Some of my most wonderful memories of childhood are of spending time with my grandmother, Mamar, in our four-family home in Brooklyn, New York. Her apartment was an oasis. It was a place where I could sneak a cup of coffee, which was really warm milk with just a touch of caffeine. She loved life. And although she worked in a factory, she saved her pennies and she traveled to Europe. And I remember poring over those pictures with her and then dancing with her to her favorite music.
Semasa kecil, saya selalu menghabiskan masa yang indah bersama nenek saya, Mamar, di rumah yang didiami 4 keluarga di Brooklyn, New York. Saya suka berada di situ. Saya akan minum kopi secara diam-diam. Kopi itu campuran susu panas dan kafeina. Nenek saya menikmati kehidupannya. Walaupun dia bekerja di kilang, dia berjimat dan menggembara ke Eropah. Saya pernah melihat gambar-gambarnya bersama dia dan menari dengan dia mengikut musik kegemarannya.
And then, when I was eight and she was 60, something changed. She no longer worked or traveled. She no longer danced. There were no more coffee times. My mother missed work and took her to doctors who couldn't make a diagnosis. And my father, who worked at night, would spend every afternoon with her, just to make sure she ate.
Semasa saya berusia 8 tahun, dan dia 60, sesuatu berlaku. Dia tidak lagi bekerja atau menggembara. Dia tidak lagi menari. Tiada lagi masa untuk minum kopi. Mak saya ambil cuti dan bawa dia jumpa doktor, tapi penyakitnya tidak diketahui. Setiap petang, ayah saya yang bekerja malam menemaninya untuk memastikan dia memakan sesuatu.
Her care became all-consuming for our family. And by the time a diagnosis was made, she was in a deep spiral.
Masalah kesihatannya menjadi tumpuan kami. Ketika jenis penyakitnya diketahui, dia telah berada dalam keadaan yang serius.
Now many of you will recognize her symptoms. My grandmother had depression. A deep, life-altering depression, from which she never recovered. And back then, so little was known about depression.
Kebanyakan antara anda tahu tentang simptonnya. Nenek saya menderitai kemurungan. Penyakit ini mengubah kehidupannya dan dia tidak pernah pulih daripadanya. Pada masa itu, cuma terdapat sedikit maklumat tentang kemurungan.
But even today, 50 years later, there's still so much more to learn. Today, we know that women are 70 percent more likely to experience depression over their lifetimes compared with men. And even with this high prevalence, women are misdiagnosed between 30 and 50 percent of the time.
Kini, selepas 50 tahun, masih terdapat banyak hal yang perlu dikaji tentangnya. Kini, kita tahu bahawa risiko wanita menderitai kemurungan Kini, kita tahu bahawa risiko wanita menderitai kemurungan adalah 70% lebih tinggi daripada lelaki. Walaupun risikonya amat tinggi, kadar kesilapan diagnosis terhadap wanita adalah antara 30% - 50%.
Now we know that women are more likely to experience the symptoms of fatigue, sleep disturbance, pain and anxiety compared with men. And these symptoms are often overlooked as symptoms of depression.
Kita juga tahu bahawa wanita lebih mudah menderitai kepenatan, kecelaruan tidur, kesakitan dan kerisauan berbanding dengan lelaki. Selalunya, semua simpton ini tidak dikaitkan dengan simpton kemurungan.
And it isn't only depression in which these sex differences occur, but they occur across so many diseases.
Faktor perbezaan jantina bukan saja wujud dalam penyakit kemurungan, ia juga wujud dalam penyakit lain.
So it's my grandmother's struggles that have really led me on a lifelong quest. And today, I lead a center in which the mission is to discover why these sex differences occur and to use that knowledge to improve the health of women.
Penyakit nenek saya inilah yang mendorong saya mencari jawapannya. Kini, saya memimpin sebuah pusat yang bertujuan mengkaji mengapa terdapatnya faktor perbezaan jantina dan menggunakan pengetahuan ini untuk memperbaik kesihatan wanita.
Today, we know that every cell has a sex. Now, that's a term coined by the Institute of Medicine. And what it means is that men and women are different down to the cellular and molecular levels. It means that we're different across all of our organs. From our brains to our hearts, our lungs, our joints.
