Thomas Goetz: It's time to redesign medical data

翻译人员: Lili Liang 校对人员: Xinxin Li

I'm going to be talking to you

我准备和大家探讨

about how we can tap

我们如何

a really underutilized resource in health care,

开发一种没有得到有效利用的医疗资源，

which is the patient,

那就是病人，

or, as I like to use the scientific term,

或者，用一个更专业的术语来说--

people.

人。

Because we are all patients, we are all people.

我们都是病人，我们也都是人。

Even doctors are patients at some point.

就连医生有时候也可能成为病人。

So I want to talk about that

我想借此机会

as an opportunity

告诉大家

that we really have failed to engage with very well in this country

在这个国家，我们一直没有很好地配合治疗

and, in fact, worldwide.

事实上，全世界都是如此。

If you want to get at the big part --

如果你从全局来看--

I mean from a public health level, where my training is --

也就是从公共卫生高度来看，这是我的专业--

you're looking at behavioral issues.

这其实是行为问题，

You're looking at things where people are actually given information,

是人们得到相关信息，

and they're not following through with it.

却没有完全按照这些信息行事。

It's a problem that manifests itself in diabetes,

这个问题反应在糖尿病，

obesity, many forms of heart disease,

肥胖症，各种心脏疾病，

even some forms of cancer -- when you think of smoking.

甚至某些癌症--如果人吸烟的话。

Those are all behaviors where people know what they're supposed to do.

对于这些，人们都知道他们应该怎么做才是对的。

They know what they're supposed to be doing,

但是，尽管他们知道哪些事情该做，

but they're not doing it.

他们就是不去做。

Now behavior change is something

行为上的改变

that is a long-standing problem in medicine.

是医学上的一个顽固问题。

It goes all the way back to Aristotle.

这可以追溯到亚里士多德的时代。

And doctors hate it, right?

医生们对此深恶痛绝。

I mean, they complain about it all the time.

他们总是为此而抱怨。

We talk about it in terms of engagement, or non-compliance.

他们把如下行为归为不配合治疗。

When people don't take their pills,

有些人不按要求吃药，

when people don't follow doctors' orders --

有些人不听从医嘱。

these are behavior problems.

这些都是行为问题。

But for as much as clinical medicine

但是尽管临床医学

agonizes over behavior change,

对病人的行为怨声载道，

there's not a lot of work done

却并没有拿出实际行动

in terms of trying to fix that problem.

来解决这个问题。

So the crux of it

问题的关键

comes down to this notion of decision-making --

在于如何帮助人们做出正确决定--

giving information to people in a form

给病人一张显示信息的表格，

that doesn't just educate them

这张表格不仅教育

or inform them,

或告知病人应该做什么，

but actually leads them to make better decisions,

而应引导人们在生活中作出更好的决定

better choices in their lives.

和更好的选择。

One part of medicine, though,

然而，有一个医学的领域

has faced the problem of behavior change pretty well,

在行为改变方面颇有建树。

and that's dentistry.

那就是牙科。

Dentistry might seem -- and I think it is --

牙科虽然看起来--个人意见--

many dentists would have to acknowledge

许多牙医可能会认为

it's somewhat of a mundane backwater of medicine.

牙科是医学中最没有发展前景的分支。

Not a lot of cool, sexy stuff happening in dentistry.

牙科领域没有太多新奇有趣的事情发生。

But they have really taken this problem of behavior change

但是，牙科却很好地解决了

and solved it.

行为改变这个问题。

It's the one great preventive health success

这是医疗系统中

we have in our health care system.

我们在预防方面所取得的重大成功。

People brush and floss their teeth.

人人都刷牙，使用牙线。

They don't do it as much as they should, but they do it.

他们虽然做得还不够多，但至少他们做了。

So I'm going to talk about one experiment

我下面会介绍一些牙科医生三十年前

that a few dentists in Connecticut

在康涅狄格州

cooked up about 30 years ago.

所做的一个试验。

So this is an old experiment, but it's a really good one,

这个试验有一定年头了，但却是一个非常棒的试验，

because it was very simple,

这个试验很简单，

so it's an easy story to tell.

