TEDxSaltLakeCity
Kevin B. Jones: Why curiosity is the key to science and medicine
凱文·瓊斯: 好奇乃是科學與醫學之鑰
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科學是個牽涉到試驗、失敗和修正的求知進程，醫學也不例外。癌症研究者凱文·瓊斯醫師以簡單、誠實的態度面對外科手術和醫學的未知領域。瓊斯醫師表示：科學的潛力在於當科學家不清楚時，會謙虛地承認他們並不清楚。
Kevin B. Jones - Cancer researcher
Kevin B. Jones is a life-long student of human nature, fascinated most by the decision-making capacity intrinsic to each of us. Full bio
Kevin B. Jones is a life-long student of human nature, fascinated most by the decision-making capacity intrinsic to each of us. Full bio
Double-click the English transcript below to play the video.
00:12
Science.
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科學
00:14
The very word for many of you conjures
unhappy memories of boredom
unhappy memories of boredom
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這詞喚起你們當中許多人
高中生物和物理課裡
無聊、不愉快的回憶。
無聊、不愉快的回憶。
00:18
in high school biology or physics class.
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00:21
But let me assure that what you did there
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但我保證，
你們當時的經歷與科學大相逕庭。
00:24
had very little to do with science.
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00:26
That was really the "what" of science.
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那其實是科學的
「是什麼」的那部分。
「是什麼」的那部分。
00:28
It was the history
of what other people had discovered.
of what other people had discovered.
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是前人發現的歷史記載。
00:32
What I'm most interested in as a scientist
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身為科學家，我最感興趣的
是科學的「如何」那部分。
是科學的「如何」那部分。
00:35
is the "how" of science.
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00:37
Because science is knowledge in process.
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因為科學是求知的進程。
00:41
We make an observation,
guess an explanation for that observation,
guess an explanation for that observation,
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我們觀察，
猜個說法用來解釋所觀察到的現象，
00:44
and then make a prediction
that we can test
that we can test
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然後預測假設，
再用實驗或其他的觀察
來測試這個預測。
來測試這個預測。
00:46
with an experiment or other observation.
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00:49
A couple of examples.
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舉兩個例子。
00:50
First of all, people noticed
that the Earth was below, the sky above,
that the Earth was below, the sky above,
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第一個，前人注意到
地在下而天在上，
地在下而天在上，
00:54
and both the Sun and the Moon
seemed to go around them.
seemed to go around them.
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看似太陽和月亮都圍繞著天地轉。
00:58
Their guessed explanation
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他們猜的解釋是
01:00
was that the Earth must be
the center of the universe.
the center of the universe.
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地球想必是宇宙的中心。
01:04
The prediction: everything
should circle around the Earth.
should circle around the Earth.
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預測：每樣東西都應該繞著地球轉。
01:08
This was first really tested
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首次有人真正檢視這說法
01:09
when Galileo got his hands
on one of the first telescopes,
on one of the first telescopes,
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是伽里略從第一批
望遠鏡中拿到了一台，
望遠鏡中拿到了一台，
01:12
and as he gazed into the night sky,
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並著手觀測星空的時候，
01:15
what he found there was a planet, Jupiter,
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他發現木星這個行星
01:18
with four moons circling around it.
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有四個繞著它轉的衛星。
01:23
He then used those moons
to follow the path of Jupiter
to follow the path of Jupiter
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他用這些衛星來追蹤木星的軌跡，
01:28
and found that Jupiter
also was not going around the Earth
also was not going around the Earth
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並且發現木星也沒繞著地球轉，
01:31
but around the Sun.
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而是繞著太陽轉。
01:35
So the prediction test failed.
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因此那個假設並未通過測試，
01:38
And this led to
the discarding of the theory
the discarding of the theory
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所以導致大家捨棄了
地球是宇宙中心的理論。
地球是宇宙中心的理論。
01:40
that the Earth was the center
of the universe.
of the universe.
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01:42
Another example: Sir Isaac Newton
noticed that things fall to the Earth.
noticed that things fall to the Earth.
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另一個例子：艾薩克·牛頓爵士
注意到東西落地。
注意到東西落地。
01:46
The guessed explanation was gravity,
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他猜測的解釋是重力，
01:50
the prediction that everything
should fall to the Earth.
should fall to the Earth.
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預測每個東西都會落地。
01:53
But of course, not everything
does fall to the Earth.
does fall to the Earth.
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當然，並非每個東西都會落地。
01:58
So did we discard gravity?
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我們因此就棄捨重力論嗎？
02:00
No. We revised the theory and said,
gravity pulls things to the Earth
gravity pulls things to the Earth
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當然不。我們把理論修正為：
重力曳引東西落地，
重力曳引東西落地，
02:05
unless there is an equal
and opposite force in the other direction.
and opposite force in the other direction.
