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

Thomas Goetz:現在係時候將醫療數據重新設計

Filmed:
587,895 views

您嘅病歷表﹕得來不易﹑無法睇得明 -- 箇中充滿著可以令您更健康嘅信息﹐但您首先要知道點樣利用佢。喺TEDMED系列演講中,Thomas Goetz大膽決定去將醫療數據重新設計,從而洞悉更深入嘅瞭解。
- 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講嘢 to you
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我將會同大家講吓
00:17
about how we can tap水龍頭
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我哋點樣可以有效利用
00:19
a really underutilized唔夠 resource資源 in health健康 care護理,
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一種絕對被忽視嘅醫療上嘅資源。
00:21
which is the patient病人,
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呢種資源就係病人本身,
00:23
or, as I like to use the scientific科學 term術語,
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或者﹐以科學術語嚟講 ——
00:26
people.
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人。
00:28
Because we are all patients患者, we are all people.
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因為我哋都係病人,我們亦都係人。
00:30
Even doctors醫生 are patients患者 at some pointD.
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就連醫生﹐有時都可以係病人。
00:32
So I want to talk about that
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所以我想討論呢種資源
00:34
as an opportunity機會
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可帶嚟嘅良機﹐
00:36
that we really have failed to engage從事 with very well in this country國家
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一項我哋國家﹐甚至全世界
00:39
and, in fact事實, worldwide全球.
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都冇足夠善用到嘅良機。
00:41
If you want to get at the big part部分 --
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如果你想由大局嚟睇 --
00:43
I mean from a public公眾 health健康 level水平, where my training培訓 is --
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由公共醫療嘅角度﹐即係我嘅職業範圍 --
00:46
you're looking at behavioral行為 issues個問題.
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我哋就見到行為上嘅問題,
00:48
You're looking at things where people are actually講真 given information信息,
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你會發現人得到訊息之後﹐
00:51
and they're not following以下 through透過 with it.
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並冇妥善跟進。
00:53
It's a problem個問題 that manifests體現 itself本身 in diabetes糖尿病,
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呢個問題﹐於糖尿病﹑
00:57
obesity肥胖, many好多 forms形式 of heart disease疾病,
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肥胖症以及多種嘅心臟病﹐
00:59
even some forms形式 of cancer癌症 -- when you think of smoking食煙.
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甚至﹐如果考慮到吸煙問題﹐於癌症方面﹐都有存在。
01:02
Those are all behaviors行為 where people know what they're supposed應該 to do.
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所有人都知道應該要點樣做先至正確﹐
01:05
They know what they're supposed應該 to be doing,
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雖然知道應該要點樣做﹐
01:07
but they're not doing it.
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但佢哋冇去做到。
01:09
Now behavior行為 change is something
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要將行為改變﹐
01:11
that is a long-standing長期 problem個問題 in medicine醫學.
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一直都係醫學上長期存在嘅問題。
01:13
It goes all the way back to Aristotle亚里士多德.
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遠至亞里士多德嘅時代都有存在。
01:15
And doctors醫生 hate討厭 it, right?
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而且醫生都討厭呢種行為,係嗎?
01:17
I mean, they complain抱怨 about it all the time.
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我意思係﹐醫生經常都抱怨呢個問題。
01:19
We talk about it in terms條款 of engagement訂婚, or non-compliance唔遵約.
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我哋通常歸納為留心聽取﹐以及唔聽指示。
01:22
When people don't take their佢哋 pills,
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當有人唔食藥﹑
01:24
when people don't follow遵循 doctors'醫生 ' orders訂單 --
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唔聽醫生吩咐﹐
01:26
these are behavior行為 problems個問題.
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呢啲都係行為問題。
01:28
But for as much as clinical臨床 medicine醫學
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但係無論臨床醫學專家點樣
01:30
agonizes時至今日起身難過 over behavior行為 change,
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為改變病人行為嘅問題而煩惱﹐
01:32
there's not a lot of work done
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要解決呢個問題﹐
01:34
in terms條款 of trying試圖 to fix修復 that problem個問題.
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我哋能力根本有限。
01:37
So the crux關鍵 of it
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因此解決問題嘅關鍵
01:39
comes down to this notion概念 of decision-making決策 --
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在於助人去作出正確嘅判斷 --
01:41
giving information信息 to people in a form形式
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即是於提供信息嘅時候﹐
01:43
that doesn't just educate教育 them
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不單只教育病人﹐
01:45
or inform可否告知 them,
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或者通知佢哋,
01:47
but actually講真 leads導致 them to make better decisions決定,
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而係實際上引導佢哋去作更好嘅決定﹐
01:49
better choices選擇 in their佢哋 lives生活.
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於生活上作更好嘅選擇。
01:51
One part部分 of medicine醫學, though雖然,
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其實﹐喺醫學上有一個領域
01:53
has faced面臨 the problem個問題 of behavior行為 change pretty well,
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已經比較成功解決到行為改變方面嘅問題﹐
01:57
and that's dentistry牙科.
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就係牙科。
01:59
Dentistry牙科 might可能 seem好似 -- and I think it is --
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好多人眼中﹐包括我自己﹐
02:01
many好多 dentists牙醫 would have to acknowledge承認
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而且好多牙醫都承認,
02:03
it's somewhat有 D of a mundane世俗 backwater囘水 of medicine醫學.
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牙科於某程度係醫學上一個沉悶嘅死角。
02:05
Not a lot of cool, sexy性感 stuff啲嘢 happening發生 in dentistry牙科.
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牙科嘅領域一般都冇任何新奇有趣嘅事發生。
02:08
But they have really taken採取 this problem個問題 of behavior行為 change
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但係佢哋確實有將改變行為嘅問題作出研究
02:11
and solved解決 it.
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而且解決咗呢個問題。
02:13
It's the one great preventive預防 health健康 success成功
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呢個係我哋嘅醫療保體系統中
02:15
we have in our health健康 care護理 system系統.
