ABOUT THE SPEAKER
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.”

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.

More profile about the speaker
Thomas Goetz | Speaker | TED.com
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:
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。
- 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

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

00:15
I'm going to be talking to you
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我准备和大家探讨
00:17
about how we can tap龙头
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我们如何
00:19
a really underutilized未充分利用 resource资源 in health健康 care关心,
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开发一种没有得到有效利用的医疗资源,
00:21
which哪一个 is the patient患者,
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那就是病人,
00:23
or, as I like to use the scientific科学 term术语,
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或者,用一个更专业的术语来说--
00:26
people.
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人。
00:28
Because we are all patients耐心, we are all people.
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我们都是病人,我们也都是人。
00:30
Even doctors医生 are patients耐心 at some point.
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就连医生有时候也可能成为病人。
00:32
So I want to talk about that
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我想借此机会
00:34
as an opportunity机会
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告诉大家
00:36
that we really have failed失败 to engage从事 with very well in this country国家
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在这个国家,我们一直没有很好地配合治疗
00:39
and, in fact事实, worldwide全世界.
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事实上,全世界都是如此。
00:41
If you want to get at the big part部分 --
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如果你从全局来看--
00:43
I mean from a public上市 health健康 level水平, where my training训练 is --
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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行为的 issues问题.
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这其实是行为问题,
00:48
You're looking at things where people are actually其实 given特定 information信息,
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是人们得到相关信息,
00:51
and they're not following以下 through通过 with it.
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却没有完全按照这些信息行事。
00:53
It's a problem问题 that manifests舱单 itself本身 in diabetes糖尿病,
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这个问题反应在糖尿病,
00:57
obesity肥胖, many许多 forms形式 of heart disease疾病,
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肥胖症,各种心脏疾病,
00:59
even some forms形式 of cancer癌症 -- when you think of smoking抽烟.
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甚至某些癌症--如果人吸烟的话。
01:02
Those are all behaviors行为 where people know what they're supposed应该 to do.
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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应该 to be doing,
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但是,尽管他们知道哪些事情该做,
01:07
but they're not doing it.
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他们就是不去做。
01:09
Now behavior行为 change更改 is something
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行为上的改变
01:11
that is a long-standing由来已久 problem问题 in medicine医学.
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是医学上的一个顽固问题。
01:13
It goes all the way back to Aristotle亚里士多德.
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这可以追溯到亚里士多德的时代。
01:15
And doctors医生 hate讨厌 it, right?
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医生们对此深恶痛绝。
01:17
I mean, they complain抱怨 about it all the time.
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他们总是为此而抱怨。
01:19
We talk about it in terms条款 of engagement订婚, or non-compliance不遵守.
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他们把如下行为归为不配合治疗。
01:22
When people don't take their pills,
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有些人不按要求吃药,
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when people don't follow跟随 doctors'医生 orders命令 --
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有些人不听从医嘱。
01:26
these are behavior行为 problems问题.
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这些都是行为问题。
01:28
But for as much as clinical临床 medicine医学
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但是尽管临床医学
01:30
agonizes激动 over behavior行为 change更改,
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对病人的行为怨声载道,
01:32
there's not a lot of work doneDONE
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却并没有拿出实际行动
01:34
in terms条款 of trying to fix固定 that problem问题.
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来解决这个问题。
01:37
So the crux症结 of it
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问题的关键
01:39
comes down to this notion概念 of decision-making做决定 --
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在于如何帮助人们做出正确决定--
01:41
giving information信息 to people in a form形成
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给病人一张显示信息的表格,
01:43
that doesn't just educate教育 them
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这张表格不仅教育
01:45
or inform通知 them,
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或告知病人应该做什么,
01:47
but actually其实 leads引线 them to make better decisions决定,
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而应引导人们在生活中作出更好的决定
01:49
better choices选择 in their lives生活.
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和更好的选择。
01:51
One part部分 of medicine医学, though虽然,
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然而,有一个医学的领域
01:53
has faced面对 the problem问题 of behavior行为 change更改 pretty漂亮 well,
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在行为改变方面颇有建树。
01:57
and that's dentistry牙科.
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那就是牙科。
01:59
Dentistry牙科 might威力 seem似乎 -- and I think it is --
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牙科虽然看起来--个人意见--
02:01
many许多 dentists牙医 would have to acknowledge确认
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许多牙医可能会认为
02:03
it's somewhat有些 of a mundane平凡 backwater回水 of medicine医学.
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牙科是医学中最没有发展前景的分支。
02:05
Not a lot of cool, sexy性感的 stuff东东 happening事件 in dentistry牙科.
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牙科领域没有太多新奇有趣的事情发生。
02:08
But they have really taken采取 this problem问题 of behavior行为 change更改
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但是,牙科却很好地解决了
02:11
and solved解决了 it.
