TEDxSaltLakeCity
Kevin B. Jones: Why curiosity is the key to science and medicine
凯文・琼斯: 为什么好奇心是科学与医药的钥匙？
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科学是一个包括实验，失败与改写的学习过程--关于医药的科学就更不例外。癌症研究员凯文・琼斯以一种简单的答案面对关于手术和医疗领域最深奥的未知：诚实。在这个围绕知识本质的令人深思的演讲中，琼斯展示了，当科学家们谦逊的承认他们所不明白的东西时，科学是如何做到更好的。
Kevin B. Jones - Cancer researcher
Kevin B. Jones is a life-long student of human nature, fascinated most by the decision-making capacity intrinsic to each of us. Full bio
Kevin B. Jones is a life-long student of human nature, fascinated most by the decision-making capacity intrinsic to each of us. Full bio
Double-click the English transcript below to play the video.
00:12
Science.
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科学。
00:14
The very word for many of you conjures
unhappy memories of boredom
unhappy memories of boredom
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这个词对于你们中的很多人来说，
召唤了对于高中生物
召唤了对于高中生物
00:18
in high school biology or physics class.
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或是物理课堂的苦闷记忆。
00:21
But let me assure that what you did there
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但是我向你们保证，
你们在那时经历的
你们在那时经历的
00:24
had very little to do with science.
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与科学是大相径庭的。
00:26
That was really the "what" of science.
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那只是科学“是什么”。
00:28
It was the history
of what other people had discovered.
of what other people had discovered.
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那是前人发现的历史记载。
我对于成为一名科学家
最感兴趣的地方
最感兴趣的地方
00:32
What I'm most interested in as a scientist
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00:35
is the "how" of science.
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是科学的“为什么”。
00:37
Because science is knowledge in process.
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因为科学的知识是正在探寻中的。
00:41
We make an observation,
guess an explanation for that observation,
guess an explanation for that observation,
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我们进行观察，
对观察提出一种设想原因，
对观察提出一种设想原因，
00:44
and then make a prediction
that we can test
that we can test
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做一种可以通过实验或是
00:46
with an experiment or other observation.
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其他观察论证的假设。
00:49
A couple of examples.
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举些例子。
00:50
First of all, people noticed
that the Earth was below, the sky above,
that the Earth was below, the sky above,
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首先，人们注意到了
大地在脚下，天空在头顶，
大地在脚下，天空在头顶，
00:54
and both the Sun and the Moon
seemed to go around them.
seemed to go around them.
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太阳和月亮都看似
围绕着它们在移动
围绕着它们在移动
他们提出的设想是
00:58
Their guessed explanation
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01:00
was that the Earth must be
the center of the universe.
the center of the universe.
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地球一定是宇宙的中心。
01:04
The prediction: everything
should circle around the Earth.
should circle around the Earth.
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预测即为：一切都是围绕着地球运动的。
当伽里略着手于第一台望远镜，
01:08
This was first really tested
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01:09
when Galileo got his hands
on one of the first telescopes,
on one of the first telescopes,
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望向天空的时候，这件事第一次
01:12
and as he gazed into the night sky,
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被真正测试了，
01:15
what he found there was a planet, Jupiter,
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他发现的是一颗行星，木星，
01:18
with four moons circling around it.
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周围还有四颗卫星环绕着它。
之后，他又利用这些卫星
去跟踪木星的轨道
去跟踪木星的轨道
01:23
He then used those moons
to follow the path of Jupiter
to follow the path of Jupiter
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01:28
and found that Jupiter
also was not going around the Earth
also was not going around the Earth
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发现木星也不是围绕地球运动的
01:31
but around the Sun.
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而是围绕太阳运动的。
01:35
So the prediction test failed.
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所以说这个假说测试就失败了。
01:38
And this led to
the discarding of the theory
the discarding of the theory
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这就导致了地球是宇宙的中心
01:40
that the Earth was the center
of the universe.
of the universe.
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这个理论被推翻。
01:42
Another example: Sir Isaac Newton
noticed that things fall to the Earth.
noticed that things fall to the Earth.
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另一个例子：艾萨克·牛顿爵士
注意到了东西都是向地面坠落的。
注意到了东西都是向地面坠落的。
01:46
The guessed explanation was gravity,
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设想原因是引力，
01:50
the prediction that everything
should fall to the Earth.
should fall to the Earth.
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预测是万物都会落向地面。
01:53
But of course, not everything
does fall to the Earth.
does fall to the Earth.
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但是当然，并不是
所有东西都落向地面的。
所有东西都落向地面的。
01:58
So did we discard gravity?
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但是我们就抛弃引力吗？
02:00
No. We revised the theory and said,
gravity pulls things to the Earth
gravity pulls things to the Earth
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不。我们重新改写理论，
说引力将万物拉向地面，
说引力将万物拉向地面，
02:05
unless there is an equal
and opposite force in the other direction.
and opposite force in the other direction.
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除非事物还受到大小相同
方向相反的力的作用。
方向相反的力的作用。
02:10
This led us to learn something new.