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除非另有個力道相等
而方向相反的作用力。
而方向相反的作用力。
02:10
This led us to learn something new.
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這讓我們學到新知識。
02:12
We began to pay more attention
to the bird and the bird's wings,
to the bird and the bird's wings,
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我們開始更加注意鳥和鳥的翅膀，
02:16
and just think of all the discoveries
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試想所有沿著這條思路
而引出的新發現。
而引出的新發現。
02:18
that have flown
from that line of thinking.
from that line of thinking.
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02:21
So the test failures,
the exceptions, the outliers
the exceptions, the outliers
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因此，失敗的測試、例外與離群值，
02:26
teach us what we don't know
and lead us to something new.
and lead us to something new.
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教導我們原先未知的，
並且引領我們發現新知。
02:32
This is how science moves forward.
This is how science learns.
This is how science learns.
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科學如此前進。
科學如此學習。
02:35
Sometimes in the media,
and even more rarely,
and even more rarely,
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雖然罕見，
有時媒體甚至連科學家都說
02:38
but sometimes even scientists will say
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02:40
that something or other
has been scientifically proven.
has been scientifically proven.
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這或那個已經被科學所證明了。
02:43
But I hope that you understand
that science never proves anything
that science never proves anything
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但我希望你們明白
科學從未終極永遠地證明過什麼。
02:48
definitively forever.
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02:51
Hopefully science remains curious enough
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希望科學家保有足夠的好奇心
02:55
to look for
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去探尋，
02:56
and humble enough to recognize
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並且謙卑得足以辨認，
02:58
when we have found
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在我們發現下一個離群值
03:00
the next outlier,
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03:02
the next exception,
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或例外時，
03:03
which, like Jupiter's moons,
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像是木星的衛星那樣，
03:05
teaches us what we don't actually know.
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教導我們原先並未真正明瞭的。
03:09
We're going to change gears
here for a second.
here for a second.
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此刻我們暫時先變換個主題。
03:11
The caduceus, or the symbol of medicine,
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蛇杖，醫學的標誌，
03:13
means a lot of different things
to different people,
to different people,
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對不同的人而言，代表不同的意思，
03:16
but most of our
public discourse on medicine
public discourse on medicine
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但大多數的公共醫學論述
03:18
really turns it into
an engineering problem.
an engineering problem.
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把它轉成了工程問題。
03:21
We have the hallways of Congress,
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國會和保險公司的董事會
03:23
and the boardrooms of insurance companies
that try to figure out how to pay for it.
that try to figure out how to pay for it.
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試圖找出支付醫療款項的方法。
03:27
The ethicists and epidemiologists
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倫理學家和流行病學家
03:29
try to figure out
how best to distribute medicine,
how best to distribute medicine,
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試圖找到分配醫藥的最佳方式。
03:32
and the hospitals and physicians
are absolutely obsessed
are absolutely obsessed
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而醫院和醫生們則完全沉迷於
03:34
with their protocols and checklists,
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他們的儀軌和清單裡，
03:36
trying to figure out
how best to safely apply medicine.
how best to safely apply medicine.
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試圖找出最佳、最安全的行醫方式。
03:40
These are all good things.
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這些都是好事。
03:42
However, they also all assume
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然而，在某種程度上他們全都假設
03:45
at some level
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03:47
that the textbook of medicine is closed.
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醫學教科書已蓋棺論定。
03:51
We start to measure
the quality of our health care
the quality of our health care
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我們以多快能獲得治療
來衡量我們的醫療品質。
來衡量我們的醫療品質。
03:53
by how quickly we can access it.
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03:56
It doesn't surprise me
that in this climate,
that in this climate,
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在這種氣氛下，我一點也不訝異
03:58
many of our institutions
for the provision of health care
for the provision of health care
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許多機構所提供的醫療
04:01
start to look a heck of a lot
like Jiffy Lube.
like Jiffy Lube.
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變得像是 Jiffy Lube
汽車維修連鎖店那樣。
汽車維修連鎖店那樣。
04:03
(Laughter)
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（笑聲）
04:06
The only problem is that
when I graduated from medical school,
when I graduated from medical school,
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唯一的問題是
當我自醫學院畢業時，
04:10
I didn't get one of those
little doohickeys
little doohickeys
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沒拿到像這樣的小玩意，
04:12
that your mechanic
has to plug into your car
has to plug into your car
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汽車技工把它插進車裡，
04:14
and find out exactly what's wrong with it,
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用來找出車子哪裡出了問題。
04:17
because the textbook of medicine
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因為醫學的教科書尚未編寫完整，
04:19
is not closed.