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行为改变这个问题。
02:13
It's the one great preventive预防 health健康 success成功
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这是医疗系统中
02:15
we have in our health健康 care关心 system系统.
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我们在预防方面所取得的重大成功。
02:17
People brush and floss their teeth.
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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.
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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实验
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我下面会介绍一些牙科医生三十年前
02:24
that a few少数 dentists牙医 in Connecticut康涅狄格
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在康涅狄格州
02:26
cooked up about 30 years年份 ago.
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所做的一个试验。
02:28
So this is an old experiment实验, but it's a really good one,
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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简单,
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这个试验很简单,
02:32
so it's an easy简单 story故事 to tell.
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所以故事很简短。
02:34
So these Connecticut康涅狄格 dentists牙医 decided决定
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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经常,
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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变量:
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他们打算使用一个变量:
02:41
they wanted to scare them.
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他们想吓唬人们。
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They wanted to tell them how bad it would be
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他们想告诉人们
02:46
if they didn't brush and floss their teeth.
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如果不刷牙不用牙线,会有什么样的后果。
02:48
They had a big patient患者 population人口.
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他们的病人很多。
02:51
They divided分为 them up into two groups.
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他们这些病人分成两组。
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They had a low-fear低恐惧 population人口,
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一组是低恐惧人群,
02:55
where they basically基本上 gave them a 13-minute-分钟 presentation介绍,
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他们给这些人做了一个十三分钟的演示,
02:57
all based基于 in science科学,
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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,
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但是,对他们说,如果你不刷牙,用牙线,
03:02
you could get gum disease疾病. If you get gum disease疾病, you will lose失去 your teeth,
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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你会 get dentures假牙, and it won't惯于 be that bad.
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但是,如果你安了假牙,问题就不大。
03:07
So that was the low-fear低恐惧 group.
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这是针对低恐惧群体的做法。
03:09
The high-fear高恐惧 group, they laid铺设 it on really thick.
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而对高恐惧群体,他们可下了狠药。
03:12
They showed显示 bloody血腥 gums齿龈.
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他们给这些人展示血淋淋的牙龈,
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They showed显示 puss oozing渗血 out from between之间 their teeth.
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让他们看牙齿间淤出来的脓,
03:17
They told them that their teeth were going to fall秋季 out.
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告诉他们,他们的牙齿很快就会脱落,
03:19
They said that they could have infections感染
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他们会得炎症
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that would spread传播 from their jaws to other parts部分 of their bodies身体,
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并且炎症会从空腔扩散到其它身体部位,
03:24
and ultimately最终, yes, they would lose失去 their teeth.
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最后,当然,他们会失去自己的牙齿。
03:26
They would get dentures假牙, and if you got dentures假牙,
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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能够 to eat corn-on-the-cob玉米上的棒子,
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你不能啃玉米棒,
03:30
you weren't going to be able能够 to eat apples苹果,
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不能咬苹果,
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you weren't going to be able能够 to eat steak牛扒.
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不能吃牛排;
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You'll你会 eat mush浓粥 for the rest休息 of your life.
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在你的下半生里你只能吃糊状物
03:36
So go brush and floss your teeth.
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还不赶快刷牙,用牙线。
03:39
That was the message信息. That was the experiment实验.
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这就是其中的信息;这个试验就是这样的。
03:41
Now they measured测量 one other variable变量.
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接着他们测量了另一个变量。
03:43
They wanted to capture捕获 one other variable变量,
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他们想测试这个变量是否起作用,
03:45
which哪一个 was the patients'耐心' sense of efficacy功效.
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那就是病人的自我效能感。
03:48
This was the notion概念 of whether是否 the patients耐心 felt
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这是病人是否认为自己
03:50
that they actually其实 would go ahead and brush and floss their teeth.
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会去刷牙和使用牙线的观念。
03:53
So they asked them at the beginning开始,
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在一开始,他们问病人,
03:55
"Do you think you'll你会 actually其实 be able能够 to stick with this program程序?"
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“你认为你会坚持照做吗?”
03:57
And the people who said, "Yeah, yeah. I'm pretty漂亮 good about that,"
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那些说“是的,是的,我会好好做的,”的人
03:59
they were characterized特征 as high efficacy功效,
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属于为高效能感人群。
04:01
and the people who said,
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而那些说
04:03
"Eh, I never get around to brushing刷牙 and flossing使用牙线 as much as I should,"
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“呃,我平时刷牙或用牙线都不够勤,”的人
04:05
they were characterized特征 as low efficacy功效.
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属于低效能感人群。
04:07
So the upshot结果 was this.