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一個非常成功嘅疾病預防嘅例子。
02:17
People brush and floss their佢哋 teeth牙齒.
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每個人都刷牙﹐而且用牙線剔牙。
02:19
They don't do it as much as they should, but they do it.
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佢哋雖然做得唔夠多﹐但係都總算有做。
02:22
So I'm going to talk about one experiment實驗
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所以我就想同大家分享一個實驗。
02:24
that a few幾個 dentists牙醫 in Connecticut康涅狄格州
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呢個係一個30年前﹐幾個喺美國康州嘅牙醫
02:26
cooked up about 30 years ago.
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諗出嚟嘅實驗。
02:28
So this is an old experiment實驗, but it's a really good one,
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呢個實驗雖然古老,但係的確唔錯
02:30
because it was very simple簡單,
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因為佢非常簡單,
02:32
so it's an easy容易 story故事 to tell.
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所以亦好容易說明。
02:34
So these Connecticut康涅狄格州 dentists牙醫 decided決定
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話說﹐呢班康州嘅牙醫決定
02:36
that they wanted to get people to brush their佢哋 teeth牙齒 and floss their佢哋 teeth牙齒 more often經常,
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想令到病人更頻密地刷牙﹐而且用牙線清理牙齒。
02:39
and they were going to use one variable變量:
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而佢哋利用咗一個變量﹕
02:41
they wanted to scare them.
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佢哋想要令人驚怕。
02:43
They wanted to tell them how bad it would be
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佢哋想講給病人知道
02:46
if they didn't brush and floss their佢哋 teeth牙齒.
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如果唔刷牙﹑唔用牙線﹐後果將會點樣嚴重。
02:48
They had a big patient病人 population人口.
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佢哋當時有好多病人。
02:51
They divided劃分 them up into two groups.
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於是將呢些病人分成兩組。
02:53
They had a low-fear低恐懼 population人口,
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一組是低恐慌組,
02:55
where they basically基本上 gave them a 13-minute分鐘 presentation表示,
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佢哋比呢組人睇一段13分鐘
02:57
all based基於 in science科學,
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有科學根據嘅講解,
02:59
but told them that, if you didn't brush and floss your teeth牙齒,
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但係亦講比佢哋知道,如果唔刷牙﹑唔用牙線,
03:02
you could get gum disease疾病. If you get gum disease疾病, you will lose失去 your teeth牙齒,
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可能就會得到牙周病,而如果得到牙周病,就會失去牙齒,
03:05
but you'll你咪會 get dentures假牙, and it won't唔會 be that bad.
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但係重可以戴假牙,情況就唔會太差。
03:07
So that was the low-fear低恐懼 group.
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呢個就是低恐慌組嘅部份。
03:09
The high-fear高恐懼 group, they laid奠定 it on really thick.
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對於高恐慌組﹐佢哋就落足料。
03:12
They showed表明 bloody血腥 gums牙肉.
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佢哋比呢一組睇見血淋淋嘅牙肉﹑
03:14
They showed表明 puss oozing滲出 out from between之間 their佢哋 teeth牙齒.
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牙縫之間流膿嘅口腔。
03:17
They told them that their佢哋 teeth牙齒 were going to fall秋天 out.
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佢哋對實驗者講牙齒會脫落﹑
03:19
They said that they could have infections感染
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佢哋會受到細菌感染
03:21
that would spread傳播 from their佢哋 jaws下巴 to other parts部分 of their佢哋 bodies機構,
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而細菌會由嘴巴擴散到身體其他部份,
03:24
and ultimately最終, yes, they would lose失去 their佢哋 teeth牙齒.
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同埋最後﹐佢哋當然會失去牙齒。
03:26
They would get dentures假牙, and if you got dentures假牙,
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雖然都可以戴假牙,但是戴假牙
03:28
you weren't唔係 going to be able to eat corn-on-the-cob粟米芯,
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就再唔可以食原條粟米﹑
03:30
you weren't唔係 going to be able to eat apples蘋果,
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唔可以食蘋果﹑
03:32
you weren't唔係 going to be able to eat steak牛扒.
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唔可以食牛扒。
03:34
You'll你咪會 eat mush粟米粥 for the rest休息 of your life.
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下半世就只好食糊狀嘅食物。
03:36
So go brush and floss your teeth牙齒.
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所以快去刷牙同埋用牙線啦。
03:39
That was the message消息. That was the experiment實驗.
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呢個就係其中嘅信息,實驗就係咁樣進行。
03:41
Now they measured測量 one other variable變量.
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跟住佢哋測試咗另一個變量。
03:43
They wanted to capture捕獲 one other variable變量,
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佢哋想要研究嘅變量就係
03:45
which was the patients'患者 ' sense of efficacy療效.
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病人自認為嘅能動性。
03:48
This was the notion概念 of whether係唔係 the patients患者 felt覺得
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即係話﹐病人自己認為佢哋會唔會
03:50
that they actually講真 would go ahead提前 and brush and floss their佢哋 teeth牙齒.
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真係去刷牙同埋用牙線。
03:53
So they asked問吓 them at the beginning初時,
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所以於實驗嘅開始﹐佢哋問病人﹐
03:55
"Do you think you'll你咪會 actually講真 be able to stick堅持 with this program程序?"
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「你哋認為自己的確會依照呢個計劃進行嗎?」
03:57
And the people who said, "Yeah, yeah. I'm pretty good about that,"
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回答「會﹑一定會﹐呢方面我好在行」嘅參加者﹐
03:59
they were characterized特點 as high efficacy療效,
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都被列入高能動性嘅一組。
04:01
and the people who said,
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而回答「噢﹐我從來都無法養成
04:03
"Eh, I never get around to brushing刷牙 and flossing as much as I should,"
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刷牙﹑用牙線嘅習慣」嘅人﹐
04:05
they were characterized特點 as low efficacy療效.
