Why Medicine Often Has Dangerous Side Effects for Women | Alyson McGregor | TED Talks

翻译人员: Gabriella Hu 校对人员: Yinchun Rui

We all go to doctors.

我们都会去看病就医。

And we do so with trust and blind faith

我们还盲目的坚信

that the test they are ordering and the medications they're prescribing

他们所做的测试以及所开的处方药

are based upon evidence --

都是有医学根据的——

evidence that's designed to help us.

为了能更好的帮助我们。

However, the reality is that that hasn't always been the case for everyone.

然而，现实状况是这些依据 并非对每个人都适用。

What if I told you

假如我告诉你

that the medical science discovered over the past century

医学研究的成果在过去的一个世纪以来

has been based on only half the population?

仅仅只是基于一半的人口数据得来的呢？

I'm an emergency medicine doctor.

我是一个急诊医生。

I was trained to be prepared in a medical emergency.

接受的都是医疗急救方面的训练。

It's about saving lives. How cool is that?

也就是关于拯救生命。 听起来很酷吧？

OK, there's a lot of runny noses and stubbed toes,

好吧，当然也有很多涕水横流 和撞伤脚趾的患者，

but no matter who walks through the door to the ER,

但是不论是谁走进急诊室的大门，

we order the same tests,

我们都会做相同的测试，

we prescribe the same medication,

开相同的处方，

without ever thinking about the sex or gender of our patients.

从来不曾考虑过患者的性别。

Why would we?

我们为何不考虑呢？

We were never taught that there were any differences between men and women.

因为我们从未被教导过 男女之间有何不同。

A recent Government Accountability study revealed that 80 percent of the drugs

最近的一项政府责任研究显示， 被从市场上撤回的

withdrawn from the market

药品中80%都是由于

are due to side effects on women.

会对女性产生副作用。

So let's think about that for a minute.

让我们思考一下。

Why are we discovering side effects on women

为什么药物已经在市场上开始流通后

only after a drug has been released to the market?

我们才发觉其对女性有副作用呢？

Do you know that it takes years for a drug to go from an idea

你知道一种药物从一个想法开始，

to being tested on cells in a laboratory,

到在实验室里对细胞进行测试，

to animal studies,

到动物研究，

to then clinical trials on humans,

到临床人体试验，

finally to go through a regulatory approval process,

最后再经过监管审批程序，

to be available for your doctor to prescribe to you?

经由你的医生开处方给你， 这一系列过程需要多少年吗？

Not to mention the millions and billions of dollars of funding

更不用说还需要 成百上千亿美金的投资款项

it takes to go through that process.

去推动这一切。

So why are we discovering unacceptable side effects

那么为何在经历重重验证后， 我们仍发现

on half the population after that has gone through?

那些不可接受的副作用 会出现在半数人口身上呢？

What's happening?

究竟发生了什么？

Well, it turns out that those cells used in that laboratory,

事实证明，被实验室用于测试的细胞，

they're male cells,

都是雄性细胞。

and the animals used in the animal studies were male animals,

动物研究时所用的也是雄性动物，

and the clinical trials have been performed almost exclusively on men.

而临床试验则几乎完全是针对男性的。

How is it that the male model became our framework for medical research?

为什么男性模型会成为医学研究的框架呢？

Let's look at an example that has been popularized in the media,

让我们来看一个已被媒体 广泛传播的示例吧，

and it has to do with the sleep aid Ambien.

是关于一种助眠药物Ambien的。

Ambien was released on the market over 20 years ago,

20多年前Ambien被投放到市场，

and since then, hundreds of millions of prescriptions have been written,

迄今为止，医生们已经 开出了数以百万计的处方，

primarily to women, because women suffer more sleep disorders than men.

主要是针对女性患者，因为女性 遭受的睡眠障碍普遍比男性多。

But just this past year,

然而仅仅在去年，

the Food and Drug Administration recommended cutting the dose in half

美国食品及药物管理局（FDA） 才建议针对女性

for women only,

消减一半的剂量，

because they just realized that women metabolize the drug

因为他们刚意识到女性代谢药物的速度

at a slower rate than men,

比男性慢得多，

causing them to wake up in the morning

这意味着她们一早醒来后

with more of the active drug in their system.

身体里所含的活性药物成分将会更多。

And then they're drowsy and they're getting behind the wheel of the car,

然后她们就昏昏欲睡地坐进驾驶座，

and they're at risk for motor vehicle accidents.