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这引领我们学到了新的东西。
02:12
We began to pay more attention
to the bird and the bird's wings,
to the bird and the bird's wings,
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我们开始更多的关注
鸟儿和它们的翅膀，
鸟儿和它们的翅膀，
02:16
and just think of all the discoveries
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想一想从那条思路
02:18
that have flown
from that line of thinking.
from that line of thinking.
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引出的一系列发现。
02:21
So the test failures,
the exceptions, the outliers
the exceptions, the outliers
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所以那些测试的
失败，意外，异常值
失败，意外，异常值
02:26
teach us what we don't know
and lead us to something new.
and lead us to something new.
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给我们传授了未知，
引领我们去发现新的东西。
引领我们去发现新的东西。
科学就是这样不断前行。
科学就是这样不断学习。
科学就是这样不断学习。
02:32
This is how science moves forward.
This is how science learns.
This is how science learns.
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有的时候在媒体当中，
甚至更罕见的，
甚至更罕见的，
02:35
Sometimes in the media,
and even more rarely,
and even more rarely,
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02:38
but sometimes even scientists will say
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有时甚至科学家们会说
02:40
that something or other
has been scientifically proven.
has been scientifically proven.
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这个或是那个
已经被科学证明了。
已经被科学证明了。
02:43
But I hope that you understand
that science never proves anything
that science never proves anything
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但是，我希望你们能够明白，
科学从不能证明任何东西，
科学从不能证明任何东西，
02:48
definitively forever.
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永远都不可能。
希望科学始终保持那种好奇感
02:51
Hopefully science remains curious enough
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02:55
to look for
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让我们去探寻，
02:56
and humble enough to recognize
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和那种谦逊感，
02:58
when we have found
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当我们发现下一个异常值，
03:00
the next outlier,
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下一个特例，
就像木星的卫星
那样的东西的时候，
那样的东西的时候，
03:02
the next exception,
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03:03
which, like Jupiter's moons,
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能够让我们去认识，
03:05
teaches us what we don't actually know.
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教会我们那些我们并不了解的东西。
03:09
We're going to change gears
here for a second.
here for a second.
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我们要在这里变换一小会儿主题了。
03:11
The caduceus, or the symbol of medicine,
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墨丘利的节杖，
或者说是医药的象征，
或者说是医药的象征，
03:13
means a lot of different things
to different people,
to different people,
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对于不同的人，有着不同的意义，
03:16
but most of our
public discourse on medicine
public discourse on medicine
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但是我们的普遍公共医学论述
03:18
really turns it into
an engineering problem.
an engineering problem.
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却将它转变为了一个工程问题。
03:21
We have the hallways of Congress,
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我们的国会长廊，
03:23
and the boardrooms of insurance companies
that try to figure out how to pay for it.
that try to figure out how to pay for it.
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还有保险公司的董事会
都试图找到支付它们的途径
都试图找到支付它们的途径
伦理学家和流行病学家
03:27
The ethicists and epidemiologists
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03:29
try to figure out
how best to distribute medicine,
how best to distribute medicine,
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试图找到如何更好分配药物的方法，
03:32
and the hospitals and physicians
are absolutely obsessed
are absolutely obsessed
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医院和医生们却完全沉迷于
03:34
with their protocols and checklists,
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他们的协议和清单，
03:36
trying to figure out
how best to safely apply medicine.
how best to safely apply medicine.
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试图找到更安全应用药物的方法。
03:40
These are all good things.
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这些都是好事。
03:42
However, they also all assume
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但是，他们也都在
03:45
at some level
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一定程度上假定了
03:47
that the textbook of medicine is closed.
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医学教科书是封闭的。
我们就开始以我们能
多快速的得到医疗服务
多快速的得到医疗服务
03:51
We start to measure
the quality of our health care
the quality of our health care
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03:53
by how quickly we can access it.
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来衡量我们的医疗质量。
03:56
It doesn't surprise me
that in this climate,
that in this climate,
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在这种风气下，
许多机构
许多机构
03:58
many of our institutions
for the provision of health care
for the provision of health care
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为寻求医疗服务，
开始大批搜寻润滑油的行为，
开始大批搜寻润滑油的行为，
04:01
start to look a heck of a lot
like Jiffy Lube.
like Jiffy Lube.
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一点儿也不使我惊讶。
04:03
(Laughter)
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（笑声）
04:06
The only problem is that
when I graduated from medical school,
when I graduated from medical school,
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唯一的问题是，
当我从医学院毕业的时候，
当我从医学院毕业的时候，
我并没有得到那个
像是你的机械师
像是你的机械师
04:10
I didn't get one of those
little doohickeys
little doohickeys
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04:12
that your mechanic
has to plug into your car
has to plug into your car
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一插进你的汽车里就能知道
04:14
and find out exactly what's wrong with it,
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车子哪里出问题的小窍门，
04:17
because the textbook of medicine
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因为医学课本
04:19
is not closed.
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并非是封闭的。
04:21
Medicine is science.
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医药是科学。
04:23
Medicine is knowledge in process.
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医药是正在进程中的知识。
我们先观察现象，
04:27
We make an observation,
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04:28
we guess an explanation
of that observation,
of that observation,
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然后猜测现象背后的解释，
04:30
and then we make a prediction
that we can test.
that we can test.
