TEDMED 2010
Thomas Goetz: It's time to redesign medical data
托马斯. 高兹：改改这难懂的医学数据
Filmed:
Readability: 3.5
587,895 views
你的病例：好比天书，令人不知所云--上面布满了有用的信息，但前提是你必须能看懂。在TEDMED系列演讲中，托马斯. 高兹大胆地提出重新设计医学数据，使之更清楚明了。
Thomas Goetz - Healthcare communicator
Thomas Goetz is the co-founder of Iodine and author of "The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine.” Full bio
Thomas Goetz is the co-founder of Iodine and author of "The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine.” Full bio
Double-click the English transcript below to play the video.
00:15
I'm going to be talking to you
0
0
2000
我准备和大家探讨
00:17
about how we can tap
1
2000
2000
我们如何
00:19
a really underutilized resource in health care,
2
4000
2000
开发一种没有得到有效利用的医疗资源，
00:21
which is the patient,
3
6000
2000
那就是病人，
00:23
or, as I like to use the scientific term,
4
8000
3000
或者，用一个更专业的术语来说--
00:26
people.
5
11000
2000
人。
00:28
Because we are all patients, we are all people.
6
13000
2000
我们都是病人，我们也都是人。
00:30
Even doctors are patients at some point.
7
15000
2000
就连医生有时候也可能成为病人。
00:32
So I want to talk about that
8
17000
2000
我想借此机会
00:34
as an opportunity
9
19000
2000
告诉大家
00:36
that we really have failed to engage with very well in this country
10
21000
3000
在这个国家，我们一直没有很好地配合治疗
00:39
and, in fact, worldwide.
11
24000
2000
事实上，全世界都是如此。
00:41
If you want to get at the big part --
12
26000
2000
如果你从全局来看--
00:43
I mean from a public health level, where my training is --
13
28000
3000
也就是从公共卫生高度来看，这是我的专业--
00:46
you're looking at behavioral issues.
14
31000
2000
这其实是行为问题，
00:48
You're looking at things where people are actually given information,
15
33000
3000
是人们得到相关信息，
00:51
and they're not following through with it.
16
36000
2000
却没有完全按照这些信息行事。
00:53
It's a problem that manifests itself in diabetes,
17
38000
4000
这个问题反应在糖尿病，
00:57
obesity, many forms of heart disease,
18
42000
2000
肥胖症，各种心脏疾病，
00:59
even some forms of cancer -- when you think of smoking.
19
44000
3000
甚至某些癌症--如果人吸烟的话。
01:02
Those are all behaviors where people know what they're supposed to do.
20
47000
3000
对于这些，人们都知道他们应该怎么做才是对的。
01:05
They know what they're supposed to be doing,
21
50000
2000
但是，尽管他们知道哪些事情该做，
01:07
but they're not doing it.
22
52000
2000
他们就是不去做。
01:09
Now behavior change is something
23
54000
2000
行为上的改变
01:11
that is a long-standing problem in medicine.
24
56000
2000
是医学上的一个顽固问题。
01:13
It goes all the way back to Aristotle.
25
58000
2000
这可以追溯到亚里士多德的时代。
01:15
And doctors hate it, right?
26
60000
2000
医生们对此深恶痛绝。
01:17
I mean, they complain about it all the time.
27
62000
2000
他们总是为此而抱怨。
01:19
We talk about it in terms of engagement, or non-compliance.
28
64000
3000
他们把如下行为归为不配合治疗。
01:22
When people don't take their pills,
29
67000
2000
有些人不按要求吃药，
01:24
when people don't follow doctors' orders --
30
69000
2000
有些人不听从医嘱。
01:26
these are behavior problems.
31
71000
2000
这些都是行为问题。
01:28
But for as much as clinical medicine
32
73000
2000
但是尽管临床医学
01:30
agonizes over behavior change,
33
75000
2000
对病人的行为怨声载道，
01:32
there's not a lot of work done
34
77000
2000
却并没有拿出实际行动
01:34
in terms of trying to fix that problem.
35
79000
3000
来解决这个问题。
01:37
So the crux of it
36
82000
2000
问题的关键
01:39
comes down to this notion of decision-making --
37
84000
2000
在于如何帮助人们做出正确决定--
01:41
giving information to people in a form
38
86000
2000
给病人一张显示信息的表格，
01:43
that doesn't just educate them
39
88000
2000
这张表格不仅教育
01:45
or inform them,
40
90000
2000
或告知病人应该做什么，
01:47
but actually leads them to make better decisions,
41
92000
2000
而应引导人们在生活中作出更好的决定
01:49
better choices in their lives.
42
94000
2000
和更好的选择。
01:51
One part of medicine, though,
43
96000
2000
然而，有一个医学的领域
01:53
has faced the problem of behavior change pretty well,
44
98000
4000
在行为改变方面颇有建树。
01:57
and that's dentistry.
45
102000
2000
那就是牙科。
01:59
Dentistry might seem -- and I think it is --
46
104000
2000
牙科虽然看起来--个人意见--
02:01
many dentists would have to acknowledge
47
106000
2000
许多牙医可能会认为
02:03
it's somewhat of a mundane backwater of medicine.
48
108000
2000
牙科是医学中最没有发展前景的分支。
02:05
Not a lot of cool, sexy stuff happening in dentistry.
