ABOUT THE SPEAKER
Ivan Oransky - Health reporter
Ivan Oransky is the executive editor of Reuters Health, and has done pioneering work in covering scientific retractions.

Why you should listen

Ivan Oransky is a doctor-turned reporter. With an MD and an internship completed, he left to cover heath and health care, bringing the insight of a trained doctor to the beat. He is now executive editor of Reuters Health, and also teaches journalism and medicine at New York University.

He is also the co-founder of Retraction Watch a blog that tracks and investigates retractions in scientific journals, and it's sister-site, Embargo Watch, doing the same for reporting on scientific papers.

More profile about the speaker
Ivan Oransky | Speaker | TED.com
TEDMED 2012

Ivan Oransky: Are we over-medicalized?

伊万.欧兰斯基:是否我们过分医疗化了?

Filmed:
697,753 views

路透社健康编辑伊万.欧兰斯基警告说,一些荒谬的先决条件已经成为了一种让我们感到十分痛苦的流行病,比如说- 糖尿病前期,癌症前期,还有更多其他的。在这个TEDMED谈话中,他展示​了医疗保险系统如何能找到解决方案...从棒球中学到的重要一课。
- Health reporter
Ivan Oransky is the executive editor of Reuters Health, and has done pioneering work in covering scientific retractions. Full bio

Double-click the English transcript below to play the video.