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之后我们作出一个
能够被测试的假设
能够被测试的假设
04:33
Now, the testing ground
of most predictions in medicine
of most predictions in medicine
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当下，我们在医药领域
大多数的测试场地就是
大多数的测试场地就是
04:37
is populations.
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群体。
04:38
And you may remember
from those boring days in biology class
from those boring days in biology class
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然后也许你还记得
在那些无聊的生物课上
在那些无聊的生物课上
04:42
that populations tend to distribute
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关于群体倾向于呈现
围绕平均值的
04:44
around a mean
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04:45
as a Gaussian or a normal curve.
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高斯或是正态分布曲线。
04:47
Therefore, in medicine,
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因此，在医药领域，
04:49
after we make a prediction
from a guessed explanation,
from a guessed explanation,
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在我们用一种可能的原因
作出预测之后，
作出预测之后，
04:52
we test it in a population.
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我们就在群体中测试它。
这就意味着，我们
关于医药学习的知识，
关于医药学习的知识，
04:55
That means that what we know in medicine,
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04:58
our knowledge and our know-how,
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我们的所有知识，
05:00
comes from populations
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都来自于群体，
而只有当达到
下一个异常值的时候，
下一个异常值的时候，
05:02
but extends only as far
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下一个特例，
05:05
as the next outlier,
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就像是木星卫星
那样的特例的时候，
那样的特例的时候，
05:07
the next exception,
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05:08
which, like Jupiter's moons,
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我们的知识才会扩张，
它们教会了我们并不了解的东西。
05:10
will teach us what we don't actually know.
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05:14
Now, I am a surgeon
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现在，我是一名外科医生，
05:15
who looks after patients with sarcoma.
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正在寻找肉瘤病人。
05:17
Sarcoma is a very rare form of cancer.
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肉瘤是一种极其罕见的癌症。
05:20
It's the cancer of flesh and bones.
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是骨与肌肉的癌变。
05:23
And I would tell you that every one
of my patients is an outlier,
of my patients is an outlier,
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然后我会告诉你，
我的每一位病人都是异常值，
我的每一位病人都是异常值，
05:27
is an exception.
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都是特例。
我为这些肉瘤患者做的手术，
没有任何一个是对照着，
没有任何一个是对照着，
05:30
There is no surgery I have ever performed
for a sarcoma patient
for a sarcoma patient
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05:33
that has ever been guided
by a randomized controlled clinical trial,
by a randomized controlled clinical trial,
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临床实验案例，就是那些
我们认识中最适合医药的
我们认识中最适合医药的
05:37
what we consider the best kind
of population-based evidence in medicine.
of population-based evidence in medicine.
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以群体为基础的实验证据，
没有任何一个是被其指导着完成的。
没有任何一个是被其指导着完成的。
人们总说要跳出定式思维，
05:42
People talk about thinking
outside the box,
outside the box,
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05:44
but we don't even have a box in sarcoma.
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但是在肉瘤病症上，我们没有定式。
05:47
What we do have as we take
a bath in the uncertainty
a bath in the uncertainty
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当我们沐浴在
关于肉瘤的，环绕我们的，
关于肉瘤的，环绕我们的，
05:50
and unknowns and exceptions
and outliers that surround us in sarcoma
and outliers that surround us in sarcoma
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那些未知，不确定，
特例，异常值中的时候，
特例，异常值中的时候，
05:55
is easy access to what I think
are those two most important values
are those two most important values
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我们所拥有的，是我眼中
对于任何一种科学，
对于任何一种科学，
最重要的两种价值观：
05:59
for any science:
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06:01
humility and curiosity.
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谦逊和好奇心。
06:04
Because if I am humble and curious,
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因为如果我是谦逊的，好奇心强的，
06:06
when a patient asks me a question,
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当病人询问我问题的时候，
06:08
and I don't know the answer,
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如果我不知道问题的答案，
我就会去询问有着相似的，
06:10
I'll ask a colleague
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06:12
who may have a similar
albeit distinct patient with sarcoma.
albeit distinct patient with sarcoma.
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尽管是不同的肉瘤病人的同事。
06:15
We'll even establish
international collaborations.
international collaborations.
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我们甚至会建立国际间的合作。
06:17
Those patients will start
to talk to each other through chat rooms
to talk to each other through chat rooms
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那些病人也会开始
在聊天室和支持团体中
在聊天室和支持团体中
06:21
and support groups.
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互相交流。
06:22
It's through this kind
of humbly curious communication
of humbly curious communication
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是通过这种谦逊的，
好奇的交流过程，
好奇的交流过程，
06:26
that we begin to try and learn new things.
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我们开始去尝试并学习新的知识。
06:31
As an example, this is a patient of mine
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作为例子，这是我的一位病人
06:33
who had a cancer near his knee.
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他在膝盖附近长了一个肿瘤。
06:35
Because of humbly curious communication
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正因为那种在国际合作中谦逊的
06:37
in international collaborations,
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好奇心驱使的沟通,
06:40
we have learned that we can repurpose
the ankle to serve as the knee
the ankle to serve as the knee
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我们学习到了如果必须
在移除肿瘤的同时移除膝盖，
在移除肿瘤的同时移除膝盖，
那么我们可以用踝关节
代替膝关节的位置。
代替膝关节的位置。
06:44
when we have to remove the knee
with the cancer.
with the cancer.