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04:21
Medicine is science.
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醫學是科學，
04:23
Medicine is knowledge in process.
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醫學是正在進程中的知識。
04:27
We make an observation,
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我們觀察，
04:28
we guess an explanation
of that observation,
of that observation,
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為所觀察到的現象猜個解釋，
04:30
and then we make a prediction
that we can test.
that we can test.
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然後做個可以測試的預測。
04:33
Now, the testing ground
of most predictions in medicine
of most predictions in medicine
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多數的醫療預測在民眾的身上測試。
04:37
is populations.
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04:38
And you may remember
from those boring days in biology class
from those boring days in biology class
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你們可能記得
從前上的無聊生物課裡說到，
04:42
that populations tend to distribute
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人口的分佈
傾向集中於平均值
04:44
around a mean
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也就是高斯或常態分佈。
04:45
as a Gaussian or a normal curve.
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04:47
Therefore, in medicine,
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因此，在醫學上
04:49
after we make a prediction
from a guessed explanation,
from a guessed explanation,
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猜了個解釋後，我們預測假設，
04:52
we test it in a population.
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然後在民眾身上測試。
04:55
That means that what we know in medicine,
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這意味著我們的醫學知識，
04:58
our knowledge and our know-how,
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我們的知識和學問
05:00
comes from populations
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來自人群，
05:02
but extends only as far
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它最遠只延伸到
05:05
as the next outlier,
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下一個離群值、
05:07
the next exception,
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下一個例外；
05:08
which, like Jupiter's moons,
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就像木星的衛星，
05:10
will teach us what we don't actually know.
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能教導我們原先未確切明白的道理。
05:14
Now, I am a surgeon
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我是個外科醫生，
05:15
who looks after patients with sarcoma.
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照顧惡性肉瘤癌症的患者。
05:17
Sarcoma is a very rare form of cancer.
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肉瘤是種罕見的癌症。
05:20
It's the cancer of flesh and bones.
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是肌肉與骨骼的癌變。
05:23
And I would tell you that every one
of my patients is an outlier,
of my patients is an outlier,
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我必須說，
我的每個病人都是個離群值，
05:27
is an exception.
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是個特例。
05:30
There is no surgery I have ever performed
for a sarcoma patient
for a sarcoma patient
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我為肉瘤患者動的手術，
不曾有任何一個遵循著
05:33
that has ever been guided
by a randomized controlled clinical trial,
by a randomized controlled clinical trial,
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隨機控制的臨床試驗，
05:37
what we consider the best kind
of population-based evidence in medicine.
of population-based evidence in medicine.
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也就是我們以為是
人口常態分佈的最佳醫療方式。
人口常態分佈的最佳醫療方式。
05:42
People talk about thinking
outside the box,
outside the box,
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人們總說要跳脫框框，
採取創造性思維，
採取創造性思維，
05:44
but we don't even have a box in sarcoma.
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但肉瘤沒有既定的框框。
05:47
What we do have as we take
a bath in the uncertainty
a bath in the uncertainty
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我們的肉瘤被不確定、
05:50
and unknowns and exceptions
and outliers that surround us in sarcoma
and outliers that surround us in sarcoma
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未知、特例和離群值所包圍，
05:55
is easy access to what I think
are those two most important values
are those two most important values
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我認為易用的是
普世科學的兩個最重要的價值：
05:59
for any science:
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06:01
humility and curiosity.
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謙卑和好奇心。
06:04
Because if I am humble and curious,
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若我謙卑和好奇，
06:06
when a patient asks me a question,
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當病患問我問題，
06:08
and I don't know the answer,
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而我沒有答案時，
06:10
I'll ask a colleague
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我會請教其他接觸過
06:12
who may have a similar
albeit distinct patient with sarcoma.
albeit distinct patient with sarcoma.
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類似但是不同的肉瘤病患的同事，
06:15
We'll even establish
international collaborations.
international collaborations.
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我們甚至會建立國際間的合作。
06:17
Those patients will start
to talk to each other through chat rooms
to talk to each other through chat rooms
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病患能透過聊天室
和支持團體彼此對談。
和支持團體彼此對談。
06:21
and support groups.
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06:22
It's through this kind
of humbly curious communication
of humbly curious communication
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經由這樣謙卑好奇的交流，
06:26
that we begin to try and learn new things.
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我們開始嘗試學習新知識。
06:31
As an example, this is a patient of mine
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例如，我的這個病人
06:33
who had a cancer near his knee.
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在近膝蓋處罹癌。
06:35
Because of humbly curious communication
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經由謙卑好奇的國際合作交流，
06:37
in international collaborations,
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06:40
we have learned that we can repurpose
the ankle to serve as the knee
the ankle to serve as the knee
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我們得知能夠移用腳踝
替代被移除的罹癌膝蓋，
06:44
when we have to remove the knee
with the cancer.
with the cancer.
