Erika Cheung: Theranos, whistleblowing and speaking truth to power | TED

Transcriber: Joseph Geni Reviewer: Krystian Aparta

So, I had graduated seven years ago from Berkeley

翻译人员: Mingming Ma 校对人员: Yolanda Zhang

七年前，我从伯克利大学毕业，

with a dual degree in molecular and cell biology and linguistics,

并获得了分子生物学 以及语言学的双学位，

and I had gone to a career fair here on campus,

然后我去了校园招聘会，

where I'd gotten an interview with a start-up called Theranos.

在招聘会上，我得到了 一个创业公司 Theranos 的面试机会。

And at the time,

在当时，

there wasn't really that much information about the company,

关于这家公司的信息 还十分有限，

but the little that was there was really impressive.

但还是有那么一点点 让人印象十分深刻。

Essentially, what the company was doing was creating a medical device

重点就是， 这家公司在发明一个医疗设备，

where you would be able to run your entire blood panel

能够完成全血检测，

on a finger-stick of blood.

只需要一滴指血就行。

So you wouldn't have to get a big needle stuck in your arm

这样的话，你就不必忍受 大针头扎在你手臂上，

in order to get your blood test done.

来完成血液检查。

So this was interesting not only because it was less painful,

所以，这个想法很有意思， 不仅因为它能减少疼痛，

but also, it could potentially open the door to predictive diagnostics.

而且，它也可能潜在地 打开了预测诊断的大门。

If you had a device

如果你有个设备，

that allowed for more frequent and continuous diagnosis,

能够进行更频繁且持续的诊断，

potentially, you could diagnose disease before someone got sick.

那么你就有可能在 某人患上疾病之前做出诊断。

And this was confirmed in an interview that the founder, Elizabeth Holmes,

该公司创始人伊丽莎白·霍尔姆斯 （Elizabeth Holmes）在《华尔街日报》上

had said in the Wall Street Journal.

发表的一篇采访中 也证实了这一点。

"The reality within our health-care system today

“在当今的医疗系统里，

is that when someone you care about gets really sick,

当你关心的人生病了，

by the time you find out it's [most often] too late

（大多数情况下） 等你发现病情的时候，

已经错过了最佳救治时机，

to do anything about it,

这很让人痛心。”

It's heartbreaking."

这就好像一个“登月计划”， 我真的很想参与其中，

This was a moon shot that I really wanted to be a part of

and I really wanted to help build.

贡献自己的一份力量。

And there was another reason why I think the story of Elizabeth

我认为伊丽莎白的故事

really appealed to me.

能这么吸引我， 还有另外一个原因。

So there was a time that someone had said to me,

曾经有人跟我说过，

"Erika, there are two types of people.

“艾瑞卡，有这么两种人。

There are those that thrive and those that survive.

一种是一直能蓬勃发展， 另一种是只能维持生存。

And you, my dear, are a survivor."

而你，亲爱的， 现在只是能维持生存。”

Before I went to university,

在我上大学之前，

I had grown up in a one-bedroom trailer with my six family members,

我们全家六口人一直 挤在只有一个卧室的房车里，

and when I told people I wanted to go to Berkeley,

当我跟别人说， 我想去伯克利上学，

they would say, "Well, I want to be an astronaut, so good luck."

他们会说， “我还想当宇航员呢。祝你好运！”

And I stuck with it, and I worked hard, and I managed to get in.

但我还是坚持我的想法，而且很努力， 并成功考进了伯克利大学。

But honestly, my first year was very challenging.

但是说实话，第一学年 对我来说真的很有挑战。

I was the victim of a series of crimes.

我曾经是一个 连环犯罪案的受害者。

I was robbed at gunpoint, I was sexually assaulted,

我曾在枪口下被抢劫， 被性侵犯，

and I was sexually assaulted a third time,

在我被性侵的第三次，

spurring on very severe panic attacks,

引发了很严重的恐慌症。

where I was failing my classes,

那段时间， 我开始挂科，

and I dropped out of school.

最后退学了。

And at this moment, people had said to me,

那时候，有人对我说：

"Erika, maybe you're not cut out for the sciences.

“艾瑞卡，也许你不适合学科学。

Maybe you should reconsider doing something else."