所以故事很简短。

So these Connecticut dentists decided

康涅狄格州的这些牙医决定

that they wanted to get people to brush their teeth and floss their teeth more often,

他们要让人们更加勤刷牙勤用牙线。

and they were going to use one variable:

他们打算使用一个变量：

they wanted to scare them.

他们想吓唬人们。

They wanted to tell them how bad it would be

他们想告诉人们

if they didn't brush and floss their teeth.

如果不刷牙不用牙线，会有什么样的后果。

They had a big patient population.

他们的病人很多。

They divided them up into two groups.

他们这些病人分成两组。

They had a low-fear population,

一组是低恐惧人群，

where they basically gave them a 13-minute presentation,

他们给这些人做了一个十三分钟的演示，

all based in science,

完全依照科学事实进行，

but told them that, if you didn't brush and floss your teeth,

但是，对他们说，如果你不刷牙，用牙线，

you could get gum disease. If you get gum disease, you will lose your teeth,

你就会得牙龈疾病。如果你的牙龈除了毛病，你的牙齿就会脱落，

but you'll get dentures, and it won't be that bad.

但是，如果你安了假牙，问题就不大。

So that was the low-fear group.

这是针对低恐惧群体的做法。

The high-fear group, they laid it on really thick.

而对高恐惧群体，他们可下了狠药。

They showed bloody gums.

他们给这些人展示血淋淋的牙龈，

They showed puss oozing out from between their teeth.

让他们看牙齿间淤出来的脓，

They told them that their teeth were going to fall out.

告诉他们，他们的牙齿很快就会脱落，

They said that they could have infections

他们会得炎症

that would spread from their jaws to other parts of their bodies,

并且炎症会从空腔扩散到其它身体部位，

and ultimately, yes, they would lose their teeth.

最后，当然，他们会失去自己的牙齿。

They would get dentures, and if you got dentures,

他们不得不使用假牙，如果你装了假牙，

you weren't going to be able to eat corn-on-the-cob,

你不能啃玉米棒，

you weren't going to be able to eat apples,

不能咬苹果，

you weren't going to be able to eat steak.

不能吃牛排；

You'll eat mush for the rest of your life.

在你的下半生里你只能吃糊状物

So go brush and floss your teeth.

还不赶快刷牙，用牙线。

That was the message. That was the experiment.

这就是其中的信息；这个试验就是这样的。

Now they measured one other variable.

接着他们测量了另一个变量。

They wanted to capture one other variable,

他们想测试这个变量是否起作用，

which was the patients' sense of efficacy.

那就是病人的自我效能感。

This was the notion of whether the patients felt

这是病人是否认为自己

that they actually would go ahead and brush and floss their teeth.

会去刷牙和使用牙线的观念。

So they asked them at the beginning,

在一开始，他们问病人，

"Do you think you'll actually be able to stick with this program?"

“你认为你会坚持照做吗？”

And the people who said, "Yeah, yeah. I'm pretty good about that,"

那些说“是的，是的，我会好好做的，”的人

they were characterized as high efficacy,

属于为高效能感人群。

and the people who said,

而那些说

"Eh, I never get around to brushing and flossing as much as I should,"

“呃，我平时刷牙或用牙线都不够勤，”的人

they were characterized as low efficacy.

属于低效能感人群。

So the upshot was this.

这是结果。

The upshot of this experiment

试验的结果是

was that fear was not really a primary driver

恐惧并不是控制行为的

of the behavior at all.

主要动力。

The people who brushed and flossed their teeth

那些勤刷牙，用牙线的人，

were not necessarily the people

并不一定是

who were really scared about what would happen --

那些害怕不良后果的人--

it's the people who simply felt that they had the capacity

他们是那些认为自己

to change their behavior.

有能力改变自己行为的人。

So fear showed up as not really the driver.

恐惧原来不是动因；

It was the sense of efficacy.

应该是自我感觉。

So I want to isolate this,

我想重点指出这个结果，

because it was a great observation --

应为这是非常有用的发现--

30 years ago, right, 30 years ago --

三十年前，对，三十前--

and it's one that's laid fallow in research.