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这是结果。
04:10
The upshot结果 of this experiment实验
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试验的结果是
04:12
was that fear恐惧 was not really a primary driver司机
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恐惧并不是控制行为的
04:15
of the behavior行为 at all.
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主要动力。
04:17
The people who brushed and flossed牙线 their teeth
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那些勤刷牙,用牙线的人,
04:19
were not necessarily一定 the people
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并不一定是
04:21
who were really scared害怕 about what would happen发生 --
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那些害怕不良后果的人--
04:23
it's the people who simply只是 felt that they had the capacity容量
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他们是那些认为自己
04:26
to change更改 their behavior行为.
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有能力改变自己行为的人。
04:28
So fear恐惧 showed显示 up as not really the driver司机.
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恐惧原来不是动因;
04:31
It was the sense of efficacy功效.
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应该是自我感觉。
04:34
So I want to isolate隔离 this,
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我想重点指出这个结果,
04:36
because it was a great observation意见 --
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应为这是非常有用的发现--
04:38
30 years年份 ago, right, 30 years年份 ago --
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三十年前,对,三十前--
04:40
and it's one that's laid铺设 fallow休耕 in research研究.
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这是当时尚未被研究的课题。
04:43
It was a notion概念 that really came来了 out
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这实际上是从阿尔伯特. 班杜拉的研究中
04:45
of Albert阿尔伯特 Bandura's班杜拉 work,
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引申出来的一个概念,
04:47
who studied研究 whether是否
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他研究了
04:49
people could get a sense of empowerment权力.
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人们是否会产生一种成就感。
04:52
The notion概念 of efficacy功效 basically基本上 boils down to one -- that
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效能感的信念最终归结到一点:
04:55
if somebody believes相信 that they have the capacity容量 to change更改 their behavior行为.
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一个人是否相信他有能力改变自己的行为。
04:58
In health健康 care关心 terms条款, you could characterize表征 this
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从医疗保健的角度看,可以这样描述这个信念:
05:01
as whether是否 or not somebody feels感觉
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一个人是否感觉
05:03
that they see a path路径 towards better health健康,
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他看到更好的健康状况的前景,
05:05
that they can actually其实 see their way towards getting得到 better health健康,
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看到自己的健康状况能够日渐转好。
05:07
and that's a very important重要 notion概念.
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这是个非常重要的信念。
05:09
It's an amazing惊人 notion概念.
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非常奇妙的信念。
05:11
We don't really know how to manipulate操作 it, though虽然, that well.
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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.
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或许,我们知道。
05:17
So fear恐惧 doesn't work, right? Fear恐惧 doesn't work.
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恐惧是不起作用的,对,恐惧不起作用。
05:19
And this is a great example
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这里有一个很好的例子,
05:21
of how we haven't没有 learned学到了 that lesson at all.
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证明了我们有多么不知悔改。
05:24
This is a campaign运动 from the American美国 Diabetes糖尿病 Association协会.
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这是美国糖尿病协会的一次活动。
05:27
This is still the way we're communicating通信 messages消息 about health健康.
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这仍然是我们传递保健信息的方式。
05:30
I mean, I showed显示 my three-year-old三十岁 this slide滑动 last night,
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我昨晚给我三岁的儿子看了这张幻灯片,
05:33
and he's like, "Papa爸爸, why is an ambulance救护车 in these people's人们 homes家园?"
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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说明, "They're trying to scare people."
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我只能解释道:“他们想吓唬人。”
05:40
And I don't know if it works作品.
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我不确定这么做是否起作用。
05:42
Now here's这里的 what does work:
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而这才是起作用的做法,
05:44
personalized个性化 information信息 works作品.
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那就是个人化信息。
05:46
Again, Bandura班杜拉 recognized认可 this
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又是班杜拉,
05:48
years年份 ago, decades几十年 ago.
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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具体 information信息
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当你给人们提供
05:52
about their health健康, where they stand,
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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威力 get to,
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以及他们预期的进展,他们可能的进展,
05:56
that path路径, that notion概念 of a path路径 --
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这个过程,对此过程的信念,
05:58
that tends趋向 to work for behavior行为 change更改.
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会改变病人的行为。
06:00
So let me just spool it out a little bit.
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我来解释一下。
06:02
So you start开始 with personalized个性化 data数据, personalized个性化 information信息
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你得到一个病人的个人数据,
06:05
that comes from an individual个人,
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个人信息之后,
06:07
and then you need to connect it to their lives生活.
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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生活,
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你需要通过让他们了解这些信息
06:12
hopefully希望 not in a fear-based基于恐惧 way, but one that they understand理解.
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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位于.
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好,我知道我的病情。
06:17
And that doesn't just work for me in terms条款 of abstract抽象 numbers数字 --
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那些抽象的数字,
06:20
this overload超载 of health健康 information信息
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还有摆在面前的
06:22
that we're inundated淹没 with.