49
110000
3000
牙科领域没有太多新奇有趣的事情发生。
02:08
But they have really taken this problem of behavior change
50
113000
3000
但是，牙科却很好地解决了
02:11
and solved it.
51
116000
2000
行为改变这个问题。
02:13
It's the one great preventive health success
52
118000
2000
这是医疗系统中
02:15
we have in our health care system.
53
120000
2000
我们在预防方面所取得的重大成功。
02:17
People brush and floss their teeth.
54
122000
2000
人人都刷牙，使用牙线。
02:19
They don't do it as much as they should, but they do it.
55
124000
3000
他们虽然做得还不够多，但至少他们做了。
02:22
So I'm going to talk about one experiment
56
127000
2000
我下面会介绍一些牙科医生三十年前
02:24
that a few dentists in Connecticut
57
129000
2000
在康涅狄格州
02:26
cooked up about 30 years ago.
58
131000
2000
所做的一个试验。
02:28
So this is an old experiment, but it's a really good one,
59
133000
2000
这个试验有一定年头了，但却是一个非常棒的试验，
02:30
because it was very simple,
60
135000
2000
这个试验很简单，
02:32
so it's an easy story to tell.
61
137000
2000
所以故事很简短。
02:34
So these Connecticut dentists decided
62
139000
2000
康涅狄格州的这些牙医决定
02:36
that they wanted to get people to brush their teeth and floss their teeth more often,
63
141000
3000
他们要让人们更加勤刷牙勤用牙线。
02:39
and they were going to use one variable:
64
144000
2000
他们打算使用一个变量：
02:41
they wanted to scare them.
65
146000
2000
他们想吓唬人们。
02:43
They wanted to tell them how bad it would be
66
148000
3000
他们想告诉人们
02:46
if they didn't brush and floss their teeth.
67
151000
2000
如果不刷牙不用牙线，会有什么样的后果。
02:48
They had a big patient population.
68
153000
3000
他们的病人很多。
02:51
They divided them up into two groups.
69
156000
2000
他们这些病人分成两组。
02:53
They had a low-fear population,
70
158000
2000
一组是低恐惧人群，
02:55
where they basically gave them a 13-minute presentation,
71
160000
2000
他们给这些人做了一个十三分钟的演示，
02:57
all based in science,
72
162000
2000
完全依照科学事实进行，
02:59
but told them that, if you didn't brush and floss your teeth,
73
164000
3000
但是，对他们说，如果你不刷牙，用牙线，
03:02
you could get gum disease. If you get gum disease, you will lose your teeth,
74
167000
3000
你就会得牙龈疾病。如果你的牙龈除了毛病，你的牙齿就会脱落，
03:05
but you'll get dentures, and it won't be that bad.
75
170000
2000
但是，如果你安了假牙，问题就不大。
03:07
So that was the low-fear group.
76
172000
2000
这是针对低恐惧群体的做法。
03:09
The high-fear group, they laid it on really thick.
77
174000
3000
而对高恐惧群体，他们可下了狠药。
03:12
They showed bloody gums.
78
177000
2000
他们给这些人展示血淋淋的牙龈，
03:14
They showed puss oozing out from between their teeth.
79
179000
3000
让他们看牙齿间淤出来的脓，
03:17
They told them that their teeth were going to fall out.
80
182000
2000
告诉他们，他们的牙齿很快就会脱落，
03:19
They said that they could have infections
81
184000
2000
他们会得炎症
03:21
that would spread from their jaws to other parts of their bodies,
82
186000
3000
并且炎症会从空腔扩散到其它身体部位，
03:24
and ultimately, yes, they would lose their teeth.
83
189000
2000
最后，当然，他们会失去自己的牙齿。
03:26
They would get dentures, and if you got dentures,
84
191000
2000
他们不得不使用假牙，如果你装了假牙，
03:28
you weren't going to be able to eat corn-on-the-cob,
85
193000
2000
你不能啃玉米棒，
03:30
you weren't going to be able to eat apples,
86
195000
2000
不能咬苹果，
03:32
you weren't going to be able to eat steak.
87
197000
2000
不能吃牛排；
03:34
You'll eat mush for the rest of your life.
88
199000
2000
在你的下半生里你只能吃糊状物
03:36
So go brush and floss your teeth.
89
201000
3000
还不赶快刷牙，用牙线。
03:39
That was the message. That was the experiment.
90
204000
2000
这就是其中的信息；这个试验就是这样的。
03:41
Now they measured one other variable.
91
206000
2000
接着他们测量了另一个变量。
03:43
They wanted to capture one other variable,
92
208000
2000
他们想测试这个变量是否起作用，
03:45
which was the patients' sense of efficacy.
93
210000
3000
那就是病人的自我效能感。
03:48
This was the notion of whether the patients felt
94
213000
2000
这是病人是否认为自己
03:50
that they actually would go ahead and brush and floss their teeth.
95
215000
3000
会去刷牙和使用牙线的观念。
03:53
So they asked them at the beginning,
96
218000
2000
在一开始，他们问病人，
03:55
"Do you think you'll actually be able to stick with this program?"
97
220000
2000
“你认为你会坚持照做吗？”
03:57
And the people who said, "Yeah, yeah. I'm pretty good about that,"
98
222000
2000
那些说“是的，是的，我会好好做的，”的人
03:59
they were characterized as high efficacy,
99
224000
2000
属于为高效能感人群。
04:01
and the people who said,
100
226000
2000
而那些说
04:03
"Eh, I never get around to brushing and flossing as much as I should,"
101
228000
2000
“呃，我平时刷牙或用牙线都不够勤，”的人
04:05
they were characterized as low efficacy.