也许你可以考虑其他选择。”

And I told myself, "You know what?

然后，我跟自己说： “你知道什么？

If I don't make the cut, I don't make the cut,

如果我没能成功， 那就是没有成功，

but I cannot give up on myself, and I'm going to go for this,

但是我不能放弃我自己， 我要继续努力，

and even if I'm not the best for it, I'm going to try and make it happen."

即使我不能成为那个最好的， 我还是要再试试，努力实现我的梦想。”

And luckily, I stuck with it, and I got the degree, and I graduated.

很幸运，我坚持下来了， 我最终毕业了，拿到了学位。

(Applause and cheers)

（掌声和欢呼声）

Thank you.

谢谢！

(Applause)

（掌声）

So when I heard Elizabeth Holmes had dropped out of Stanford at age 19

所以，当听说伊丽莎白·霍尔姆斯 19 岁就从斯坦福大学退学

to start this company,

去开公司了，

and it was being quite successful,

而且创业非常成功，

to me, it was a signal

对我来说，那就意味着，

of, you know, it didn't matter what your background was.

你的背景根本不重要。

As long as you committed to hard work and intelligence,

只要你肯努力工作，努力学习，

that was enough to make an impact in the world.

那就足以对世界产生影响。

And this was something, for me, personally,

对我个人来说，这意味着

that I had to believe in my life,

我必须相信我的人生，

because it was one of the few anchors that I had had

因为这是为数不多的， 能在我脑海中挥之不去的

that got me through the day.

转折点之一。

So you can imagine,

所以，各位可以想象，

when I received this letter, I was so excited.

当我收到这封聘书的时候， 我超级激动，

I was over the moon.

简直开心极了。

This was finally my opportunity to contribute to society,

我终于有机会 为社会做些贡献了，

to solve the problems that I had seen in the world,

去解决我看到过的问题，

and really, when I thought about Theranos,

当我想到 Theranos,

I really anticipated that this would be the first

我真的希望这将是 我为之工作的第一家，

and the last company that I was going to work for.

也会是最后一家公司。

But I started to notice some problems.

不过，我渐渐开始 注意到了一些问题。

So, I started off as an entry-level associate in the lab.

我是从初级实验助理开始做的。

And we would be sitting in a lab meeting,

我们有实验室会议，

reviewing data to confirm whether the technology worked or not,

在会上，我们会审核数据， 以确认技术方法是否有效。

and we'd get datasets like this,

然后，我们会得到 像这样的数据集，

and someone would say to me,

然后，会有人对我说：

"Well, let's get rid of the outlier

“让我们去掉这些异常值，

and see how that affects the accuracy rate."

然后看看它们是 怎么影响准确率的。”

So what constitutes an outlier here?

那么，这里的异常值 都是什么呢？

Which one is the outlier?

哪一个是异常值？

And the answer is, you have no idea.

答案是：你不知道。

You don't know. Right?

你根本不知道。对吧？

And deleting a data point

而删除这样一个数据点

is really violating one of the things that I found so beautiful

则完全违背了我所已知的

about the scientific process --

科学探索过程的美好之处——

it really allows the data to reveal the truth to you.

也就是，应该让数据 真实地反应事实真相。

And as tempting as it might be in certain scenarios

在某些特定情境下， 这么做可能会很诱人，

to place your story on the data to confirm your own narrative,

就是为了肯定自己对故事的叙述， 把自己的故事强加在数据上进行解释。

when you do this, it has really bad future consequences.

而一旦你这么做了， 可能会产生非常严重的后果。

So this, to me, was almost immediately a red flag,

所以这对于我来说， 马上就触发了一个危险信号，

and it kind of folded in to the next experience

并且不断与下一次的经历，

and the next red flag

下一个危险信号叠加，

that I started to see within the clinical laboratory.

于是，我开始注意观察 临床实验室内部的情况。

So a clinical laboratory

临床实验室

is where you actively process patient samples.

