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.
我童年時最美好的回憶 有許多是和祖母共度, 在我們位於紐約布魯克林的四口之家。 她的公寓就像綠洲。 是個我能偷偷喝杯咖啡的地方, 其實是一杯摻有一點點咖啡因的熱牛奶。 她熱愛生命。 雖然她在工廠上班, 但是她還是存到了錢去歐洲旅行。 我記得會和她一起端詳這些照片, 接著和她聽著最喜愛的音樂共舞。
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.
然而在我 8 歲,她 60 歲時, 事情有了變化。 她不再工作或旅行。 她不再跳舞。 再也沒有咖啡時光了。 我的母親請了假,帶她去看過很多醫生, 但是都診斷不出來。 而我在夜間工作的父親,每天下午都會陪她, 只為了確定她真的有吃飯。
Her care became all-consuming for our family. And by the time a diagnosis was made, she was in a deep spiral.
照顧她成了家人們全心投入的事。 最後診斷出病因, 她的情況急轉直下。
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.
現在在座很多人認得出她的症狀。 我祖母得了憂鬱症, 一種會完全改變一生的憂鬱症, 後來她沒能從此病中痊癒。 當時我們對憂鬱症所知甚少。
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.
即使到 50 年後的今日, 仍有許多需要學習。 今天,我們知道女性在一生中 較男性多 70% 的可能性 得到憂鬱症。 即使如此普遍, 女性卻有 30% 至 50% 的可能性被誤診。
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.
現在我們知道相較於男性 女性有較高的機率經歷疲勞、睡眠障礙、 疼痛和焦慮。 而這些是憂鬱症的症狀 卻常常被忽略。
And it isn't only depression in which these sex differences occur, but they occur across so many diseases.
這些性別的差異 不只發生在憂鬱症, 也發生在許多疾病中。
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.
因此我祖母遭遇的困難 讓我花一輩子的時間去探尋。 現在,我帶領一個研究中心, 目的在找到這些 性別差異發生的原因, 並運用那學問 改善女性的健康。
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.
現今,我們知道每個細胞都有性別。 這是由醫學研究院創造的名詞。 意謂著男人和女人的不同 是在細胞與分子的層面。 那代表我們的差異遍及所有的器官。 從我們的腦、心、肺,到關節。
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.
而距今僅 20 年前, 我們沒有任何女性健康的資訊, 除了我們的生育機能。 但是在 1993 年時, 簽署了國家衛生研究院的新生法, 這項法律主要在明文規定 將女性和少數族群納入臨床試驗, 由國家衛生研究院提供資金。 這項法律在許多方面起了效用。 現在女性已固定納入臨床研究, 我們得知兩性 體驗疾病的方式 有很大的差異。 然而驚人的是 我們發現這些差異常被忽略。
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.
因此我們必須自問: 為什麼要讓女性的健康碰運氣? 我們用兩種方式碰運氣。 首先,我們需要學習的甚多, 但是我們卻沒投入 在全盤了解這些性別差異的程度。 第二,我們未採納所學, 並例行地運用在臨床照顧中。 我們做得還是不夠。
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.
因此我想和各位分享三個例子, 其中性別差異影響了女性的健康, 而我們應該要做得更多。
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.
讓我們以心臟病開始。 心臟病是目前美國女性的頭號殺手。 這是心臟病的面容。 琳達是中年婦女, 她在其中一條通往心臟的動脈內 植入支架。 當她有復發的症狀時,她回到醫院。 她的醫生做了黃金標準測試: 心導管。 但是沒顯示出阻塞。 琳達的症狀持續, 她必須停止工作。 那時她找上我們。 當琳達向我們求助, 我們做了另一次心導管, 而這次我們找到了線索。 但是我們需要另一項測試 來做出診斷。 我們做了冠狀動脈內超音波, 你可以運用音波檢視動脈, 從裡到外。
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.
我們發現 琳達的病看起來不像 典型的男性疾病。 典型的男性疾病看起來像這樣。 有不連續的阻塞或狹窄。 琳達的病就和許多女性的一樣, 看起來像這樣。 血小板沿著動脈分布更平均、更擴散, 也更難看得出來。 因此對琳達和許多女性來說, 這黃金標準測試並非黃金。
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.
現在琳達獲得正確的治療。 她恢復生活,而且幸運的是 至今她的狀況依然良好。 但那是琳達幸運。 她找到我們,我們找出她的疾病。
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.
但是對太多女性來說, 可不是那麼一回事。 我們有工具。 我們有科技能做出診斷。 但是這些性別差異 都太常被忽視了。
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?