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都被列入缺乏能動性嘅一組。
04:07
So the upshot結果 was this.
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終於得到嘅結論就係咁樣。
04:10
The upshot結果 of this experiment實驗
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呢個實驗證實
04:12
was that fear恐懼 was not really a primary主要 driver司機
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恐懼其實完全唔係帶動行為的
04:15
of the behavior行為 at all.
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主要因素。
04:17
The people who brushed and flossed their佢哋 teeth牙齒
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照指示刷牙﹑用牙線嘅人
04:19
were not necessarily必然 the people
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並唔一定係
04:21
who were really scared害怕 about what would happen發生 --
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對可能帶來嘅後果感到恐懼嘅人﹐
04:23
it's the people who simply淨係 felt覺得 that they had the capacity能力
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而係只需要係認為自己有能力
04:26
to change their佢哋 behavior行為.
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去改變自己行為嘅人。
04:28
So fear恐懼 showed表明 up as not really the driver司機.
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因此顯示到﹐能夠改變行為嘅原動力並唔係恐懼,
04:31
It was the sense of efficacy療效.
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而係病人自認為嘅能動性。
04:34
So I want to isolate分離 this,
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所以我想特別談及呢個例子,
04:36
because it was a great observation觀察 --
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因為呢個確實係非常唔錯嘅觀察結果,
04:38
30 years ago, right, 30 years ago --
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30年前﹐冇錯﹐係30年前嘅結論﹐
04:40
and it's one that's laid奠定 fallow休閒 in research研究.
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而一直冇被發揮﹑利用嘅﹐就係呢個結論。
04:43
It was a notion概念 that really came out
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呢個想法其實起源於
04:45
of Albert阿尔伯特 Bandura's班杜拉嘅 work,
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Albert Bandura 嘅研究之中﹐
04:47
who studied研究 whether係唔係
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佢曾研究
04:49
people could get a sense of empowerment授權.
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人是否可取得賦能感。
04:52
The notion概念 of efficacy療效 basically基本上 boils沸騰 down to one -- that
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能動性嘅理念最後可以總結為﹕
04:55
if somebody有人 believes相信 that they have the capacity能力 to change their佢哋 behavior行為.
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一個人是否相信﹐自己有能力去改變自己嘅行為。
04:58
In health健康 care護理 terms條款, you could characterize表徵 this
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以醫療角度,我哋可以將呢個概括爲
05:01
as whether係唔係 or not somebody有人 feels感覺
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人是否能夠意識到
05:03
that they see a path路徑 towards better health健康,
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佢哋改善健康狀況嘅途徑,
05:05
that they can actually講真 see their佢哋 way towards getting得到 better health健康,
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以至佢哋能夠確實為自己健康作出改善。
05:07
and that's a very important重要 notion概念.
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而呢個係非常重要嘅一個觀點。
05:09
It's an amazing驚人 notion概念.
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係一個奇妙嘅觀點。
05:11
We don't really know how to manipulate操縱 it, though雖然, that well.
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只不過我哋未懂得點樣去有效利用佢。
05:14
Except除咗, maybe we do.
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又或者﹐我哋已經懂得。
05:17
So fear恐懼 doesn't work, right? Fear恐懼 doesn't work.
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恐懼起唔到作用。係﹐恐懼起唔到作用。
05:19
And this is a great example例子
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而呢個係個非常好嘅例子,
05:21
of how we haven't learned that lesson at all.
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證明我哋完全唔會接受教訓。
05:24
This is a campaign運動 from the American美國 Diabetes糖尿病 Association協會.
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以下係美國糖尿病協會嘅一個宣傳活動。
05:27
This is still the way we're communicating溝通 messages消息 about health健康.
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亦都係目前醫療健康方面仍然採用來傳達信息嘅方法。
05:30
I mean, I showed表明 my three-year-old三歲 this slide幻燈片 last night,
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我想講嘅係,我昨晚比我三歲嘅孩子睇咗呢張幻燈片,
05:33
and he's like, "Papa老竇, why is an ambulance救護車 in these people's人民 homes家庭?"
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然後佢話:「爸爸,點解呢啲人屋企裡面會有救護車呢?」
05:37
And I had to explain解釋, "They're trying試圖 to scare people."
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我只能解釋:「呢個只係用來嚇人。」
05:40
And I don't know if it works工程.
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我都唔知道呢個做法有效與否。
05:42
Now here's呢度有 what does work:
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而以下才是有效嘅方法。
05:44
personalized個性化 information信息 works工程.
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就係個人化嘅信息。
05:46
Again, Bandura班杜拉 recognized認可 this
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又是 Bandura﹐喺幾十年前
05:48
years ago, decades幾十年 ago.
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認出了呢一點。
05:50
When you give people specific特定 information信息
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當您向他人提供具體嘅﹑
05:52
about their佢哋 health健康, where they stand,
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關乎佢哋健康嘅﹑佢哋目前病情嘅信息﹐
05:54
and where they want to get to, where they might可能 get to,
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以及佢哋可以達到嘅狀況﹑可能會出現嘅情況嘅信息﹐
05:56
that path路徑, that notion概念 of a path路徑 --
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就是呢條路途﹑呢條路途嘅理念﹐
05:58
that tends往往 to work for behavior行為 change.
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令到人嘅行為作出改變。
06:00
So let me just spool閥芯 it out a little bit.
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請等我詳盡少少去解釋。
06:02
So you start初時 with personalized個性化 data數據, personalized個性化 information信息
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您可以由一個人身上得到嘅
06:05
that comes from an individual,
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個人化嘅數據﹑個人化嘅資料開始﹐
06:07
and then you need to connect連接 it to their佢哋 lives生活.
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然後將呢啲跟每個人的生活聯繫起來。
06:10
You need to connect連接 it to their佢哋 lives生活,
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您要將資訊跟佢哋嘅生活聯繫起來。
06:12
hopefully希望 not in a fear-based基於恐懼的 way, but one that they understand理解.
