Jenna C. Lester: Why skin disease is often misdiagnosed in darker skin tones | TED

翻译人员: Xinlin Liu 校对人员: Yip Yan Yeung

皮肤是人体最大的器官，

也是预警健康最有力的器官之一。

莱姆病的主要病征 便是这种游走性红斑，

The skin is the human body's largest organ

这是一种在 80 多个 国家都出现的蜱媒病，

and one of the most powerful predictors of our health.

每年预计影响 476000 名美国人。

This is erythema migrans, a hallmark feature of Lyme disease,

a tick-borne illness present in over 80 countries

像我一样的皮肤科医生，

and estimated to affect 476,000 people in the United States each year.

接受训练以诊断和治疗皮肤病。

教科书里的游走性红斑是这样的，

Dermatologists like me are doctors of the skin

似靶心一样的皮疹，或红或粉，

trained to diagnose and treat skin disease.

And this is how we're trained to see erythema migrans,

但是游走性红斑在 深色皮肤上根本不是这样的。

as a bullseye-shaped rash that ranges from red to pink.

如你所见，

可能是紫色的、 品红色、甚至是深棕色。

But this is not at all what it looks like in dark skin.

如果我们只靠教科书

As you can see here,

来教我们如何判断皮肤病，

there are hues of violet, of magenta, and even dark brown.

诊疗有色人种病患时 就会误诊频发。

If we were to rely only on dermatology textbooks

而这也是一个大问题， 因为莱姆病需要得到治疗，

to teach us how to identify skin disease,

we would frequently misdiagnose it in patients of color.

如果不治疗的话， 莱姆病会带来严重的后果。

And this is a huge problem because Lyme disease needs to be treated.

包括关节炎，甚至是神经损伤。

Left untreated, Lyme disease has significant health ramifications

更甚的是，

随着莱姆病发病率的增加，

including arthritis and even nerve damage.

这一现象部分归因于气候变化，

And what's more,

随着我们继续看到 和感受到气候变化的影响，

as we've seen an increase in the incidence of Lyme disease,

a phenomenon attributed in part to climate change,

我们可能会看到 更多的人感染莱姆病，

能够准确地诊断它 就变得更重要了。

as we continue to see and experience the effects of climate change,

现在，这个游走性红斑的故事 象征着一个更大的问题。

we may see more people infected with Lyme disease,

making it even more important that we're able to accurately diagnose it.

在美国，47% 的皮肤科毕业生

Now, this story of erythema migrans is emblematic of a larger issue.

报告在诊断深色皮肤患者的 皮肤病时感到不适。

In the United States, 47 percent of graduating dermatology residents

47%。我想让大家花一点 时间好好理解一下。

report feeling uncomfortable diagnosing skin disease in patients with dark skin.

这是一个惊人的数字，

这意味着那些刚刚经历过

47 percent. I just want that to sink in for a second.

最密集的训练， 要成为皮肤科医生的毕业生，

对诊断和治疗所有 类型的患者感到不适。

This is a staggering statistic,

and this means that the people who have just undergone

即便如此，他们 还是从实习中毕业，

their most intensive training to become doctors of the skin

他们有资格成为委员会 认证的皮肤科医生，

don't feel comfortable diagnosing and treating all patients.

有资格去照顾所有类型的人。

And even so, they graduate from residency,

现在，我在想， 这会是我们仍然看到、在经历

and they're eligible to become board-certified dermatologists,

医疗保健差异的原因吗？

qualified to care for all people.

不论是在皮肤科， 还是在医学的各方面。

Now, I wonder, could this be why we still see and experience

我相信这两个事实之间有联系，

几乎一半的皮肤科住院医师

health care disparities in all aspects of medicine,

在诊断和治疗某些 患者时感到不适，

including dermatology?

I believe there's a connection between the fact

这些患者的健康状况也较差。

that almost half of dermatology residents

feel uncomfortable diagnosing and treating certain patients

我总是和有色人种的患者谈话，

他们表达了他们意识到

and the poorer health outcomes of those same patients.

他们的皮肤科医生

对在他们肤色的人群中 确诊皮肤病不熟悉。

I speak to patients of color all the time

或者在教他们如何护理头发 或头皮时让他们感到不适。

who express an awareness of the fact

that their dermatologist is unfamiliar

with diagnosing skin disease in their skin tone

我想知道，你意识到你的 医生对你感到不适，

or uncomfortable teaching them how to care for their hair or scalp.