主要用来处理病人的样本。

And so before I would run a patient's sample,

所以，在我处理 一份病人样本之前，

I would have a sample where I knew what the concentration was,

我要知道这个样本的浓度是多少。

and in this case, it was 0.2 for tPSA,

在这份样本里， 病人的 总前列腺特异性抗原 (tPSA) 浓度是0.2。

which is an indicator of whether someone has prostate cancer,

这是一个用来检测某人 是否患有前列腺癌，

or is at risk of prostate cancer or not.

或者是否有可能 患上前列腺癌的指标。

But then, when I'd run it in the Theranos device,

但是当我把这份样本放到 Theranos 的设备里检测的时候，

it would come out 8.9,

结果却是 8.9。

and then I'd run it again, and it would run out 5.1,

我又重新则了一遍， 结果显示 5.1。

and I would run it again, and it would come out 0.5,

而第三次的结果是 0.5，

which is technically in range,

从技术上来说 是在误差范围内的，

but what do you do in this scenario?

但是在这种情景下， 我该怎么办？

What is the accurate answer?

到底哪个结果是准确的？

And this wasn't an instance that I was seeing just one-off.

而且，我见到这样的情况 不止一次了。

This was happening nearly every day,

这几乎每天都在不停地发生。

across so many different tests.

而且发生在很多 不同类型的检测中。

And mind you, this is for a sample where I know what the concentration is.

注意，这可是 一个已知浓度的样本。

What happens when I don't know what the concentration is,

要是我事先不知道浓度，

like with a patient sample?

尤其是病人样本的浓度呢？

How am I supposed to trust what the result is, at that point?

这种情况下， 我该如何相信结果？

So this led to, sort of, the last and final red flag for me,

所以，对我来说， 这就是最后的危险信号了。

and this is when we were doing testing,

这也正是我们需要 做测试的时候，

in order to confirm and certify

为了确认和证明

whether we could continue processing patient samples.

我们是否可以继续处理病人样本。

So what regulators will do is they'll give you a sample,

那么，监管部门是怎么做的？ 他们会给你一份样本，

and they'll say, "Run this sample,

然后告诉你： “通过你们正常的工作程序

just like the quality control, through your normal workflow,

对这份样本进行一次质量检测，

how you normally test on patients,

就像对患者进行正常检测那样，

and then give us the results,

把结果告诉我们，

and we will tell you: do you pass, or do you fail."

然后我们会告诉你： 你通过了，还是失败了。”

So because we were seeing so many issues with the Theranos device

所以，由于我们在 曾经一直用来检测

that was actively being used to test on patients,

病人样本的 Theranos 设备上 看到了太多的问题，

what we had done is we had taken the sample

我们当时采取的行动就是，

and we had run it through an FDA-approved machine

把样本拿到 有 FDA 认证的设备上去检测，

and we had run it through the Theranos device.

然后再把样本拿到 Theranos 的设备测试一遍。

And guess what happened?

猜猜发生了什么？

We got two very, very different results.

我们得到了两个完全不同的结果。

So what do you think they did in this scenario?

那么你觉得这种情况下， 他们会怎么办？

You would anticipate that you would tell the regulators,

理论上，你会告诉监管机构：

like, "We have some discrepancies here with this new technology."

“这项新技术显示的结果 和实际结果有差异。”

But instead, Theranos had sent the result of the FDA-approved machine.

然而，Theranos 却提交了 FDA 认证设备得出的检测结果。

So what does this signal to you?

那这个信号对你来说 意味着什么？

This signals to you that even within your own organization,

这意味着， 甚至在你自己的企业里，

you don't trust the results that your technology is producing.

你都不相信你的技术 所产生的结果。

So how do we have any business running patient samples

那么我们是如何 在这种“问题设备”上

on this particular machine?

运行病人样本的呢？

So of course, you know, I am a recent grad,

当然，你们知道， 我是个刚毕业的学生，

I have, at this point, run all these different experiments,

此时，我已经做过 各种各样的试验，

I've compiled all this evidence, and I'd gone into the office of the COO

收集好了所有的证据， 于是我去了首席运营官办公室，

and I was raising my concerns.

提出了我的担心。

"Within the lab, we're seeing a lot of variability.

“我在实验室看到了很多异常现象。

The accuracy rate doesn't seem right.

准确度好像不对。

I don't feel right about testing on patients.

我觉得我们对病人的检测有问题。

These things, I'm just not comfortable with."