面临着高概率的机动车事故。

And I can't help but think, as an emergency physician,

作为一名急诊医生，我不禁想到，

how many of my patients that I've cared for over the years

那么多年来我看过的病人中， 有多少人

were involved in a motor vehicle accident

经历的机动车事故

that possibly could have been prevented

是可以避免的，

if this type of analysis was performed and acted upon 20 years ago

如果这种分析能在20年前进行并实施，

when this drug was first released.

尤其在药品流通到市场上之前。

How many other things need to be analyzed by gender?

还有多少其他事情是需要做性别分析的？

What else are we missing?

我们还遗漏了什么？

World War II changed a lot of things,

第二次世界大战改变了许多事情，

and one of them was this need to protect people

其中一件就是保护所有人

from becoming victims of medical research without informed consent.

避免成为医学研究的无辜受害者。

So some much-needed guidelines or rules were set into place,

许多政策和规则需要立即制定出来，

and part of that was this desire to protect women of childbearing age

其中一部分就旨在保护育龄女性

from entering into any medical research studies.

不受参与医学研究的威胁。

There was fear: what if something happened to the fetus during the study?

因为存在这样的担心： 如果胎儿在研究中受到伤害怎么办？

Who would be responsible?

谁会为此负责呢？

And so the scientists at this time actually thought

所以当时的科学家们还认为

this was a blessing in disguise,

这是因祸得福，

because let's face it -- men's bodies are pretty homogeneous.

因为事实上—— 男性的体征是非常平稳的。

They don't have the constantly fluctuating levels of hormones

他们不会有长期荷尔蒙紊乱的情况

that could disrupt clean data they could get if they had only men.

去扰乱整齐的数据， 所以他们只把男性作为研究对象。

It was easier. It was cheaper.

这样更简单，也更廉价。

Not to mention, at this time, there was a general assumption

更何况，在那个时候人们普遍认为

that men and women were alike in every way,

男性和女性的生理特征几乎一模一样，

apart from their reproductive organs and sex hormones.

除了生殖器官和性激素之外。

So it was decided:

于是就有了这样一个决定：

medical research was performed on men,

所有医学研究测试都针对男性，

and the results were later applied to women.

之后的研究结果再应用于女性身上。

What did this do to the notion of women's health?

这对女性健康的概念有什么影响呢？

Women's health became synonymous with reproduction:

女性的健康被与生殖相等同：

breasts, ovaries, uterus, pregnancy.

乳房，卵巢，子宫，怀孕。

It's this term we now refer to as "bikini medicine."

这些词都统称为“比基尼药学”。

And this stayed this way until about the 1980s,

这种现象一直持续到上世纪八十年代，

when this concept was challenged by the medical community

直到医学界以及公共卫生负责人

and by the public health policymakers when they realized that

对此提出异议，当他们发现

by excluding women from all medical research studies

在所有医学研究中排除女性

we actually did them a disservice,

反而是欲速则不达，

in that apart from reproductive issues,

因为除了生殖问题之外，

virtually nothing was known about the unique needs

我们对女性病人的独特需求

of the female patient.

一无所知。

Since that time, an overwhelming amount of evidence has come to light

从那时起，大量证据不断涌现，

that shows us just how different men and women are in every way.

指明了男女之间在各方面都存在差异。

You know, we have this saying in medicine:

我们在医学中有这么一句话：

children are not just little adults.

不能把小孩儿当作成人的微缩版。

And we say that to remind ourselves

我们这么说是为了提醒自己

that children actually have a different physiology than normal adults.

儿童的生理状况其实和成人不同。

And it's because of this that the medical specialty of pediatrics came to light.

而就是因为这个，医学界中才有儿科。

And we now conduct research on children in order to improve their lives.

现在我们有儿童医学研究 来改善他们的生活。

And I know the same thing can be said about women.

我知道，女性也面临同样的情况。

Women are not just men with boobs and tubes.

女性不只是有女性生殖器官的男性。

But they have their own anatomy and physiology

她们有自己独特的生理结构，

that deserves to be studied with the same intensity.

也需要受到同样的重视。

Let's take the cardiovascular system, for example.

我们拿心血管系统来举例。

This area in medicine has done the most to try to figure out

这个医学领域做出了许多努力试图找到

why it seems men and women have completely different heart attacks.

为什么男性和女性心脏病 发作的症状不同。

Heart disease is the number one killer for both men and women,

心脏病在两性中都是最常见的死因，

but more women die within the first year of having a heart attack than men.