00:16
Those of you who have seen看到 the film电影 "Moneyball点球成金,"
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在座看过电影“点球成金”的
00:20
or have read the book by Michael迈克尔 Lewis刘易斯,
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又或者读过麦克·路易斯的书的,
00:22
will be familiar with the story故事 of Billy比利 Beane比恩.
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会对比利·比恩的故事很熟悉。
00:25
Billy比利 was supposed应该 to be a tremendous巨大 ballplayer球坛; all the scouts侦察兵 told him so.
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比利应该是一个非常好的球员;所以的球探都这么跟他说。
00:29
They told his parents父母 that
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他们告诉他的父母,
00:31
they predicted预料到的 that he was going to be a star.
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他们预测他会变成一个明星。
00:33
But what actually其实 happened发生 when he signed the contract合同 -- and by the way, he didn't
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但事实上当他签约后 -- 其实他并不想
00:38
want to sign标志 that contract合同, he wanted to go to
college学院 --
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签约,他想去上大学 --
00:40
which哪一个 is what my mother母亲, who actually其实 does
love me,
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而这是真的爱我的母亲
00:43
said that I should do too, and I did --
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说我应该做的,而我也这么做了 --
00:46
well, he didn't do very well. He struggled挣扎
mightily强烈地.
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但其实他没做多好。他挣扎着去适应。
00:49
He got traded交易 a couple一对 of times, he ended结束 up in the Minors未成年人 for most of his career事业,
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他被交易了几次,并在小联盟打了他大部分的职业球赛,
00:53
and he actually其实 ended结束 up in management管理. He ended结束 up as a General一般 Manager经理 of the
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最终来到了管理层。它做了奥克兰运动家球队
00:57
Oakland奥克兰 A's.
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的总经理。
00:58
Now for many许多 of you in this room房间, ending结尾 up in management管理, which哪一个 is also what I've doneDONE,
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对于在座的大多数人来说,像我一样成为管理层的一部分
01:02
is seen看到 as a success成功.
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会被看做是成功。
01:04
I can assure保证 you that for a kid孩子 trying to make it in the Bigs大个子,
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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,
01:07
going into management管理 ain't no success成功 story故事. It's a failure失败.
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进入管理层不是一个成功的故事。它是一种失败。
01:12
And what I want to talk to you about today今天, and share分享 with you, is that our
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而我今天想和你说的,便是
01:16
healthcare卫生保健 system系统, our medical system系统, is
just as bad at predicting预测
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我们的医保系统,医疗系统,在对于预测
01:21
what happens发生 to people in it -- patients耐心,
others其他 --
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将发生在人身上的事情也很差 -- 病患,其他的 --
01:25
as those scouts侦察兵 were at predicting预测 what would happen发生 to Billy比利 Beane比恩.
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就像那些预测比利·比恩会成功的球探一样。
01:30
And yet然而, every一切 day
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但每一天
01:32
thousands数千 of people in this country国家
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在这个国家里仍然有上千个人
01:34
are diagnosed确诊 with preconditions先决条件.
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被诊断出疾病前兆。
01:38
We hear about pre-hypertension高血压前期, we hear about pre-dementia前痴呆,
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我们听到高血压前兆,痴呆症前兆,
01:42
we hear about pre-anxiety前焦虑, and I'm pretty漂亮 sure that I diagnosed确诊 myself with
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焦虑症前兆,而我确定我在那绿色的房间里
01:48
that in the green绿色 room房间.
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给了自己这个诊断。
01:49
We also refer参考 to subclinical conditions条件.
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同样的,我们也提到亚临床症状。
01:53
There's subclinical atherosclerosis动脉粥样硬化, subclinical hardening硬化 of the arteries动脉,
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我们有亚临床动脉硬化,
01:58
obviously明显 linked关联 to heart attacks攻击, potentially可能.
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潜在的联系到心力衰竭。
02:02
One of my favorites最爱 is called
subclinical acne粉刺.
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我最喜欢的叫做亚临床粉刺。
02:05
If you look up subclinical acne粉刺, you may可能 find a website网站, which哪一个 I did,
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如果你搜索亚临床粉刺,你可能会像我一样找到一个网站,
02:09
which哪一个 says that this is the easiest最简单的 type类型 of acne粉刺 to treat对待.
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上面说这种粉刺最容易被治疗。
02:13
You don't have the pustules脓疱 or the redness发红 and inflammation.
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你不会有脓包,红肿或炎症。
02:20
Maybe that's because you don't actually其实
have acne粉刺.
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但这也有可能是因为你并没有粉刺。
02:23
I have a name名称 for all of these conditions条件, it's another另一个 precondition前提:
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我给这些病症起了个名字,它也是一种前兆症:
02:30
I call them preposterous荒谬.
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我叫它们 ”荒谬绝伦“。
02:32
In baseball棒球, the game游戏 follows如下 the pre-game赛前.
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在棒球中,正式比赛在热身赛后开始。
02:38
Season季节 follows如下 the pre-season季前.