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06:46
He can then wear a prosthetic
and run and jump and play.
and run and jump and play.
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他就可以戴著假肢跑、跳與玩耍了。
06:50
This opportunity was available to him
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他因國際的合作而有了這契機。
06:53
because of international collaborations.
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06:56
It was desirable to him
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他希望做這樣的手術，
06:57
because he had contacted other patients
who had experienced it.
who had experienced it.
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因他接觸過其他經歷過的病人。
07:01
And so exceptions and outliers in medicine
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因此，醫學上的特例和離群值
07:06
teach us what we don't know,
but also lead us to new thinking.
but also lead us to new thinking.
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教我們原本我們所不知道的，
也引導我們產生新的想法。
07:11
Now, very importantly,
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非常重要的是，
07:12
all the new thinking that outliers
and exceptions lead us to in medicine
and exceptions lead us to in medicine
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所有的特例和離群值
帶給我們醫學領域的新想法
帶給我們醫學領域的新想法
07:16
does not only apply
to the outliers and exceptions.
to the outliers and exceptions.
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不僅適用於特例和離群值。
07:20
It is not that we only learn
from sarcoma patients
from sarcoma patients
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我們從肉瘤病患身上
不僅學到治療肉瘤患者的方法。
不僅學到治療肉瘤患者的方法。
07:24
ways to manage sarcoma patients.
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07:26
Sometimes, the outliers
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有時候特例和離群值
07:29
and the exceptions
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07:30
teach us things that matter quite a lot
to the general population.
to the general population.
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教我們許多適用於普羅大眾的新知。
07:35
Like a tree standing outside a forest,
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就像矗立在森林外的樹木，
07:37
the outliers and the exceptions
draw our attention
draw our attention
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特例和離群值吸引我們去注意、
07:41
and lead us into a much greater sense
of perhaps what a tree is.
of perhaps what a tree is.
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引領我們去領悟更宏觀的認識，
像「樹木是什麼」。
07:45
We often talk about
losing the forests for the trees,
losing the forests for the trees,
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我們常說見樹不見林，
07:48
but one also loses a tree
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但人們也常會見林而忽視了樹。
07:50
within a forest.
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07:53
But the tree that stands out by itself
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獨自矗立在森林之外的樹
07:54
makes those relationships
that define a tree,
that define a tree,
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使得樹木定義的關係，
07:57
the relationships between trunk
and roots and branches,
and roots and branches,
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那些樹幹、樹根、樹枝間的關係，
08:01
much more apparent.
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更為明朗。
08:03
Even if that tree is crooked
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即使那是棵歪斜扭曲的樹，
08:05
or even if that tree
has very unusual relationships
has very unusual relationships
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或者那棵樹的樹幹、樹根、
與樹枝間的關係不尋常，
與樹枝間的關係不尋常，
08:08
between trunk and roots and branches,
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08:10
it nonetheless draws our attention
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儘管如此，它仍吸引我們的注意力，
08:13
and allows us to make observations
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讓我們觀察，
08:15
that we can then test
in the general population.
in the general population.
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然後在普羅大眾的身上測試。
08:18
I told you that sarcomas are rare.
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我說過肉瘤癌極為罕見，
08:20
They make up about one percent
of all cancers.
of all cancers.
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大約只佔所有癌症案例的百分之一。
08:23
You also probably know that cancer
is considered a genetic disease.
is considered a genetic disease.
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你們大概也知道，
癌症被視為是一種遺傳疾病。
癌症被視為是一種遺傳疾病。
08:27
By genetic disease we mean
that cancer is caused by oncogenes
that cancer is caused by oncogenes
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遺傳疾病的意思是
癌基因引起癌症，
08:31
that are turned on in cancer
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當癌基因被開啟
08:32
and tumor suppressor genes
that are turned off to cause cancer.
that are turned off to cause cancer.
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而腫瘤抑制基因卻關閉時，
誘發了癌症。
08:36
You might think
that we learned about oncogenes
that we learned about oncogenes
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你可能認為
我們對癌基因和腫瘤抑制基因的認識
08:38
and tumor suppressor genes
from common cancers
from common cancers
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來自常見的癌症，
08:40
like breast cancer and prostate cancer
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像是乳癌、前列腺癌
08:42
and lung cancer,
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和肺癌，
08:44
but you'd be wrong.
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但你錯了。
08:46
We learned about oncogenes
and tumor suppressor genes
and tumor suppressor genes
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我們首次學到癌基因和腫瘤抑制基因
08:48
for the first time
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08:50
in that itty-bitty little one percent
of cancers called sarcoma.
of cancers called sarcoma.