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最好係以一種唔會令人感到恐懼嘅方式﹐而係一種佢哋可以理解嘅方式。
06:14
Okay, I know where I sit. I know where I'm situated位於.
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好喇﹐我已知道自己嘅立場。我已知道自己嘅位置。
06:17
And that doesn't just work for me in terms條款 of abstract抽象 numbers數字 --
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而用抽象嘅數目子作根基的話﹐對我毫無意義﹐
06:20
this overload過載 of health健康 information信息
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呢啲過多嘅有關健康嘅資訊
06:22
that we're inundated淹沒 with.
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實在氾濫得令我哋應付不來﹐
06:24
But it actually講真 hits home.
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但係佢哋其實係解決問題嘅根源。
06:26
It's not just hitting us in our heads; it's hitting us in our hearts.
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佢哋不單止影響我哋嘅思想﹐亦都帶動我哋嘅情緒。
06:28
There's an emotional情感 connection連接 to information信息
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我哋對呢啲信息有不解嘅情結,
06:30
because it's from us.
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因為呢啲信息起源自我哋本身。
06:32
That information信息 then needs需要 to be connected連接 to choices選擇,
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然後﹐呢啲資料需要與選擇串連起來,
06:35
needs需要 to be connected連接 to a range範圍 of options選項,
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需要與各種各樣嘅選摘連貫起來,
06:37
directions方向 that we might可能 go to --
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包括有可能嘅發生嘅情況 --
06:39
trade-offs權衡, benefits著數.
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各種利弊。
06:41
Finally最後, we need to be presented提出 with a clear清楚 pointD of action行動.
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最後,我哋需要被清楚地告知﹐要採取點樣嘅行動。
06:44
We need to connect連接 the information信息
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我哋需要每次都將信息
06:46
always with the action行動,
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跟行動串連起來﹐
06:48
and then that action行動 feeds飼料 back
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然後果個行動再反饋成
06:50
into different不同 information信息,
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另一份信息
06:52
and it creates創建, of course課程, a feedback反饋 loop.
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而當然,咁樣因此形成一個反饋循環。
06:54
Now this is a very well-observed良好觀察 and well-established完善嘅 notion概念
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其實呢一套理念﹐已經係一套相當有根據﹑廣泛被公認嘅﹑
06:57
for behavior行為 change.
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用作行為改變嘅理念。
06:59
But the problem個問題 is that things -- in the upper-right右上角 corner角落 there --
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但問題係,圖中右上角嘅
07:02
personalized個性化 data數據, it's been pretty hard努力 to come by.
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個人數據﹐因為通常都係難以取得嘅。
07:04
It's a difficult困難 and expensive昂貴 commodity商品,
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個人數據係一種難以得到嘅奢侈品﹐
07:07
until直到 now.
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直到目前為止。
07:09
So I'm going to give you an example例子, a very simple簡單 example例子 of how this works工程.
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我再來向大家講解一個例子,一個非常簡單嘅例子﹐去說明呢個原理。
07:12
So we've我哋都 all seen看到 these. These are the "your speed速度 limit限制" signs迹象.
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我哋每個人都見過呢啲標示牌。呢啲係顯示「你的時速」嘅標示牌。
07:15
You've seen看到 them all around,
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大家喺任何地方都一定見過,
07:17
especially尤其係 these days as radars雷達 are cheaper.
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尤其是而家雷達儀器比較便宜嘅時代。
07:19
And here's呢度有 how they work in the feedback反饋 loop.
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而以下就係佢哋點樣牽涉反饋循環嘅現象。
07:21
So you start初時 with the personalized個性化 data數據
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一開始﹐您所得嘅個人化數據﹐就係
07:23
where the speed速度 limit限制 on the road道路 that you are at that pointD
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您當時於路面嘅時速限制﹐
07:25
is 25,
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25﹐
07:27
and, of course課程, you're going faster更快 than that.
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而當然﹐您當時正超速。
07:29
We always are. We're always going above以上 the speed速度 limit限制.
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我哋﹐永遠都會超速。
07:32
The choice選擇 in this case情況下 is pretty simple簡單.
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呢個例子中嘅選擇係非常簡單。
07:34
We either一係 keep going fast快速, or we slow down.
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我哋一係就繼續超速,一係就將速度減慢。
07:36
We should probably可能 slow down,
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其實我哋應該要將速度減慢。
07:38
and that pointD of action行動 is probably可能 now.
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而且大概要立刻行動。
07:40
We should take our foot隻腳 off the pedal踏板 right now,
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我們應該立刻將腳從油門鬆開。
07:43
and generally麻麻 we do. These things are shown顯示 to be pretty effective有效
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而通常我哋都會咁樣做。呢類設備﹐通常都有效令到
07:46
in terms條款 of getting得到 people to slow down.
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司機將行車速度減慢。
07:48
They reduce減少 speeds速度 by about five to 10 percent百分比.
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佢哋有效將車速減慢百分之五到百分之十。
07:50
They last for about five miles英里,
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而且有效持續五英哩左右。
07:52
in which case情況下 we put our foot隻腳 back on the pedal踏板.
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之後我哋又再將腳踩落油門。
07:54
But it works工程, and it even has some health健康 repercussions影響.
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但至少起作用﹐甚至帶嚟一啲健康嘅效應。
07:56
Your blood pressure壓力 might可能 drop下降 a little bit.
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您嘅血壓可能會降低些少。
07:58
Maybe there's fewer accidents事故, so there's public公眾 health健康 benefits著數.
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亦可能會減少意外發生,因此對大眾健康帶來益處。
08:01
But by and large, this is a feedback反饋 loop
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但具體嚟講﹐呢類一流嘅反饋環
08:03
that's so nifty and too rare罕見.