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赛季在赛前季后。
02:40
But with a lot of these conditions条件, that actually其实 isn't the case案件, or at least最小 it isn't the
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但对于这些疾病来说,这大多数情况
02:45
case案件 all the time. It's as if there's a rain delay延迟, every一切 single time in many许多 cases.
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并不成立。在很多病例中它就像在球赛被下雨取消了一般。
02:49
We have pre-cancerous癌前病变 lesions病变,
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我们有癌前病变,
02:51
which哪一个 often经常 don't turn into cancer癌症.
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但它们经常不会转化为癌症。
02:55
And yet然而,
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然而,
02:56
if you take, for example, subclinical
osteoporosis骨质疏松, a bone thinning细化 disease疾病,
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如果你拿亚临床骨质疏松症做例子,
03:00
the precondition前提,
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它的前兆症状,
03:02
otherwise除此以外 known已知 as osteopenia骨质疏松,
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被称为骨质减少,
03:04
you would have to treat对待 270
women妇女 for three years年份
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你必须为270个女人提供长达3年的治疗,
03:08
in order订购 to prevent避免 one broken破碎 bone.
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来防止一个断裂的骨头。
03:10
That's an awful可怕 lot of women妇女
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当你用时间乘以被诊断为骨质减少的
03:12
when you multiply by the number of women妇女
who were diagnosed确诊
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女人人数时,
03:15
with this osteopenia骨质疏松.
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这个数字是相当庞大的。
03:17
And so is it any wonder奇迹,
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所以,看看每年
03:19
given特定 all of the costs成本 and the side effects效果
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我们花费在这些病症前兆上的
03:21
of the drugs毒品 that we're using运用 to treat对待 these preconditions先决条件, that every一切 year
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药物的费用以及它们导致的副作用,
03:25
we're spending开支 more than two trillion dollars美元 on healthcare卫生保健 and yet然而
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我们每年都要在医保上花费2万亿美元以上的钱,
03:29
100,000 people a year -- and that's a conservative保守 estimate估计 -- are dying垂死
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但每年仍然有10万人 死亡-- 而这只是一个保守的估计,
03:32
not because of the conditions条件 they have,
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不是因为他们所有的病症,
03:34
but because of the treatments治疗 that we're giving them and the complications并发症 of those treatments治疗?
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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。
03:39
We've我们已经 medicalized用医学方法 everything
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我们医疗化了这个国家
03:41
in this country国家.
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的一切。
03:42
Women妇女 in the audience听众, I have
some
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在座的女性们,我有一些
03:46
pretty漂亮 bad news新闻 that you already已经 know,
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你已经知道的坏消息,
03:48
and that's that every一切 aspect方面 of your
life
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那就是你们生活的每一部分
03:50
has been medicalized用医学方法.
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都被医疗化了。
03:52
Strike罢工 one is when you hit击中 puberty青春期.
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第一次是当你来到青春期。
03:54
You now have something that happens发生 to you once一旦 a month that has been medicalized用医学方法.
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你现在有了一个被医疗化的,每月都发作一次的东西。
03:59
It's a condition条件;
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它变成了一个病症;
03:59
it has to be treated治疗. Strike罢工 two
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它必须被治疗。第二次是
04:01
is if you get pregnant.
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当你怀孕的时候。
04:03
That's been medicalized用医学方法 as
well.
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那也被医疗化了。
04:06
You have to have a high-tech高科技 experience经验
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你必须使用高科技
04:08
of pregnancy怀孕, otherwise除此以外 something might威力 go wrong错误.
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来保护孕期,不然有些地方可能会出错。
04:10
Strike罢工 three is menopause绝经.
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第三次是更年期。
04:14
We all know what happened发生 when millions百万 of women妇女 were given特定 hormone激素 replacement替代 therapy治疗
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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
04:18
for menopausal更年期 symptoms症状
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来治疗更年期症状,
04:21
for decades几十年 until直到 all of a sudden突然 we realized实现, because a study研究 came来了 out, a big one,
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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
04:26
NIH-fundedNIH资助.
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得出来的结果。
04:27
It said,
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研究说,
04:28
actually其实, a lot of that hormone激素 replacement替代 therapy治疗 may可能 be doing more harm危害 than good
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其实太多的激素取代疗法对于很多女人来说
04:32
for many许多 of those women妇女.
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坏处可能多于好处。
04:34
Just in case案件,
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为了以防万一,
04:36
I don't want to leave离开 the men男人 out --