102
230000
2000
属于低效能感人群。
04:07
So the upshot was this.
103
232000
3000
这是结果。
04:10
The upshot of this experiment
104
235000
2000
试验的结果是
04:12
was that fear was not really a primary driver
105
237000
3000
恐惧并不是控制行为的
04:15
of the behavior at all.
106
240000
2000
主要动力。
04:17
The people who brushed and flossed their teeth
107
242000
2000
那些勤刷牙，用牙线的人，
04:19
were not necessarily the people
108
244000
2000
并不一定是
04:21
who were really scared about what would happen --
109
246000
2000
那些害怕不良后果的人--
04:23
it's the people who simply felt that they had the capacity
110
248000
3000
他们是那些认为自己
04:26
to change their behavior.
111
251000
2000
有能力改变自己行为的人。
04:28
So fear showed up as not really the driver.
112
253000
3000
恐惧原来不是动因；
04:31
It was the sense of efficacy.
113
256000
3000
应该是自我感觉。
04:34
So I want to isolate this,
114
259000
2000
我想重点指出这个结果，
04:36
because it was a great observation --
115
261000
2000
应为这是非常有用的发现--
04:38
30 years ago, right, 30 years ago --
116
263000
2000
三十年前，对，三十前--
04:40
and it's one that's laid fallow in research.
117
265000
3000
这是当时尚未被研究的课题。
04:43
It was a notion that really came out
118
268000
2000
这实际上是从阿尔伯特. 班杜拉的研究中
04:45
of Albert Bandura's work,
119
270000
2000
引申出来的一个概念，
04:47
who studied whether
120
272000
2000
他研究了
04:49
people could get a sense of empowerment.
121
274000
3000
人们是否会产生一种成就感。
04:52
The notion of efficacy basically boils down to one -- that
122
277000
3000
效能感的信念最终归结到一点：
04:55
if somebody believes that they have the capacity to change their behavior.
123
280000
3000
一个人是否相信他有能力改变自己的行为。
04:58
In health care terms, you could characterize this
124
283000
3000
从医疗保健的角度看，可以这样描述这个信念：
05:01
as whether or not somebody feels
125
286000
2000
一个人是否感觉
05:03
that they see a path towards better health,
126
288000
2000
他看到更好的健康状况的前景，
05:05
that they can actually see their way towards getting better health,
127
290000
2000
看到自己的健康状况能够日渐转好。
05:07
and that's a very important notion.
128
292000
2000
这是个非常重要的信念。
05:09
It's an amazing notion.
129
294000
2000
非常奇妙的信念。
05:11
We don't really know how to manipulate it, though, that well.
130
296000
3000
然而，我们还不知道怎样自如地控制这个信念。
05:14
Except, maybe we do.
131
299000
3000
或许，我们知道。
05:17
So fear doesn't work, right? Fear doesn't work.
132
302000
2000
恐惧是不起作用的，对，恐惧不起作用。
05:19
And this is a great example
133
304000
2000
这里有一个很好的例子，
05:21
of how we haven't learned that lesson at all.
134
306000
3000
证明了我们有多么不知悔改。
05:24
This is a campaign from the American Diabetes Association.
135
309000
3000
这是美国糖尿病协会的一次活动。
05:27
This is still the way we're communicating messages about health.
136
312000
3000
这仍然是我们传递保健信息的方式。
05:30
I mean, I showed my three-year-old this slide last night,
137
315000
3000
我昨晚给我三岁的儿子看了这张幻灯片，
05:33
and he's like, "Papa, why is an ambulance in these people's homes?"
138
318000
4000
他问：“爸爸，为什么这些人把救护车停在家里啊？”
05:37
And I had to explain, "They're trying to scare people."
139
322000
3000
我只能解释道：“他们想吓唬人。”
05:40
And I don't know if it works.
140
325000
2000
我不确定这么做是否起作用。
05:42
Now here's what does work:
141
327000
2000
而这才是起作用的做法，
05:44
personalized information works.
142
329000
2000
那就是个人化信息。
05:46
Again, Bandura recognized this
143
331000
2000
又是班杜拉，
05:48
years ago, decades ago.
144
333000
2000
他在几年前，甚至几十年前认识到了这一点。
05:50
When you give people specific information
145
335000
2000
当你给人们提供
05:52
about their health, where they stand,
146
337000
2000
关于他们健康状况的具体信息，他们的目前的病情，
05:54
and where they want to get to, where they might get to,
147
339000
2000
以及他们预期的进展，他们可能的进展，
05:56
that path, that notion of a path --
148
341000
2000
这个过程，对此过程的信念，
05:58
that tends to work for behavior change.
149
343000
2000
会改变病人的行为。
06:00
So let me just spool it out a little bit.
150
345000
2000
我来解释一下。
06:02
So you start with personalized data, personalized information
151
347000
3000
你得到一个病人的个人数据，
06:05
that comes from an individual,
152
350000
2000
个人信息之后，
06:07
and then you need to connect it to their lives.