这是当时尚未被研究的课题。

It was a notion that really came out

这实际上是从阿尔伯特. 班杜拉的研究中

of Albert Bandura's work,

引申出来的一个概念，

who studied whether

他研究了

people could get a sense of empowerment.

人们是否会产生一种成就感。

The notion of efficacy basically boils down to one -- that

效能感的信念最终归结到一点：

if somebody believes that they have the capacity to change their behavior.

一个人是否相信他有能力改变自己的行为。

In health care terms, you could characterize this

从医疗保健的角度看，可以这样描述这个信念：

as whether or not somebody feels

一个人是否感觉

that they see a path towards better health,

他看到更好的健康状况的前景，

that they can actually see their way towards getting better health,

看到自己的健康状况能够日渐转好。

and that's a very important notion.

这是个非常重要的信念。

It's an amazing notion.

非常奇妙的信念。

We don't really know how to manipulate it, though, that well.

然而，我们还不知道怎样自如地控制这个信念。

Except, maybe we do.

或许，我们知道。

So fear doesn't work, right? Fear doesn't work.

恐惧是不起作用的，对，恐惧不起作用。

And this is a great example

这里有一个很好的例子，

of how we haven't learned that lesson at all.

证明了我们有多么不知悔改。

This is a campaign from the American Diabetes Association.

这是美国糖尿病协会的一次活动。

This is still the way we're communicating messages about health.

这仍然是我们传递保健信息的方式。

I mean, I showed my three-year-old this slide last night,

我昨晚给我三岁的儿子看了这张幻灯片，

and he's like, "Papa, why is an ambulance in these people's homes?"

他问：“爸爸，为什么这些人把救护车停在家里啊？”

And I had to explain, "They're trying to scare people."

我只能解释道：“他们想吓唬人。”

And I don't know if it works.

我不确定这么做是否起作用。

Now here's what does work:

而这才是起作用的做法，

personalized information works.

那就是个人化信息。

Again, Bandura recognized this

又是班杜拉，

years ago, decades ago.

他在几年前，甚至几十年前认识到了这一点。

When you give people specific information

当你给人们提供

about their health, where they stand,

关于他们健康状况的具体信息，他们的目前的病情，

and where they want to get to, where they might get to,

以及他们预期的进展，他们可能的进展，

that path, that notion of a path --

这个过程，对此过程的信念，

that tends to work for behavior change.

会改变病人的行为。

So let me just spool it out a little bit.

我来解释一下。

So you start with personalized data, personalized information

你得到一个病人的个人数据，

that comes from an individual,

个人信息之后，

and then you need to connect it to their lives.

你必须把它与病人的生活联系起来。

You need to connect it to their lives,

你需要通过让他们了解这些信息

hopefully not in a fear-based way, but one that they understand.

来把信息与他们的生活联系起来，而不是吓唬他们。

Okay, I know where I sit. I know where I'm situated.

好，我知道我的病情。

And that doesn't just work for me in terms of abstract numbers --

那些抽象的数字，

this overload of health information

还有摆在面前的

that we're inundated with.

那一大堆健康信息让我摸不着头脑，

But it actually hits home.

但这对我影响巨大。

It's not just hitting us in our heads; it's hitting us in our hearts.

这些信息不仅进入我们的头脑，还影响到我们的心理。

There's an emotional connection to information

我们对这些信息有不解的情结，

because it's from us.

因为这是关于我们自己的信息。

That information then needs to be connected to choices,

接着我们要把信息与人们的选择，

needs to be connected to a range of options,

选择的范围，

directions that we might go to --

以及方向联系起来--

trade-offs, benefits.

其中有哪些利弊。

Finally, we need to be presented with a clear point of action.

最后，我们要清楚明了地告知人们他们应采取什么行动。

We need to connect the information

我们必须时刻把信息与行动

always with the action,

联系起来，

and then that action feeds back

行动会产生反馈，

into different information,

从而得到新的信息，

and it creates, of course, a feedback loop.

周而复始，形成一个反馈圈。

Now this is a very well-observed and well-established notion

实践证实，这个信念对于改变行为

for behavior change.

十分可靠。

But the problem is that things -- in the upper-right corner there --

然而，问题是，右上角的

personalized data, it's been pretty hard to come by.