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係少之又少嘅。
08:06
Because in health健康 care護理, most health健康 care護理,
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因為喺醫療系統中,又或者大部份醫療系統中,
08:08
the data數據 is very removed刪除 from the action行動.
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數據已經被行動所分離。
08:11
It's very difficult困難 to line things up so neatly企理.
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因此好難將事件每部份清晰串連起嚟。
08:14
But we have an opportunity機會.
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但係我哋有呢個機會。
08:16
So I want to talk about, I want to shift轉變 now to think about
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因此我而家想轉話題去討論
08:18
how we deliver提供 health健康 information信息 in this country國家,
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我哋國家係點樣去將有關醫療信息傳達﹑
08:20
how we actually講真 get information信息.
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我哋點樣取得呢啲信息。
08:23
This is a pharmaceutical製藥 ad廣告.
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呢個係一個西藥嘅廣告。
08:26
Actually講真, it's a spoof惡搞. It's not a real真正 pharmaceutical製藥 ad廣告.
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其實呢個係一個諷刺廣告,而唔係真嘅藥品廣告。
08:28
Nobody's任何人 had the brilliant輝煌 idea想法
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到目前為止﹐未有人聰明到用
08:30
of calling their佢哋 drug藥物 HavidolHavidol quite都幾 yet尚未.
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「Havidol」為藥品命名。
08:34
But it looks睇黎 completely完全 right.
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但係佢看似完全冇問題。
08:36
So it's exactly完全 the way we get
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我哋就係以呢種方法
08:38
health健康 information信息 and pharmaceutical製藥 information信息,
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取得有關健康同藥品嘅資訊﹐
08:41
and it just sounds聽上去 perfect完美.
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而且看似非常完美。
08:43
And then we turn the page網頁 of the magazine雜誌,
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跟住我哋翻到雜誌嘅下一頁,
08:45
and we see this --
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係喇﹐我們可以見到呢個情況。
08:48
now this is the page網頁 the FDAFda requires需要 pharmaceutical製藥 companies公司
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呢一頁就係食物及藥物管制局﹐要求製藥公司
08:51
to put into their佢哋 ads廣告, or to follow遵循 their佢哋 ads廣告,
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放入廣告內或附加到廣告後面嘅說明。
08:54
and to me, this is one of the most
cynical憤世嫉俗 exercises練習 in medicine醫學.
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而對我而言,呢個動作﹐係醫學界其中一種多餘嘅動作。
08:58
Because we know.
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因為我哋知道
09:00
Who among之間 us would actually講真 say that people read this?
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在座中﹐我哋邊個真係會去睇呢些啲說明呢?
09:02
And who among之間 us would actually講真 say
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又或者在座中﹐我哋邊個真係認為
09:04
that people who do try to read this
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會有人試圖去睇呢啲說明﹐
09:06
actually講真 get anything out of it?
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而又真係從中獲益呢?
09:08
This is a bankrupt破產 effort努力
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呢個係一個完全殘缺嘅﹑
09:10
at communicating溝通 health健康 information信息.
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去企圖將醫療信息轉達嘅方法。
09:13
There is no good faith信仰 in this.
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呢種做法欠缺誠意。
09:15
So this is a different不同 approach方法.
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以下就係另外一種方法。
09:17
This is an approach方法 that has been developed開發
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係達特茅斯醫學院嘅兩位研究員
09:20
by a couple夫婦 researchers研究者 at Dartmouth達特茅斯 Medical醫療 School學校,
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想出嚟嘅辦法。
09:23
Lisa麗莎 Schwartz施瓦茨 and Steven史蒂文 WoloshinWoloshin.
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佢哋係 Lisa Schwartz 同埋 Steven Woloshin。
09:25
And they created創建 this thing called the "drug藥物 facts事實 box."
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佢哋將呢個發明稱之為藥物成分說明表。
09:28
They took inspiration靈感 from, of all things,
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有趣嘅係﹐佢哋主要係從
09:30
Cap'n船長 Crunch緊縮.
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Cap'n Crunch 取得靈感。
09:32
They went to the nutritional營養 information信息 box
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佢哋見到﹐穀類早餐上嘅營養標籤
09:35
and saw that what works工程 for cereal麥片, works工程 for our food食品,
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就如其他食物標籤一樣﹐實際上真可以有效幫助人
09:38
actually講真 helps幫手 people understand理解 what's in their佢哋 food食品.
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去瞭解自己嘅食物存有甚麼成份。
09:42
God forbid禁止 we should use that same相同 standard標準
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我哋點解未想過﹐
09:44
that we make Cap'n船長 Crunch緊縮 live by
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將 Cap'n Crunch 嘅製造標準﹐
09:46
and bring it to drug藥物 companies公司.
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帶到製藥公司﹖
09:49
So let me just walk through透過 this quickly迅速.
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請等我簡短地講解。
09:51
It says very clearly清楚 what the drug藥物 is for, specifically特別 who it is good for,
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佢會清楚說明藥物嘅用途﹐尤其是係使用對象。
09:54
so you can start初時 to personalize個性化 your understanding理解
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咁樣您就可以根據自己情況﹐
09:56
of whether係唔係 the information信息 is relevant相關 to you
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去理解究竟呢段資訊﹑
09:58
or whether係唔係 the drug藥物 is relevant相關 to you.
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又或者呢項藥物﹐是否與您相關。
10:00
You can understand理解 exactly完全 what the benefits著數 are.
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於是您就能清楚知道﹐藥物對您有乜嘢幫助。
10:03
It isn't this kind一種 of vague模糊 promise承諾 that it's going to work no matter個問題 what,
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唔再係以往一般﹑含糊地向您保證﹐藥物無論如何都一定有效﹐
10:06
but you get the statistics統計 for how effective有效 it is.
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而係透過統計數據令您知道佢點樣有效。
10:09
And finally最後, you understand理解 what those choices選擇 are.
