ABOUT THE SPEAKER
David Casarett - Physician
David Casarett asks: What if mainstream health care operated more like a medical marijuana dispensary?

Why you should listen

In his third book, Stoned: A Doctor's Case for Medical Marijuana, palliative care physician David Casarett takes a first-person investigative journalist's approach to making sense of marijuana's therapeutic potential and adverse effects. He shares what he's learned about this chronically misunderstood drug -- including the control it gives patients over their health and the educational atmosphere of dispensaries -- and outlines what we still need to do to explore its potential health benefits.

Casarett is a professor of medicine at the Duke University School of Medicine and chief of palliative care for the Duke Health System. He is the author of more than 100 journal articles, numerous magazine articles, and Shocked, another nonfiction book about the science of resuscitation. Casarett's first novel in the Ethical Chiang Mai Detective Agency series, Murder at the House of Rooster Happiness, was published in September 2016. The next installment, The Missing Guests of the Magic Grove Hotel, will be published in the fall of 2017.

More profile about the speaker
David Casarett | Speaker | TED.com
TEDMED 2016

David Casarett: A doctor's case for medical marijuana

大卫·卡萨瑞特: 从医生角度看药用大麻

Filmed:
2,801,315 views

大卫·卡萨瑞特医生对于听到的对医用大麻的大肆渲染和半真半假的传言感到厌倦,因此,他用一种质疑的眼光亲自去调查。最终,他得出了一份令他满意的关于药用大麻的答卷,里面提到了被大众熟知的以及不为所知的内容。同时,他还阐述了我们主流医疗系统应该在哪些方面向这些现代药用大麻药房学习。
- Physician
David Casarett asks: What if mainstream health care operated more like a medical marijuana dispensary? Full bio