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我不想把男人置身事外 --
04:38
I am one, after all --
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毕竟我也是其中一份子 --
04:40
I have really bad news新闻 for all of you in
this room房间,
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对于在座的给位以及正在收听和
04:42
and for everyone大家
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收看的观众,
04:43
listening and watching观看 elsewhere别处:
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我有很坏的消息:
04:45
You all have
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你们都有
04:46
a universally举世 fatal致命 condition条件.
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一个普遍的致命病症。
04:49
So, just take a moment时刻.
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所以,请深呼吸一下。
04:52
It's called pre-death预死亡.
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他叫死亡前兆。
04:54
Every一切 single one of you has it, because
you have the risk风险 factor因子 for it,
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你们每个人都有,因为你们都有它的危险因素,
04:59
which哪一个 is being存在 alive.
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那就是活着。
05:01
But I have some good news新闻 for you,
because
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但我也有些好消息,因为我是
05:04
I'm a journalist记者, I like to end结束 things in a happy快乐 way or a forward-thinking前瞻思维 way.
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一个新闻记者,我喜欢以一种开心和积极的心态来结尾。
05:08
And that good news新闻 is that if you can survive生存 to the end结束 of my talk, which哪一个
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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,
05:12
we'll see if that happens发生 for everyone大家,
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这点我相信大家都可以,
05:14
you will be a pre-vivor预vivor.
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你会是一个前存者 (pre-vivor)。
05:17
I made制作 up pre-death预死亡.
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死亡前兆是我编的。
05:22
If I used someone有人 else's别人的 pre-death预死亡, I apologize道歉,
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如有雷同,对不起,
05:26
I think I made制作 it up.
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但我想这的确是我编的。
05:28
I didn't make up pre-vivor预vivor.
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但我没有编出前存者 (pre-vivor)。
05:30
Pre-vivor预vivor is what a particular特定 cancer癌症 advocacy拥护 group would like everyone大家 who
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前存者(其实指癌症高危人群) 是一个癌症宣传组织,
05:35
just has a risk风险 factor因子,
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它是指某些人有癌症高发因素,
05:36
but hasn't有没有 actually其实 had that cancer癌症,
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但却还没发展成癌症
05:39
to call themselves他们自己.
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他们就这么称呼他们自己。
05:40
You are a pre-vivor预vivor.
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你们都是前存者(癌症高危人群)。
05:42
We've我们已经 had HBOHBO here this morning早上. I'm wondering想知道 if Mark标记 Burnett伯内特 is anywhere随地 in the
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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
05:46
audience听众, I'd like to suggest建议
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现在在观众席中。我建议开办一个
05:48
a reality现实 TV电视 show显示 called "Pre-vivor预vivor."
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叫做“前存者”的真人秀节目。
05:52
If you develop发展 a disease疾病, you're off
the island.
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谁患上了一种疾病,就要从岛上退出。
05:55
But the problem问题 is, we have a system系统
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但问题是,我们的系统
06:01
that is completely全然 --
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完完全全的 --
06:02
basically基本上 promoted提拔 this.
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时时刻刻地在促进它的发生。
06:04
We've我们已经 selected, at every一切 point in this system系统,
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我们在这个系统的每个时刻都选择了
06:07
to do what we do, and to give everyone大家 a
precondition前提 and then eventually终于
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我们在做什么,于是它给了每一个人一个前兆
06:11
a condition条件, in some cases.
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而最终,其中某些前兆转变为病症。
06:13
Start开始 with the doctor-patient医患
relationship关系. Doctors医生, most of them,
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让我们从医患关系说起。大多数医生,
06:18
are in a fee-for-service服务费 system系统. They are
basically基本上 incentivized诱因 to do more --
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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。
06:23
procedures程序, tests测试,
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比如步骤,检测,
06:24
prescribe规定 medications药物治疗.
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还有开处方。
06:26
Patients耐心 come to them,
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病人来找医生,
06:27
they want to do something. We're
Americans美国人, we can't just stand
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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,
06:31
there, we have to do something. And so
they want a drug药物.
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我们得做些什么啊。他们只是想要药物。
06:34
They want a treatment治疗. They want to be told, this is what you have and this is how
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他们只是想要得到治疗。他们想被告知,这就是你得的病,
06:38
you treat对待 it. If the doctor医生
doesn't give you that,
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这就是你的治疗方法。如果医生没能给你这些,
06:40