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那一大堆健康信息让我摸不着头脑,
06:24
But it actually其实 hits点击 home.
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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心中.
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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情绪化 connection连接 to information信息
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我们对这些信息有不解的情结,
06:30
because it's from us.
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因为这是关于我们自己的信息。
06:32
That information信息 then needs需求 to be connected连接的 to choices选择,
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接着我们要把信息与人们的选择,
06:35
needs需求 to be connected连接的 to a range范围 of options选项,
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选择的范围,
06:37
directions方向 that we might威力 go to --
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以及方向联系起来--
06:39
trade-offs权衡, benefits好处.
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其中有哪些利弊。
06:41
Finally最后, we need to be presented呈现 with a clear明确 point of action行动.
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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信息
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我们必须时刻把信息与行动
06:46
always with the action行动,
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联系起来,
06:48
and then that action行动 feeds供稿 back
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行动会产生反馈,
06:50
into different不同 information信息,
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从而得到新的信息,
06:52
and it creates创建, of course课程, a feedback反馈 loop循环.
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周而复始,形成一个反馈圈。
06:54
Now this is a very well-observed公观察 and well-established成熟 notion概念
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实践证实,这个信念对于改变行为
06:57
for behavior行为 change更改.
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十分可靠。
06:59
But the problem问题 is that things -- in the upper-right右上方 corner there --
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然而,问题是,右上角的
07:02
personalized个性化 data数据, it's been pretty漂亮 hard to come by.
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个人数据,往往很难得到。
07:04
It's a difficult and expensive昂贵 commodity商品,
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得到个人数据可谓困难重重,而且要花不少钱。
07:07
until直到 now.
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直到现在。
07:09
So I'm going to give you an example, a very simple简单 example of how this works作品.
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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我们已经 all seen看到 these. These are the "your speed速度 limit限制" signs迹象.
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我们都见过这些标示牌,这些是限速牌。
07:15
You've seen看到 them all around,
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我们随处都能看到这些牌子,
07:17
especially特别 these days as radars雷达 are cheaper便宜.
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尤其在雷达价格越发便宜的现在。
07:19
And here's这里的 how they work in the feedback反馈 loop循环.
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它们在反馈圈中是这样起作用的。
07:21
So you start开始 with the personalized个性化 data数据
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一开始是个性化数据,
07:23
where the speed速度 limit限制 on the road that you are at that point
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此时你所在公路的限速
07:25
is 25,
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是25,
07:27
and, of course课程, you're going faster更快 than that.
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当然你有些超速了。
07:29
We always are. We're always going above以上 the speed速度 limit限制.
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我们总是超速的。
07:32
The choice选择 in this case案件 is pretty漂亮 simple简单.
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在此情况下我们只有两种选择。
07:34
We either keep going fast快速, or we slow down.
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我们要么保持原速,要么减速。
07:36
We should probably大概 slow down,
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我们或许应该减速,
07:38
and that point of action行动 is probably大概 now.
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那么,现在就行动。
07:40
We should take our foot脚丫子 off the pedal踏板 right now,
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我们应该马上放松油门。
07:43
and generally通常 we do. These things are shown显示 to be pretty漂亮 effective有效
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我们一般都会这么做;这些限速牌非常有效地
07:46
in terms条款 of getting得到 people to slow down.
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提醒了人们要减速。
07:48
They reduce减少 speeds速度 by about five to 10 percent百分.
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他们将速度降低了百分之十。
07:50
They last for about five miles英里,
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并且减速能坚持五英里路程,
07:52
in which哪一个 case案件 we put our foot脚丫子 back on the pedal踏板.
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接着我们才会再次踩油门。
07:54
But it works作品, and it even has some health健康 repercussions反响.
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但在还是起作用了,甚至还有益于身心健康。
07:56
Your blood血液 pressure压力 might威力 drop下降 a little bit.
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你的血压可能没那么高了。
07:58
Maybe there's fewer accidents事故, so there's public上市 health健康 benefits好处.
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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反馈 loop循环
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但是,总的来看,这是个
08:03
that's so nifty俏皮的 and too rare罕见.
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难得的一流反馈圈。
08:06
Because in health健康 care关心, most health健康 care关心,
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因为在医疗保健方面,大多数情况下,
08:08
the data数据 is very removed去除 from the action行动.
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数据与行动相互分离。
08:11
It's very difficult to line线 things up so neatly整洁.
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很难把事情理得那么顺。
08:14
But we have an opportunity机会.