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

00:13
I would like to tell you
about the most embarrassing尴尬 thing
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我想要告诉你们
在我作为饱受疗法医生的许多年里,
00:17
that has ever happened发生 to me in my years年份
of working加工 as a palliative治标不治本 care关心 physician医师.
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所发生过的最尴尬的事。
00:22
This happened发生 a couple一对 of years年份 ago.
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这发生在数年前,
00:24
I was asked as a consultant顾问
to see a woman女人 in her 70s --
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我受邀去会诊一位70高龄的女士。
00:28
retired退休 English英语 professor教授
who had pancreatic cancer癌症.
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她是一位退休的英语教授
并患胰腺癌。
我受邀去看她,
因为她感到疼痛、恶心、呕吐...
00:32
I was asked to see her because
she had pain疼痛, nausea恶心, vomiting呕吐 ...
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00:37
When I went to see her,
we talked about those symptoms症状
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当我去看她时,
我们讨论了这些症状,
00:40
and in the course课程 of that consultation会诊,
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在会诊的过程中,
她问我是否觉得医用大麻能帮到她。
00:42
she asked me whether是否 I thought
that medical marijuana大麻 might威力 help her.
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00:48
I thought back to everything
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我回想在医学院里学到的
00:50
that I had learned学到了 in medical school学校
about medical marijuana大麻,
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有关医用大麻的任何东西,
这并没有花费我多长时间
因为我完全没学到什么东西。
00:54
which哪一个 didn't take very long
because I had learned学到了 absolutely绝对 nothing.
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00:58
And so I told her that as far as I knew知道,
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所以我告诉她,据我所知,
医用大麻没有一点好处。
01:01
medical marijuana大麻
had no benefits好处 whatsoever任何.
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然后她微笑,点点头,
把手伸到了床边的手提包里,
01:05
And she smiled笑笑 and nodded点头 and reached到达
into the handbag手提包 next下一个 to the bed,
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掏出了一叠大概十多个
随机对照实验的记录,
01:09
and pulled out a stack of about a dozen
randomized随机 controlled受控 trials试验
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这些实验显示医用大麻对于诸如
01:13
showing展示 that medical
marijuana大麻 has benefits好处
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恶心、疼痛和焦虑
这样的症状有一定好处。
01:16
for symptoms症状 like nausea恶心
and pain疼痛 and anxiety焦虑.
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她递给我这些文章,然后说,
01:20
She handed me those articles用品 and said,
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“在你发表意见之前
也许你应该读下这些文章...
01:23
"Maybe you should read these
before offering an opinion意见 ...
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01:28
doctor医生."
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医生。”
(观众笑声)
01:30
(Laughter笑声)
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所以我这样做了。
01:31
So I did.
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那天晚上我读完了那些文章,
同时也找到了更多的文章。
01:33
That night I read all of those articles用品
and found发现 a bunch more.
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当我后一天去看她的时候,
01:36
When I came来了 to see her the next下一个 morning早上,
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我必须承认
看起来是有些证据表明
01:38
I had to admit承认 that it looks容貌 like
there is some evidence证据
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大麻具有医疗效益。
01:42
that marijuana大麻 can offer提供 medical benefits好处
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然后我建议她,
如果真的感兴趣的话,
01:46
and I suggested建议 that if she
really was interested有兴趣,
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她应该去试一下。
01:49
she should try it.
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01:51
You know what she said?
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你知道她回答的什么吗?
01:54
This 73-year-old-岁,
retired退休 English英语 professor教授?
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这位73岁的老太太,
退休的英语教授?
01:58
She said, "I did try it
about six months个月 ago.
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她说我大约
六个月前就试过了,
这种感觉太棒了。
02:00
It was amazing惊人.
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此后我每天都抽一点。
02:02
I've been using运用 it every一切 day since以来.
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这是我发现的最好的药物。
02:04
It's the best最好 drug药物 I've discovered发现.
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我不知道为什么自己73岁
才发现它,这实在太棒了。
02:07
I don't know why it took me 73 years年份
to discover发现 this stuff东东. It's amazing惊人."
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(笑声)
02:11
(Laughter笑声)
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在那一瞬间,我意识到
02:12
That was the moment时刻 at which哪一个 I realized实现
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我需要了解一下有关医用大麻的信息,
02:14
I needed需要 to learn学习 something
about medical marijuana大麻
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因为我在医学院学到的东西
02:17
because what I was prepared准备 for
in medical school学校
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与现实毫无联系。
02:20
bore no relationship关系 to reality现实.
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02:23
So I started开始 reading more articles用品,
I started开始 talking to researchers研究人员,
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所以我开始阅读更多文章,
开始与研究人员交流,
02:27
I started开始 talking to doctors医生,
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我开始与医生交流,
但最重要的是
我开始倾听病人的意见。
02:28
and most importantly重要的,
I started开始 listening to patients耐心.
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02:32
I ended结束 up writing写作 a book
based基于 on those conversations对话,
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最后我基于这些对话写了一本书,
02:35
and that book really revolved围绕
around three surprises惊喜 --
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那本书实际上围绕着三个令人惊讶的点——
总之这些东西对我来说很惊奇。