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是從那微少、僅僅佔百分之一，
名為肉瘤癌的癌症。
08:54
In 1966, Peyton Rous got the Nobel Prize
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佩頓·勞斯在 1966 年
獲得了諾貝爾獎，
獲得了諾貝爾獎，
08:57
for realizing that chickens
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由於他發現了雞禽裡
08:59
had a transmissible form of sarcoma.
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有種傳染性肉瘤。
09:03
Thirty years later, Harold Varmus
and Mike Bishop discovered
and Mike Bishop discovered
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三十年後，哈羅德·瓦爾姆斯
與麥克·畢曉普發現了
與麥克·畢曉普發現了
09:06
what that transmissible element was.
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那種傳染性的因子究竟是什麼。
09:08
It was a virus
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它是一種攜帶基因的病毒，
09:10
carrying a gene,
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09:11
the src oncogene.
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SRC 癌基因。
09:13
Now, I will not tell you
that src is the most important oncogene.
that src is the most important oncogene.
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我不是說 SRC 是最重要的癌基因。
09:17
I will not tell you
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也不是說
09:18
that src is the most frequently
turned on oncogene in all of cancer.
turned on oncogene in all of cancer.
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SRC 是所有的癌症中
最常被開啟的癌基因。
最常被開啟的癌基因。
09:22
But it was the first oncogene.
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但它是第一個被發現的癌基因。
09:25
The exception, the outlier
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這特例、離群值
09:28
drew our attention and led us to something
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吸引了我們的注意，帶領我們發現，
09:31
that taught us very important things
about the rest of biology.
about the rest of biology.
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教導我們其他
有關生物學的重要知識。
有關生物學的重要知識。
09:36
Now, TP53 is the most important
tumor suppressor gene.
tumor suppressor gene.
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TP53 是最重要的腫瘤抑制基因。
09:41
It is the most frequently turned off
tumor suppressor gene
tumor suppressor gene
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是幾乎所有的癌症裡
最常關閉的腫瘤抑制基因。
最常關閉的腫瘤抑制基因。
09:43
in almost every kind of cancer.
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09:46
But we didn't learn about it
from common cancers.
from common cancers.
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但我們不是從一般的癌症裡
學到這一點。
學到這一點。
09:48
We learned about it
when doctors Li and Fraumeni
when doctors Li and Fraumeni
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而是當李醫生和佛美尼醫生
09:51
were looking at families,
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在檢視家族病史時，
09:52
and they realized that these families
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發現這些家庭的肉瘤癌症比例
09:54
had way too many sarcomas.
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遠高於一般家庭。
09:57
I told you that sarcoma is rare.
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我說過肉瘤癌極為罕見。
09:59
Remember that a one
in a million diagnosis,
in a million diagnosis,
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請記住，
一般而言一個家庭裡發生
兩件肉瘤癌的機率是百萬分之一，
兩件肉瘤癌的機率是百萬分之一，
10:02
if it happens twice in one family,
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10:05
is way too common in that family.
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但那個家庭的發生率實在太高了。
10:08
The very fact that these are rare
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就是因為十分罕見，
10:11
draws our attention
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所以吸引我們的注意，
10:13
and leads us to new kinds of thinking.
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啟發我們新的思考。
10:17
Now, many of you may say,
214
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或許你們當中的很多人會說，
10:18
and may rightly say,
215
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也有權這樣說，
10:20
that yeah, Kevin, that's great,
216
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是啊，凱文，那很棒，
10:22
but you're not talking
about a bird's wing.
about a bird's wing.
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但是你所說的並非鳥的翅膀，
10:24
You're not talking about moons
floating around some planet Jupiter.
floating around some planet Jupiter.
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也不是繞著木星轉的衛星，
10:28
This is a person.
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而是人啊。
10:30
This outlier, this exception,
may lead to the advancement of science,
may lead to the advancement of science,
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離群值或特例能引致科學的進步，
10:33
but this is a person.
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但我們談的是人啊。
10:36
And all I can say
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我只能說，
10:37
is that I know that all too well.
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我太明白了。
10:41
I have conversations with these patients
with rare and deadly diseases.
with rare and deadly diseases.
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我與這些罹患罕見
而致命疾病的患者對話。
而致命疾病的患者對話。
10:45
I write about these conversations.
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我紀錄這些對話。
10:47
These conversations are terribly fraught.
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這些對話非常令人焦慮，
10:50
They're fraught with horrible phrases
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1816
充滿著恐怖的語句，
10:51
like "I have bad news"
or "There's nothing more we can do."
or "There's nothing more we can do."