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但是我们有一线希望。
08:16
So I want to talk about, I want to shift转移 now to think about
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我想将话题转移,来探讨
08:18
how we deliver交付 health健康 information信息 in this country国家,
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在我国,我们如何传递健康信息,
08:20
how we actually其实 get information信息.
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以及我们如何获取信息。
08:23
This is a pharmaceutical制药 ad广告.
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这是一个药品广告。
08:26
Actually其实, it's a spoof欺骗. It's not a real真实 pharmaceutical制药 ad广告.
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这实际上是在耍花腔;而不是真正的药品广告。
08:28
Nobody's没有人的 had the brilliant辉煌 idea理念
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还没有人聪明到用”Havidol“
08:30
of calling调用 their drug药物 HavidolHavidol quite相当 yet然而.
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来给药品命名的。
08:34
But it looks容貌 completely全然 right.
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但是它看起来完全没问题。
08:36
So it's exactly究竟 the way we get
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这就是我们
08:38
health健康 information信息 and pharmaceutical制药 information信息,
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得到健康信息和药品信息的方式,
08:41
and it just sounds声音 perfect完善.
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看上去完美无缺。
08:43
And then we turn the page of the magazine杂志,
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当翻开杂志,
08:45
and we see this --
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我们看到这样一页,对吧。
08:48
now this is the page the FDAFDA requires要求 pharmaceutical制药 companies公司
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食品及药物管理局要求制药公司
08:51
to put into their ads广告, or to follow跟随 their ads广告,
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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愤世嫉俗的 exercises演习 in medicine医学.
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对于我而言,这是医学界一大倍受诟病的做法。
08:58
Because we know.
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因为我们知道,
09:00
Who among其中 us would actually其实 say that people read this?
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我们中间有谁认为人们会读这一页?
09:02
And who among其中 us would actually其实 say
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有谁认为
09:04
that people who do try to read this
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那些读了这一页的人
09:06
actually其实 get anything out of it?
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能够得到任何有用信息?
09:08
This is a bankrupt破产者 effort功夫
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这是医疗信息沟通的
09:10
at communicating通信 health健康 information信息.
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昏庸之举。
09:13
There is no good faith信仰 in this.
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没有人会买账。
09:15
So this is a different不同 approach途径.
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而这是另一种方式。
09:17
This is an approach途径 that has been developed发达
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这种方式是由
09:20
by a couple一对 researchers研究人员 at Dartmouth达特茅斯 Medical School学校,
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达特茅斯医学院的几位研究人员所开发。
09:23
Lisa丽莎 Schwartz施瓦茨 and Steven史蒂芬 WoloshinWoloshin.
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他们是莉莎. 史沃兹和史蒂芬. 沃罗森。
09:25
And they created创建 this thing called the "drug药物 facts事实 box."
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他们的这个发明叫做药物成分说明表。
09:28
They took inspiration灵感 from, of all things,
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出乎人意料的是,他们的灵感来自
09:30
Cap'n头儿 Crunch紧缩.
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Cap‘n Crunch麦片。
09:32
They went to the nutritional营养 information信息 box
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他们看到上面的营养成分介绍,
09:35
and saw that what works作品 for cereal谷类, works作品 for our food餐饮,
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并意识到麦片,食物的成分介绍,
09:38
actually其实 helps帮助 people understand理解 what's in their food餐饮.
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实际上有助于人们了解他们食物中有哪些成分。
09:42
God forbid禁止 we should use that same相同 standard标准
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我们怎么就没想到,
09:44
that we make Cap'n头儿 Crunch紧缩 live生活 by
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可以把Cap'n Crunch麦片的成分介绍模式
09:46
and bring带来 it to drug药物 companies公司.
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推广到制药公司。
09:49
So let me just walk步行 through通过 this quickly很快.
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我快速给大家展示一下。
09:51
It says very clearly明确地 what the drug药物 is for, specifically特别 who it is good for,
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它清清楚楚地说明了该药的用途,使用对象,
09:54
so you can start开始 to personalize个性化 your understanding理解
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这样你就可以对号入座,
09:56
of whether是否 the information信息 is relevant相应 to you
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看上面的信息是否与你的情况相符,
09:58
or whether是否 the drug药物 is relevant相应 to you.
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这药是否适合你服用。
10:00
You can understand理解 exactly究竟 what the benefits好处 are.
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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模糊 promise诺言 that it's going to work no matter what,
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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统计 for how effective有效 it is.
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但是你可以通过数据来了解药的效果。
10:09
And finally最后, you understand理解 what those choices选择 are.
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最后,你明确了自己有哪些选择。
10:12
You can start开始 to unpack解压 the choices选择 involved参与
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你可以开始挑拣有关的选择,
10:14
because of the side effects效果.
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因为你要考虑到药的副作用。
10:16
Every一切 time you take a drug药物, you're walking步行 into a possible可能 side effect影响.