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06:46
He can then wear a prosthetic
and run and jump and play.
and run and jump and play.
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这样他就可以带着假肢
跑，跳，玩耍了。
跑，跳，玩耍了。
06:50
This opportunity was available to him
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是国际间合作
06:53
because of international collaborations.
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给了他这样的机会。
06:56
It was desirable to him
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这也是他所希望的，
06:57
because he had contacted other patients
who had experienced it.
who had experienced it.
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因为他与经历过这些的
其他病人联系过了。
其他病人联系过了。
07:01
And so exceptions and outliers in medicine
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所以在医药领域的特例与异常值
07:06
teach us what we don't know,
but also lead us to new thinking.
but also lead us to new thinking.
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教会了我们那些不了解的东西，
同时也引发了我们作出新的思考。
同时也引发了我们作出新的思考。
07:11
Now, very importantly,
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现在，非常重要的是，
07:12
all the new thinking that outliers
and exceptions lead us to in medicine
and exceptions lead us to in medicine
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所有这些在医药领域
关于异常值和特例的新的思考
关于异常值和特例的新的思考
07:16
does not only apply
to the outliers and exceptions.
to the outliers and exceptions.
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并非只能运用于那些特例的情况中。
07:20
It is not that we only learn
from sarcoma patients
from sarcoma patients
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我们从肉瘤病人身上学习到的，
07:24
ways to manage sarcoma patients.
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并非仅仅是治疗肉瘤病人的方法。
07:26
Sometimes, the outliers
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有的时候，这些异常情况，
07:29
and the exceptions
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这些特例，
07:30
teach us things that matter quite a lot
to the general population.
to the general population.
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也教会了我们一些，对大众
同样十分重要的事情。
同样十分重要的事情。
就像是身处树林之外的一棵树，
07:35
Like a tree standing outside a forest,
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07:37
the outliers and the exceptions
draw our attention
draw our attention
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这些外围的，特例般的存在，
吸引了我们的注意力，
吸引了我们的注意力，
07:41
and lead us into a much greater sense
of perhaps what a tree is.
of perhaps what a tree is.
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并能够引领我们得到一个，像是
“树是什么”，这种更为宏观的认识。
“树是什么”，这种更为宏观的认识。
07:45
We often talk about
losing the forests for the trees,
losing the forests for the trees,
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我们经常说，树木们失去了森林，
07:48
but one also loses a tree
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但是，我们也会
07:50
within a forest.
159
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失去森林里的树木。
那些独自站立的树，
07:53
But the tree that stands out by itself
160
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07:54
makes those relationships
that define a tree,
that define a tree,
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它们同样，甚至以一种更加明确的方式
07:57
the relationships between trunk
and roots and branches,
and roots and branches,
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定义了树木的概念，
树干，树根与树枝间的联系。
08:01
much more apparent.
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08:03
Even if that tree is crooked
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即使那颗树是弯曲的，
08:05
or even if that tree
has very unusual relationships
has very unusual relationships
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或者甚至它的树干，树根与树枝
08:08
between trunk and roots and branches,
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之间的联系是非同寻常的，
08:10
it nonetheless draws our attention
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它吸引了我们的注意力，
08:13
and allows us to make observations
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让我们作出了观察，
08:15
that we can then test
in the general population.
in the general population.
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然后能够在普试群体中进行测试。
08:18
I told you that sarcomas are rare.
170
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1976
我告诉过你们了，肉瘤是罕见的。
08:20
They make up about one percent
of all cancers.
of all cancers.
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它们只在所有癌症中占有1%
08:23
You also probably know that cancer
is considered a genetic disease.
is considered a genetic disease.
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你也许还知道癌症是一种基因疾病。
08:27
By genetic disease we mean
that cancer is caused by oncogenes
that cancer is caused by oncogenes
173
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基因疾病是指癌症是由于
08:31
that are turned on in cancer
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原癌基因的触发和
08:32
and tumor suppressor genes
that are turned off to cause cancer.
that are turned off to cause cancer.
175
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抑癌基因的失效所诱发的。
你也许会认为我们
是从那先常见癌症，
是从那先常见癌症，
08:36
You might think
that we learned about oncogenes
that we learned about oncogenes
176
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2416
08:38
and tumor suppressor genes
from common cancers
from common cancers
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2216
像是乳腺癌，前列腺癌，
肺癌中，
08:40
like breast cancer and prostate cancer
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1976
发现原癌基因与抑癌基因的，
08:42
and lung cancer,
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08:44
but you'd be wrong.
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1199
但是，那样想你就错了。
08:46
We learned about oncogenes
and tumor suppressor genes
and tumor suppressor genes
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我们是从那些
极少数的，1%的肉瘤中
极少数的，1%的肉瘤中
08:48
for the first time
182
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1216
第一次的，
08:50
in that itty-bitty little one percent
of cancers called sarcoma.
of cancers called sarcoma.