153
352000
3000
你必须把它与病人的生活联系起来。
06:10
You need to connect it to their lives,
154
355000
2000
你需要通过让他们了解这些信息
06:12
hopefully not in a fear-based way, but one that they understand.
155
357000
2000
来把信息与他们的生活联系起来，而不是吓唬他们。
06:14
Okay, I know where I sit. I know where I'm situated.
156
359000
3000
好，我知道我的病情。
06:17
And that doesn't just work for me in terms of abstract numbers --
157
362000
3000
那些抽象的数字，
06:20
this overload of health information
158
365000
2000
还有摆在面前的
06:22
that we're inundated with.
159
367000
2000
那一大堆健康信息让我摸不着头脑，
06:24
But it actually hits home.
160
369000
2000
但这对我影响巨大。
06:26
It's not just hitting us in our heads; it's hitting us in our hearts.
161
371000
2000
这些信息不仅进入我们的头脑，还影响到我们的心理。
06:28
There's an emotional connection to information
162
373000
2000
我们对这些信息有不解的情结，
06:30
because it's from us.
163
375000
2000
因为这是关于我们自己的信息。
06:32
That information then needs to be connected to choices,
164
377000
3000
接着我们要把信息与人们的选择，
06:35
needs to be connected to a range of options,
165
380000
2000
选择的范围，
06:37
directions that we might go to --
166
382000
2000
以及方向联系起来--
06:39
trade-offs, benefits.
167
384000
2000
其中有哪些利弊。
06:41
Finally, we need to be presented with a clear point of action.
168
386000
3000
最后，我们要清楚明了地告知人们他们应采取什么行动。
06:44
We need to connect the information
169
389000
2000
我们必须时刻把信息与行动
06:46
always with the action,
170
391000
2000
联系起来，
06:48
and then that action feeds back
171
393000
2000
行动会产生反馈，
06:50
into different information,
172
395000
2000
从而得到新的信息，
06:52
and it creates, of course, a feedback loop.
173
397000
2000
周而复始，形成一个反馈圈。
06:54
Now this is a very well-observed and well-established notion
174
399000
3000
实践证实，这个信念对于改变行为
06:57
for behavior change.
175
402000
2000
十分可靠。
06:59
But the problem is that things -- in the upper-right corner there --
176
404000
3000
然而，问题是，右上角的
07:02
personalized data, it's been pretty hard to come by.
177
407000
2000
个人数据，往往很难得到。
07:04
It's a difficult and expensive commodity,
178
409000
3000
得到个人数据可谓困难重重，而且要花不少钱。
07:07
until now.
179
412000
2000
直到现在。
07:09
So I'm going to give you an example, a very simple example of how this works.
180
414000
3000
我接下来要给大家看一个例子，这个简单的例子展示我们如何得到个人数据。
07:12
So we've all seen these. These are the "your speed limit" signs.
181
417000
3000
我们都见过这些标示牌，这些是限速牌。
07:15
You've seen them all around,
182
420000
2000
我们随处都能看到这些牌子，
07:17
especially these days as radars are cheaper.
183
422000
2000
尤其在雷达价格越发便宜的现在。
07:19
And here's how they work in the feedback loop.
184
424000
2000
它们在反馈圈中是这样起作用的。
07:21
So you start with the personalized data
185
426000
2000
一开始是个性化数据，
07:23
where the speed limit on the road that you are at that point
186
428000
2000
此时你所在公路的限速
07:25
is 25,
187
430000
2000
是25，
07:27
and, of course, you're going faster than that.
188
432000
2000
当然你有些超速了。
07:29
We always are. We're always going above the speed limit.
189
434000
3000
我们总是超速的。
07:32
The choice in this case is pretty simple.
190
437000
2000
在此情况下我们只有两种选择。
07:34
We either keep going fast, or we slow down.
191
439000
2000
我们要么保持原速，要么减速。
07:36
We should probably slow down,
192
441000
2000
我们或许应该减速，
07:38
and that point of action is probably now.
193
443000
2000
那么，现在就行动。
07:40
We should take our foot off the pedal right now,
194
445000
3000
我们应该马上放松油门。
07:43
and generally we do. These things are shown to be pretty effective
195
448000
3000
我们一般都会这么做；这些限速牌非常有效地
07:46
in terms of getting people to slow down.
196
451000
2000
提醒了人们要减速。
07:48
They reduce speeds by about five to 10 percent.
197
453000
2000
他们将速度降低了百分之十。
07:50
They last for about five miles,
198
455000
2000
并且减速能坚持五英里路程，
07:52
in which case we put our foot back on the pedal.
199
457000
2000
接着我们才会再次踩油门。
07:54
But it works, and it even has some health repercussions.
200
459000
2000
但在还是起作用了，甚至还有益于身心健康。
07:56
Your blood pressure might drop a little bit.
201
461000
2000
你的血压可能没那么高了。
07:58
Maybe there's fewer accidents, so there's public health benefits.
202
463000
3000
可能交通事故减少了，造福了公众健康。
08:01
But by and large, this is a feedback loop
203
466000
2000
但是，总的来看，这是个
08:03
that's so nifty and too rare.
204
468000
3000
难得的一流反馈圈。
08:06
Because in health care, most health care,
205
471000
2000
因为在医疗保健方面，大多数情况下，
08:08
the data is very removed from the action.
206
473000
3000
数据与行动相互分离。
08:11
It's very difficult to line things up so neatly.
