Paula Johnson: His and hers ... healthcare

翻译人员: liu angela 校对人员: Jina Chen

Some of my most wonderful memories of childhood

我童年一些最美好的时光

are of spending time with my grandmother, Mamar,

是和我奶奶一块儿

in our four-family home in Brooklyn, New York.

在我们纽约，布鲁克林的四口之家度过的。

Her apartment was an oasis.

她的公寓就像一个乐园。

It was a place where I could sneak a cup of coffee,

在那儿我可以偷着喝点咖啡，

which was really warm milk with just a touch of caffeine.

其实就是热牛奶兑了一点点咖啡。

She loved life.

她热爱生活。

And although she worked in a factory,

尽管她只在一个工厂上班，

she saved her pennies and she traveled to Europe.

她还是一点一滴攒下钱去欧洲旅游。

And I remember poring over those pictures with her

记得那会儿我和她一起细细品味那些照片，

and then dancing with her to her favorite music.

然后伴着她最喜欢的音乐一起跳舞。

And then, when I was eight and she was 60,

后来，当我8岁，她60岁的时候，

something changed.

这一切都变了。

She no longer worked or traveled.

她不再上班或者旅游了。

She no longer danced.

也不再跳舞了。

There were no more coffee times.

我们再也没有咖啡时间了。

My mother missed work and took her to doctors

我妈妈请了假带奶奶去看医生，

who couldn't make a diagnosis.

却无法得到一个诊断。

And my father, who worked at night, would spend every afternoon with her,

我爸爸上夜班，他每个下午都陪着奶奶，

just to make sure she ate.

就为了保证她吃了东西。

Her care became all-consuming for our family.

全家人一门心思地扑到了奶奶身上。

And by the time a diagnosis was made,

当终于有一个诊断的时候，

she was in a deep spiral.

她的情况已经岌岌可危了。

Now many of you will recognize her symptoms.

现在在座的很多人能推断出她的症状。

My grandmother had depression.

我奶奶得的是抑郁症。

A deep, life-altering depression,

颠覆了她生活的重度抑郁症，

from which she never recovered.

她再也没有恢复过来。

And back then, so little was known about depression.

当时，人们对抑郁症知之甚少。

But even today, 50 years later,

但即使是50年以后的今天，

there's still so much more to learn.

也还有很多需要去了解。

Today, we know that women are 70 percent more likely

如今，我们知道，一生中女性患上抑郁症

to experience depression over their lifetimes

的几率比男性高出

compared with men.

70%。

And even with this high prevalence,

而即使有这样高的患病率，

women are misdiagnosed between 30 and 50 percent of the time.

30% 到 50%的女性还是会被误诊。

Now we know that women are more likely

现在我们知道，与男性相比，

to experience the symptoms of fatigue, sleep disturbance,

女性更可能会出现疲劳、 睡眠紊乱、

pain and anxiety compared with men.

疼痛、以及焦虑的症状。

And these symptoms are often overlooked

这些症状往往被忽视

as symptoms of depression.

而未能推断出是抑郁症的症状。

And it isn't only depression in which these sex differences occur,

这类性别差异并非只存在于抑郁症中，

but they occur across so many diseases.

还存在于很多其他疾病中。

So it's my grandmother's struggles

所以，正是由于我奶奶的种种挣扎

that have really led me on a lifelong quest.

促使了我进行终身探索。

And today, I lead a center in which the mission

如今，我带领着一个团队，其使命

is to discover why these sex differences occur

就是去探寻出现这些性别差异的原因

and to use that knowledge

并利用这些知识

to improve the health of women.

来改善女性健康。

Today, we know that every cell has a sex.

今天，我们知道每个细胞都有性别。

Now, that's a term coined by the Institute of Medicine.

这是个由医学机构所创造的词。

And what it means is that men and women are different

它的意思是，男人和女人的区别，

down to the cellular and molecular levels.

直达细胞和分子的层面。

It means that we're different across all of our organs.

这意味着我们之间的区别反映在各个器官上。

From our brains to our hearts, our lungs, our joints.

从我们的大脑、到我们的心脏、 我们的肺部、 我们的关节。

Now, it was only 20 years ago

仅仅在20 年前，

that we hardly had any data on women's health

我们还几乎没有任何关于女性健康的数据，

beyond our reproductive functions.

除了我们的生殖功能。

But then in 1993,

但后来在 1993 年，

the NIH Revitalization Act was signed into law.

《美国国家卫生研究院复兴法 》 通过签署成为法律。

And what this law did was it mandated

这项法律规定

that women and minorities be included in clinical trials

由国家卫生研究院资助的临床试验

that were funded by the National Institutes of Health.

需要包含女性和少数族裔。

And in many ways, the law has worked.

从许多方面看，这项法律起到了作用。

Women are now routinely included in clinical studies,

现如今女性通常会参与临床研究，

and we've learned that there are major differences

我们也了解了男性和女性

in the ways that women and men

在罹患疾病时的

experience disease.

主要区别。

But remarkably,

但值得注意的是，

what we have learned about these differences is often overlooked.