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3441
学习到了原癌基因和抑癌基因的。
1966年，佩顿·劳斯获得了诺贝尔奖
08:54
In 1966, Peyton Rous got the Nobel Prize
184
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08:57
for realizing that chickens
185
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2016
他发现了鸡群中一种
08:59
had a transmissible form of sarcoma.
186
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3120
传染性的肉瘤。
三十年之后，哈罗德·瓦尔姆斯
与麦克·毕晓普发现了
与麦克·毕晓普发现了
09:03
Thirty years later, Harold Varmus
and Mike Bishop discovered
and Mike Bishop discovered
187
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2836
09:06
what that transmissible element was.
188
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2536
那种传染性的因子究竟是什么。
09:08
It was a virus
189
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那是一种病毒
09:10
carrying a gene,
190
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1416
它携带一种基因，
09:11
the src oncogene.
191
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那就是肉瘤原癌基因。
09:13
Now, I will not tell you
that src is the most important oncogene.
that src is the most important oncogene.
192
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3656
现在，我不会说肉瘤原癌基因
是最重要的原癌基因。
是最重要的原癌基因。
09:17
I will not tell you
193
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我也不会告诉你
09:18
that src is the most frequently
turned on oncogene in all of cancer.
turned on oncogene in all of cancer.
194
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3496
肉瘤原癌基因是最常见的原癌基因。
09:22
But it was the first oncogene.
195
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2440
但是，它是第一个
被发现的原癌基因。
被发现的原癌基因。
09:25
The exception, the outlier
196
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2336
那个特例，那个异常值，
09:28
drew our attention and led us to something
197
556320
2520
它吸引了我们的注意力，
并引领了我们，
并引领了我们，
09:31
that taught us very important things
about the rest of biology.
about the rest of biology.
198
559520
4040
教会了我们关于整个
生物领域重要的东西。
生物领域重要的东西。
09:36
Now, TP53 is the most important
tumor suppressor gene.
tumor suppressor gene.
199
564880
4096
当下，肿瘤抑制蛋白p53
是最重要的抑癌因子。
是最重要的抑癌因子。
09:41
It is the most frequently turned off
tumor suppressor gene
tumor suppressor gene
200
569000
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它是最常见的失效
而引发各种肿瘤的
而引发各种肿瘤的
09:43
in almost every kind of cancer.
201
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1800
抑癌基因。
09:46
But we didn't learn about it
from common cancers.
from common cancers.
202
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2296
但是我们并不是从
一般的癌症当中发现它的。
一般的癌症当中发现它的。
09:48
We learned about it
when doctors Li and Fraumeni
when doctors Li and Fraumeni
203
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是当李医生和弗劳梅尼医生
09:51
were looking at families,
204
579120
1576
在关注家庭史过程中，
09:52
and they realized that these families
205
580720
2016
发现有些家庭患肉瘤病人
概率远高于其他家庭时
概率远高于其他家庭时
09:54
had way too many sarcomas.
206
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我们才发现的p53。
我告诉过你们了，肉瘤很罕见。
09:57
I told you that sarcoma is rare.
207
585920
1776
09:59
Remember that a one
in a million diagnosis,
in a million diagnosis,
208
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3176
记住，百万分之一的诊断率，
10:02
if it happens twice in one family,
209
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2136
如果在同一个家庭中出现两例，
10:05
is way too common in that family.
210
593080
2400
那就已经远高于其他家庭了。
就是因为它们十分罕见的特性，
10:08
The very fact that these are rare
211
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2696
10:11
draws our attention
212
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1440
吸引了我们的注意力，
10:13
and leads us to new kinds of thinking.
213
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2240
并引发了我们作出新的思考。
你们中的很多人可能会说，
10:17
Now, many of you may say,
214
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1456
10:18
and may rightly say,
215
606960
1536
或者现在正在说，
10:20
that yeah, Kevin, that's great,
216
608520
1896
嗯，凯文，这听起来不错，
10:22
but you're not talking
about a bird's wing.
about a bird's wing.
217
610440
2056
但是你所说的并非是鸟的翅膀，
10:24
You're not talking about moons
floating around some planet Jupiter.
floating around some planet Jupiter.
218
612520
3480
或者是卫星围绕着木星漂行。
10:28
This is a person.
219
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1536
这是一个人。
10:30
This outlier, this exception,
may lead to the advancement of science,
may lead to the advancement of science,
220
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这种特例，这种异常值，
也许会引领我们科学的进步，
也许会引领我们科学的进步，
10:33
but this is a person.
221
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1200
但是，这是一个人。
而我能说的只是，
10:36
And all I can say
222
624280
1616
10:37
is that I know that all too well.
223
625920
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我太了解了。
我与这些患有罕见的，
致命的疾病的患者交流过。
致命的疾病的患者交流过。
10:41
I have conversations with these patients
with rare and deadly diseases.
with rare and deadly diseases.
224
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3400
我记录下了我们的对话。
10:45
I write about these conversations.
225
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1936
10:47
These conversations are terribly fraught.
226
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2296
这些谈话都是极度令人担忧的。
10:50
They're fraught with horrible phrases
227
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1816
它们充满了那些可怕的短语
10:51
like "I have bad news"
or "There's nothing more we can do."
or "There's nothing more we can do."