207
476000
3000
很难把事情理得那么顺。
08:14
But we have an opportunity.
208
479000
2000
但是我们有一线希望。
08:16
So I want to talk about, I want to shift now to think about
209
481000
2000
我想将话题转移，来探讨
08:18
how we deliver health information in this country,
210
483000
2000
在我国，我们如何传递健康信息，
08:20
how we actually get information.
211
485000
3000
以及我们如何获取信息。
08:23
This is a pharmaceutical ad.
212
488000
3000
这是一个药品广告。
08:26
Actually, it's a spoof. It's not a real pharmaceutical ad.
213
491000
2000
这实际上是在耍花腔；而不是真正的药品广告。
08:28
Nobody's had the brilliant idea
214
493000
2000
还没有人聪明到用”Havidol“
08:30
of calling their drug Havidol quite yet.
215
495000
3000
来给药品命名的。
08:34
But it looks completely right.
216
499000
2000
但是它看起来完全没问题。
08:36
So it's exactly the way we get
217
501000
2000
这就是我们
08:38
health information and pharmaceutical information,
218
503000
3000
得到健康信息和药品信息的方式，
08:41
and it just sounds perfect.
219
506000
2000
看上去完美无缺。
08:43
And then we turn the page of the magazine,
220
508000
2000
当翻开杂志，
08:45
and we see this --
221
510000
3000
我们看到这样一页，对吧。
08:48
now this is the page the FDA requires pharmaceutical companies
222
513000
3000
食品及药物管理局要求制药公司
08:51
to put into their ads, or to follow their ads,
223
516000
3000
把这一页放进他们广告中，或加在广告后面。
08:54
and to me, this is one of the most
cynical exercises in medicine.
cynical exercises in medicine.
224
519000
4000
对于我而言，这是医学界一大倍受诟病的做法。
08:58
Because we know.
225
523000
2000
因为我们知道，
09:00
Who among us would actually say that people read this?
226
525000
2000
我们中间有谁认为人们会读这一页？
09:02
And who among us would actually say
227
527000
2000
有谁认为
09:04
that people who do try to read this
228
529000
2000
那些读了这一页的人
09:06
actually get anything out of it?
229
531000
2000
能够得到任何有用信息？
09:08
This is a bankrupt effort
230
533000
2000
这是医疗信息沟通的
09:10
at communicating health information.
231
535000
3000
昏庸之举。
09:13
There is no good faith in this.
232
538000
2000
没有人会买账。
09:15
So this is a different approach.
233
540000
2000
而这是另一种方式。
09:17
This is an approach that has been developed
234
542000
3000
这种方式是由
09:20
by a couple researchers at Dartmouth Medical School,
235
545000
3000
达特茅斯医学院的几位研究人员所开发。
09:23
Lisa Schwartz and Steven Woloshin.
236
548000
2000
他们是莉莎. 史沃兹和史蒂芬. 沃罗森。
09:25
And they created this thing called the "drug facts box."
237
550000
3000
他们的这个发明叫做药物成分说明表。
09:28
They took inspiration from, of all things,
238
553000
2000
出乎人意料的是，他们的灵感来自
09:30
Cap'n Crunch.
239
555000
2000
Cap‘n Crunch麦片。
09:32
They went to the nutritional information box
240
557000
3000
他们看到上面的营养成分介绍，
09:35
and saw that what works for cereal, works for our food,
241
560000
3000
并意识到麦片，食物的成分介绍，
09:38
actually helps people understand what's in their food.
242
563000
3000
实际上有助于人们了解他们食物中有哪些成分。
09:42
God forbid we should use that same standard
243
567000
2000
我们怎么就没想到，
09:44
that we make Cap'n Crunch live by
244
569000
2000
可以把Cap'n Crunch麦片的成分介绍模式
09:46
and bring it to drug companies.
245
571000
3000
推广到制药公司。
09:49
So let me just walk through this quickly.
246
574000
2000
我快速给大家展示一下。
09:51
It says very clearly what the drug is for, specifically who it is good for,
247
576000
3000
它清清楚楚地说明了该药的用途，使用对象，
09:54
so you can start to personalize your understanding
248
579000
2000
这样你就可以对号入座，
09:56
of whether the information is relevant to you
249
581000
2000
看上面的信息是否与你的情况相符，
09:58
or whether the drug is relevant to you.
250
583000
2000
这药是否适合你服用。
10:00
You can understand exactly what the benefits are.
251
585000
3000
你能够清楚地了解服药之后会有哪些好处。
10:03
It isn't this kind of vague promise that it's going to work no matter what,
252
588000
3000
它并没有含糊地承诺，无论怎样都能药到病除，
10:06
but you get the statistics for how effective it is.
253
591000
3000
但是你可以通过数据来了解药的效果。
10:09
And finally, you understand what those choices are.
254
594000
3000
最后，你明确了自己有哪些选择。
10:12
You can start to unpack the choices involved
255
597000
2000
你可以开始挑拣有关的选择，
10:14
because of the side effects.
256
599000
2000
因为你要考虑到药的副作用。
10:16
Every time you take a drug, you're walking into a possible side effect.
257
601000
3000
每一次吃药，你都有可能面临某种副作用。
10:19
So it spells those out in very clean terms,
258
604000
2000
它明明白白地列出了可能的副作用。
10:21
and that works.
259
606000
2000
这很管用。
10:23
So I love this. I love that drug facts box.