我们已知的这些区别往往被忽视。

So, we have to ask ourselves the question:

所以，我们必须问自己这个问题：

Why leave women's health to chance?

为什么女性的健康得看运气？

And we're leaving it to chance in two ways.

从两方面来看，我们在靠运气。

The first is that there is so much more to learn

第一是要研究的内容甚多，

and we're not making the investment

而我们并没有在这方面投资

in fully understanding the extent of these sex differences.

以全面了解这些性别差异。

And the second is that we aren't taking what we have learned,

第二是我们是没有把已经学到的东西

and routinely applying it in clinical care.

应用在常规的临床护理中。

We are just not doing enough.

我们做得实在不够。

So, I'm going to share with you three examples

所以，我要与你分享三个例子，

of where sex differences have impacted the health of women,

关于性别差异如何影响了女性的健康

and where we need to do more.

以及我们需要努力的地方。

Let's start with heart disease.

我们先看心脏疾病。

It's the number one killer of women in the United States today.

这是如今美国女性的头号杀手。

This is the face of heart disease.

这是患心脏病的人。

Linda is a middle-aged woman,

琳达是一名中年女子，

who had a stent placed in one of the arteries

在她到心脏的一根动脉中

going to her heart.

做了一个血管支架。

When she had recurring symptoms she went back to her doctor.

当她有复发症状的时候，她再次回去看医生。

Her doctor did the gold standard test:

医生给她做了一个万无一失的标准测试：

a cardiac catheterization.

心导管检查。

It showed no blockages.

显示没有堵塞。

Linda's symptoms continued.

琳达的症状继续着。

She had to stop working.

她不得不停止了工作。

And that's when she found us.

那时是她找上我们的时候。

When Linda came to us, we did another cardiac catheterization

当琳达来我们那儿的时候，我们做了另一次心导管检查

and this time, we found clues.

而这次，我们找到了些线索。

But we needed another test

但我们需要另一个测试

to make the diagnosis.

才能做诊断。

So we did a test called an intracoronary ultrasound,

于是我们做了一个叫冠状动脉内超声波的测试，

where you use soundwaves to look at the artery

也就是用声波从里到外

from the inside out.

来看动脉。

And what we found

我们发现

was that Linda's disease didn't look like

琳达的病看起来不像

the typical male disease.

典型的男性心脏病。

The typical male disease looks like this.

典型的男性疾病看起来像这样。

There's a discrete blockage or stenosis.

会有离散堵塞或着狭窄症。

Linda's disease, like the disease of so many women,

琳达的病，像很多女性的心脏病

looks like this.

看起来像这样。

The plaque is laid down more evenly, more diffusely

匾沿着动脉分布得更均匀、 更扩散，

along the artery, and it's harder to see.

也更难看出来。

So for Linda, and for so many women,

所以对琳达，和众多女性来说，

the gold standard test wasn't gold.

万无一失标准测试不那么万无一失了。

Now, Linda received the right treatment.

如今，接受了正确的治疗之后，

She went back to her life and, fortunately, today

琳达非常幸运地又回归了正常生活，

she is doing well.

现在她情况不错。

But Linda was lucky.

但琳达是幸运的。

She found us, we found her disease.

她找到了我们，我们搞清了她的疾病。

But for too many women, that's not the case.

但对于太多的女性而言，她们的遭遇并非如此。

We have the tools.

我们有工具，

We have the technology to make the diagnosis.

并有技术来做诊断。

But it's all too often that these sex diffferences

但太多时候，这些性别上的区别

are overlooked.

被忽略了。

So what about treatment?

那么治疗呢？

A landmark study that was published two years ago

一篇两年前发表的标志性研究

asked the very important question:

问了个很重要的问题：

What are the most effective treatments for heart disease in women?

对女性而言，最有效的治疗心脏病的方法是什么？

The authors looked at papers written over a 10-year period,

其作者搜索了10 年的文献，

and hundreds had to be thrown out.

而不得不弃用其中数百个文献。

And what they found out was that of those that were tossed out,

他们发现弃用的文献中，

65 percent were excluded

有65%必须弃用是由于

because even though women were included in the studies,

即使其中的研究包括了女性，

the analysis didn't differentiate between women and men.

分析部分也没有区分女性和男性。

What a lost opportunity.

真是个错失了的机会。

The money had been spent

钱用掉了

and we didn't learn how women fared.

而我们却不知道女性的情况如何。

And these studies could not contribute one iota

这些研究无法对这一个非常、非常重要的问题

to the very, very important question,

作出丝毫的贡献：

what are the most effective treatments

治疗女性心脏病

for heart disease in women?

最有效的方法是什么？

I want to introduce you to Hortense, my godmother,

我想向你们介绍我的教母霍滕斯，

Hung Wei, a relative of a colleague,

一位同事的亲戚，洪魏，

and somebody you may recognize --

还有一位你也许认得 — —

Dana, Christopher Reeve's wife.

达娜，克里斯托弗 · 里夫的妻子。

All three women have something very important in common.

这三位女性都有一个很重要的共同点。

All three were diagnosed with lung cancer,

她们三位都诊断为患有肺癌，

the number one cancer killer of women

这是如今美国女性的

in the United States today.