Kini, kita tahu bahawa sel badan mempunyai jantina. Pernyataan ini diberikan oleh Institut Perubatan, Amerika. Maksudnya, sel dan molekul bagi lelaki dan wanita adalah berbeza. Maksudnya, sel dan molekul bagi lelaki dan wanita adalah berbeza. Jadi, organ lelaki dan wanita adalah berbeza, sama ada otak, jantung, peparu, atau sendi kita.
Now, it was only 20 years ago that we hardly had any data on women's health beyond our reproductive functions. But then in 1993, the NIH Revitalization Act was signed into law. And what this law did was it mandated that women and minorities be included in clinical trials that were funded by the National Institutes of Health. And in many ways, the law has worked. Women are now routinely included in clinical studies, and we've learned that there are major differences in the ways that women and men experience disease. But remarkably, what we have learned about these differences is often overlooked.
Pada 20 tahun yang lalu, selain fungsi reproduktif, kita kekurangan data tentang kesihatan wanita. Tapi pada tahun 1993, Akta Pengukuhan Semula NIH diluluskan. Undang-undang ini mewajibkan penglibatan wanita dan golongan minoriti dalam ujian klinikal yang ditaja oleh Institut Kesihatan Kebangsaan, Amerika. Undang-undang ini amat berkesan. Kini, wanita terlibat dalam kajian klinikal dan kita tahu bahawa terdapat perbezaan utama dari segi bagaimana wanita dan lelaki menderitai penyakit. dari segi bagaimana wanita dan lelaki menderitai penyakit. Tapi, faktor perbezaan yang telah diketahui ini tidak diberikan perhatian. Tapi, faktor perbezaan yang telah diketahui ini tidak diberikan perhatian.
So, we have to ask ourselves the question: Why leave women's health to chance? And we're leaving it to chance in two ways. The first is that there is so much more to learn and we're not making the investment in fully understanding the extent of these sex differences. And the second is that we aren't taking what we have learned, and routinely applying it in clinical care. We are just not doing enough.
Jadi, soalannya ialah: Mengapa kita merisikokan kesihatan wanita? Terdapat 2 masalah. Pertama, terdapat banyak lagi yang perlu dikaji, tapi kita tidak berusaha memahami setakat mana perbezaan lelaki dan wanita ini. Kedua, kita tidak menggunakan pengetahuan sedia ada dan mengamalkannya dalam rawatan kesihatan. Usaha kita tidak memadai.
So, I'm going to share with you three examples of where sex differences have impacted the health of women, and where we need to do more.
Jadi, saya akan berkongsi 3 contoh bagaimana faktor perbezaan jantina telah mempengaruhi kesihatan wanita, dan perkara yang perlu dilakukan.
Let's start with heart disease. It's the number one killer of women in the United States today. This is the face of heart disease. Linda is a middle-aged woman, who had a stent placed in one of the arteries going to her heart. When she had recurring symptoms she went back to her doctor. Her doctor did the gold standard test: a cardiac catheterization. It showed no blockages. Linda's symptoms continued. She had to stop working. And that's when she found us. When Linda came to us, we did another cardiac catheterization and this time, we found clues. But we needed another test to make the diagnosis. So we did a test called an intracoronary ultrasound, where you use soundwaves to look at the artery from the inside out.
Kita mulakan dengan penyakit jantung. Kini, ia pembunuh utama wanita di Amerika. Dia pesakit jantung. Linda wanita pertengahan umur. Sebuah alat sokongan ditempatkan pada salah satu arteri yang menuju ke jantungnya. Dia menemui doktornya setelah dia mengalami simpton yang berulang. Doktornya menjalankan ujian standard: pengkateteran jantung. Arterinya tidak tersumbat. Simpton Linda berterusan. Dia terpaksa berhenti bekerja. Pada masa itulah dia menemui kami. Kami menjalankan ujian pengkateteran jantung dan kali ini, kami menemui sesuatu. Tapi, kami perlu menjalankan ujian lain untuk membuat diagnosis itu. Jadi, kami menjalankan ujian ultrabunyi intrakoronari, iaitu menggunakan gelombang bunyi untuk mencari arteri yang bermasalah.
And what we found was that Linda's disease didn't look like the typical male disease. The typical male disease looks like this. There's a discrete blockage or stenosis. Linda's disease, like the disease of so many women, looks like this. The plaque is laid down more evenly, more diffusely along the artery, and it's harder to see. So for Linda, and for so many women, the gold standard test wasn't gold.