02:38
surprises惊喜 to me, anyway无论如何.
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一是我已经提到过的,
02:40
One I already已经 alluded暗示 to --
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医用大麻确实有一些优点存在。
02:41
that there really are some benefits好处
to medical marijuana大麻.
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这些优点也许
没有那些医用大麻的热切拥护者
02:45
Those benefits好处 may可能 not be
as huge巨大 or as stunning令人惊叹
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想要我们相信的那样
02:48
as some of the most avid狂热 proponents支持者
of medical marijuana大麻
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效果显著,
02:51
would have us believe,
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但是这些优点确实存在。
02:52
but they are real真实.
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02:54
Surprise number two:
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第二点是:
02:56
medical marijuana大麻 does have some risks风险.
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医用大麻确实有一些风险。
这些风险也没有
那些反对者想要我们相信的那样
02:59
Those risks风险 may可能 not be
as huge巨大 and as scary害怕
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危害巨大,
03:02
as some of the opponents对手 of medical
marijuana大麻 would have us believe,
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但确实是存在一定危险。
03:05
but they are real真实 risks风险, nonetheless尽管如此,.
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03:08
But it was the third第三 surprise
that was most ...
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但是第三点是
03:10
surprising奇怪.
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最令人意外的。
很多和我交谈过的
03:12
And that is that a lot
of the patients耐心 I talked with
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曾经求助于医用大麻的患者,
03:15
who've谁一直 turned转身 to medical
marijuana大麻 for help,
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并不是因为医用大麻的效用,
03:18
weren't turning车削 to medical marijuana大麻
because of its benefits好处
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或者考虑其优点和风险的平衡,
03:21
or the balance平衡 of risks风险 and benefits好处,
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亦或者因为他们以为
这是奇药而求助于它,
03:23
or because they thought
it was a wonder奇迹 drug药物,
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而是因为它能让病人控制他们的疾病。
03:25
but because it gave them
control控制 over their illness疾病.
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让他们通过一种对他们来说高效的
03:29
It let them manage管理 their health健康
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易看到效果的并且感觉舒服的方式,
03:31
in a way that was productive生产的 and efficient高效
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来管理自己的健康。
03:34
and effective有效 and comfortable自在 for them.
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03:38
To show显示 you what I mean,
let me tell you about another另一个 patient患者.
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为了让你理解我想说什么,
我再提一下另一个病人。
我见到罗宾时,她40多岁。
03:41
Robin知更鸟 was in her early 40s when I met会见 her.
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但是她看起来却快70岁了。
03:43
She looked看着 though虽然
like she was in her late晚了 60s.
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过去20年里,
她饱受类风湿性关节炎的折磨,
03:46
She had suffered遭遇 from rheumatoid类风湿 arthritis关节炎
for the last 20 years年份,
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她的手因为关节炎变的扭曲,
03:50
her hands were gnarled粗糙 by arthritis关节炎,
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并且还有驼背,
03:52
her spine脊柱 was crooked,
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必须依靠轮椅才能走动。
03:54
she had to rely依靠
on a wheelchair轮椅 to get around.
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她看起来孱弱无力,
03:56
She looked看着 weak and frail脆弱,
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我想她的身体上或许确实如此,
03:58
and I guess猜测 physically物理 she probably大概 was,
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但是从感情上,认知上和心理上,
04:00
but emotionally感情上,
cognitively认知, psychologically心理,
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她确是我所见过的最坚强的人之一。
04:03
she was among其中 the toughest最艰难的
people I've ever met会见.
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04:08
And when I satSAT down next下一个 to her
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在加州北部的一个医用大麻配药房里,
04:09
in a medical marijuana大麻 dispensary药房
in Northern北方 California加州
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我坐在她旁边,
问她为什么使用医用大麻,
04:12
to ask her about why she turned转身
to medical marijuana大麻,
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它为她提供了什么,并如何帮助到她的。
04:15
what it did for her and how it helped帮助 her,
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她开始告诉我一些东西,
04:18
she started开始 out by telling告诉 me things
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一些我以前听许多病人讲述过的东西。
04:20
that I had heard听说
from many许多 patients耐心 before.
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它帮助她减轻焦虑;
04:22
It helped帮助 with her anxiety焦虑;
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帮助她减少疼痛;
04:24
it helped帮助 with her pain疼痛;
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当疼痛减轻些,睡眠就好多了。
04:26
when her pain疼痛 was better,
she slept better.
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这些东西我都曾经听到过。
04:28
And I'd heard听说 all that before.
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但接着她又说了一些我从来没听过的东西,
04:29
But then she said something
that I'd never heard听说 before,
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她说这能使她掌控自己的生命,
04:32
and that is that it gave her
control控制 over her life
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掌控自己的健康。
04:36
and over her health健康.
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当她想用时就能用,
04:37
She could use it when she wanted,
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并且以她喜欢的方式,
04:39
in the way that she wanted,
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以一种对她有效果的剂量和频次。
04:41
at the dose剂量 and frequency频率
that worked工作 for her.