个人数据，往往很难得到。

It's a difficult and expensive commodity,

得到个人数据可谓困难重重，而且要花不少钱。

until now.

直到现在。

So I'm going to give you an example, a very simple example of how this works.

我接下来要给大家看一个例子，这个简单的例子展示我们如何得到个人数据。

So we've all seen these. These are the "your speed limit" signs.

我们都见过这些标示牌，这些是限速牌。

You've seen them all around,

我们随处都能看到这些牌子，

especially these days as radars are cheaper.

尤其在雷达价格越发便宜的现在。

And here's how they work in the feedback loop.

它们在反馈圈中是这样起作用的。

So you start with the personalized data

一开始是个性化数据，

where the speed limit on the road that you are at that point

此时你所在公路的限速

is 25,

是25，

and, of course, you're going faster than that.

当然你有些超速了。

We always are. We're always going above the speed limit.

我们总是超速的。

The choice in this case is pretty simple.

在此情况下我们只有两种选择。

We either keep going fast, or we slow down.

我们要么保持原速，要么减速。

We should probably slow down,

我们或许应该减速，

and that point of action is probably now.

那么，现在就行动。

We should take our foot off the pedal right now,

我们应该马上放松油门。

and generally we do. These things are shown to be pretty effective

我们一般都会这么做；这些限速牌非常有效地

in terms of getting people to slow down.

提醒了人们要减速。

They reduce speeds by about five to 10 percent.

他们将速度降低了百分之十。

They last for about five miles,

并且减速能坚持五英里路程，

in which case we put our foot back on the pedal.

接着我们才会再次踩油门。

But it works, and it even has some health repercussions.

但在还是起作用了，甚至还有益于身心健康。

Your blood pressure might drop a little bit.

你的血压可能没那么高了。

Maybe there's fewer accidents, so there's public health benefits.

可能交通事故减少了，造福了公众健康。

But by and large, this is a feedback loop

但是，总的来看，这是个

that's so nifty and too rare.

难得的一流反馈圈。

Because in health care, most health care,

因为在医疗保健方面，大多数情况下，

the data is very removed from the action.

数据与行动相互分离。

It's very difficult to line things up so neatly.

很难把事情理得那么顺。

But we have an opportunity.

但是我们有一线希望。

So I want to talk about, I want to shift now to think about

我想将话题转移，来探讨

how we deliver health information in this country,

在我国，我们如何传递健康信息，

how we actually get information.

以及我们如何获取信息。

This is a pharmaceutical ad.

这是一个药品广告。

Actually, it's a spoof. It's not a real pharmaceutical ad.

这实际上是在耍花腔；而不是真正的药品广告。

Nobody's had the brilliant idea

还没有人聪明到用”Havidol“

of calling their drug Havidol quite yet.

来给药品命名的。

But it looks completely right.

但是它看起来完全没问题。

So it's exactly the way we get

这就是我们

health information and pharmaceutical information,

得到健康信息和药品信息的方式，

and it just sounds perfect.

看上去完美无缺。

And then we turn the page of the magazine,

当翻开杂志，

and we see this --

我们看到这样一页，对吧。

now this is the page the FDA requires pharmaceutical companies

食品及药物管理局要求制药公司

to put into their ads, or to follow their ads,

把这一页放进他们广告中，或加在广告后面。

and to me, this is one of the most cynical exercises in medicine.

对于我而言，这是医学界一大倍受诟病的做法。

Because we know.

因为我们知道，

Who among us would actually say that people read this?

我们中间有谁认为人们会读这一页？

And who among us would actually say

有谁认为

that people who do try to read this

那些读了这一页的人

actually get anything out of it?

能够得到任何有用信息？

This is a bankrupt effort

这是医疗信息沟通的

at communicating health information.

昏庸之举。

There is no good faith in this.

没有人会买账。

So this is a different approach.

而这是另一种方式。

This is an approach that has been developed

这种方式是由

by a couple researchers at Dartmouth Medical School,

达特茅斯医学院的几位研究人员所开发。

Lisa Schwartz and Steven Woloshin.

他们是莉莎. 史沃兹和史蒂芬. 沃罗森。

And they created this thing called the "drug facts box."