Kami mendapati bahawa penyakit Linda berbeza daripada penyakit yang dialami lelaki. Bagi lelaki, ia kelihatan begini. Terdapat penyempitan yang berasingan. Seperti kebanyakan wanita, penyakit Linda kelihatan begini. Plak di situ lebih seimbang dan wujud di sepanjang arterinya, dan ia lebih sukar ditemui. Jadi, untuk Linda dan kebanyakan wanita, ujian standard tidak sesuai bagi mereka.
Now, Linda received the right treatment. She went back to her life and, fortunately, today she is doing well. But Linda was lucky. She found us, we found her disease.
Linda telah menerima rawatan yang betul dan menjalani kehidupan yang normal semula. Kini, dia baik saja. Tapi, Linda bernasib baik. Dia menemui kami, dan kami menemui penyakitnya.
But for too many women, that's not the case. We have the tools. We have the technology to make the diagnosis. But it's all too often that these sex diffferences are overlooked.
Tapi bagi kebanyakan wanita, ia bukannya begitu. Kami mempunyai peralatannya dan teknologi untuk mendiagnosis. Tapi, selalunya faktor perbezaan jantina tidak diberikan perhatian.
So what about treatment? A landmark study that was published two years ago asked the very important question: What are the most effective treatments for heart disease in women? The authors looked at papers written over a 10-year period, and hundreds had to be thrown out. And what they found out was that of those that were tossed out, 65 percent were excluded because even though women were included in the studies, the analysis didn't differentiate between women and men. What a lost opportunity. The money had been spent and we didn't learn how women fared. And these studies could not contribute one iota to the very, very important question, what are the most effective treatments for heart disease in women?
Bagaimana pula dengan rawatan? Sebuah kajian yang penting diterbitkan 2 tahun yang lalu. Soalan kajian itu ialah: Apakah rawatan penyakit jantung yang paling berkesan bagi wanita? Para pengkaji membaca artikel yang telah diterbitkan dalam masa 10 tahun dan beratus-ratus artikel didapati tidak membantu. Antara artikel yang tidak membantu itu, 65% daripadanya tidak membantu kerana walaupun wanita terlibat dalam kajian-kajian itu, analisis yang dijalankan tidak membezakan wanita dan lelaki. Sayang sekali. Wang telah dibelanjakan, tapi wanita tidak menerima manfaatnya. Kajian-kajian itu tidak dapat menjawab soalan yang amat penting: Apakah rawatan penyakit jantung yang paling berkesan bagi wanita? Apakah rawatan penyakit jantung yang paling berkesan bagi wanita?
I want to introduce you to Hortense, my godmother, Hung Wei, a relative of a colleague, and somebody you may recognize -- Dana, Christopher Reeve's wife. All three women have something very important in common. All three were diagnosed with lung cancer, the number one cancer killer of women in the United States today. All three were nonsmokers. Sadly, Dana and Hung Wei died of their disease. Today, what we know is that women who are nonsmokers are three times more likely to be diagnosed with lung cancer than are men who are nonsmokers. Now interestingly, when women are diagnosed with lung cancer, their survival tends to be better than that of men. Now, here are some clues. Our investigators have found that there are certain genes in the lung tumor cells of both women and men. And these genes are activated mainly by estrogen. And when these genes are over-expressed, it's associated with improved survival only in young women. Now this is a very early finding and we don't yet know whether it has relevance to clinical care. But it's findings like this that may provide hope and may provide an opportunity to save lives of both women and men.