260
608000
2000
我特别喜欢这个药物说明表。
10:25
And so I was thinking about,
261
610000
2000
于是，我在思考，
10:27
what's an opportunity that I could have
262
612000
2000
我怎样才能
10:29
to help people understand information?
263
614000
3000
帮助人们理解信息呢？
10:32
What's another latent body of information that's out there
264
617000
4000
还有哪个未被充分理解的信息源
10:36
that people are really not putting to use?
265
621000
3000
让人们无所适从呢？
10:39
And so I came up with this: lab test results.
266
624000
3000
于是，我想到了这个：实验室检测结果。
10:42
Blood test results are this great source of information.
267
627000
3000
这一大堆信息是血液检测的结果。
10:45
They're packed with information.
268
630000
2000
上面满满的都是信息。
10:47
They're just not for us. They're not for people. They're not for patients.
269
632000
3000
这不是给我们看的；不是给人们看的；不是给病人看的。
10:50
They go right to doctors.
270
635000
2000
是直接给医生看的。
10:52
And God forbid -- I think many doctors, if you really asked them,
271
637000
3000
上帝啊！我敢说，很多医生，如果你问他们，
10:55
they don't really understand all this stuff either.
272
640000
3000
他们也不完全明白这些东西。
10:58
This is the worst presented information.
273
643000
3000
这样的信息表述实在是糟透了。
11:01
You ask Tufte, and he would say,
274
646000
3000
如果你问塔夫特，他会说：
11:04
"Yes, this is the absolute worst presentation of information possible."
275
649000
3000
“毫无疑问，这样的信息表述真是槽糕透顶了。”
11:07
What we did at Wired
276
652000
2000
在《连线》（Wired）杂志社，
11:09
was we went, and I got our graphic design department
277
654000
2000
我让我们的图表设计部
11:11
to re-imagine these lab reports.
278
656000
2000
对这些测试报告进行重新设计。
11:13
So that's what I want to walk you through.
279
658000
2000
我给大家简短地展示一下。
11:15
So this is the general blood work before,
280
660000
3000
这是一项常规血液检测报告原来的版本，
11:18
and this is the after, this is what we came up with.
281
663000
2000
这是修改后的版本，这就是我们的设计。
11:20
The after takes what was four pages --
282
665000
2000
修改后的版本将原来的四页纸--
11:22
that previous slide was actually
283
667000
2000
上一张幻灯片实际上
11:24
the first of four pages of data
284
669000
2000
四页纸的第一页，
11:26
that's just the general blood work.
285
671000
2000
这还只是一项常规的血液检测。
11:28
It goes on and on and on, all these values, all these numbers you don't know.
286
673000
3000
全篇洋洋洒洒，那么多的数值，那么多的数字，你根本看不懂。
11:31
This is our one-page summary.
287
676000
3000
这是我们一页纸的总结。
11:34
We use the notion of color.
288
679000
2000
我们运用颜色作为信号。
11:36
It's an amazing notion that color could be used.
289
681000
3000
颜色的运用真是太妙了。
11:39
So on the top-level you have your overall results,
290
684000
3000
最上面一层是你的测试结果概况，
11:42
the things that might jump out at you from the fine print.
291
687000
3000
清晰的印刷让你一目了然。
11:45
Then you can drill down
292
690000
2000
你接着往下看，
11:47
and understand how actually we put your level in context,
293
692000
3000
我们把你的等级
11:50
and we use color to illustrate
294
695000
2000
用颜色作图解
11:52
exactly where your value falls.
295
697000
2000
标明你的数值在哪一个区域里。
11:54
In this case, this patient is slightly at risk of diabetes
296
699000
3000
这个案例中的病人有轻微患糖尿病的危险，
11:57
because of their glucose level.
297
702000
2000
因为他的葡萄糖含量。
11:59
Likewise, you can go over your lipids
298
704000
2000
类似地，你可以查看你的油脂含量
12:01
and, again, understand what your overall cholesterol level is
299
706000
3000
了解你总体的胆固醇含量，
12:04
and then break down into the HDL and the LDL if you so choose.
300
709000
3000
你还可以进一步查看高密度脂蛋白和低密度脂蛋白的情况。
12:07
But again, always using color
301
712000
2000
你看，我们总是使用颜色
12:09
and personalized proximity
302
714000
2000
让那些信息
12:11
to that information.
303
716000
2000
更加平易近人。
12:13
All those other values,
304
718000
2000
我们对那一大堆其它数值
12:15
all those pages and pages of values that are full of nothing,
305
720000
2000
那一大叠布满数字但毫无意义的纸
12:17
we summarize.
306
722000
2000
作了精简。
12:19
We tell you that you're okay, you're normal.
307
724000
2000
我们告诉你，你的情况正常。
12:21
But you don't have to wade through it. You don't have to go through the junk.
308
726000
3000
你用不着在数字的海洋里苦苦寻觅，用不着管那些没用的信息。
12:24
And then we do two other very important things
309
729000
2000
接着我们做了另外两件非常重要的事情，
12:26
that kind of help fill in this feedback loop:
310
731000
2000
这两件事有助于填满这个反馈圈。
12:28
we help people understand in a little more detail
311
733000
2000
我们帮助人们进一步理解更多细节，
12:30
what these values are and what they might indicate.