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最後,您就會明白應該作甚麼選擇。
10:12
You can start初時 to unpack解壓 the choices選擇 involved涉及
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您可以根據副作用的情況
10:14
because of the side一邊 effects影響.
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去收窄要選擇嘅範圍。
10:16
Every time you take a drug藥物, you're walking into a possible可能 side一邊 effect影響.
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每次無論食乜嘢藥,都可能會產生副作用。
10:19
So it spells法術 those out in very clean清潔 terms條款,
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呢個模式﹐可以清晰令您瞭解佢哋。
10:21
and that works工程.
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而真係有效。
10:23
So I love this. I love that drug藥物 facts事實 box.
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所以我非常鐘意呢個辦法。呢個藥物成分說明表。
10:25
And so I was thinking思維 about,
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跟住我開始思考,
10:27
what's an opportunity機會 that I could have
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我可以利用乜嘢良機
10:29
to help people understand理解 information信息?
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去幫其他人理解呢些信息呢?
10:32
What's another另一個 latent body身體 of information信息 that's out there
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有乜嘢其他潛在嘅信息
10:36
that people are really not putting to use?
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係我哋未有善用呢﹖
10:39
And so I came up with this: lab實驗室 test測試 results結果.
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於是我想到呢個:化驗結果。
10:42
Blood test測試 results結果 are this great source of information信息.
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血液化驗報告就是這類相當有用嘅信息﹐
10:45
They're packed包裝 with information信息.
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佢哋充滿一大堆嘅資料。
10:47
They're just not for us. They're not for people. They're not for patients患者.
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只不過呢種報告唔係比我哋嘅,唔係比普通人嘅,亦唔係比病人嘅。
10:50
They go right to doctors醫生.
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只有醫生才睇得明白。
10:52
And God forbid禁止 -- I think many好多 doctors醫生, if you really asked問吓 them,
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而天知曉﹐我覺得如果你真係問到,恐怕多數醫生
10:55
they don't really understand理解 all this stuff啲嘢 either一係.
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都未必一定明白呢堆資料。
10:58
This is the worst糟糕 presented提出 information信息.
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呢類嘅信息表達實在係最差嘅。
11:01
You ask問吓 Tufte塔夫特, and he would say,
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您去問 Tufte﹐佢亦會話﹕
11:04
"Yes, this is the absolute絕對 worst糟糕 presentation表示 of information信息 possible可能."
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「係呀﹐呢種信息表達﹐實在差到極點。」
11:07
What we did at Wired有線
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喺《連線》雜誌社,
11:09
was we went, and I got our graphic圖形 design設計 department部門
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我利用我哋嘅圖表設計部
11:11
to re-imagine重新想象 these lab實驗室 reports報告.
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去重新設計呢啲化驗報告。
11:13
So that's what I want to walk you through透過.
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呢啲亦都係我想比在座各位見到嘅。
11:15
So this is the general麻麻 blood work before,
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呢份係之前見到嘅血液化驗報告,
11:18
and this is the after, this is what we came up with.
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而呢張係經過我哋重新設計之後嘅報告。
11:20
The after takes what was four pages頁面 --
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後者將原來嘅四頁紙 --
11:22
that previous以前 slide幻燈片 was actually講真
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其實上一張幻燈片
11:24
the first of four pages頁面 of data數據
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只有顯示四頁資料嘅第一頁,
11:26
that's just the general麻麻 blood work.
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而呢份只不過係巡例嘅血液化驗部告。
11:28
It goes on and on and on, all these values, all these numbers數字 you don't know.
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呢啲數值﹑您唔明白嘅數字﹐無窮無盡地繼續。
11:31
This is our one-page單頁 summary總結.
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而呢份就是我哋嘅一頁摘要。
11:34
We use the notion概念 of color顏色.
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我哋用顔色加以區分。
11:36
It's an amazing驚人 notion概念 that color顏色 could be used.
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其實用顔色作區分﹐係非常奇妙嘅概念。
11:39
So on the top-level頂層 you have your overall整體 results結果,
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於最上面一欄﹐係您報告結果嘅概況,
11:42
the things that might可能 jump out at you from the fine print打印.
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呢啲通常係字裡行間最顯眼嘅要點。
11:45
Then you can drill down
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然後你可以更詳細看下去,
11:47
and understand理解 how actually講真 we put your level水平 in context上下文,
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而實質瞭解﹐我哋點樣將資訊帶到您嘅水平。
11:50
and we use color顏色 to illustrate
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我哋通過顔色來清晰表明
11:52
exactly完全 where your value價值 falls瀑布.
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您嘅數值處於邊一個位置。
11:54
In this case情況下, this patient病人 is slightly at risk風險 of diabetes糖尿病
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呢個例子裡面﹐據葡萄糖含量可見到
11:57
because of their佢哋 glucose葡萄糖 level水平.
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呢個病人存有輕微患糖尿病嘅風險。
11:59
Likewise同樣, you can go over your lipids血脂
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同樣,您可以見到您嘅血脂含量,
12:01
and, again, understand理解 what your overall整體 cholesterol膽固醇 level水平 is
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然後瞭解您總體嘅膽固醇含量,
12:04
and then break打破 down into the HDLHdl and the LDLLdl if you so choose選擇.
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再有興趣的話﹐進一步得知高密度膽固醇及低密度膽固醇嘅程度。
12:07
But again, always using使用 color顏色
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但無論如何,都係以顔色
12:09
and personalized個性化 proximity接近
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以及個人化關聯
12:11
to that information信息.
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去表達信息。
12:13
All those other values,
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所有其他嘅數值,
12:15
all those pages頁面 and pages頁面 of values that are full of nothing,
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所有果啲無止境嘅一大堆數值,根本毫無意義﹐
12:17
we summarize總結.
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而我哋將佢哋簡化。
12:19
We tell you that you're okay, you're normal正常.
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我哋會比您知道你情況唔錯﹑一切正常。
12:21
But you don't have to wade韋德 through透過 it. You don't have to go through透過 the junk垃圾.
