了一個比較好的方式告訴我 你該減少你的膽固醇攝取量 喔,不對, 他是說:「出門去減個肥吧!之後再來和我見面 還是打個電話通知我,讓我知道你已經開始減肥了
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.
對我來說 這是一條可行的路 順帶一提 比利.比恩也學到了同樣的道理 他終於僱用了這個孩子,而這個孩子也真的成功了 他在這之中學到了並不只是要打出全壘打 不是每一球都要像打擊率高的選手一樣每球必中 這就和洋基隊那種熱門球隊的作法一樣 他們喜歡挑選那樣的人 這個孩子告訴他,你要好好觀察這些人 然後找出一個喜歡走路的人 因為步行上壘是件好事 而在我們的醫藥體系中 我們需要認出 這是真的好球嗎? 還是就此遺忘,別理這件事? 謝謝