但是在心脏病发作第一年内 女性死亡率比男性要高。

Men will complain of crushing chest pain --

发病时，男性常常抱怨有胸口剧痛——

an elephant is sitting on their chest.

像一头大象坐在胸口一样。

And we call this typical.

我们把这叫做典型心脏病。

Women have chest pain, too.

女性也会经历胸痛。

But more women than men will complain of "just not feeling right,"

但是更多女性会抱怨 “感觉不对劲，”

"can't seem to get enough air in,"

“好像喘不过气来，”

"just so tired lately."

“感觉最近太累了。”

And for some reason we call this atypical,

我们通常把这个叫做非典型心脏病，

even though, as I mentioned, women do make up half the population.

尽管我刚才提到过，人口的一半是女性。

And so what is some of the evidence to help explain some of these differences?

那我们有什么证据来解释这些差异呢？

If we look at the anatomy,

如果从解剖学的角度来看的话，

the blood vessels that surround the heart are smaller in women compared to men,

女性环绕着心脏的血管 要比男性的小一些，

and the way that those blood vessels develop disease is different

这些血管发展疾病的方式 在不同性别间

in women compared to men.

也存在着差异。

And the test that we use to determine if someone is at risk for a heart attack,

而我们诊断病人心脏病发病率的测试

well, they were initially designed and tested and perfected in men,

原本是根据男性的生理特征 来设计，检测和完善的，

and so aren't as good at determining that in women.

所以并不适用于女性。

And then if we think about the medications --

接下来再看看药品——

common medications that we use, like aspirin.

常用的药品，比如阿司匹林。

We give aspirin to healthy men to help prevent them from having a heart attack,

我们让健康男性服用阿司匹林 来预防心脏病，

but do you know that if you give aspirin to a healthy woman,

但是你知道如果给健康女性阿司匹林，

it's actually harmful?

其实是有害的吗？

What this is doing is merely telling us

这些都是在告诉我们

that we are scratching the surface.

我们对这方面的了解还十分有限。

Emergency medicine is a fast-paced business.

急诊药物是一个快节奏商业。

In how many life-saving areas of medicine,

在多少旨在挽救生命的药学领域，

like cancer and stroke,

比如癌症和中风，

are there important differences between men and women that we could be utilizing?

在男女之间存在重要的区别， 让我们可以用来发展医学？

Or even, why is it that some people get those runny noses

甚至，为什么有些人比其他人

more than others,

更容易流鼻涕，

or why the pain medication that we give to those stubbed toes

或者那些碰伤脚趾的人使用的止痛药

work in some and not in others?

只在某些人身上管用？

The Institute of Medicine has said every cell has a sex.

医学研究所已经发现每个细胞 都有自己的性别。

What does this mean?

这代表什么呢？

Sex is DNA.

生理性别就是DNA（脱氧核糖核酸）。

Gender is how someone presents themselves in society.

社会性别则取决于一个人在社会中的 举动和表现。

And these two may not always match up,

这两者并不一定完全匹配，

as we can see with our transgendered population.

比如我们看到的变性人群体。

But it's important to realize that from the moment of conception,

但是我们必须要认识到， 从受孕的那一刻起，

every cell in our bodies --

我们身体里的每一个细胞——

skin, hair, heart and lungs --

皮肤，头发，心脏，肺脏——

contains our own unique DNA,

都包含着我们独特的DNA，

and that DNA contains the chromosomes that determine

而这些DNA中就含有决定你的性别，

whether we become male or female, man or woman.

是男性还是女性的染色体。

It used to be thought

过去我们常认为

照片中的性染色体——

that those sex-determining chromosomes pictured here --

XY if you're male, XX if you're female --

男性是XY，女性是XX——

merely determined whether you would be born with ovaries or testes,

只会决定你会有卵巢还是睾丸，

and it was the sex hormones that those organs produced

而这些器官产生的性激素

that were responsible for the differences we see in the opposite sex.

是我们看到的异性区别的原因。

But we now know that that theory was wrong --

但是我们现在知道这个理论是错误的——

or it's at least a little incomplete.