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如果效果不大,她可以自己做些改变。
04:43
And if it didn't work for her,
then she could make changes变化.
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一切事都是由她自己决定。
04:47
Everything was up to her.
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她说,最重要的是
04:48
The most important重要 thing she said
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她并不需要得到其他人的允许——
04:50
was she didn't need
anybody任何人 else's别人的 permission允许 --
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没有就诊预约,没有医生的药方,
04:53
not a clinic诊所 appointment约定,
not a doctor's医生 prescription处方,
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没有药剂师的命令。
04:55
not a pharmacist's药师 order订购.
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一切由她决定。
04:57
It was all up to her.
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她是控制一切的人。
04:59
She was in control控制.
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05:01
And if that seems似乎 like a little thing
for somebody with chronic慢性 illness疾病,
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这似乎对患有慢性病的人来说是一件小事,
但并不是这样,一点也不。
05:05
it's not -- not at all.
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05:07
When we face面对 a chronic慢性 serious严重 illness疾病,
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当我们面临着严重的慢性疾病,
不管是类风湿关节炎,狼疮,癌症,糖尿病,
05:09
whether是否 it's rheumatoid类风湿 arthritis关节炎
or lupus狼疮 or cancer癌症 or diabetes糖尿病,
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或者是肝硬化,
05:14
or cirrhosis硬化,
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我们就失去了掌控。
05:16
we lose失去 control控制.
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请注意我所说的,“当你得了疾病”,而不是“假设”。
05:18
And note注意 what I said: "when," not "if."
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每个人在人生中某个节点都会面临严重的
05:20
All of us at some point in our lives生活
will face面对 a chronic慢性 serious严重 illness疾病
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我们无法控制的严重慢性疾病,
05:25
that causes原因 us to lose失去 control控制.
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我们身体的功能会慢慢衰竭,
甚至有些人的认知能力也会下降,
05:27
We'll see our function功能 decline下降,
some of us will see our cognition认识 decline下降,
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我们不再有能力自己照顾自己,
05:31
we'll be no longer able能够
to care关心 for ourselves我们自己,
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也无法做自己想做的事情。
05:34
to do the things that we want to do.
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我们的身体会背叛自己,
05:36
Our bodies身体 will betray背叛 us,
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在那个过程中,
我们将失去对自己身体的掌控。
05:38
and in that process处理, we'll lose失去 control控制.
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这非常可怕。
05:41
And that's scary害怕.
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不仅是可怕——这令人惊恐,
05:43
Not just scary害怕 -- that's frightening可怕的,
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让人吓破了胆。
05:45
it's terrifying可怕的.
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当我和我使用保守疗法的病人交流时,
05:46
When I talk to my patients耐心,
my palliative治标不治本 care关心 patients耐心,
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他们许多人正面临着绝症,
05:49
many许多 of whom are facing面对 illnesses疾病
that will end结束 their lives生活,
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他们有很多感到害怕的东西——
05:53
they have a lot of be frightened受惊 of --
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疼痛,恶心,呕吐,便秘,疲乏,
05:55
pain疼痛, nausea恶心, vomiting呕吐,
constipation便秘, fatigue疲劳,
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以及迫近的死亡。
05:59
their impending即将到来的 mortality死亡.
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但令他们更害怕的是,
06:00
But what scares恐慌 them
more than anything else其他
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在某一刻,
06:03
is this possibility可能性 that at some point,
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明天,或者一个月后,
06:05
tomorrow明天 or a month from now,
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他们可能会不再能掌控对他们自己的健康,
06:07
they're going to lose失去
control控制 of their health健康,
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自己的生活,
06:10
of their lives生活,
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自己的医疗情况,
06:12
of their healthcare卫生保健,
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他们将不得不依赖于其他人,
06:13
and they're going to become成为
dependent依赖的 on others其他,
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这才是最恐怖的地方。
06:16
and that's terrifying可怕的.
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06:18
So it's no wonder奇迹 really
that patients耐心 like Robin知更鸟,
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所以不难想象为什么很多患者都像
那个我刚刚提到的
06:22
who I just told you about,
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在小诊所遇到的罗宾一样,
06:24
who I met会见 in that clinic诊所,
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会求助于医用大麻,
06:25
turn to medical marijuana大麻
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并尝试去夺回一些虚假的控制感。
06:27
to try to claw back
some semblance外表 of control控制.
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那他们是如何做到的呢?
06:30
How do they do it though虽然?
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那些像我遇到罗宾的小诊所一样的
06:32
How do these medical
marijuana大麻 dispensaries药房 --
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提供医用大麻的药房,
06:34
like the one where I met会见 Robin知更鸟 --
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是如何提供给和罗宾一样的病人
以所需的控制感的?
06:36
how do they give patients耐心 like Robin知更鸟
back the sort分类 of control控制 that they need?
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他们是通过什么方式做到的,
06:43
And how do they do it
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至少对罗宾来说,
06:44
in a way that mainstream主流
medical hospitals医院 and clinics诊所,
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主流药物医院和诊所都无法做到的东西?
06:48
at least最小 for Robin知更鸟, weren't able能够 to?
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他们的秘密是什么?