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每一次吃药,你都有可能面临某种副作用。
10:19
So it spells法术 those out in very clean清洁 terms条款,
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它明明白白地列出了可能的副作用。
10:21
and that works作品.
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这很管用。
10:23
So I love this. I love that drug药物 facts事实 box.
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我特别喜欢这个药物说明表。
10:25
And so I was thinking思维 about,
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于是,我在思考,
10:27
what's an opportunity机会 that I could have
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我怎样才能
10:29
to help people understand理解 information信息?
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帮助人们理解信息呢?
10:32
What's another另一个 latent body身体 of information信息 that's out there
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还有哪个未被充分理解的信息源
10:36
that people are really not putting to use?
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让人们无所适从呢?
10:39
And so I came来了 up with this: lab实验室 test测试 results结果.
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于是,我想到了这个:实验室检测结果。
10:42
Blood血液 test测试 results结果 are this great source资源 of information信息.
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这一大堆信息是血液检测的结果。
10:45
They're packed打包 with information信息.
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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耐心.
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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医生.
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是直接给医生看的。
10:52
And God forbid禁止 -- I think many许多 doctors医生, if you really asked them,
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上帝啊!我敢说,很多医生,如果你问他们,
10:55
they don't really understand理解 all this stuff东东 either.
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他们也不完全明白这些东西。
10:58
This is the worst最差 presented呈现 information信息.
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这样的信息表述实在是糟透了。
11:01
You ask Tufte塔夫特, and he would say,
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如果你问塔夫特,他会说:
11:04
"Yes, this is the absolute绝对 worst最差 presentation介绍 of information信息 possible可能."
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“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有线
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在《连线》(Wired)杂志社,
11:09
was we went, and I got our graphic图像 design设计 department
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我让我们的图表设计部
11:11
to re-imagine重新想象 these lab实验室 reports报告.
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对这些测试报告进行重新设计。
11:13
So that's what I want to walk步行 you through通过.
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我给大家简短地展示一下。
11:15
So this is the general一般 blood血液 work before,
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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来了 up with.
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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网页 --
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修改后的版本将原来的四页纸--
11:22
that previous以前 slide滑动 was actually其实
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上一张幻灯片实际上
11:24
the first of four pages网页 of data数据
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四页纸的第一页,
11:26
that's just the general一般 blood血液 work.
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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数字 you don't know.
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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一页 summary概要.
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这是我们一页纸的总结。
11:34
We use the notion概念 of color颜色.
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我们运用颜色作为信号。
11:36
It's an amazing惊人 notion概念 that color颜色 could be used.
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颜色的运用真是太妙了。
11:39
So on the top-level顶层 you have your overall总体 results结果,
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最上面一层是你的测试结果概况,
11:42
the things that might威力 jump out at you from the fine print打印.
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清晰的印刷让你一目了然。
11:45
Then you can drill钻头 down
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你接着往下看,
11:47
and understand理解 how actually其实 we put your level水平 in context上下文,
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我们把你的等级
11:50
and we use color颜色 to illustrate说明
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用颜色作图解
11:52
exactly究竟 where your value falls下降.
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标明你的数值在哪一个区域里。
11:54
In this case案件, this patient患者 is slightly at risk风险 of diabetes糖尿病
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这个案例中的病人有轻微患糖尿病的危险,
11:57
because of their glucose葡萄糖 level水平.
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因为他的葡萄糖含量。
11:59
Likewise同样, you can go over your lipids血脂
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类似地,你可以查看你的油脂含量
12:01
and, again, understand理解 what your overall总体 cholesterol胆固醇 level水平 is
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了解你总体的胆固醇含量,
12:04
and then break打破 down into the HDLHDL and the LDLLDL if you so choose选择.
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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运用 color颜色
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你看,我们总是使用颜色
12:09
and personalized个性化 proximity接近
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让那些信息
12:11
to that information信息.
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更加平易近人。
12:13
All those other values,
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我们对那一大堆其它数值
12:15
all those pages网页 and pages网页 of values that are full充分 of nothing,
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那一大叠布满数字但毫无意义的纸
12:17
we summarize总结.
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作了精简。
12:19
We tell you that you're okay, you're normal正常.
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我们告诉你,你的情况正常。
12:21
But you don't have to wade through通过 it. You don't have to go through通过 the junk破烂.
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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重要 things
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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反馈 loop循环:
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这两件事有助于填满这个反馈圈。
12:28
we help people understand理解 in a little more detail详情
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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威力 indicate表明.
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理解这些数值代表什么,表明了什么。
12:33
And then we go a further进一步 step -- we tell them what they can do.
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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眼光
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我们帮助他们判断
12:38
into what choices选择 they can make, what actions行动 they can take.