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而您無須喺數字堆之中尋覓﹑無須理會雜亂﹑無意義嘅信息。
12:24
And then we do two other very important重要 things
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根住我哋還會做兩件非常重要嘅事,
12:26
that kind一種 of help fill填補 in this feedback反饋 loop:
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去填補呢個反饋循環存在嘅空隙。
12:28
we help people understand理解 in a little more detail詳細
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我哋令人明白一點更多嘅細節,
12:30
what these values are and what they might可能 indicate表明.
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也即是呢啲數值代表甚麼﹑可能表明甚麼。
12:33
And then we go a further進一步 step -- we tell them what they can do.
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然後我哋更進一步﹕話比病人知道佢哋可以做甚麼。
12:36
We give them some insight洞察力
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我哋會幫佢哋洞悉
12:38
into what choices選擇 they can make, what actions行動 they can take.
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從而更有效作出選擇﹑採取行動。
12:41
So that's our general麻麻 blood work test測試.
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呢份就係我哋嘅基本血液報告。
12:44
Then we went to CRPCrp test測試.
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跟住我哋再來睇一份C反應蛋白測試。
12:46
In this case情況下, it's a sin of omission.
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今次就係一個嚴重缺失嘅例子。
12:48
They have this huge巨大 amount of space空間,
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呢度上面有一大片空白,
12:50
and they don't use it for anything, so we do.
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既然佢哋冇善用,我哋就嚟將空白加以利用。
12:52
Now the CRPCrp test測試 is often經常 done
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目前﹐C反應蛋白測試通常
12:54
following以下 a cholesterol膽固醇 test測試,
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都用作跟進膽固醇測試,
12:56
or in conjunction連接 with a cholesterol膽固醇 test測試.
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或者與膽固醇測試一齊進行。
12:58
So we take the bold大膽 step
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因此我們大膽地
13:00
of putting the cholesterol膽固醇 information信息 on the same相同 page網頁,
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將膽固醇測試結果放於在同一頁上面,
13:03
which is the way the doctor醫生 is going to evaluate評價 it.
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因為醫生亦都係咁樣用資料作診斷。
13:05
So we thought the patient病人 might可能 actually講真 want to know the context上下文 as well.
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所以我哋都覺得﹐病人亦都或者想知道有關來龍去脈。
13:08
It's a protein蛋白 that shows顯示 up
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呢個係當您血管有炎症嘅時候,
13:10
when your blood vessels船隻 might可能 be inflamed發炎,
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一種會被驗出來嘅蛋白質,
13:12
which might可能 be a risk風險 for heart disease疾病.
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亦可能係存有患心臟病風險嘅反映。
13:14
What you're actually講真 measuring測量
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我哋用易明瞭嘅語言
13:16
is spelled拼寫 out in clean清潔 language語言.
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去顯示報告上嘅信息。
13:18
Then we use the information信息
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然後我哋用上
13:20
that's already in the lab實驗室 report報告.
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化驗報告裡頭已存有嘅資訊。
13:22
We use the person's人嘅 age年齡 and their佢哋 gender性別
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我哋以病人嘅年齡﹑性別
13:24
to start初時 to fill填補 in the personalized個性化 risks風險.
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去將佢哋嘅風險作出個人化嘅評估。
13:27
So we start初時 to use the data數據 we have
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我哋用手上掌握嘅数據
13:29
to run運行 a very simple簡單 calculation計算
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進行一個非常簡單嘅計算,
13:31
that's on all sorts各種 of online在線 calculators計算機
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網上已經有各式各樣類似嘅計算器﹐
13:33
to get a sense of what the actual實際 risk風險 is.
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從而對實際風險作出預測。
13:36
The last one I'll show顯示 you is a PSAPsa test測試.
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最後我展示嘅﹐係前列腺特異性抗原測試。
13:38
Here's呢度有 the before, and here's呢度有 the after.
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呢份係修改之前嘅﹑呢份係修改之後嘅。
13:41
Now a lot of our effort努力 on this one --
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我哋喺呢一份化驗報告上﹐下咗好大功夫 --
13:43
as many好多 of you probably可能 know,
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大概好多人都知道
13:45
a PSAPsa test測試 is a very controversial爭議 test測試.
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前列腺特異性抗原測試﹐係一項具有極度爭議嘅測試。
13:47
It's used to test測試 for prostate前列腺 cancer癌症,
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佢係用來檢測病人是否患有前列腺癌﹐
13:49
but there are all sorts各種 of reasons原因
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但實際上有各種原因
13:51
why your prostate前列腺 might可能 be enlarged擴大.
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會導致前列腺腫脹。
13:53
And so we spent a good deal交易 of our time
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因此我哋花咗好多時間
13:55
indicating指示 that.
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去指出呢一點。
13:57
We again personalized個性化 the risks風險.
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同樣我哋會根據個人情況﹐去評估風險。
13:59
So this patient病人 is in their佢哋 50s,
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例如呢位病人50幾歲﹐
14:01
so we can actually講真 give them a very precise精確 estimate估計
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我哋就能夠精確估計到
14:03
of what their佢哋 risk風險 for prostate前列腺 cancer癌症 is.
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佢患前列腺癌嘅風險。
14:05
In this case情況下 it's about 25 percent百分比, based基於 on that.
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根據計算,呢個病例嘅風險大概係百分之二十五。
14:08
And then again, the follow-up後續行動 actions行動.
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然後又係要採取嘅對策。
14:11
So our cost成本 for this was less than 10,000 dollars美元, all right.
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我哋做這項工作嘅成本少於一萬美元。
14:14
That's what Wired有線 magazine雜誌 spent on this.
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呢個數目就係《連線》雜誌於呢方面所花嘅成本。
14:17
Why is Wired有線 magazine雜誌 doing this?
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點解《連線》雜誌要做呢項工作呢?