06:51
What's their secret秘密?
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我决定去找出来。
06:53
So I decided决定 to find out.
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我去了加州威尼斯滩的一个破旧的诊所,
06:55
I went to a seedy褴褛的 clinic诊所
in Venice威尼斯 Beach海滩 in California加州
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并拿到了推荐信,
06:59
and got a recommendation建议
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这会让我佯装一个使用医用大麻的病人。
07:01
that would allow允许 me
to be a medical marijuana大麻 patient患者.
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我拿到了允许我购买医用大麻的推荐信。
07:04
I got a letter of recommendation建议
that would let me buy购买 medical marijuana大麻.
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我非法地拿到了那封信,
07:08
I got that recommendation建议 illegally非法,
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因为我不是加利福尼亚的居民——
07:10
because I'm not
a resident居民 of California加州 --
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我应该说明这件事情。
07:12
I should note注意 that.
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为了说清楚,我也应该说明,
07:14
I should also note注意, for the record记录,
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我从来没有用那封建议信购买任何东西,
07:15
that I never used that letter
of recommendation建议 to make a purchase采购,
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这是向缉毒局的人员说的——
07:19
and to all of you DEA数据包络分析 agents代理 out there --
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(笑声)
07:22
(Laughter笑声)
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支持你们的工作,
07:23
love the work that you're doing,
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继续努力。
07:24
keep it up.
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(笑声)
07:26
(Laughter笑声)
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尽管这不能让我购买东西,
07:27
Even though虽然 it didn't let me
make a purchase采购 though虽然,
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07:30
that letter was priceless无价
because it let me be a patient患者.
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它仍是无价的,
因为这让我成为了一位病人。
这让我经历到当像罗宾那样的病人,
07:34
It let me experience经验
what patients耐心 like Robin知更鸟 experience经验
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去医用大麻药房里时所经历的东西。
07:38
when they go to a medical
marijuana大麻 dispensary药房.
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然后我所经历到的——
07:41
And what I experienced有经验的 --
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他们每天所经历的,
07:43
what they experience经验 every一切 day,
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成百上千像罗宾一样的人所经历的——
07:45
hundreds数以百计 of thousands数千
of people like Robin知更鸟 --
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很让人惊奇。
07:48
was really amazing惊人.
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我走进了小诊所,
07:51
I walked into the clinic诊所,
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当我走进许多这样的诊所或药房的那一刻,
07:52
and from the moment时刻 that I entered进入
many许多 of these clinics诊所 and dispensaries药房,
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我就感觉到,那个药房,那个诊所
07:55
I felt like that dispensary药房, that clinic诊所,
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一直等待着我。
07:58
was there for me.
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08:00
There were questions问题
at the outset开始 about who I am,
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开始就问些关于我是谁,
我做什么样的工作,
08:03
what kind of work I do,
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我寻求医用大麻配方或者产品
08:05
what my goals目标 are in looking
for a medical marijuana大麻 prescription处方,
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的目的是什么,
08:09
or product产品,
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我的目标是什么,我有什么偏好,
08:12
what my goals目标 are,
what my preferences优先 are,
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我的期望是什么,
08:15
what my hopes希望 are,
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我是怎么想的,我希望这能如何帮到自己,
08:16
how do I think, how do I hope希望
this might威力 help me,
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我害怕什么。
08:18
what am I afraid害怕 of.
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这类问题是像罗宾那样的患者
08:20
These are the sorts排序 of questions问题
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一直被问的问题。
08:22
that patients耐心 like Robin知更鸟
get asked all the time.
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这类问题使我确信
08:24
These are the sorts排序 of questions问题
that make me confident信心
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和我谈话的人从心底考虑了我的利益,
08:27
that the person I'm talking with
really has my best最好 interests利益 at heart
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并且想要了解我。
08:31
and wants to get to know me.
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08:34
The second第二 thing I learned学到了
in those clinics诊所
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我从这些诊所中所学到的第二件事是,
08:36
is the availability可用性 of education教育.
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教育的可得性。
柜台后面的人们提供的教育
08:39
Education教育 from the folks乡亲
behind背后 the counter计数器,
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和候诊室的人们提供的教育。
08:41
but also education教育
from folks乡亲 in the waiting等候 room房间.
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当我坐在他们旁边时,他们都非常高兴——
08:45
People I met会见 were more than happy快乐,
as I was sitting坐在 next下一个 to them --
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像罗宾一样的人——
08:48
people like Robin知更鸟 --
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告诉我他们是谁,为什么使用医用大麻,
08:50
to tell me about who they are,
why they use medical marijuana大麻,
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什么帮助了他们,是如何帮助的他们,
08:53
what helps帮助 them, how it helps帮助 them,
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并给我一些忠告和建议。
08:56
and to give me advice忠告 and suggestions建议.
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那些会诊室是充满互动
建议和支持的热闹场所。
08:58
Those waiting等候 rooms客房 really are