我对这些事情感觉很不好。”

And the response I got back is,

而我得到的反馈是：

"You don't know what you're talking about."

“你不知道你在说什么。

What you need to do is what I'm paying you to do,

我花钱雇你干什么， 你就要干什么，

and you need to process patient samples."

就是说，你只需要 处理病人样本就好了。”

So that night, I called up a colleague of mine

于是那天晚上， 我给我的一个同事打了电话，

who I had befriended within the organization, Tyler Shultz,

泰勒·舒尔茨（Tyler Shultz）， 他是我在公司里的朋友，

who also happened to have a grandfather who was on the Board of Directors.

他的爷爷刚好也是 Theranos 的董事会成员。

And so we had decided to go to his grandfather's house

然后，我们决定去他爷爷家。

and tell him, at dinner,

在晚餐的时候对他吐露实情，

what the company was telling him was going on

即公司跟他汇报的情况

was actually not what was happening behind closed doors.

和实际情况完全不符。

And not to mention,

更不用说，

Tyler's grandfather was George Schultz,

泰勒的爷爷是 乔治·舒尔茨（George Schultz），

the ex-secretary of state of the United States.

美国前国务卿。

So you can imagine me as a 20-something-year-old

所以，你可以想象， 20 几岁的我

just shaking, like, "What are you getting yourself into?"

心中忐忑不已，不停自问， “你这是要干什么？”

But we had sat down at his dinner table and said,

不过我们终究还是 在晚饭桌旁坐下了，然后说：

"When you think that they've taken this blood sample

“当你认为他们已经采了血液样本，

and they put it in this device, and it pops out a result,

并放进了这个仪器里， 然后会有个检测结果弹出来，

what's really happening is the moment you step outside of the room,

但事实却是， 在你走出房间的那一刻，

they take that blood sample, they run it to a back door,

他们会把那些样本 拿到另一个房间去做检测，

and there are five people on standby that are taking this tiny blood sample

那儿有五个人在待命, 他们会把这滴微小的血液样本分装到

and splitting it amongst five different machines."

五个不同的仪器里。”

And he says to us, "I know Tyler's very smart,

结果，他对我们说： “我知道泰勒很聪明，

you seem very smart,

你看起来也很聪明，

but the fact of the matter is I've brought in a wealth of intelligent people,

但事实是，我已经带来了 一群聪明的人，

and they tell me that this device is going to revolutionize health care.

他们告诉我，这个仪器将会 给医疗行业带来革命性的改变。

And so maybe you should consider doing something else."

所以，也许你该考虑干点别的。”

So this had gone through a period of about seven months,

当时，这种情况 已经持续了大概有七个月。

and I decided to quit that very next day.

于是，第二天我就决定辞职了。

And this --

这个——

(Applause and cheers)

（掌声和欢呼声）

But this was a moment that I had to sit with myself

但是到了这个时候， 我也不得不平静下来，

and do a bit of a mental health check.

先进行一下 心理健康方面的自我检查。

I'd raised concerns in the lab.

我在实验室表达了我的担忧。

I'd raised concerns with the COO.

我跟首席运营官 提出了我的担忧。

I had raised concerns with a board member.

我还跟一位董事会成员 提出了我的担忧。

And meanwhile,

而且，与此同时，

Elizabeth is on the cover of every major magazine across America.

伊丽莎白已经登上了 美国各大主流杂志的封面。

So there's one common thread here,

所以这里有个 贯穿一切的主线，

and that's me.

就是我。

Maybe I'm the problem?

也许，我才是问题所在?

Maybe there's something that I'm not seeing?

也许，有什么东西我没看到？

Maybe I'm the crazy one.

也许我才是出了问题的那个。

And this is the part in my story where I really get lucky.

然而接下来，我的运气来了。

I was approached

一位非常有才华的记者 找到了我，

by a very talented journalist, John Carreyrou

他就是来自《华尔街日报》的

from the Wall Street Journal, and he --

约翰•卡雷鲁（John Carreyrou）。

And he had basically said that he also had heard concerns

他说，他也已经从其他业内人士和

about the company from other people in the industry

公司内部的员工那里听说了

and working for the company.