会对医患关系、

对医疗机构的信任、

And I wonder, what does this awareness that your doctor is uncomfortable with you

或者来复诊接受额外护理的 可能性造成什么影响？

due to the physician-patient relationship;

皮肤科中的一个问题是，

to trust in the medical establishment;

我们没有教皮肤病是 如何在所有肤色中出现的。

or to the likelihood that someone returns for additional care?

作为一个医学生， 我和我的同学很快意识到，

我们只有在学习梅毒的时候 才会看见深色皮肤。

A problem in dermatology is

that we're not taught how skin disease appears in all skin tones.

这一观察得到了 我已发表研究的支持，

As a medical student, my classmates and I quickly realized

于 2019 年发表在 《英国皮肤病学杂志》上。

that we only saw dark skin when we were learning about syphilis.

研究显示，深色皮肤在性传播 疾病的章节中出现比例过高。

And this observation is supported by research that I published

in the British Journal of Dermatology in 2019

然而在同一本书中，这些肤色 在其他章节中出现比例会很低。

that shows an overrepresentation of dark skin in chapters

focused on sexually transmitted infections,

这对易受影响的 学习者有什么影响？

even while those same skin tones are underrepresented elsewhere

这会不会让他们觉得深色皮肤的人

是否更有可能感染性病？

in the same textbook.

What does this do to impressionable learners?

我知道你们有些人可能在想，

Does it make them think that someone with dark skin

我知道一种算法可以解决这个 问题，或者用机器学习来解决。

is more likely to have a sexually transmitted infection?

我稍稍表示不同意。

Now, I know some of you may be thinking,

这是因为这些算法学习的数据

I know an algorithm that can solve this or machine learning to the rescue.

是同一批在某些皮肤病中 深色皮肤比例过高的照片，

And I'm here to gently disagree.

即使在其他病中 深色皮肤比例过少。

And that's because the data from which these algorithms learn

换而言之，这些算法 会和我们一样存有偏见。

are the same photos that overrepresent dark skin

in certain skin conditions,

除非我们做出重大改变。

even while underrepresenting them in others.

我在加利福尼亚大学旧金山分校 启动了“肤色”项目，

In other words, these algorithms will be as biased as we are

我与医学院学生 和住院医生一起工作

unless we make significant change.

努力帮助他们摆脱 这些有害的模式，

I started the Skin of Color program

at the University of California, San Francisco,

比如让他们更容易看清 深色皮肤患有梅毒，

where I work with medical students and residents

却难以看出深色皮肤 患有游走性红斑。

in an effort to begin to help them unlearn some of these harmful patterns

我教所有的东西， 从如何识别深色皮肤的炎症

that make it easier to see some things,

like dark skin with syphilis,

and harder to see others, like dark skin with erythema migrans.

到如何与黑人女性 谈论她的头发护理。

还有一个我总是要提到的重要事实

I teach everything from how to identify inflammation in dark skin

就是对于黑人女性来说

to how to talk to a Black woman about her hair care practices.

每天洗头既不有益也不寻常。

所以任何与头发 和头皮有关的治疗方案，

And one important fact that I always make sure to mention

is that it's neither good nor common

都需要展现出这个重要的理解。

for Black women to wash their hair every day.

我在“肤色”项目中的工作，

And any treatment regimen

以及我在这个国家 其他相似项目中的工作，

focused on taking care of the hair and scalp

should reflect this important understanding.

展示创造专门教育环境的重要性

My work at the Skin of Color program,

as well as the work of similar programs across the country,

来让住院医师和医学生 学习皮肤病的全范围知识，

demonstrate the importance of creating a dedicated educational environment

无论肤色如何，它们都会 出现在所有患者身上。

for residents and medical students to learn the full spectrum of skin disease

这是重要的第一步，

是在消除皮肤科医疗保健差异 漫长道路上的第一步。

as they appear in all patients, regardless of skin tone.

但是，让我们致力于 在这条道路上携手共进。

This is an important first step

谢谢。

（掌声）

on a long road towards eliminating health care disparities in dermatology.

But let's commit to taking this journey together.

Thank you.

(Applause)