you go somewhere某处 else其他.
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你会到别处就医。
06:42
That's not very good for doctors'医生
business商业.
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这对医生的生意是很不利的噢。
06:44
Or even worse更差,
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更坏的是,
06:46
if you are diagnosed确诊 with something
eventually终于, and the doctor医生 didn't order订购 that test测试,
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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,
06:50
you get sued起诉.
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你会起诉他。
06:52
We have pharmaceutical制药 companies公司 that are
constantly经常 trying to expand扩大
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我们有些制药公司一直在试图扩大用药指征,
06:55
the indications适应症, expand扩大 the number of people who are eligible合格 for a given特定 treatment治疗,
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好让更多的人有理由接受它的治疗。
07:00
because that obviously明显 helps帮助 their bottom底部 line线.
We have advocacy拥护 groups,
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因为这样明显会有利于他们盈利。我们有一些宣传组织,
07:03
like the one that's come up with
pre-vivor预vivor,
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就像刚刚那个想出来前存者的组织,
07:05
who want to make more and more people feel they are at risk风险, or might威力 have a condition条件,
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他们想让越来越多的人觉得自己有高发因素,或是有症状,
07:10
so that they can raise提高 more funds资金
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好让他们募得更多的资金,
07:12
and raise提高 visibility能见度, et cetera等等.
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或是提高知名度或获取其他利益。
07:14
But this isn't actually其实,
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这其实并不实际,
07:16
despite尽管 what journalists记者 typically一般 do,
this isn't actually其实 about blaming归咎
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尽管这是典型的新闻人会干的事,但我其实并不是
07:19
particular特定 players玩家.
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在责怪某些人。
07:21
We are all responsible主管.
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我们对此都有责任。
07:22
I'm responsible主管.
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我也要对此负责。
07:24
I actually其实 root for the Yankees洋基, I mean talk
about
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我其实支持Yankee队,我的意思是说
07:27
rooting生根 for the worst最差
possible可能
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在有能力做任何事情的情况下
07:30
offender犯罪分子 when it comes to doing
everything you can do.
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支持最可能的罪犯
07:33
Thank you.
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谢谢。
07:34
But everyone大家 is responsible主管.
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但是的确人人有责。
07:38
I went to medical school学校,
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我在上医学院的时候,
07:41
and I didn't have a course课程 called How to Think Skeptically怀疑地,
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并没有一门课程叫做“如何抱有怀疑态度地思考”
07:46
or How Not to Order订购 Tests测试.
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或是“如何选择检测方法”
07:48
We have this system系统
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我们的这个体制就这样,
07:50
where that's what you do.
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你还得继续你应该做的事。
07:53
And it actually其实 took being存在 a journalist记者
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不过好像只有新闻人才懂得这些诱因。
07:55
to understand理解 all these incentives奖励. You know, economists经济学家 like to say,
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知道吗,经济学家说,
07:59
there are no bad people,
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世上本无坏人,
08:00
there are just bad incentives奖励.
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只有坏念头。
08:02
And that's actually其实 true真正.
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这绝对是真理。
08:04
Because what we've我们已经 created创建 is a sort分类 of Field领域 of Dreams, when it comes to medical technology技术.
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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)。
08:07
So when you put another另一个 MRIMRI in
every一切 corner, you put a robot机器人
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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
08:13
in every一切 hospital醫院 saying that everyone大家 has to have robotic机器人 surgery手术.
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并且说每个人都只能进行机器人手术。
08:16
Well, we've我们已经 created创建 a system系统 where if you
build建立 it, they will come.
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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。
08:20
But you can actually其实 perversely倒行逆施
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当然你也可以倔强不屈,
08:24
tell people to come, convince说服 them
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告诉人们将发生什么,
08:26
that they have to come.
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让他们明白这一切是必须发生的。
08:28
It was when I became成为 a journalist记者 that I really realized实现 how I was part部分 of this problem问题,
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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,
08:33
and how we all are part部分 of this problem问题.
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意识到我们是怎样都和这个问题有关的。
08:35
I was medicalizingmedicalizing every一切 risk风险 factor因子, I was writing写作 stories故事, commissioning试运行 stories故事,
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我在医疗化每个危险因素,我在写故事,授权故事,
08:39