312
735000
3000
理解这些数值代表什么，表明了什么。
12:33
And then we go a further step -- we tell them what they can do.
313
738000
3000
然后，更进一步：我们告诉他们下一步应该做什么。
12:36
We give them some insight
314
741000
2000
我们帮助他们判断
12:38
into what choices they can make, what actions they can take.
315
743000
3000
他们应该做哪些选择，采取哪些行动。
12:41
So that's our general blood work test.
316
746000
3000
这就是我们做的常规血液检测报告。
12:44
Then we went to CRP test.
317
749000
2000
我们接着开始做CRP检测。
12:46
In this case, it's a sin of omission.
318
751000
2000
这是一个信息严重缺失的案例。
12:48
They have this huge amount of space,
319
753000
2000
这上面有一大片空白，
12:50
and they don't use it for anything, so we do.
320
755000
2000
没有人用它，我们就把这片空白用上了。
12:52
Now the CRP test is often done
321
757000
2000
CRP检测往往
12:54
following a cholesterol test,
322
759000
2000
跟在胆固醇含量检测之后，
12:56
or in conjunction with a cholesterol test.
323
761000
2000
或者与胆固醇含量测试一同进行。
12:58
So we take the bold step
324
763000
2000
于是我们大胆地
13:00
of putting the cholesterol information on the same page,
325
765000
3000
把胆固醇测试信息印在同一页上，
13:03
which is the way the doctor is going to evaluate it.
326
768000
2000
让医生进行诊断。
13:05
So we thought the patient might actually want to know the context as well.
327
770000
3000
我们想到，病人可能也想看明白其中的玄机。
13:08
It's a protein that shows up
328
773000
2000
这是一种维生素，
13:10
when your blood vessels might be inflamed,
329
775000
2000
当你的血管发炎时，这种维生素就会产生，
13:12
which might be a risk for heart disease.
330
777000
2000
有导致心脏病的风险。
13:14
What you're actually measuring
331
779000
2000
简单明了的语言
13:16
is spelled out in clean language.
332
781000
2000
把测试结果解释得清清楚楚。
13:18
Then we use the information
333
783000
2000
接着我们用上了
13:20
that's already in the lab report.
334
785000
2000
测试报告上的信息。
13:22
We use the person's age and their gender
335
787000
2000
我们通过病人的年龄与性别
13:24
to start to fill in the personalized risks.
336
789000
3000
对其具体所面临的风险进行评估。
13:27
So we start to use the data we have
337
792000
2000
我们用手上掌握的数据
13:29
to run a very simple calculation
338
794000
2000
进行一个非常简单的计算，
13:31
that's on all sorts of online calculators
339
796000
2000
各种网上计算器都能进行这种计算，
13:33
to get a sense of what the actual risk is.
340
798000
3000
最后对实际风险进行预测。
13:36
The last one I'll show you is a PSA test.
341
801000
2000
最后我将展示的是PSA（前列腺特异抗原）检测。
13:38
Here's the before, and here's the after.
342
803000
3000
这是修改之前，这是之后。
13:41
Now a lot of our effort on this one --
343
806000
2000
我们在这上面花了不少功夫--
13:43
as many of you probably know,
344
808000
2000
在做许多人可能知道，
13:45
a PSA test is a very controversial test.
345
810000
2000
PSA测试是一种非常具有争议的检测。
13:47
It's used to test for prostate cancer,
346
812000
2000
它是用于检测病人是否患上前列腺癌的，
13:49
but there are all sorts of reasons
347
814000
2000
但是，引起前列腺肿大的原因
13:51
why your prostate might be enlarged.
348
816000
2000
是多种多样的。
13:53
And so we spent a good deal of our time
349
818000
2000
于是我们花了不少时间，
13:55
indicating that.
350
820000
2000
研究如何表述测试结果。
13:57
We again personalized the risks.
351
822000
2000
我们再次根据个人情况评估风险。
13:59
So this patient is in their 50s,
352
824000
2000
这是针对五十多岁病人的报告，
14:01
so we can actually give them a very precise estimate
353
826000
2000
我们能够非常准确地
14:03
of what their risk for prostate cancer is.
354
828000
2000
评估他们患前列腺癌的风险。
14:05
In this case it's about 25 percent, based on that.
355
830000
3000
根据数据显示，这个病例的风险是百分之二十五。
14:08
And then again, the follow-up actions.
356
833000
3000
下面列出了应采取的对策。
14:11
So our cost for this was less than 10,000 dollars, all right.
357
836000
3000
我们做这项工作的成本不到一万美元。
14:14
That's what Wired magazine spent on this.
358
839000
3000
这就是《连线》杂志在这上面的成本。
14:17
Why is Wired magazine doing this?
359
842000
2000
为什么《连线》杂志要做这样一项工作呢？
14:19
(Laughter)
360
844000
3000
（众人笑）
14:22
Quest Diagnostics and LabCorp,
361
847000
2000
两家最大的实验室检测公司，
14:24
the two largest lab testing companies --
362
849000
3000
奎斯特诊断公司和LabCorp公司：
14:27
last year, they made profits of over 700 million dollars
363
852000
3000
去年，他们的利润分别超过了七亿美元，
14:30
and over 500 million dollars respectively.
364
855000
3000
和五亿美元。
14:33
Now this is not a problem of resources;
365
858000
2000
问题的关键不在于资源，
14:35
this is a problem of incentives.