Saya perkenalkan Hortense, ibu pembaptisan saya; Hung Wei, saudara kepada rakan sekerja saya, dan mungkin anda kenal dia: Dana, isteri Christopher Reeve. Mereka mempunyai satu persamaan yang amat penting. Mereka didiagnosis dengan kanser peparu. Di Amerika, ia kanser yang meragut paling banyak nyawa wanita. Di Amerika, ia kanser yang meragut paling banyak nyawa wanita. Mereka bukan perokok. Malangnya, Dana dan Hung Wei telah meninggal dunia. Risiko wanita yang bukan perokok mendapat kanser peparu adalah 3 kali lebih tinggi berbanding dengan lelaki yang bukan perokok. adalah 3 kali lebih tinggi berbanding dengan lelaki yang bukan perokok. Tapi, bagi wanita yang didiagnosis dengan kanser peparu, jangka bertahan hidup mereka adalah lebih tinggi daripada lelaki. Berikut merupakan sebab-sebabnya. Pengkaji kami telah mendapati bahawa terdapat gen-gen tertentu dalam sel-sel tumor peparu wanita dan lelaki. Gen-gen ini diaktifkan oleh estrogen. Gen-gen ini diaktifkan oleh estrogen. Apabila gen-gen ini terlampau banyak, ia cuma meningkatkan jangka bertahan hidup wanita. ia cuma meningkatkan jangka bertahan hidup wanita. Penemuan ini masih di peringkat awal, dan kami belum tahu sama ada ia berkaitan dengan rawatan. dan kami belum tahu sama ada ia berkaitan dengan rawatan. Tapi, penemuan sebeginilah yang memberikan harapan dan peluang untuk menyelamatkan nyawa wanita dan lelaki.
Now, let me share with you an example of when we do consider sex differences, it can drive the science. Several years ago a new lung cancer drug was being evaluated, and when the authors looked at whose tumors shrank, they found that 82 percent were women. This led them to ask the question: Well, why? And what they found was that the genetic mutations that the drug targeted were far more common in women. And what this has led to is a more personalized approach to the treatment of lung cancer that also includes sex.
Saya mahu berkongsi sebuah contoh yang mempertimbangkan faktor perbezaan jantina. Beberapa tahun yang lalu, sejenis ubat kanser peparu dinilai. Beberapa tahun yang lalu, sejenis ubat kanser peparu dinilai. Semasa pengkaji melihat tumor siapa yang mengecut, didapati bahawa 82% daripadanya ialah wanita. Ia membangkitkan soalan ini: Mengapa? Mereka mendapati bahawa mutasi genetik yang menjadi sasaran ubat itu lebih kerap berlaku dalam kes wanita. Ia telah membawa kepada rawatan kanser peparu yang diperibadikan yang juga mengambil kira faktor jantina.
This is what we can accomplish when we don't leave women's health to chance. We know that when you invest in research, you get results. Take a look at the death rate from breast cancer over time. And now take a look at the death rates from lung cancer in women over time. Now let's look at the dollars invested in breast cancer -- these are the dollars invested per death -- and the dollars invested in lung cancer. Now, it's clear that our investment in breast cancer has produced results. They may not be fast enough, but it has produced results. We can do the same for lung cancer and for every other disease.
Inilah yang boleh dicapai jika kita tidak merisikokan kesihatan wanita. Apabila kita melabur dalam penyelidikan, kita akan mendapat hasilnya. Ini kadar kematian kanser payudara dari masa ke masa. Ini kadar kematian kanser peparu wanita dari masa ke masa. Ini kadar kematian kanser peparu wanita dari masa ke masa. Ini jumlah wang yang telah dilaburkan dalam kajian kanser payudara, dan kanser peparu. Pelaburan kita dalam kajian kanser payudara telah memberikan hasil yang lebih baik. Mungkin hasilnya belum memadai, tapi ia telah memberikan hasil. Kita boleh melabur dalam kajian kanser peparu dan penyakit-penyakit lain.
So let's go back to depression. Depression is the number one cause of disability in women in the world today. Our investigators have found that there are differences in the brains of women and men in the areas that are connected with mood. And when you put men and women in a functional MRI scanner -- that's the kind of scanner that shows how the brain is functioning when it's activated -- so you put them in the scanner and you expose them to stress. You can actually see the difference. And it's findings like this that we believe hold some of the clues for why we see these very significant sex differences in depression.
Mari kita balik kepada kemurungan. Kemurungan ialah punca utama kehilangan upaya wanita pada masa kini. Pengkaji kami telah mendapati bahawa bahagian otak wanita dan lelaki Pengkaji kami telah mendapati bahawa bahagian otak wanita dan lelaki yang berkaitan dengan emosi adalah berbeza. yang berkaitan dengan emosi adalah berbeza. Otak subjek lelaki dan wanita diimbas dengan pengimbas MRI. Otak subjek lelaki dan wanita diimbas dengan pengimbas MRI. Pengimbas itu menunjukkan bagaimana otak berfungsi apabila ia dirangsang. Mereka dimasukkan ke dalam pengimbas dan didedahkan kepada tekanan. Perbezaannya dapat dilihat. Penemuan sebeginilah yang dipercayai dapat memberikan jawapan mengapa terdapat perbezaan yang ketara bagi wanita dan lelaki yang menderitai kemurungan.