a hive蜂巢 of interaction相互作用, advice忠告 and support支持.
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09:04
And third第三, the folks乡亲 behind背后 the counter计数器.
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第三,柜台后的人们。
09:06
I was amazed吃惊 at how willing愿意
those people were
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我很惊讶这些人为何乐意去花一个小时
或者更多时间去教我分辨,
09:10
to spend sometimes有时 an hour小时 or more
talking me through通过 the nuances细微之处
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这种拉伤与另一种拉伤,
09:14
of this strain应变 versus that strain应变,
200
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烟熏和蒸汽,
09:16
smoking抽烟 versus vaporizing蒸发,
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食用品和酊剂的细微差别——
09:18
edibles零嘴 versus tinctures酊剂 --
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请记住,我还没有购买任何东西。
09:20
all, remember记得, without me
making制造 any purchase采购 whatsoever任何.
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09:25
Think about the last time
you went to any hospital醫院 or clinic诊所
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回想一下你最后一次去医院或诊所,
最后一次有人花一小时时间
对你解释这类事物。
09:29
and the last time anybody任何人 spent花费 an hour小时
explaining说明 those sorts排序 of things to you.
205
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4800
09:34
The fact事实 that patients耐心 like Robin知更鸟
are going to these clinics诊所,
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和罗宾一样的病人都去这些诊所,
去这些药房,
09:38
are going to these dispensaries药房
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1576
得到的那些个人关注,
09:39
and getting得到 that sort分类
of personalized个性化 attention注意
208
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教育和服务,
09:42
and education教育 and service服务,
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这些事情应该成为现存医疗制度的警钟。
09:44
really should be a wake-up醒来 call
to the healthcare卫生保健 system系统.
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3416
像罗宾一样的人正远离主流医药救助,
09:48
People like Robin知更鸟 are turning车削 away
from mainstream主流 medicine医学,
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而转向医用大麻配药室,
09:51
turning车削 to medical marijuana大麻 dispensaries药房
212
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因为这些药房给了他们所需要的东西。
09:53
because those dispensaries药房
are giving them what they need.
213
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3880
09:58
If that's a wake-up醒来 call
to the medical establishment编制,
214
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2576
如果这是对医疗机构的警钟,
10:01
it's a wake-up醒来 call that many许多
of my colleagues同事 are either not hearing听力
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3776
这是对我那些要么不倾听
要么不想听的同事们的警钟。
10:04
or not wanting希望 to hear.
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1720
10:07
When I talk to my colleagues同事,
physicians医师 in particular特定,
217
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2736
当我和同事们
特别是内科医生
10:10
about medical marijuana大麻,
218
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讨论医用大麻时,
他们说,“喔,我们需要更多的证据。
10:11
they say, "Oh, we need more evidence证据.
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599360
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我们需要对其益处和风险
做更多的调查获得更多的证据。”
10:14
We need more research研究 into benefits好处,
we need more evidence证据 about risks风险."
220
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3960
10:18
And you know what? They're right.
221
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1856
你知道吗?他们是对的。
他们完全正确。
10:20
They're absolutely绝对 right.
222
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针对医用大麻的好处,
我们确实需要更多证据。
10:21
We do need much more evidence证据
about the benefits好处 of medical marijuana大麻.
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我们同样需要请求联邦政府
把大麻重新定义为二类药,
10:25
We also need to ask the federal联邦 government政府
to reschedule改期 marijuana大麻 to Schedule附表 IIII,
224
613960
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或者完全取消这类药,
让这种研究成为可能。
10:31
or to deschedule取消调度 it entirely完全
to make that research研究 possible可能.
225
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3560
10:35
We also need more research研究
into medical marijuana's大麻的 risks风险.
226
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3656
我们同样需要对医用大麻的风险
做更多研究。
医用大麻的风险——
10:39
Medical marijuana's大麻的 risks风险 --
227
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我们熟知大麻娱乐性用途的危害,
10:40
we know a lot about
the risks风险 of recreational休闲 use,
228
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但我们几乎不了解医用大麻的风险。
10:43
we know next下一个 to nothing
about the risks风险 of medical marijuana大麻.
229
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2896
10:46
So we absolutely绝对 do need research研究,
230
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2576
所以我们确实需要做调查研究,
但是要是说,我们需要做研究,
10:48
but to say that we need research研究
231
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2336
但我们现在不需要做出任何改变,
10:51
and not that we need
to make any changes变化 now
232
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3056
就完全错失了重点了。
10:54
is to miss小姐 the point entirely完全.
233
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1936
像罗宾那样的人寻求医用大麻,
10:56
People like Robin知更鸟
aren't seeking out medical marijuana大麻
234
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2576
并不是因为他们认为这是特效药,
10:58
because they think it's a wonder奇迹 drug药物,
235
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1856
或者他们认为这完全没有风险,
11:00
or because they think
it's entirely完全 risk-free没有风险.
236
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2736
他们寻求它是因为,其递送、管理和使用
11:03
They seek寻求 it out because the context上下文
in which哪一个 it's delivered交付 and administered管理
237
651400
4656
的环境,
11:08
and used,
238
656080
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给了他们一种所需要的
对于生活的掌控,
11:09
gives them the sort分类 of control控制
they need over their lives生活.
239
657320
3536
这才是我们需要注意的地方。
11:12
And that's a wake-up醒来 call