那治療呢? 兩年前有一項重大的研究發表, 其中提出一個非常重要的問題: 對女性心臟病患者最有效的治療是什麼? 作者研究這十年來發表的論文, 有上百篇應該被扔掉。 他們發現其中被丟棄的 有 65% 不應列入考慮的原因是 雖然女性在這些研究中被列入考量, 但是分析並未區分出 男性與女性的差別。 多可惜啊! 花了這麼多錢, 我們卻沒能學到女性遭遇的情況。 這些研究可能無法 對那非常重要的問題 做出任何一絲回應, 對女性心臟病患者 最有效的治療是什麼?
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.
我想介紹我的教母荷頓斯, 一位同事的親戚 ── 洪瑋(音譯), 以及你可能知道的── 黛娜,克里斯多福.李維的妻子。 這三位女性有極重要的相似處。 她們都被診斷出肺癌, 而肺癌是現今美國女性 頭號癌症殺手。 她們三位都不吸煙。 讓人難過的是,黛娜和洪瑋都因病去逝。 現在,我們知道不抽煙的女性 被診斷罹患肺癌的機率 是不抽煙男性的三倍。 有趣的是當女性被診斷出肺癌, 她們的存活率通常較男性高。 這裡有一些線索。 我們的研究員發現 兩性的肺腫瘤細胞都有某種基因。 這些基因主要 被雌激素活化。 這些基因過度表現時, 只會和改善年輕女性的 存活率有關。 這是很新的發現, 我們還不知道它是否 和臨床照護有關。 但是就是像這樣的發現能帶來希望, 並且能提供一個救命的機會, 不論是男是女。
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.
讓我和大家分享關於 當我們考慮性別差異時, 就能帶動科學的例子。 幾年前,有一種新的肺癌藥 被拿來評估, 當研究者檢視看誰的腫瘤變小了, 他們發現其中 82% 都是女性。 這讓他們想問:為什麼? 他們發現 藥物標靶的基因突變 在女性中更常見。 這讓肺癌的治療方式 更能符合個人需求, 也能將性別列入考量。
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.
這是我們能做到的, 我們讓女性的健康不是只能碰運氣。 我們知道當你投資研究 就會得到結果。 看看歷年來乳癌死亡率的改變。 再看看歷年來女性肺癌死亡率的改變。 看看投資在乳癌研究的金額 ──這是對每一位死亡病患的投資金額── 以及投資在肺癌的金額。 顯然我們在乳癌的投資 證明了這一點。 雖然不見得夠快, 但還是帶來成果。 我們也可以同樣投資 肺癌和每一種癌症。
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.
讓我們回到憂鬱症。 憂鬱症是全球女性 造成身心障礙最主要的因素。 我們的研究員發現 男性與女性的腦部 在與情緒相關的區塊有差異。 如果你把男性和女性 放入功能性磁振造影裝置 ──這種裝置能在腦部被活化時 讓你看出它如何運作── 因此當你把他們放入裝置,對他們施加壓力, 就能明顯地看出差異。 就是像這樣的研究 讓我們相信掌握了些許線索, 了解為什麼我們會看到 這些顯著的性別差異 出現在憂鬱症中。 但是即使我們知道
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.
這些差異會發生, 有 66% 的動物腦部研究 不是針對雄性動物, 就是針對未驗明性別的動物。 因此,我認為我們應該再次提問:
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.
為什麼要讓女性的健康碰運氣? 這個問題在科學與醫學界的我們心中 徘徊不去, 我們相信我們即將為女性的健康 帶來卓越的進展。 我們知道每個細胞都有性別。 我們知道這些差異常被忽略。 因此我們知道女性在現代科學與醫學中, 未能完全受惠。 我們有工具, 卻缺乏集體意願和動力。 女性健康是一項平權的議題,
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.
就和同工同酬一樣重要。 而這項議題攸關 科學和醫學的品質與廉正。 (掌聲) 想像我們為了改善女性健康 能激發的動力, 只要我們能多考量,不管是 在精心設計的研究之初 呈現這些性別差異; 還是我們用性別來分析資料。
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.
大家常問我: 我可以做什麼? 我建議你: 首先,我建議你把女性健康的重要性 看得和其它你所重視、關心的事物 一樣重要。 第二點,同樣重要的是 身為一名女性, 你應該要問你的醫生, 以及那些照顧你所愛的人的醫生: 這個疾病或治療方式 是否因女性而不同? 這是個深奧的問題, 因為答案很可能是肯定的, 但是你的醫生可能不知道 是如此,至少還不知道。 然而如果你問了這個問題, 你的醫生很可能 會去找答案。 而這很重要, 不只是對我們自己, 也是對所有我們所愛的人。 不論是母親、女兒、姊妹、 朋友,或是祖母。
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.
是我祖母的苦痛 激勵我努力 改善女性健康。 這是她所留下來的東西。 我們留給後人的東西 可以是改善女性健康, 為這個世代 也為未來的世代。
Thank you. (Applause)
謝謝! (掌聲)