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他们应该做哪些选择,采取哪些行动。
12:41
So that's our general一般 blood血液 work test测试.
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这就是我们做的常规血液检测报告。
12:44
Then we went to CRPCRP test测试.
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我们接着开始做CRP检测。
12:46
In this case案件, it's a sin of omission省略.
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这是一个信息严重缺失的案例。
12:48
They have this huge巨大 amount of space空间,
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这上面有一大片空白,
12:50
and they don't use it for anything, so we do.
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没有人用它,我们就把这片空白用上了。
12:52
Now the CRPCRP test测试 is often经常 doneDONE
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CRP检测往往
12:54
following以下 a cholesterol胆固醇 test测试,
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跟在胆固醇含量检测之后,
12:56
or in conjunction连词 with a cholesterol胆固醇 test测试.
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或者与胆固醇含量测试一同进行。
12:58
So we take the bold胆大 step
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于是我们大胆地
13:00
of putting the cholesterol胆固醇 information信息 on the same相同 page,
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把胆固醇测试信息印在同一页上,
13:03
which哪一个 is the way the doctor医生 is going to evaluate评估 it.
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让医生进行诊断。
13:05
So we thought the patient患者 might威力 actually其实 want to know the context上下文 as well.
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我们想到,病人可能也想看明白其中的玄机。
13:08
It's a protein蛋白 that shows节目 up
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这是一种维生素,
13:10
when your blood血液 vessels船只 might威力 be inflamed发炎的,
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当你的血管发炎时,这种维生素就会产生,
13:12
which哪一个 might威力 be a risk风险 for heart disease疾病.
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有导致心脏病的风险。
13:14
What you're actually其实 measuring测量
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简单明了的语言
13:16
is spelled拼写 out in clean清洁 language语言.
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把测试结果解释得清清楚楚。
13:18
Then we use the information信息
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接着我们用上了
13:20
that's already已经 in the lab实验室 report报告.
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测试报告上的信息。
13:22
We use the person's人的 age年龄 and their gender性别
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我们通过病人的年龄与性别
13:24
to start开始 to fill in the personalized个性化 risks风险.
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对其具体所面临的风险进行评估。
13:27
So we start开始 to use the data数据 we have
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我们用手上掌握的数据
13:29
to run a very simple简单 calculation计算
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进行一个非常简单的计算,
13:31
that's on all sorts排序 of online线上 calculators计算器
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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实际 risk风险 is.
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最后对实际风险进行预测。
13:36
The last one I'll show显示 you is a PSAPSA test测试.
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最后我将展示的是PSA(前列腺特异抗原)检测。
13:38
Here's这里的 the before, and here's这里的 the after.
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这是修改之前,这是之后。
13:41
Now a lot of our effort功夫 on this one --
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我们在这上面花了不少功夫--
13:43
as many许多 of you probably大概 know,
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在做许多人可能知道,
13:45
a PSAPSA test测试 is a very controversial争论的 test测试.
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PSA测试是一种非常具有争议的检测。
13:47
It's used to test测试 for prostate前列腺 cancer癌症,
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它是用于检测病人是否患上前列腺癌的,
13:49
but there are all sorts排序 of reasons原因
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但是,引起前列腺肿大的原因
13:51
why your prostate前列腺 might威力 be enlarged放大.
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是多种多样的。
13:53
And so we spent花费 a good deal合同 of our time
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于是我们花了不少时间,
13:55
indicating说明 that.
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研究如何表述测试结果。
13:57
We again personalized个性化 the risks风险.
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我们再次根据个人情况评估风险。
13:59
So this patient患者 is in their 50s,
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这是针对五十多岁病人的报告,
14:01
so we can actually其实 give them a very precise精确 estimate估计
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我们能够非常准确地
14:03
of what their risk风险 for prostate前列腺 cancer癌症 is.
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评估他们患前列腺癌的风险。
14:05
In this case案件 it's about 25 percent百分, based基于 on that.
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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跟进 actions行动.
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下面列出了应采取的对策。
14:11
So our cost成本 for this was less than 10,000 dollars美元, all right.
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我们做这项工作的成本不到一万美元。
14:14
That's what Wired有线 magazine杂志 spent花费 on this.
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这就是《连线》杂志在这上面的成本。
14:17
Why is Wired有线 magazine杂志 doing this?
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为什么《连线》杂志要做这样一项工作呢?
14:19
(Laughter笑声)
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(众人笑)
14:22
Quest寻求 Diagnostics诊断 and LabCorp美国控股实验室公司,
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两家最大的实验室检测公司,
14:24
the two largest最大 lab实验室 testing测试 companies公司 --
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奎斯特诊断公司和LabCorp公司:
14:27
last year, they made制作 profits利润 of over 700 million百万 dollars美元
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去年,他们的利润分别超过了七亿美元,
14:30
and over 500 million百万 dollars美元 respectively分别.