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639920
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像是「我有個壞消息」
或是「我們一籌莫展」。
10:55
Sometimes these conversations
turn on a single word:
turn on a single word:
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有時對話轉向一個單詞：
10:59
"terminal."
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「末期」。
11:04
Silence can also be rather uncomfortable.
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沉默能讓人非常難受。
11:09
Where the blanks are in medicine
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在醫學裡，空白的位置
可能會像那些對話裡的
用字遣詞一樣重要。
用字遣詞一樣重要。
11:11
can be just as important
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11:13
as the words that we use
in these conversations.
in these conversations.
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11:17
What are the unknowns?
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什麼是未知的？
11:18
What are the experiments
that are being done?
that are being done?
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哪些試驗正在進行中？
11:21
Do this little exercise with me.
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和我一同做個小練習。
11:23
Up there on the screen,
you see this phrase, "no where."
you see this phrase, "no where."
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看在銀幕上的片語：「無處」。
11:26
Notice where the blank is.
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注意空格落在何處。
11:28
If we move that blank one space over
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如果我們把空格向右移一格，
11:32
"no where"
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「無處」
11:34
becomes "now here,"
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變成了「此刻在這裡」，
11:36
the exact opposite meaning,
243
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完全相反的意思，
11:38
just by shifting the blank one space over.
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僅僅把空格向右移了一格。
11:43
I'll never forget the night
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我永遠忘不了走進
一位患者病房的那一晚。
一位患者病房的那一晚。
11:45
that I walked into
one of my patients' rooms.
one of my patients' rooms.
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11:48
I had been operating long that day
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雖然我在手術房裡忙了一天，
11:49
but I still wanted to come and see him.
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仍然想去看看他。
11:52
He was a boy I had diagnosed
with a bone cancer a few days before.
with a bone cancer a few days before.
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幾天前我診斷出
這個男孩罹患了骨癌。
這個男孩罹患了骨癌。
11:55
He and his mother had been meeting
with the chemotherapy doctors
with the chemotherapy doctors
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稍早他和他的母親
與化療醫生談過話，
與化療醫生談過話，
11:58
earlier that day,
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12:00
and he had been admitted
to the hospital to begin chemotherapy.
to the hospital to begin chemotherapy.
252
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他剛剛入院開始化療。
12:03
It was almost midnight
when I got to his room.
when I got to his room.
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約在午夜時分，我進到他的病房。
他沉睡著，
12:05
He was asleep, but I found his mother
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而他的母親正在病床旁
12:07
reading by flashlight
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藉由手電筒的光閱讀著。
12:09
next to his bed.
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12:10
She came out in the hall
to chat with me for a few minutes.
to chat with me for a few minutes.
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她走出來，在走道上
和我聊了幾分鐘。
和我聊了幾分鐘。
12:14
It turned out that
what she had been reading
what she had been reading
258
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原來她正在閱讀
12:16
was the protocol
that the chemotherapy doctors
that the chemotherapy doctors
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2176
當天稍早化療醫生給她的程序手冊。
12:18
had given her that day.
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12:20
She had memorized it.
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她記住了裡面的內容。
12:23
She said, "Dr. Jones, you told me
262
731200
3536
她說：「瓊斯醫生，
你告訴過我
12:26
that we don't always win
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2176
這種癌症未必能被療癒，
12:28
with this type of cancer,
264
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12:31
but I've been studying this protocol,
and I think I can do it.
and I think I can do it.
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3480
但我很仔細研究治療程序，
認為我做得到。
12:35
I think I can comply
with these very difficult treatments.
with these very difficult treatments.
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我認為我們能夠承受這困難的治療。
12:39
I'm going to quit my job.
I'm going to move in with my parents.
I'm going to move in with my parents.
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我要辭職，
搬去和父母親同住。
我要救我的孩子。」
12:42
I'm going to keep my baby safe."
268
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1960
12:47
I didn't tell her.
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1200
我沒告訴她。
12:49
I didn't stop to correct her thinking.
270
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2920
我沒糾正她的想法。
12:53
She was trusting in a protocol
271
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2256
她信任的醫療程序，
12:55
that even if complied with,
272
763960
3216
即使完全照著做，
12:59
wouldn't necessarily save her son.
273
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2400
也未必救得了她的兒子。
13:03
I didn't tell her.
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1200
我沒告訴她。
13:06
I didn't fill in that blank.
275
774360
1400
我沒填入那個空白。
13:09
But a year and a half later
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777080
1976
一年半後，
13:11
her boy nonetheless died of his cancer.
277
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2720
她的兒子還是死於癌症。
13:15
Should I have told her?
278
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1320
當時我應該告訴她嗎？
13:17
Now, many of you may say, "So what?