228
639920
3240
像是“我有一个坏消息”
或是“我们已经尽力了”
或是“我们已经尽力了”
10:55
Sometimes these conversations
turn on a single word:
turn on a single word:
229
643760
3200
有的时候，这些对话就带来了一个词：
10:59
"terminal."
230
647760
1200
“晚期。”
11:04
Silence can also be rather uncomfortable.
231
652920
2920
沉默也是同等的令人难受的。
医药中的空白和我们在这些
11:09
Where the blanks are in medicine
232
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2576
11:11
can be just as important
233
659960
1856
对话中用语的间隙，
11:13
as the words that we use
in these conversations.
in these conversations.
234
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2240
是同等重要的。
11:17
What are the unknowns?
235
665080
1536
什么是未知的？
11:18
What are the experiments
that are being done?
that are being done?
236
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2200
有哪些实验是正在做的？
和我一起做一个小练习。
11:21
Do this little exercise with me.
237
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1696
11:23
Up there on the screen,
you see this phrase, "no where."
you see this phrase, "no where."
238
671400
3216
在屏幕上，你可以看到
这个短语，“没有地方“
这个短语，“没有地方“
11:26
Notice where the blank is.
239
674640
1280
注意一下间歇的地方。
11:28
If we move that blank one space over
240
676680
3200
如果我们移动一格那个空隙，
11:32
"no where"
241
680640
1576
“没有地方”
11:34
becomes "now here,"
242
682240
2696
就变成了“现在在这”
11:36
the exact opposite meaning,
243
684960
1896
正好是相反的意思，
11:38
just by shifting the blank one space over.
244
686880
2200
仅仅是移动一个空格。
我永远不会忘记走进
11:43
I'll never forget the night
245
691680
1576
11:45
that I walked into
one of my patients' rooms.
one of my patients' rooms.
246
693280
2240
我的一位病人房间的那个夜晚。
11:48
I had been operating long that day
247
696280
1656
虽然一整天都在做手术，
11:49
but I still wanted to come and see him.
248
697960
2016
我还是想要过去看看他。
11:52
He was a boy I had diagnosed
with a bone cancer a few days before.
with a bone cancer a few days before.
249
700000
3200
他是个孩子，在几天前被诊断出了骨癌。
11:55
He and his mother had been meeting
with the chemotherapy doctors
with the chemotherapy doctors
250
703840
3056
他和他的妈妈在那天早些时候
见了负责他的化疗医生，
11:58
earlier that day,
251
706920
1216
12:00
and he had been admitted
to the hospital to begin chemotherapy.
to the hospital to begin chemotherapy.
252
708160
2976
他被允许进入医院开始化疗。
12:03
It was almost midnight
when I got to his room.
when I got to his room.
253
711160
2176
当我进入他的房间的时候，
已经是将近午夜了。
已经是将近午夜了。
12:05
He was asleep, but I found his mother
254
713360
2176
他睡着了，但是我发现他的妈妈
12:07
reading by flashlight
255
715560
1576
还在他的床边，
12:09
next to his bed.
256
717160
1456
在灯光下阅读着。
12:10
She came out in the hall
to chat with me for a few minutes.
to chat with me for a few minutes.
257
718640
2800
她出来和我在走廊里聊了几分钟。
12:14
It turned out that
what she had been reading
what she had been reading
258
722280
2096
结果得知她在阅读的是当天
12:16
was the protocol
that the chemotherapy doctors
that the chemotherapy doctors
259
724400
2176
化疗医生给她的一份
12:18
had given her that day.
260
726600
1240
协议书。
12:20
She had memorized it.
261
728200
1240
她记住了里面的内容。
她说，“琼斯医生，你告诉我们，
12:23
She said, "Dr. Jones, you told me
262
731200
3536
12:26
that we don't always win
263
734760
2176
我们并不是总能战胜
12:28
with this type of cancer,
264
736960
1280
这种癌症，
12:31
but I've been studying this protocol,
and I think I can do it.
and I think I can do it.
265
739680
3480
但是我很仔细的研究了
这份协议，我认为我们能做到的。
这份协议，我认为我们能做到的。
12:35
I think I can comply
with these very difficult treatments.
with these very difficult treatments.
266
743960
3576
我认为我们可以应对
这些非常困难的治疗
这些非常困难的治疗
12:39
I'm going to quit my job.
I'm going to move in with my parents.
I'm going to move in with my parents.
267
747560
2976
我要辞掉我的工作。
我会搬去和我的父母一起住。
我会搬去和我的父母一起住。
12:42
I'm going to keep my baby safe."
268
750560
1960
我要保护我的孩子。”
我没有告诉她。
12:47
I didn't tell her.
269
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1200
我没有纠正她的想法。
12:49
I didn't stop to correct her thinking.
270
757840
2920
她正在相信一份协议书，
12:53
She was trusting in a protocol
271
761680
2256
12:55
that even if complied with,
272
763960
3216
即使遵守了，
12:59
wouldn't necessarily save her son.
273
767200
2400
也不一定能挽救她的儿子。
我没有告诉她。
13:03
I didn't tell her.