对于 Theranos 检测设备的担忧。

And in that moment, it clicked in my head:

在那一刻，我的脑海里 闪过了一个念头：

"Erika, you are not crazy.

“艾瑞卡，你没有疯。

You're not the crazy one.

你不是疯子。

In fact, there are other people out there just like you

实际上，还有其他人跟你一样，

that are just as scared of coming forward,

只是害怕站出来，

but see the same problems and the same concerns that you do."

他们跟你一样看到了 同样的问题，有着同样的担忧。”

So before John's exposé and investigative report had come out

所以，在约翰揭露 Theranos 真相的

to reveal the truth of what was going on in the company,

调查报告问世之前，

the company decided to go on a witch hunt for all sorts of former employees,

Theranos 已经决定对 所有工种的前雇员进行威胁，

myself included,

包括我，

to basically intimidate us from coming forward or talking to one another.

导致我们不敢站出来发声， 或者互相交谈。

And the scary thing, really, for me in this instance

这时候，对我来说， 真正可怕的是

was the fact that it triggered,

它触发的一连串事件，

and I realized that they were following me once I received this letter,

当我收到这封信的时候， 我才意识到他们在跟踪我，

but it was also, in a way, a bit of a blessing,

但从某种程度上来说， 这也是因祸得福，

because it forced me to call a lawyer.

因为它迫使我打电话给律师了。

And I was lucky enough -- I called a free lawyer,

我很幸运——联系到了 一位提供免费服务的律师，

but he had suggested,

不过他建议：

"Why don't you report to a regulatory agency?"

“你为什么不向监管部门报告？”

And this was something that didn't even click in my head,

这个念头甚至 从没在我脑海里闪过，

probably because I was so inexperienced,

可能因为我太没经验了,

but once that happened, that's exactly what I did.

但是，一旦有了这个念头， 我就立刻采取了行动

I had decided to write a letter, and a complaint letter, to regulators,

我决定写一封投诉信给监管机构，

illustrating all the deficiencies and the problems that I had seen

说明我所看到的 关于 Theranos 实验室的

in the laboratory.

不足和问题。

And as endearingly as my dad kind of notes this

就像我父亲说的，

as being my, like, dragon-slayer moment,

这就像是我的屠龙时刻，

where I had risen up and fought this behemoth

我起身奋力反抗一个庞然大物，

and it caused this domino effect,

并引起了多米诺效应。

I can tell you right now,

现在我可以坦白地说，

I felt anything but courageous.

我当时恐慌不已，

I was scared, I was terrified,

内心只有害怕和胆怯。

I was anxious,

我十分焦虑，

I was ashamed, slightly,

还有点羞愧，

that it took me a month to write the letter.

我花了一个月的时间 才写完那封投诉信。

There was a glimmer of hope in there

我一直心怀侥幸，

that maybe somehow no one would ever figure out

也许不会有人知道

that it was me.

举报人就是我。

But despite all that emotion and all that volatility,

但尽管经历了各种情绪波动，

I still did it,

我还是举报了。

and luckily, it triggered an investigation

幸运的是，我的举报引发了

that shown to light

一系列调查，

that there were huge deficiencies in the lab,

证明了 Theranos 的实验室 的确存在严重缺陷，

and it stopped Theranos from processing patient samples.

并阻止了 Theranos 继续进行患者样品检测。

(Applause)

(掌声)

So you would hope, going through a very challenging

所以，在经历了这样富有挑战

and crazy situation like this,

又疯狂的状况后，

that I would be able to sort of culminate some how-tos

各位可能觉得我将会 为处于这种情况下的其他人

or recipe for success for other people that are in this situation.

总结一些成功的诀窍或方法。

But frankly, when it comes to situations like this,

但是，坦白说， 当遇到这种情况时，

the only quote that kind of gets it right is this Mike Tyson quote that says,

唯一可以恰当引用的话 就是迈克·泰森说的，

"Everyone has a plan until you get punched in the mouth."

“每个人都有自己的计划， 直到被迎面痛击。”

(Laughter)

(笑声)

And that's exactly how this is.