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和五亿美元。
14:33
Now this is not a problem问题 of resources资源;
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问题的关键不在于资源,
14:35
this is a problem问题 of incentives奖励.
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而在于刺激。
14:38
We need to recognize认识 that the target目标 of this information信息
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我们需要认识到:信息的接收对象
14:41
should not be the doctor医生, should not be the insurance保险 company公司.
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不应该是医生或保险公司;
14:44
It should be the patient患者.
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而应是病人。
14:46
It's the person who actually其实, in the end结束,
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病人,归根结底,
14:48
is going to be having to change更改 their lives生活
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要改变自己的生活,
14:50
and then start开始 adopting采用 new behaviors行为.
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并养成新的行为习惯。
14:52
This is information信息 that is incredibly令人难以置信 powerful强大.
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而信息在其中扮演了举足轻重的角色。
14:54
It's an incredibly令人难以置信 powerful强大 catalyst催化剂 to change更改.
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这是促成改变的强力催化剂。
14:57
But we're not using运用 it. It's just sitting坐在 there.
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它近在咫尺,但我们却不去用它。
14:59
It's being存在 lost丢失.
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它白白被浪费了。
15:01
So I want to just offer提供 four questions问题
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我想提出四个
15:03
that every一切 patient患者 should ask,
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病人应该问的问题,
15:05
because I don't actually其实 expect期望 people
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因为我实际上并不指望
15:07
to start开始 developing发展 these lab实验室 test测试 reports报告.
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人们自行撰写这些实验室检测报告。
15:09
But you can create创建 your own拥有 feedback反馈 loop循环.
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但是你可以创造自己的反馈圈。
15:11
Anybody任何人 can create创建 their feedback反馈 loop循环 by asking these simple简单 questions问题:
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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结果?
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我可以得到我的检测结果吗?
15:16
And the only acceptable接受 answer回答 is --
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唯一的答案是--
15:18
(Audience听众: Yes.) -- yes.
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(观众:可以。)--可以。
15:20
What does this mean? Help me understand理解 what the data数据 is.
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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选项? What choices选择 are now on the table?
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我有哪些选择?哪些做法的可行的?
15:25
And then, what's next下一个?
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接下来我该怎么做?
15:27
How do I integrate整合 this information信息
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在未来的日子中,
15:29
into the longer course课程 of my life?
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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展示
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最后,我想告诉大家
15:34
that people have the capacity容量 to understand理解 this information信息.
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人们是有能力理解这些信息的。
15:36
This is not beyond the grasp把握 of ordinary普通 people.
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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教育 level水平 of people in this room房间.
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人们并不需要拥有在座各位的教育水平。
15:42
Ordinary普通 people are capable of understanding理解 this information信息,
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平常人有能力理解这些信息,
15:45
if we only go to the effort功夫 of presenting呈现 it to them
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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形成 that they can engage从事 with.
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方便他们理解,让他们参与进来。
15:50
And engagement订婚 is essential必要 here,
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在此,参与是关键因素,
15:52
because it's not just giving them information信息;
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因为,光给他们提供信息,意义不大,
15:54
it's giving them an opportunity机会 to act法案.
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而要给他们行动的机会。
15:56
That's what engagement订婚 is. It's different不同 from compliance合规.
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这才是真正的参与;不同于服从。
15:58
It works作品 totally完全 different不同 from the way we talk about behavior行为
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这不同于与我们今天说的
16:01
in medicine医学 today今天.
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医学上的行为。
16:03
And this information信息 is out there.
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这信息就在眼前。
16:05
I've been talking today今天 about latent information信息,
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今天我所探讨的是被掩盖了的信息,
16:07
all this information信息 that exists存在 in the system系统
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这些信息存在于这个系统之中,
16:09
that we're not putting to use.
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而我们却没有加以利用。
16:11
But there are all sorts排序 of other bodies身体 of information信息
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但各种各样的信息
16:13
that are coming未来 online线上,
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正逐渐在网上涌现。
16:15
and we need to recognize认识 the capacity容量 of this information信息
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我们需要认识到这信息的力量,
16:18
to engage从事 people, to help people
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让人们参与进来,帮助人们
16:20
and to change更改 the course课程 of their lives生活.
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改变他们生命的轨迹。
16:22
Thank you very much.
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非常感谢
16:24
(Applause掌声)
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(众人鼓掌)
Translated by Lili Liang
Reviewed by Xinxin Li

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ABOUT THE SPEAKER
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.”

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.

More profile about the speaker
Thomas Goetz | Speaker | TED.com