366
860000
3000
而在于刺激。
14:38
We need to recognize that the target of this information
367
863000
3000
我们需要认识到：信息的接收对象
14:41
should not be the doctor, should not be the insurance company.
368
866000
3000
不应该是医生或保险公司；
14:44
It should be the patient.
369
869000
2000
而应是病人。
14:46
It's the person who actually, in the end,
370
871000
2000
病人，归根结底，
14:48
is going to be having to change their lives
371
873000
2000
要改变自己的生活，
14:50
and then start adopting new behaviors.
372
875000
2000
并养成新的行为习惯。
14:52
This is information that is incredibly powerful.
373
877000
2000
而信息在其中扮演了举足轻重的角色。
14:54
It's an incredibly powerful catalyst to change.
374
879000
3000
这是促成改变的强力催化剂。
14:57
But we're not using it. It's just sitting there.
375
882000
2000
它近在咫尺，但我们却不去用它。
14:59
It's being lost.
376
884000
2000
它白白被浪费了。
15:01
So I want to just offer four questions
377
886000
2000
我想提出四个
15:03
that every patient should ask,
378
888000
2000
病人应该问的问题，
15:05
because I don't actually expect people
379
890000
2000
因为我实际上并不指望
15:07
to start developing these lab test reports.
380
892000
2000
人们自行撰写这些实验室检测报告。
15:09
But you can create your own feedback loop.
381
894000
2000
但是你可以创造自己的反馈圈。
15:11
Anybody can create their feedback loop by asking these simple questions:
382
896000
3000
每个人都可以通过问下列简单的问题来创造反馈圈：
15:14
Can I have my results?
383
899000
2000
我可以得到我的检测结果吗？
15:16
And the only acceptable answer is --
384
901000
2000
唯一的答案是--
15:18
(Audience: Yes.) -- yes.
385
903000
2000
（观众：可以。）--可以。
15:20
What does this mean? Help me understand what the data is.
386
905000
2000
这份报告说明了什么？帮助我理解这些数据都代表什么。
15:22
What are my options? What choices are now on the table?
387
907000
3000
我有哪些选择？哪些做法的可行的？
15:25
And then, what's next?
388
910000
2000
接下来我该怎么做？
15:27
How do I integrate this information
389
912000
2000
在未来的日子中，
15:29
into the longer course of my life?
390
914000
2000
我如何根据这些信息改变我的生活？
15:32
So I want to wind up by just showing
391
917000
2000
最后，我想告诉大家
15:34
that people have the capacity to understand this information.
392
919000
2000
人们是有能力理解这些信息的。
15:36
This is not beyond the grasp of ordinary people.
393
921000
3000
这对于平常人来说是完全有可能做到的。
15:39
You do not need to have the education level of people in this room.
394
924000
3000
人们并不需要拥有在座各位的教育水平。
15:42
Ordinary people are capable of understanding this information,
395
927000
3000
平常人有能力理解这些信息，
15:45
if we only go to the effort of presenting it to them
396
930000
3000
只要我们愿意为在信息的表述上多下一些功夫，
15:48
in a form that they can engage with.
397
933000
2000
方便他们理解，让他们参与进来。
15:50
And engagement is essential here,
398
935000
2000
在此，参与是关键因素，
15:52
because it's not just giving them information;
399
937000
2000
因为，光给他们提供信息，意义不大，
15:54
it's giving them an opportunity to act.
400
939000
2000
而要给他们行动的机会。
15:56
That's what engagement is. It's different from compliance.
401
941000
2000
这才是真正的参与；不同于服从。
15:58
It works totally different from the way we talk about behavior
402
943000
3000
这不同于与我们今天说的
16:01
in medicine today.
403
946000
2000
医学上的行为。
16:03
And this information is out there.
404
948000
2000
这信息就在眼前。
16:05
I've been talking today about latent information,
405
950000
2000
今天我所探讨的是被掩盖了的信息，
16:07
all this information that exists in the system
406
952000
2000
这些信息存在于这个系统之中，
16:09
that we're not putting to use.
407
954000
2000
而我们却没有加以利用。
16:11
But there are all sorts of other bodies of information
408
956000
2000
但各种各样的信息
16:13
that are coming online,
409
958000
2000
正逐渐在网上涌现。
16:15
and we need to recognize the capacity of this information
410
960000
3000
我们需要认识到这信息的力量，
16:18
to engage people, to help people
411
963000
2000
让人们参与进来，帮助人们
16:20
and to change the course of their lives.
412
965000
2000
改变他们生命的轨迹。
16:22
Thank you very much.
413
967000
2000
非常感谢
16:24
(Applause)
414
969000
3000
（众人鼓掌）
ABOUT THE SPEAKER
Thomas Goetz - Healthcare communicatorThomas Goetz is the co-founder of Iodine and author of "The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine.”
Why you should listen
Thomas Goetz is the co-founder of Iodine, a new company that gives consumers better information -- and better visualizations -- of their health data. The former executive editor of Wired, Goetz has a Master's of Public Health from UC Berkeley. In 2010 he published The Decision Tree, a fascinating look at modern medical decisionmaking and technology. Former FDA commissioner Dr. David Kessler called the book "a game changer.” His next book, The Remedy, explores the germ theory of disease and the quest to cure tuberculosis.
Thomas Goetz | Speaker | TED.com