事实也的确是这样的。

But today, you know,

不过今天，

we're here to kind of convene on moon shots,

我们来到这里是 为了讨论“登月计划”的，

and moon shots are these highly innovative projects

“登月计划”指的就是 一类高度创新的项目，

that are very ambitious,

雄心勃勃，

that everyone wants to believe in.

每个人都愿意去相信。

But what happens when the vision is so compelling

但是，当愿景如此引人注目，

and the desire to believe is so strong

当相信它的欲望如此强烈的时候，

that it starts to cloud your judgment about what reality is?

它就会开始影响你对现实的判断。

And particularly when these innovative projects

尤其是当这些创新项目

start to be a detriment to society,

开始危害社会的时候，

what are the mechanisms in place

有什么机制

in which we can prevent these potential consequences?

可以帮助我们预防 这些潜在的后果吗？

And really, in my mind, the simplest way to do that

在我的脑海里， 有个最简单的办法

is to foster stronger cultures of people who speak up

就是培育更牢固的文化—— 敢于发言

and listening to those who speak up.

和倾听这些 敢于发言的人的文化。

So now the big question is,

那现在的一个大问题就是，

how do we make speaking up the norm and not the exception?

我们怎样才能使直言不讳 成为一种规范而不是例外呢?

(Applause and cheers)

(掌声和欢呼声)

So luckily, in my own experience,

在我的经历中， 幸运的是，

I realized that when it comes to speaking up,

我意识到在大多数情况下， 当把事情说出来了，

the action tends to be pretty straightforward in most cases,

行动往往就会相当直接。

but the hard part is really deciding whether to act or not.

但决定是不是 真的要行动，是最难的。

So how do we frame our decisions

那么，我们该如何制定决策，

in a way that makes it easier for us to act

使我们更容易采取行动，

and produce more ethical outcomes?

并获得更符合道德的结果？

So UC San Diego came up with this excellent framework

加州大学圣地亚哥分校 提出了一个非常好的框架，

called the "Three Cs,"

叫做 “3C” ,

and it's called commitment, consciousness and competency.

全称叫做“承诺、意识和胜任力”。

And commitment is the desire to do the right thing

承诺，是对做正确的事的渴望，

regardless of the cost.

无论代价如何。

In my case at Theranos,

在 Theranos 的事件中，

if I was wrong,

如果我错了，

I was going to have to pay the consequences.

我必须要承担相应的后果。

But if I was right,

但如果我是对的，

the fact that I could have been a person

那么我差一点就成为了

that knew what was going on and didn't say something,

一个知道真相，却选择 闭口不言的人的这个事实，

that was purgatory.

就是不可饶恕的。

Being silent was purgatory.

沉默本身就是一种罪恶。

Then there's consciousness,

然后，要有意识。

the awareness to act consistently and apply moral convictions

始终如一地行动， 和将道德信念

to daily behavior,

应用于日常行为的

behavior.

意识。

And the third aspect is competency.

第三个是胜任力。

And competency is the ability to collect and evaluate information

胜任力是有能力 搜集和评估信息，

and foresee potential consequences and risk.

以及有能力预测 潜在的后果和风险。

And the reason I could trust my competency

我之所以相信我的胜任力，

was because I was acting in service of others.

是因为我是在为他人服务。

So I think a simple process is really taking those actions

我认为一个简单的过程 就是采取实际行动，

and imagining,

并想象，

"If this happened to my children,

“如果这些事情发生在 我的孩子身上，

to my parents,

发生在我父母身上，

to my spouse,

发生在我伴侣身上，

to my neighbors, to my community,

发生在我邻居身上， 发生在我的社区里，

if I took that ...

如果是这样的话——

How will it be remembered?"

公众会怎么想？”

And with that,

带着这样的想法，

I hope, as we all leave here

我希望， 各位在会议结束后，

and venture off to build our own moon shots,

继续冒险建造 自己的“登月计划”的时候，

we don't just conceptualize them,

我们不只是在概念化这些项目，

in a way, as a means for people to survive

不能只是把它们当作 人类生存的一种手段，

but really see them as opportunities and chances for everybody to thrive.

而是要真正把它们当成机会， 当成每个人都能成功的机会。

Thank you.

谢谢！

(Applause and cheers)

(掌声和欢呼声)