至少是不全面的。

And thankfully, scientists like Dr. Page from the Whitehead Institute,

幸好有像来自怀特海德研究所的 Page博士一样的科学家，

who works on the Y chromosome,

一直在进行Y染色体的研究，

and Doctor Yang from UCLA,

还有加州大学洛杉矶分校的杨博士，

they have found evidence that tells us that those sex-determining chromosomes

他们已经找到证据指明我们身体中

that are in every cell in our bodies

每个细胞中的性染色体

continue to remain active for our entire lives

在我们的一生中一直处于活跃状态，

and could be what's responsible for the differences we see

而且可能和我们观察到的男女

in the dosing of drugs,

用药剂量上的差别有关，

or why there are differences between men and women

还有男性和女性对疾病的易感性和

in the susceptibility and severity of diseases.

病情严重程度存在区别的原因。

This new knowledge is the game-changer,

这个新发现会彻底改变我们的认知，

and it's up to those scientists that continue to find that evidence,

当前科学家有责任继续 寻找和研究这些证据，

but it's up to the clinicians to start translating this data

但是临床医生有责任去分析这些数据，

并运用于临床上。

at the bedside, today.

Right now.

现在就要采取行动。

And to help do this, I'm a co-founder of a national organization

为了推动这项工作， 我与人合作创立了一个全国性组织，

called Sex and Gender Women's Health Collaborative,

叫做“性别研究女性健康协会”，

and we collect all of this data so that it's available for teaching

我们收集了所有的这些相关数据， 用于教学

and for patient care.

和患者护理。

And we're working to bring together the medical educators to the table.

我们试图汇集医学教育家来一起合作。

That's a big job.

这是一项巨大的任务。

It's changing the way medical training has been done since its inception.

从一开始，这就在改变医疗培训的方式。

But I believe in them.

但是我相信他们能够做到。

I know they're going to see the value of incorporating the gender lens

我知道他们会认识到性别研究的重要性，

into the current curriculum.

并把它纳入课程中。

It's about training the future health care providers correctly.

这直接联系到对未来医疗人员的 正确培训。

And regionally,

在本地，

I'm a co-creator of a division within the Department of Emergency Medicine

我是布朗大学急诊医药学科

here at Brown University,

一个部门的联合创始人，

called Sex and Gender in Emergency Medicine,

部门的名字是“急诊医疗中的性别研究”，

and we conduct the research to determine the differences between men and women

我们正在对男性和女性在紧急状况中

in emergent conditions,

不同的反应进行研究，

like heart disease and stroke and sepsis and substance abuse,

比如心脏病，中风，脓血症和药物滥用，

but we also believe that education is paramount.

但是我们始终相信教育是最重要的。

We've created a 360-degree model of education.

我们创造了一个全方位的教育模式。

We have programs for the doctors, for the nurses, for the students

我们有针对医生，护士，学生和病人的

and for the patients.

课程方案。

Because this cannot just be left up to the health care leaders.

因为我们不能把问题都留给医疗管理者。

We all have a role in making a difference.

我们每一个人都有责任去改变现状。

But I must warn you: this is not easy.

但是我必须事先提醒你们： 这并不简单。

In fact, it's hard.

事实上十分艰难。

It's essentially changing the way we think about medicine

这在实质上改变了我们看待药物，

and health and research.

健康，还有研究的方式。

It's changing our relationship to the health care system.

这也改变了我们和医疗系统之间的关系。

But there's no going back.

但是我们已经无路可退了。

We now know just enough

我们现在所了解的已经足够证明

to know that we weren't doing it right.

我们之前的做法是错误的。

Martin Luther King, Jr. has said,

马丁路德金曾说过，

“改变不会自动到来，

"Change does not roll in on the wheels of inevitability,

but comes through continuous struggle."

唯有经过不断抗争。”

And the first step towards change is awareness.

而我们要做的第一步就是提高意识。

This is not just about improving medical care for women.

这不仅仅关系到女性的医疗保健。

This is about personalized, individualized health care for everyone.

这是关于每一个人的个性化， 个体化的医疗。

This awareness has the power to transform medical care for men and women.

这种意识有能力完全改变两性的医疗。

And from now on, I want you to ask your doctors

从现在开始， 我想让你们问问自己的医生，

whether the treatments you are receiving are specific to your sex and gender.

你们接受的治疗是否针对你的性别。

They may not know the answer --

他们或许不知道答案——

yet.

但马上就会知道了。

But the conversation has begun, and together we can all learn.

改变已经发生了， 我们可以一起学习和进步。

Remember, for me and my colleagues in this field,

请记住，对我和我的同事而言，

your sex and gender matter.

你的性别很重要。

Thank you.

谢谢！

(Applause)

（掌声）