274
771960
1200
我没有填补那个空隙。
13:06
I didn't fill in that blank.
275
774360
1400
13:09
But a year and a half later
276
777080
1976
但是一年半之后，
13:11
her boy nonetheless died of his cancer.
277
779080
2720
她的儿子还是死于了癌症。
我应该告诉她吗？
13:15
Should I have told her?
278
783400
1320
13:17
Now, many of you may say, "So what?
279
785360
2256
现在，你们中的很多人
可能会说，“那又怎样？”
可能会说，“那又怎样？”
13:19
I don't have sarcoma.
280
787640
1256
我有没有得肉瘤。
13:20
No one in my family has sarcoma.
281
788920
1896
我们家也没有人得肉瘤。
13:22
And this is all fine and well,
282
790840
1456
好吧，这也许是事实，
13:24
but it probably doesn't
matter in my life."
matter in my life."
283
792320
2696
但它可能根本不会
出现在我的人生中。”
出现在我的人生中。”
13:27
And you're probably right.
284
795040
1256
你说的没错。
13:28
Sarcoma may not matter
a whole lot in your life.
a whole lot in your life.
285
796320
2680
肉瘤也许与你的人生毫无关系。
但是那些存在于医药中的空白，
13:33
But where the blanks are in medicine
286
801040
2336
13:35
does matter in your life.
287
803400
1320
是影响你的人生的。
我没有告诉你们一个肮脏的小秘密。
13:38
I didn't tell you one dirty little secret.
288
806520
2296
13:40
I told you that in medicine,
we test predictions in populations,
we test predictions in populations,
289
808840
4376
我告诉了你们，在医药领域，
我们在人群中进行测试，
我们在人群中进行测试，
13:45
but I didn't tell you,
290
813240
1256
但是我没有告诉你们的是，
13:46
and so often medicine never tells you
291
814520
2216
在很多情况中，药物不会告诉你
13:48
that every time an individual
292
816760
2856
每当一个个体
13:51
encounters medicine,
293
819640
2096
遇见药物，
13:53
even if that individual is firmly
embedded in the general population,
embedded in the general population,
294
821760
4040
即便是那个个体深信自己
隐藏于普试人群当中，
隐藏于普试人群当中，
个体或是医生都不会知道，
13:59
neither the individual
nor the physician knows
nor the physician knows
295
827360
2376
14:01
where in that population
the individual will land.
the individual will land.
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实验最后降临在谁的头上。
因此，每次服用药物，
14:05
Therefore, every encounter with medicine
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14:07
is an experiment.
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都是一次实验。
14:09
You will be a subject
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你就是那个实验中的
14:11
in an experiment.
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被实验者。
而实验结果既可能是好的，
也可能是不好的。
也可能是不好的。
14:14
And the outcome will be either
a better or a worse result for you.
a better or a worse result for you.
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只要药物起作用，
14:20
As long as medicine works well,
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14:22
we're fine with fast service,
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我们就能满足于这种快速的服务，
14:25
bravado, brimmingly
confident conversations.
confident conversations.
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自满的，充满自信的谈话。
但是当事情进展不顺利，
14:29
But when things don't work well,
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14:31
sometimes we want something different.
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有时我们就希望得到不同。
14:34
A colleague of mine
removed a tumor from a patient's limb.
removed a tumor from a patient's limb.
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我的一个同事从一位病人的
身上摘下了一个肿瘤。
身上摘下了一个肿瘤。
他很担心这个肿瘤。
14:38
He was concerned about this tumor.
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14:40
In our physician conferences,
he talked about his concern
he talked about his concern
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在我们的研讨会上，
他谈论了自己的担忧，
他谈论了自己的担忧，
14:43
that this was a type of tumor
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这是一种，有着极高的
14:45
that had a high risk
for coming back in the same limb.
for coming back in the same limb.
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原位复发率的肿瘤。
但是他与病患的交流
14:48
But his conversations with the patient
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14:50
were exactly what a patient might want:
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却完全是病患想听到的那种：
14:52
brimming with confidence.
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充满自信。
14:54
He said, "I got it all
and you're good to go."
and you're good to go."
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他说：“我已经把它搞定了，
你已经可以出院了。”
你已经可以出院了。”
14:57
She and her husband were thrilled.
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她和她的丈夫为此十分兴奋。
14:58
They went out, celebrated, fancy dinner,
opened a bottle of champagne.
opened a bottle of champagne.
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他们离开了，庆祝了，
美妙的晚餐，还开了一瓶香槟。
美妙的晚餐，还开了一瓶香槟。
15:04
The only problem was a few weeks later,
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唯一的问题就在于几周之后，
15:06
she started to notice
another nodule in the same area.
another nodule in the same area.
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她开始注意
到在同一片区域的另一个结节。
到在同一片区域的另一个结节。
结果表明他没搞定肿瘤，
她也还不能出院。
她也还不能出院。
15:09
It turned out he hadn't gotten it all,
and she wasn't good to go.
and she wasn't good to go.
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15:13
But what happened at this juncture
absolutely fascinates me.
absolutely fascinates me.