every一切 day, that were trying to,
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天天如此,目的就是
08:42
not necessarily一定 make people worried担心, although虽然 that was what often经常 happened发生.
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不让人们这么焦虑,虽然这通常都不管用。
08:45
But, you know, there are ways方法 out.
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但是知道吗,其实有解决的方法。
08:48
I saw my own拥有 internist内科医生 last week,
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上个星期我才见了我的内科医生,
08:50
and he said to me,
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他对我说,
08:52
"You know," and he told me something that
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“你知道吗”,
08:55
everyone大家 in this audience听众 could have
told me for free自由,
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这些话在座各位都可以告诉我而不收取任何费用,
08:57
but I paid支付 him for the privilege特权, which哪一个
is that
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而我却付给他钱让他来告诉我,
09:00
I need to lose失去 some weight重量.
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那就是我需要减肥。
09:02
Well, he's right. I've had honest-to-goodness诚实,善良 high blood血液 pressure压力
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好吧,他是对的。我是如假包换的高血压患者,
09:06
for a dozen years年份 now, same相同
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已经是老油条了,
09:08
age年龄 my father父亲 got it,
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患病年龄跟我父亲一样。
09:09
and it's a real真实 disease疾病. It's not pre-hypertension高血压前期, it's actual实际
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这的确是一种疾病,这不是高血压前兆,
09:13
hypertension高血压, high blood血液 pressure压力.
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1973
这的的确确就是高血压,高血压病。
09:15
Well, he's right,
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好吧,他是对的,
09:16
but he didn't say to me,
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但他没有告诉我说,
09:19
well, you have pre-obesity预肥胖 or
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额,你有肥胖症前兆或是
09:21
you have pre-diabetes糖尿病前期, or anything like that. He didn't say,
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你有糖尿病前兆或是其他种种,他都没说,
09:24
better start开始 taking服用 this Statin他汀类药物, you need to lower降低 your cholesterol胆固醇.
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他也没说让我用抑制素来降低胆固醇。
09:28
No, he said, "Go out and lose失去 some weight重量. Come back and see me in a bit,
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他只是说,‘出去走走,减减肥,回来让我好好看看你。
09:31
or just give me a call and let me know how you're doing."
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或者干脆给我打个电话让我知道你在做什么。“
09:33
So that's, to me,
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这就是对于我的
09:35
a way forward前锋.
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一个解决的方法。
09:37
Billy比利 Beane比恩, by the way, learned学到了 the same相同
thing.
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同样地,Billy Beane(电影《点球成金》男主角)也学到了这点。
09:39
He learned学到了,
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他学会了什么呢?
09:40
from watching观看 this kid孩子 who he eventually终于 hired雇用, who was really successful成功 for him,
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通过观察他最终雇佣的那个为他赢得巨大成功的孩子,
09:44
that it wasn't swinging摆荡 for the fences围栏, it
wasn't swinging摆荡 at every一切 pitch沥青
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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,
09:49
like the sluggers重击手 do, which哪一个 is what all the expensive昂贵 teams球队 like the Yankees洋基 like to --
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就好比那些富队比如yankees会做的一样使用蛮力,
09:54
they like to pick up those guys.
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他们是用心去挑选球员,善用人才。
09:55
This kid孩子 told him, you know, you gotta总得 watch the guys, and you gotta总得 go out and find
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那孩子告诉他,你要看那些选手,你要到外面去看看,
10:00
the guys who like to walk步行,
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哪些家伙喜欢走路,
10:01
because getting得到 on base基础 by a walk步行
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因为步行上垒不失为一种好方法,
10:02
is just as good, and in our healthcare卫生保健
system系统
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而在我们的医保体系里
10:05
we need to figure数字 out,
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我们得弄明白
10:07
is that really a good pitch沥青
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这真的是医疗的一块好球场吗?
10:08
or should we let it go by and not swing摇摆 at everything?
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或者我们就应该让他维持现状而不去作任何改变?
10:11
Thanks谢谢.
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谢谢。
Translated by Ccord Chao
Reviewed by Yi Zong

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ABOUT THE SPEAKER
Ivan Oransky - Health reporter
Ivan Oransky is the executive editor of Reuters Health, and has done pioneering work in covering scientific retractions.

Why you should listen

Ivan Oransky is a doctor-turned reporter. With an MD and an internship completed, he left to cover heath and health care, bringing the insight of a trained doctor to the beat. He is now executive editor of Reuters Health, and also teaches journalism and medicine at New York University.

He is also the co-founder of Retraction Watch a blog that tracks and investigates retractions in scientific journals, and it's sister-site, Embargo Watch, doing the same for reporting on scientific papers.

More profile about the speaker
Ivan Oransky | Speaker | TED.com