14:19
(Laughter笑聲)
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(笑聲)
14:22
Quest追求 Diagnostics診斷 and LabCorpLabCorp,
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Quest Diagnostics 以及 LabCorp﹐
14:24
the two largest最大 lab實驗室 testing測試 companies公司 --
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兩間最大規模嘅化驗公司
14:27
last year, they made作出 profits利潤 of over 700 million dollars美元
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去年,佢哋分別賺得超過7億
14:30
and over 500 million dollars美元 respectively分别.
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以及5億美元。
14:33
Now this is not a problem個問題 of resources資源;
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咁樣睇嚟﹐呢個根本唔係資源嘅問題,
14:35
this is a problem個問題 of incentives激勵.
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而係動機嘅問題。
14:38
We need to recognize認識 that the target目標 of this information信息
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我哋要認清楚﹐呢啲信息嘅目標
14:41
should not be the doctor醫生, should not be the insurance保險 company公司.
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並唔應該係醫生,亦唔應該係保險公司,
14:44
It should be the patient病人.
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而應該係病人。
14:46
It's the person who actually講真, in the end結束,
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最後始終都係病人本身﹐
14:48
is going to be having to change their佢哋 lives生活
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要去為自己嘅人生作出改變﹐
14:50
and then start初時 adopting採用 new新增功能 behaviors行為.
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而開始去養成新嘅行為習慣。
14:52
This is information信息 that is incredibly令人難以置信 powerful強大.
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呢啲係具有無窮力量嘅信息。
14:54
It's an incredibly令人難以置信 powerful強大 catalyst催化劑 to change.
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係能促使人類改變嘅強力催化劑。
14:57
But we're not using使用 it. It's just sitting there.
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佢近在咫尺,但係我哋一直冇去將佢善用。
14:59
It's being lost失去.
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佢不斷流失。
15:01
So I want to just offer提供 four questions個問題
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所以我只想提出四個問題
15:03
that every patient病人 should ask問吓,
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每個病人都應該要問呢啲問題
15:05
because I don't actually講真 expect期望 people
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因為我冇指望有人真的會
15:07
to start初時 developing發展 these lab實驗室 test測試 reports報告.
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實質地去製造呢類化驗報告。
15:09
But you can create創建 your own自己 feedback反饋 loop.
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但係您可以創造屬於自己嘅反饋環。
15:11
Anybody任何人 can create創建 their佢哋 feedback反饋 loop by asking問吓 these simple簡單 questions個問題:
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任何人都可以透過問以下幾個簡單嘅問題﹐來創造自己嘅反饋環:
15:14
Can I have my results結果?
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我可以取回我嘅測試結果嗎?
15:16
And the only acceptable可以接受 answer回答 is --
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而呢個問題只能有一個可接受嘅答案,就係 ——
15:18
(Audience觀眾: Yes.) -- yes.
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(觀眾:可以)—— 可以。
15:20
What does this mean? Help me understand理解 what the data數據 is.
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呢份報告說明乜嘢﹖請幫我理解呢啲數據代表乜嘢。
15:22
What are my options選項? What choices選擇 are now on the table?
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我有邊啲選擇?邊啲做法係可行?
15:25
And then, what's next?
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然後又點樣﹖
15:27
How do I integrate整合 this information信息
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於未來嘅日子﹐我點樣可以將呢啲資料
15:29
into the longer course課程 of my life?
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運用於生活當中﹖
15:32
So I want to wind up by just showing顯示
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結束之前﹐我想令大家知道,
15:34
that people have the capacity能力 to understand理解 this information信息.
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每個人都有能力去理解呢啲信息。
15:36
This is not beyond超越 the grasp把握 of ordinary普通 people.
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呢個並非超出普通人可理解嘅範圍。
15:39
You do not need to have the education教育 level水平 of people in this room間房.
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無須擁有像在座各位嘅教育程度,
15:42
Ordinary普通 people are capable可以 of understanding理解 this information信息,
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普通人已經可以理解呢啲信息,
15:45
if we only go to the effort努力 of presenting提出 it to them
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只要我哋願意為信息嘅表達方面努力,
15:48
in a form形式 that they can engage從事 with.
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做到可以容許病人參與嘅模式。
15:50
And engagement訂婚 is essential基本 here,
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喺呢度﹐參與係關鍵因素,
15:52
because it's not just giving them information信息;
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因為不單止關乎向病人提供信息﹐
15:54
it's giving them an opportunity機會 to act行為.
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更重要嘅係比佢哋行動嘅機會。
15:56
That's what engagement訂婚 is. It's different不同 from compliance合規.
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呢個就係參與嘅意義﹔與服從唔同。
15:58
It works工程 totally完全 different不同 from the way we talk about behavior行為
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呢個同我哋所討論有關現今醫學界嘅行為﹐
16:01
in medicine醫學 today今日.
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完全唔同。
16:03
And this information信息 is out there.
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而呢啲信息就在眼前。
16:05
I've been talking講嘢 today今日 about latent information信息,
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我今日一直講及潛在嘅信息,
16:07
all this information信息 that exists存在 in the system系統
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呢啲信息存在於呢個體系之中,
16:09
that we're not putting to use.
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而我們卻未有加以利用。
16:11
But there are all sorts各種 of other bodies機構 of information信息
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但仍有大量各種其他信息
16:13
that are coming online在線,
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正逐漸可於網上取得。
16:15
and we need to recognize認識 the capacity能力 of this information信息
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我哋需要認清楚呢啲信息嘅力量,
16:18
to engage從事 people, to help people
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去吸引人去參與﹑去幫助人,
16:20
and to change the course課程 of their佢哋 lives生活.
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而且去改變佢哋嘅生命路程。
16:22
Thank you very much.
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多謝大家。
16:24
(Applause掌聲)
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(掌聲)
Translated by Vikki Leung
Reviewed by Chitmin Ng

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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