他们的这个发明叫做药物成分说明表。

They took inspiration from, of all things,

出乎人意料的是，他们的灵感来自

Cap'n Crunch.

Cap‘n Crunch麦片。

They went to the nutritional information box

他们看到上面的营养成分介绍，

and saw that what works for cereal, works for our food,

并意识到麦片，食物的成分介绍，

actually helps people understand what's in their food.

实际上有助于人们了解他们食物中有哪些成分。

God forbid we should use that same standard

我们怎么就没想到，

that we make Cap'n Crunch live by

可以把Cap'n Crunch麦片的成分介绍模式

and bring it to drug companies.

推广到制药公司。

So let me just walk through this quickly.

我快速给大家展示一下。

It says very clearly what the drug is for, specifically who it is good for,

它清清楚楚地说明了该药的用途，使用对象，

so you can start to personalize your understanding

这样你就可以对号入座，

of whether the information is relevant to you

看上面的信息是否与你的情况相符，

or whether the drug is relevant to you.

这药是否适合你服用。

You can understand exactly what the benefits are.

你能够清楚地了解服药之后会有哪些好处。

It isn't this kind of vague promise that it's going to work no matter what,

它并没有含糊地承诺，无论怎样都能药到病除，

but you get the statistics for how effective it is.

但是你可以通过数据来了解药的效果。

And finally, you understand what those choices are.

最后，你明确了自己有哪些选择。

You can start to unpack the choices involved

你可以开始挑拣有关的选择，

because of the side effects.

因为你要考虑到药的副作用。

Every time you take a drug, you're walking into a possible side effect.

每一次吃药，你都有可能面临某种副作用。

So it spells those out in very clean terms,

它明明白白地列出了可能的副作用。

and that works.

这很管用。

So I love this. I love that drug facts box.

我特别喜欢这个药物说明表。

And so I was thinking about,

于是，我在思考，

what's an opportunity that I could have

我怎样才能

to help people understand information?

帮助人们理解信息呢？

What's another latent body of information that's out there

还有哪个未被充分理解的信息源

that people are really not putting to use?

让人们无所适从呢？

And so I came up with this: lab test results.

于是，我想到了这个：实验室检测结果。

Blood test results are this great source of information.

这一大堆信息是血液检测的结果。

They're packed with information.

上面满满的都是信息。

They're just not for us. They're not for people. They're not for patients.

这不是给我们看的；不是给人们看的；不是给病人看的。

They go right to doctors.

是直接给医生看的。

And God forbid -- I think many doctors, if you really asked them,

上帝啊！我敢说，很多医生，如果你问他们，

they don't really understand all this stuff either.

他们也不完全明白这些东西。

This is the worst presented information.

这样的信息表述实在是糟透了。

You ask Tufte, and he would say,

如果你问塔夫特，他会说：

"Yes, this is the absolute worst presentation of information possible."

“毫无疑问，这样的信息表述真是槽糕透顶了。”

What we did at Wired

在《连线》（Wired）杂志社，

was we went, and I got our graphic design department

我让我们的图表设计部

to re-imagine these lab reports.

对这些测试报告进行重新设计。

So that's what I want to walk you through.

我给大家简短地展示一下。

So this is the general blood work before,

这是一项常规血液检测报告原来的版本，

and this is the after, this is what we came up with.

这是修改后的版本，这就是我们的设计。

The after takes what was four pages --

修改后的版本将原来的四页纸--

that previous slide was actually

上一张幻灯片实际上

the first of four pages of data

四页纸的第一页，

that's just the general blood work.

这还只是一项常规的血液检测。

It goes on and on and on, all these values, all these numbers you don't know.

全篇洋洋洒洒，那么多的数值，那么多的数字，你根本看不懂。

This is our one-page summary.

这是我们一页纸的总结。

We use the notion of color.

我们运用颜色作为信号。

It's an amazing notion that color could be used.

颜色的运用真是太妙了。

So on the top-level you have your overall results,

最上面一层是你的测试结果概况，

the things that might jump out at you from the fine print.

清晰的印刷让你一目了然。

Then you can drill down

你接着往下看，

and understand how actually we put your level in context,

我们把你的等级

and we use color to illustrate

用颜色作图解

exactly where your value falls.