we really need to pay工资 attention注意 to.
240
660880
3040
11:17
The good news新闻 though虽然 is that
there are lessons教训 we can learn学习 today今天
241
665040
3736
好消息是那些医用大麻配药房身上,
有我们现在可以学到的东西。
11:20
from those medical marijuana大麻 dispensaries药房.
242
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2976
那些我们真的应该学习的东西。
11:23
And those are lessons教训
we really should learn学习.
243
671800
2136
那些诊所通常非常小,家庭经营,
11:25
These are often经常 small,
mom-and-pop妈妈和流行 operations操作
244
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2736
由没有受过医疗训练的人来运营,
11:28
run by people with no medical training训练.
245
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2456
同时这是非常难堪的去考虑
11:31
And while it's embarrassing尴尬 to think
246
679200
2576
许多这样的小诊所和药房提供的服务
11:33
that many许多 of these clinics诊所
and dispensaries药房 are providing提供 services服务
247
681800
4056
和支持以及患者需要的满足,
11:37
and support支持 and meeting会议 patients'耐心' needs需求
248
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2376
是有着十亿美金的
健康保障体系所没有提供的——
11:40
in ways方法 that billion-dollar十亿美元
healthcare卫生保健 systems系统 aren't --
249
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4016
我们真应该感到难堪——
11:44
we should be embarrassed尴尬 by that --
250
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1696
但我们仍能从中学到东西。
11:46
but we can also learn学习 from that.
251
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1896
从那些小药房中,我们至少
11:47
And there are probably大概
three lessons教训 at least最小
252
695960
2136
可以学到三个教训。
11:50
that we can learn学习
from those small dispensaries药房.
253
698120
2240
11:52
One: we need to find ways方法
to give patients耐心 more control控制
254
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3656
一、我们需要找出给予病人
更多控制感的方式,
比较微小但又非常重要的方式。
11:56
in small but important重要 ways方法.
255
704520
2016
怎样与医疗保健提供者互动,
11:58
How to interact相互作用 with healthcare卫生保健 providers供应商,
256
706560
2056
什么时候与医疗保健者互动,
12:00
when to interact相互作用
with healthcare卫生保健 providers供应商,
257
708640
2176
怎样以对他们有效的方式使用药物。
12:02
how to use medications药物治疗
in ways方法 that work for them.
258
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3616
以我的自身实践来说,
12:06
In my own拥有 practice实践,
259
714480
1216
在支持我病人安全地使用药物
12:07
I've gotten得到 much more
creative创作的 and flexible灵活
260
715720
2736
去控制其症状方面,
12:10
in supporting支持 my patients耐心
in using运用 drugs毒品 safely安然
261
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3136
我已经很有创造力且比较灵活——
12:13
to manage管理 their symptoms症状 --
262
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其重点是安全。
12:15
with the emphasis重点 on safely安然.
263
723160
1376
我开出的药方很多都是阿片类
或苯二氮平类药物,
12:16
Many许多 of the drugs毒品 I prescribe规定
are drugs毒品 like opioids阿片类药物 or benzodiazepines苯二氮卓
264
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如果滥用将会非常危险。
12:21
which哪一个 can be dangerous危险 if overused过度使用.
265
729040
2776
重点来了。
12:23
But here's这里的 the point.
266
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1216
如果它们被滥用,将会变得危险,
12:25
They can be dangerous危险 if they're overused过度使用,
267
733080
2056
但如果没按照病人想要并需要的方式使用,
12:27
but they can also be ineffective不灵
if they're not used in a way
268
735160
2896
它们将会失效。
12:30
that's consistent一贯 with
what patients耐心 want and need.
269
738080
2656
所以那种灵活性,
如果安全地使用药物,
12:32
So that flexibility灵活性,
if it's delivered交付 safely安然,
270
740760
3216
会对病人和他的家庭格外有价值。
12:36
can be extraordinarily异常 valuable有价值
for patients耐心 and their families家庭.
271
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3096
这是第一点。
12:39
That's number one.
272
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1216
第二点,教育。
12:40
Number two: education教育.
273
748360
2016
这是一个大大的机会
12:42
Huge巨大 opportunities机会
274
750400
1216
去学习这些医用大麻药房的技巧,
12:43
to learn学习 from some of the tricks技巧
of those medical marijuana大麻 dispensaries药房
275
751640
3456
去提供更多的
12:47
to provide提供 more education教育
276
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1376
不要求大量必需的
12:48
that doesn't require要求
a lot of physician医师 time necessarily一定,
277
756520
2736
或任何的医师时间的教育,
12:51
or any physician医师 time,
278
759280
1736
这是去了解我们正在使用何种药物,
12:53
but opportunities机会 to learn学习
about what medications药物治疗 we're using运用
279
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4376
为什么要用,
12:57
and why,
280
765440
1216
以及疾病的预示和轨迹的机会,
12:58
prognoses预后, trajectories轨迹 of illness疾病,
281
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2056
最重要的是,
13:00
and most importantly重要的,
282
768760
1216
对患者来说这也是彼此间互相学习的机会。
13:02
opportunities机会 for patients耐心
to learn学习 from each other.
283
770000
2736
我们怎样才能复制
13:04
How can we replicate复制 what goes on
284
772760
1936
在这些诊所和医药大麻药房等待室里
展现的场景?
13:06
in those clinic诊所 and medical
dispensary药房 waiting等候 rooms客房?
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患者是如何互相学习的,
人们是如何与他人分享的。
13:10
How patients耐心 learn学习 from each other,
how people share分享 with each other.
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3680
13:14
And last but not least最小,
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最后却很重要的一点是,
13:15
putting patients耐心 first the way
those medical marijuana大麻 dispensaries药房 do,
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那些医疗大麻药房
把患者放在第一位,
使患者自然的感觉到
他们想要什么,
13:19
making制造 patients耐心 feel
legitimately合理地 like what they want,
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他们需要什么,
13:24
what they need,
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这也是为什么
作为医疗保障提供者,
13:26
is why, as healthcare卫生保健 providers供应商,
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我们在这里的原因。
13:27
we're here.
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13:29
Asking patients耐心 about their hopes希望,
their fears恐惧, their goals目标 and preferences优先.
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询问患者他们的希望、
恐惧、目标以及偏好。
13:33
As a palliative治标不治本 care关心 provider提供商,
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作为一个保守治疗提供者,
我询问我的患者
什么是他们希望的及害怕的。
13:35
I ask all my patients耐心 what they're