But even though we know that these differences occur, 66 percent of the brain research that begins in animals is done in either male animals or animals in whom the sex is not identified.
Tapi, walaupun kita tahu bahawa terdapatnya perbezaan ini, 66% daripada kajian otak yang dimulakan dengan haiwan 66% daripada kajian otak yang dimulakan dengan haiwan dijalankan pada haiwan jantan atau haiwan yang jantinanya tidak dikenal pasti.
So, I think we have to ask again the question: Why leave women's health to chance? And this is a question that haunts those of us in science and medicine who believe that we are on the verge of being able to dramatically improve the health of women. We know that every cell has a sex. We know that these differences are often overlooked. And therefore we know that women are not getting the full benefit of modern science and medicine today. We have the tools but we lack the collective will and momentum.
Jadi, soalannya adalah sama: Mengapa kita merisikokan kesihatan wanita? Soalan ini telah menghantui pakar-pakar dalam bidang sains dan perubatan yang percaya bahawa mereka dapat memperbaik kesihatan wanita. yang percaya bahawa mereka dapat memperbaik kesihatan wanita. Kita tahu bahawa sel badan mempunyai jantina. Kita tahu bahawa perbezaan ini tidak diberikan perhatian. Jadi, kita tahu bahawa wanita tidak mendapat manfaat penuh daripada bidang sains dan perubatan moden. Kita mempunyai peralatannya, tapi kita kekurangan hasrat kolektif dan dorongan.
Women's health is an equal rights issue as important as equal pay. And it's an issue of the quality and the integrity of science and medicine. (Applause) So imagine the momentum we could achieve in advancing the health of women if we considered whether these sex differences were present at the very beginning of designing research. Or if we analyzed our data by sex.
Kesihatan wanita merupakan isu persamaan hak yang sepenting persamaan gaji. Ia juga merupakan isu kualiti dan integriti bidang sains dan perubatan. (Tepukan) Bayangkanlah dorongan yang bakal diperoleh dalam memperbaik kesihatan wanita jika kita mempertimbangkan faktor perbezaan jantina pada peringkat merangka kajian, atau jika kita menganalisis data berdasarkan faktor jantina.
So, people often ask me: What can I do? And here's what I suggest: First, I suggest that you think about women's health in the same way that you think and care about other causes that are important to you. And second, and equally as important, that as a woman, you have to ask your doctor and the doctors who are caring for those who you love: Is this disease or treatment different in women? Now, this is a profound question because the answer is likely yes, but your doctor may not know the answer, at least not yet. But if you ask the question, your doctor will very likely go looking for the answer. And this is so important, not only for ourselves, but for all of those whom we love. Whether it be a mother, a daughter, a sister, a friend or a grandmother.
Orang ramai selalu menanya: Apakah yang boleh saya lakukan? Inilah cadangan saya: Pertama, berfikir tentang kesihatan wanita sebagaimana anda berfikir tentang hal-hal lain yang penting. Kedua, sebagai seorang wanita, anda perlu menanya doktor anda dan doktor yang mengubati orang yang anda sayangi: Adakah penyakit atau rawatan ini berbeza bagi wanita? Soalan ini amat penting kerana jawapannya mungkin "ya", tapi mungkin doktor anda tidak tahu atau belum tahu jawapannya. Tapi jika anda menanya soalan ini, kemungkinannya besar doktor anda akan mencari jawapannya. Ini amat penting. Ia bukan saja untuk diri kita, ia juga untuk semua orang yang kita sayangi, sama ada orang itu emak, anak, kakak, adik kawan atau nenek kita.
It was my grandmother's suffering that inspired my work to improve the health of women. That's her legacy. Our legacy can be to improve the health of women for this generation and for generations to come.
Penderitaan nenek sayalah yang mendorong saya untuk memperbaik kesihatan wanita. Itulah pengaruh dia. Bagi kita, mungkin kita dapat memperbaik kesihatan wanita bagi generasi ini dan generasi akan datang.
Thank you. (Applause)
Terima kasih. (Tepukan)