标明你的数值在哪一个区域里。

In this case, this patient is slightly at risk of diabetes

这个案例中的病人有轻微患糖尿病的危险，

because of their glucose level.

因为他的葡萄糖含量。

Likewise, you can go over your lipids

类似地，你可以查看你的油脂含量

and, again, understand what your overall cholesterol level is

了解你总体的胆固醇含量，

and then break down into the HDL and the LDL if you so choose.

你还可以进一步查看高密度脂蛋白和低密度脂蛋白的情况。

But again, always using color

你看，我们总是使用颜色

and personalized proximity

让那些信息

to that information.

更加平易近人。

All those other values,

我们对那一大堆其它数值

all those pages and pages of values that are full of nothing,

那一大叠布满数字但毫无意义的纸

we summarize.

作了精简。

We tell you that you're okay, you're normal.

我们告诉你，你的情况正常。

But you don't have to wade through it. You don't have to go through the junk.

你用不着在数字的海洋里苦苦寻觅，用不着管那些没用的信息。

And then we do two other very important things

接着我们做了另外两件非常重要的事情，

that kind of help fill in this feedback loop:

这两件事有助于填满这个反馈圈。

we help people understand in a little more detail

我们帮助人们进一步理解更多细节，

what these values are and what they might indicate.

理解这些数值代表什么，表明了什么。

And then we go a further step -- we tell them what they can do.

然后，更进一步：我们告诉他们下一步应该做什么。

We give them some insight

我们帮助他们判断

into what choices they can make, what actions they can take.

他们应该做哪些选择，采取哪些行动。

So that's our general blood work test.

这就是我们做的常规血液检测报告。

Then we went to CRP test.

我们接着开始做CRP检测。

In this case, it's a sin of omission.

这是一个信息严重缺失的案例。

They have this huge amount of space,

这上面有一大片空白，

and they don't use it for anything, so we do.

没有人用它，我们就把这片空白用上了。

Now the CRP test is often done

CRP检测往往

following a cholesterol test,

跟在胆固醇含量检测之后，

or in conjunction with a cholesterol test.

或者与胆固醇含量测试一同进行。

So we take the bold step

于是我们大胆地

of putting the cholesterol information on the same page,

把胆固醇测试信息印在同一页上，

which is the way the doctor is going to evaluate it.

让医生进行诊断。

So we thought the patient might actually want to know the context as well.

我们想到，病人可能也想看明白其中的玄机。

It's a protein that shows up

这是一种维生素，

when your blood vessels might be inflamed,

当你的血管发炎时，这种维生素就会产生，

which might be a risk for heart disease.

有导致心脏病的风险。

What you're actually measuring

简单明了的语言

is spelled out in clean language.

把测试结果解释得清清楚楚。

Then we use the information

接着我们用上了

that's already in the lab report.

测试报告上的信息。

We use the person's age and their gender

我们通过病人的年龄与性别

to start to fill in the personalized risks.

对其具体所面临的风险进行评估。

So we start to use the data we have

我们用手上掌握的数据

to run a very simple calculation

进行一个非常简单的计算，

that's on all sorts of online calculators

各种网上计算器都能进行这种计算，

to get a sense of what the actual risk is.

最后对实际风险进行预测。

The last one I'll show you is a PSA test.

最后我将展示的是PSA（前列腺特异抗原）检测。

Here's the before, and here's the after.

这是修改之前，这是之后。

Now a lot of our effort on this one --

我们在这上面花了不少功夫--

as many of you probably know,

在做许多人可能知道，

a PSA test is a very controversial test.

PSA测试是一种非常具有争议的检测。

It's used to test for prostate cancer,

它是用于检测病人是否患上前列腺癌的，

but there are all sorts of reasons

但是，引起前列腺肿大的原因

why your prostate might be enlarged.

是多种多样的。

And so we spent a good deal of our time

于是我们花了不少时间，

indicating that.

研究如何表述测试结果。

We again personalized the risks.

我们再次根据个人情况评估风险。

So this patient is in their 50s,

这是针对五十多岁病人的报告，

so we can actually give them a very precise estimate

我们能够非常准确地

of what their risk for prostate cancer is.