hoping希望 for and what they're afraid害怕 of.
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13:39
But here's这里的 the thing.
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但是问题来了。
患者不应该一直等待,
直到他们患严重慢性病
13:40
Patients耐心 shouldn't不能 have to wait
until直到 they're chronically长期地 seriously认真地 ill生病,
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经常是接近生命尾声的时候,
13:44
often经常 near the end结束 of life,
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他们也不应该一直等待,
直到他们遇到像我一样的医师的时候
13:46
they shouldn't不能 have to wait
until直到 they're seeing眼看 a physician医师 like me
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才被问到,
13:50
before somebody asks them,
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“你的期望是什么?”
13:52
"What are you hoping希望 for?"
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“你的恐惧是什么?“
13:53
"What are you afraid害怕 of?"
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这应该成为
医疗保健被传递的一种方式。
13:54
That should be baked烘烤的 into the way
that healthcare卫生保健 is delivered交付.
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13:59
We can do this --
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我们可以做到——
14:01
we really can.
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我们真的可以。
全美的医用大麻药房和诊所
14:02
Medical marijuana大麻 dispensaries药房
and clinics诊所 all across横过 the country国家
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正在尝试弄清楚这个问题。
14:05
are figuring盘算 this out.
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他们通过大的主流健康体系
14:07
They're figuring盘算 this out
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远远落后于他们的方法解决了这个问题。
14:08
in ways方法 that larger, more mainstream主流
health健康 systems系统 are years年份 behind背后.
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但是我们可以从他们身上学习,
14:14
But we can learn学习 from them,
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我们也不得不向他们学习。
14:15
and we have to learn学习 from them.
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我们所需要做的就是放下我们的骄傲——
14:17
All we have to do is swallow our pride自豪 --
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2336
暂时把傲娇的想法放到一边,
14:19
put aside在旁边 the thought for a minute分钟
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因为我们有跟多跟随者,
14:21
that because we have
lots of letters after our name名称,
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因为我们是专家,
14:23
because we're experts专家,
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851960
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因为我们是主要的卫生保健体系的主要人员,
14:25
because we're chief首席 medical officers长官
of a large healthcare卫生保健 system系统,
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3136
我们知道如何满足我们患者的需要。
14:28
we know all there is to know
about how to meet遇到 patients'耐心' needs需求.
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4176
我们需要放下我们的骄傲,
14:32
We need to swallow our pride自豪.
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我们需要去参观一些医用大麻药店。
14:34
We need to go visit访问
a few少数 medical marijuana大麻 dispensaries药房.
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3056
我们需要去了解他们在做什么。
14:37
We need to figure数字 out what they're doing.
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1976
我们需要弄清为什么
如此多的像罗宾一样的患者
14:39
We need to figure数字 out
why so many许多 patients耐心 like Robin知更鸟
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2576
离开我们主流的医疗诊所,
14:41
are leaving离开 our mainstream主流 medical clinics诊所
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2176
而去这些医疗大麻药店。
14:43
and going to these medical
marijuana大麻 dispensaries药房 instead代替.
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3376
我们需要弄清这些药店的技巧是什么,
14:47
We need to figure数字 out
what their tricks技巧 are,
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它们的工具是什么,
14:49
what their tools工具 are,
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并且我们需要向他们学习。
14:50
and we need to learn学习 from them.
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2136
如果我们这样做了,
14:52
If we do,
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我认为我们能并且绝对是必须这样做,
14:54
and I think we can,
and I absolutely绝对 think we have to,
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我们可以保证所有的患者
都会有更好的就诊经历。
14:57
we can guarantee保证 all of our patients耐心
will have a much better experience经验.
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15:01
Thank you.
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谢谢大家。
15:02
(Applause掌声)
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(掌声 .
Translated by Wenyu Liu
Reviewed by Lipeng Chen

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ABOUT THE SPEAKER
David Casarett - Physician
David Casarett asks: What if mainstream health care operated more like a medical marijuana dispensary?

Why you should listen

In his third book, Stoned: A Doctor's Case for Medical Marijuana, palliative care physician David Casarett takes a first-person investigative journalist's approach to making sense of marijuana's therapeutic potential and adverse effects. He shares what he's learned about this chronically misunderstood drug -- including the control it gives patients over their health and the educational atmosphere of dispensaries -- and outlines what we still need to do to explore its potential health benefits.

Casarett is a professor of medicine at the Duke University School of Medicine and chief of palliative care for the Duke Health System. He is the author of more than 100 journal articles, numerous magazine articles, and Shocked, another nonfiction book about the science of resuscitation. Casarett's first novel in the Ethical Chiang Mai Detective Agency series, Murder at the House of Rooster Happiness, was published in September 2016. The next installment, The Missing Guests of the Magic Grove Hotel, will be published in the fall of 2017.

More profile about the speaker
David Casarett | Speaker | TED.com

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