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但这个时候发生的事，
我却觉得十分有趣。
我却觉得十分有趣。
我的同事找到我，并说，
15:17
My colleague came to me and said,
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15:18
"Kevin, would you mind
looking after this patient for me?"
looking after this patient for me?"
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“凯文，你愿意帮我照顾这个病人吗？”
15:22
I said, "Why, you know the right thing
to do as well as I do.
to do as well as I do.
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我说：“为什么，你和我一样，
知道该怎么做啊。
知道该怎么做啊。
15:25
You haven't done anything wrong."
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你没做错任何事情。”
15:27
He said, "Please, just look
after this patient for me."
after this patient for me."
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他说，“求你了，就帮我
照看一下这个病人吧。”
照看一下这个病人吧。”
他感到脸红--
15:33
He was embarrassed --
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15:34
not by what he had done,
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不是为他所做的，
而是为他所说的，
15:37
but by the conversation that he had had,
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为他的过度自信。
15:39
by the overconfidence.
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所以我又做了一个
更加侵入性的手术
更加侵入性的手术
15:42
So I performed
a much more invasive surgery
a much more invasive surgery
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15:45
and had a very different conversation
with the patient afterwards.
with the patient afterwards.
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在之后与病患做了
一个截然不同的对话。
一个截然不同的对话。
15:48
I said, "Most likely I've gotten it all
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我说，“最可能的情况是，
我已经完全切除了，
我已经完全切除了，
15:50
and you're most likely good to go,
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你应该可以走了，
15:53
but this is the experiment
that we're doing.
that we're doing.
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但是这是我们的一个实验。
这是你需要继续观察的。
15:57
This is what you're going to watch for.
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15:59
This is what I'm going to watch for.
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这也是我需要继续观察的。
16:01
And we're going to work together
to find out if this surgery will work
to find out if this surgery will work
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然后我们会一起努力，
来探寻手术是否
来探寻手术是否
16:04
to get rid of your cancer."
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成功解决了你的癌症。“
16:06
I can guarantee you, she and her husband
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我可以向你们保证，
在这次谈话后，
在这次谈话后，
16:08
did not crack another bottle of champagne
after talking to me.
after talking to me.
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她和她的丈夫没有
再开一瓶香槟庆祝
再开一瓶香槟庆祝
16:13
But she was now a scientist,
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但是，她却变为了一名科学家，
16:16
not only a subject in her experiment.
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而不仅仅是实验中的实验对象。
所以，我鼓励你们去
16:21
And so I encourage you
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16:23
to seek humility and curiosity
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在你们的医生那儿，
寻找谦逊精神和好奇心。
16:27
in your physicians.
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16:28
Almost 20 billion times each year,
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每年大概有200亿次，
16:31
a person walks into a doctor's office,
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当一个人走进医生的办公室，
16:35
and that person becomes a patient.
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然后出来时就变成了一名患者。
16:39
You or someone you love
will be that patient sometime very soon.
will be that patient sometime very soon.
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你和你所爱的人很快
也会变成那个患者。
也会变成那个患者。
16:43
How will you talk to your doctors?
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你会如何和你的医生们说？
16:46
What will you tell them?
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你会告诉他们什么？
他们会告诉你什么？
16:48
What will they tell you?
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16:52
They cannot tell you
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他们不能告诉你
16:54
what they do not know,
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他们也不确定的事，
16:57
but they can tell you when they don't know
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但是他们也可以告诉你
他们不知道，
他们不知道，
只有当你问的时候。
17:02
if only you'll ask.
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17:04
So please, join the conversation.
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所以，请你们加入谈话当中吧。
谢谢。
17:08
Thank you.
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17:09
(Applause)
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（掌声）
ABOUT THE SPEAKER
Kevin B. Jones - Cancer researcherKevin B. Jones is a life-long student of human nature, fascinated most by the decision-making capacity intrinsic to each of us.
Why you should listen
Kevin B. Jones diagnoses and performs surgeries to remove rare cancers called sarcomas from the limbs of children and adults. Counseling patients -- especially teenagers with bone cancers -- about the decisions they must make with regard to their bodies has brought the uncertainties of medicine into keen focus for him. How does a person decipher what medicine has told her? How can a person choose among options given very limited understanding of the implications of each? Intrigued by these riddles and conundrums that patient-physician communication frequently creates, Jones wrote a book, What Doctors Cannot Tell You: Clarity, Confidence and Uncertainty in Medicine.
Jones also runs a scientific research laboratory focused on the biology of sarcomas. Here, his team studies the decisions cells make on the way to becoming a cancer. Again the complexities and uncertainties inherent to these decisions are in full relief.
Jones sees patients and does surgery as an associate professor at the University of Utah in the Department of Orthopaedics, working at both Primary Children's Hospital and the Huntsman Cancer Institute. His laboratory is in the Huntsman Cancer Institute, where he is an adjunct faculty member in the Department of Oncological Sciences.
Jones studied English literature at Harvard, medicine at Johns Hopkins, orthopedic surgery at the University of Iowa, and musculoskeletal oncology at the University of Toronto. He lives in Salt Lake City with his wife and four children.
Kevin B. Jones | Speaker | TED.com