评估他们患前列腺癌的风险。

In this case it's about 25 percent, based on that.

根据数据显示，这个病例的风险是百分之二十五。

And then again, the follow-up actions.

下面列出了应采取的对策。

So our cost for this was less than 10,000 dollars, all right.

我们做这项工作的成本不到一万美元。

That's what Wired magazine spent on this.

这就是《连线》杂志在这上面的成本。

Why is Wired magazine doing this?

为什么《连线》杂志要做这样一项工作呢？

(Laughter)

（众人笑）

Quest Diagnostics and LabCorp,

两家最大的实验室检测公司，

the two largest lab testing companies --

奎斯特诊断公司和LabCorp公司：

last year, they made profits of over 700 million dollars

去年，他们的利润分别超过了七亿美元，

and over 500 million dollars respectively.

和五亿美元。

Now this is not a problem of resources;

问题的关键不在于资源，

this is a problem of incentives.

而在于刺激。

We need to recognize that the target of this information

我们需要认识到：信息的接收对象

should not be the doctor, should not be the insurance company.

不应该是医生或保险公司；

It should be the patient.

而应是病人。

It's the person who actually, in the end,

病人，归根结底，

is going to be having to change their lives

要改变自己的生活，

and then start adopting new behaviors.

并养成新的行为习惯。

This is information that is incredibly powerful.

而信息在其中扮演了举足轻重的角色。

It's an incredibly powerful catalyst to change.

这是促成改变的强力催化剂。

But we're not using it. It's just sitting there.

它近在咫尺，但我们却不去用它。

It's being lost.

它白白被浪费了。

So I want to just offer four questions

我想提出四个

that every patient should ask,

病人应该问的问题，

because I don't actually expect people

因为我实际上并不指望

to start developing these lab test reports.

人们自行撰写这些实验室检测报告。

But you can create your own feedback loop.

但是你可以创造自己的反馈圈。

Anybody can create their feedback loop by asking these simple questions:

每个人都可以通过问下列简单的问题来创造反馈圈：

Can I have my results?

我可以得到我的检测结果吗？

And the only acceptable answer is --

唯一的答案是--

(Audience: Yes.) -- yes.

（观众：可以。）--可以。

What does this mean? Help me understand what the data is.

这份报告说明了什么？帮助我理解这些数据都代表什么。

What are my options? What choices are now on the table?

我有哪些选择？哪些做法的可行的？

And then, what's next?

接下来我该怎么做？

How do I integrate this information

在未来的日子中，

into the longer course of my life?

我如何根据这些信息改变我的生活？

So I want to wind up by just showing

最后，我想告诉大家

that people have the capacity to understand this information.

人们是有能力理解这些信息的。

This is not beyond the grasp of ordinary people.

这对于平常人来说是完全有可能做到的。

You do not need to have the education level of people in this room.

人们并不需要拥有在座各位的教育水平。

Ordinary people are capable of understanding this information,

平常人有能力理解这些信息，

if we only go to the effort of presenting it to them

只要我们愿意为在信息的表述上多下一些功夫，

in a form that they can engage with.

方便他们理解，让他们参与进来。

And engagement is essential here,

在此，参与是关键因素，

because it's not just giving them information;

因为，光给他们提供信息，意义不大，

it's giving them an opportunity to act.

而要给他们行动的机会。

That's what engagement is. It's different from compliance.

这才是真正的参与；不同于服从。

It works totally different from the way we talk about behavior

这不同于与我们今天说的

in medicine today.

医学上的行为。

And this information is out there.

这信息就在眼前。

I've been talking today about latent information,

今天我所探讨的是被掩盖了的信息，

all this information that exists in the system

这些信息存在于这个系统之中，

that we're not putting to use.

而我们却没有加以利用。

But there are all sorts of other bodies of information

但各种各样的信息

that are coming online,

正逐渐在网上涌现。

and we need to recognize the capacity of this information

我们需要认识到这信息的力量，

to engage people, to help people

让人们参与进来，帮助人们

and to change the course of their lives.

改变他们生命的轨迹。

Thank you very much.

非常感谢

(Applause)

（众人鼓掌）