279
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2256
或許你們當中有許多人會說：
「那又怎樣？
13:19
I don't have sarcoma.
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787640
1256
我沒罹患肉瘤癌。
13:20
No one in my family has sarcoma.
281
788920
1896
我的家族沒有任何人罹患肉瘤癌。
13:22
And this is all fine and well,
282
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1456
這些都有道理，
13:24
but it probably doesn't
matter in my life."
matter in my life."
283
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2696
但大概與我無關。」
13:27
And you're probably right.
284
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1256
或許你是對的。
13:28
Sarcoma may not matter
a whole lot in your life.
a whole lot in your life.
285
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2680
肉瘤癌或許與你無甚關聯。
13:33
But where the blanks are in medicine
286
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2336
但是醫學上的空白部分
13:35
does matter in your life.
287
803400
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卻與你的生命息息相關。
13:38
I didn't tell you one dirty little secret.
288
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我沒告訴你們
一個不甚光彩的小秘密。
一個不甚光彩的小秘密。
13:40
I told you that in medicine,
we test predictions in populations,
we test predictions in populations,
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我說過在醫學裡，
我們在民眾的身上
測試所預測的假設。
測試所預測的假設。
13:45
but I didn't tell you,
290
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但我沒說的是，
13:46
and so often medicine never tells you
291
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2216
通常醫學並未告訴你們，
13:48
that every time an individual
292
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每次某個人接觸治療，
13:51
encounters medicine,
293
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13:53
even if that individual is firmly
embedded in the general population,
embedded in the general population,
294
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4040
即使那個人的確是普羅大眾的一員，
13:59
neither the individual
nor the physician knows
nor the physician knows
295
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2376
他和醫生都不知道
14:01
where in that population
the individual will land.
the individual will land.
296
829760
2680
他在人口分布中會落在哪一點。
14:05
Therefore, every encounter with medicine
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2696
因此，每個醫療行為都是個試驗。
14:07
is an experiment.
298
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1440
14:09
You will be a subject
299
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2016
你將會是個被試驗的主體。
14:11
in an experiment.
300
839960
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14:14
And the outcome will be either
a better or a worse result for you.
a better or a worse result for you.
301
842560
4840
試驗結果，
你的情況可能變好也可能變差。
14:20
As long as medicine works well,
302
848320
2016
只要藥物起作用，
14:22
we're fine with fast service,
303
850360
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我們不在乎治療的快慢，
以及那些自滿、充滿自信的談話。
14:25
bravado, brimmingly
confident conversations.
confident conversations.
304
853400
3440
14:29
But when things don't work well,
305
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但是如果事情進展不順利，
14:31
sometimes we want something different.
306
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1840
有時我們就要做法不同。
14:34
A colleague of mine
removed a tumor from a patient's limb.
removed a tumor from a patient's limb.
307
862520
3280
我有個同事切除病人肢體的腫瘤。
14:38
He was concerned about this tumor.
308
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他很擔心這個腫瘤。
14:40
In our physician conferences,
he talked about his concern
he talked about his concern
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在我們的研討會上，
他講述他的憂慮，
他講述他的憂慮，
14:43
that this was a type of tumor
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這是種原位複發率極高的腫瘤。
14:45
that had a high risk
for coming back in the same limb.
for coming back in the same limb.
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14:48
But his conversations with the patient
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但是他與病患的對話
14:50
were exactly what a patient might want:
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卻完全是病患想聽到的那種：
14:52
brimming with confidence.
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充滿了自信。
14:54
He said, "I got it all
and you're good to go."
and you're good to go."
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他說：「我已完全清除腫瘤，
妳可以回家了。」
14:57
She and her husband were thrilled.
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她和她的丈夫喜出望外。
14:58
They went out, celebrated, fancy dinner,
opened a bottle of champagne.
opened a bottle of champagne.
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他們上館子慶祝，
享用大餐，還開了瓶香檳。
15:04
The only problem was a few weeks later,
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唯一的問題是幾個星期後，
15:06
she started to notice
another nodule in the same area.
another nodule in the same area.
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她注意到在相同的區域
出現了另一個硬塊。
出現了另一個硬塊。
15:09
It turned out he hadn't gotten it all,
and she wasn't good to go.
and she wasn't good to go.
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真相是醫生並未清乾淨腫瘤，
她並未真的痊癒可以返家。
15:13
But what happened at this juncture
absolutely fascinates me.
absolutely fascinates me.
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當下發生的事吸引了我。
15:17
My colleague came to me and said,
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我的同事問我：
15:18
"Kevin, would you mind
looking after this patient for me?"
looking after this patient for me?"
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「凱文，你願意幫我
照料這個病人嗎？」
照料這個病人嗎？」
15:22
I said, "Why, you know the right thing
to do as well as I do.
to do as well as I do.
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我說：「為什麼，
你和我一樣知道該怎麼做啊。
15:25
You haven't done anything wrong."
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你沒做錯任何事。」
15:27
He said, "Please, just look
after this patient for me."
after this patient for me."
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他說：「拜託你，
幫我照料這個病人吧。 」
15:33
He was embarrassed --
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他很尷尬，
15:34
not by what he had done,
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但不是為了他動的手術，
15:37
but by the conversation that he had had,
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而是他先前的對話，
15:39
by the overconfidence.
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和過度的自信讓他很尷尬。
15:42
So I performed
a much more invasive surgery
a much more invasive surgery
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因此我動了更深入的切除手術，
15:45
and had a very different conversation
with the patient afterwards.
with the patient afterwards.
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術後和我和病人的對話截然不同。
15:48
I said, "Most likely I've gotten it all
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我說：「看起來很像已經清乾淨了，
15:50
and you're most likely good to go,
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妳看似可以回家了。
15:53
but this is the experiment
that we're doing.
that we're doing.
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但我們做的是個試驗。
15:57
This is what you're going to watch for.
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妳需要繼續觀察，
15:59
This is what I'm going to watch for.
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我也需要繼續觀察。
16:01
And we're going to work together
to find out if this surgery will work
to find out if this surgery will work
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我們一起努力，
看手術是否成功去除了妳的腫瘤。」
16:04
to get rid of your cancer."
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16:06
I can guarantee you, she and her husband
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我可以向你們保證，
在這次談話後，她和她的丈夫
並沒再開一瓶香檳慶祝。
並沒再開一瓶香檳慶祝。
16:08
did not crack another bottle of champagne
after talking to me.
after talking to me.
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16:13
But she was now a scientist,
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但她現在採取科學家的態度，
16:16
not only a subject in her experiment.
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而不僅是個被試驗的主體而已。
16:21
And so I encourage you
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因此我鼓勵你們
16:23
to seek humility and curiosity
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尋求你們醫生的謙遜和好奇心。
16:27
in your physicians.
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16:28
Almost 20 billion times each year,
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每年大約兩百億次，
16:31
a person walks into a doctor's office,
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一個人走進醫生的辦公室
16:35
and that person becomes a patient.
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成了一名病患。
16:39
You or someone you love
will be that patient sometime very soon.
will be that patient sometime very soon.
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你和你所愛的人
不久的將來也會成為病患。
不久的將來也會成為病患。
16:43
How will you talk to your doctors?
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你如何與你的醫生對話？
16:46
What will you tell them?
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你要怎麼跟他們說？
16:48
What will they tell you?
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他們會告訴你些什麼？
16:52
They cannot tell you
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他們自己也不知道的事，
他們無法告訴你，
他們無法告訴你，
16:54
what they do not know,
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16:57
but they can tell you when they don't know
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但是如果你問了，
當他們不知道的時候，
他們會回答不知道。
他們會回答不知道。
17:02
if only you'll ask.
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17:04
So please, join the conversation.
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所以，請加入對話吧。
17:08
Thank you.
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謝謝。
17:09
(Applause)
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（掌聲）
ABOUT THE SPEAKER
Kevin B. Jones - Cancer researcherKevin B. Jones is a life-long student of human nature, fascinated most by the decision-making capacity intrinsic to each of us.
Why you should listen
Kevin B. Jones diagnoses and performs surgeries to remove rare cancers called sarcomas from the limbs of children and adults. Counseling patients -- especially teenagers with bone cancers -- about the decisions they must make with regard to their bodies has brought the uncertainties of medicine into keen focus for him. How does a person decipher what medicine has told her? How can a person choose among options given very limited understanding of the implications of each? Intrigued by these riddles and conundrums that patient-physician communication frequently creates, Jones wrote a book, What Doctors Cannot Tell You: Clarity, Confidence and Uncertainty in Medicine.
Jones also runs a scientific research laboratory focused on the biology of sarcomas. Here, his team studies the decisions cells make on the way to becoming a cancer. Again the complexities and uncertainties inherent to these decisions are in full relief.
Jones sees patients and does surgery as an associate professor at the University of Utah in the Department of Orthopaedics, working at both Primary Children's Hospital and the Huntsman Cancer Institute. His laboratory is in the Huntsman Cancer Institute, where he is an adjunct faculty member in the Department of Oncological Sciences.
Jones studied English literature at Harvard, medicine at Johns Hopkins, orthopedic surgery at the University of Iowa, and musculoskeletal oncology at the University of Toronto. He lives in Salt Lake City with his wife and four children.
Kevin B. Jones | Speaker | TED.com