头号癌症杀手。

All three were nonsmokers.

她们三个人都不抽烟。

Sadly, Dana and Hung Wei died of their disease.

可悲的是，达娜和洪魏死于肺癌。

Today, what we know is that women who are nonsmokers are three times more likely

今天，我们知道，不抽烟的女性

to be diagnosed with lung cancer than are men

得到肺癌的诊断要比不抽烟的男性

who are nonsmokers.

高三倍。

Now interestingly, when women are diagnosed with lung cancer,

有趣的是，当女性诊断为患有肺癌时，

their survival tends to be better than that of men.

他们的生存率往往比男性好。

Now, here are some clues.

那么这其中有些线索。

Our investigators have found that there are

我们的调查人员

certain genes in the lung tumor cells of both women and men.

在女性和男性的肺肿瘤细胞中发现了某些基因。

And these genes are activated

这些基因主要

mainly by estrogen.

是由雌激素来激活。

And when these genes are over-expressed,

而当这些基因过度释放时，

it's associated with improved survival

它与提升生存率的关联

only in young women.

只存在于年轻女性中。

Now this is a very early finding

现在这还是个非常早期的发现，

and we don't yet know whether it has relevance

我们还不知道它对临床护理

to clinical care.

是否有意义。

But it's findings like this that may provide hope

但像这样的研究结果或许能创造希望

and may provide an opportunity to save lives

并且提供机会来拯救女性和男性

of both women and men.

的生命。

Now, let me share with you an example

现在，让我与大家分享一个例子，

of when we do consider sex differences, it can drive the science.

说的是我们对性别差异的考虑能够驱动科学发展。

Several years ago a new lung cancer drug

前几年，一种新的肺癌药物

was being evaluated,

正接受评估，

and when the authors looked at whose tumors shrank,

当研究人员观察哪些人的肿瘤缩小的时候，

they found that 82 percent were women.

他们发现 82% 是女性。

This led them to ask the question: Well, why?

这使得他们提出了这个问题： 这是为什么呢？

And what they found

他们发现的是

was that the genetic mutations that the drug targeted

这种药物针对的的基因突变

were far more common in women.

在女性中更为常见。

And what this has led to

这带出的结果是

is a more personalized approach

对肺癌的治疗更加个人化的方法

to the treatment of lung cancer that also includes sex.

也需考虑性别差异。

This is what we can accomplish

这就是我们能做到的，

when we don't leave women's health to chance.

只要我们不放任女性健康于运气。

We know that when you invest in research,

我们知道当你投资在研究上，

you get results.

你就会有收获。

Take a look at the death rate from breast cancer over time.

来看看乳腺癌随着时间推移的死亡率。

And now take a look at the death rates

再看看女性肺癌

from lung cancer in women over time.

随着时间推移的死亡率。

Now let's look at the dollars invested in breast cancer --

现在再看看投在乳腺癌上的金额 --

these are the dollars invested per death --

这些是每个死亡人数的投资金额数 --

and the dollars invested in lung cancer.

对比投在肺癌上的金额数。

Now, it's clear that our investment in breast cancer

那么显然，我们在乳腺癌的投资

has produced results.

取得了成果。

They may not be fast enough,

或许不足够快，

but it has produced results.

但确实有成果。

We can do the same

而我们也能

for lung cancer and for every other disease.

为肺癌以及其他各种疾病创造出同样的成果。

So let's go back to depression.

那么，让我们回来说说抑郁症。

Depression is the number one cause

抑郁症是导致当今世界女性

of disability in women in the world today.

残疾的第一大原因

Our investigators have found

我们的调查人员发现

that there are differences in the brains

女性和男性大脑中

of women and men

的区别存在于

in the areas that are connected with mood.

与情绪相关的区域。

And when you put men and women

当你把男人和女人

in a functional MRI scanner --

放入功能性磁共振成像扫描仪中 — —

that's the kind of scanner that shows how the brain is functioning when it's activated --

这是那种显示被激活的大脑是如何工作的扫描仪 — —

so you put them in the scanner and you expose them to stress.

把这些人放在扫描仪中，然后给他们压力。

You can actually see the difference.

你真的可以看到其中的区别。

And it's findings like this

我们相信像这样的研究结果，

that we believe hold some of the clues

对于为什么在抑郁症上

for why we see these very significant sex differences

我们观察到这些非常显著的性别差异

in depression.

提供着某些思路。

But even though we know

但即使我们知道

that these differences occur,

这类差异的存在，

66 percent

66% 的

of the brain research that begins in animals

动物大脑研究

is done in either male animals

是在雄性动物中完成的

or animals in whom the sex is not identified.

或是在未鉴定性别的动物中完成的。

So, I think we have to ask again the question:

所以，我认为我们要再次问这个问题：

Why leave women's health to chance?

为什么女性的健康得看运气？

And this is a question that haunts those of us

这是一个萦绕在我们

in science and medicine

科学界和医学界的问题，

who believe that we are on the verge of being able to dramatically improve

我们相信我们即将有能力去显著改进

the health of women.

女性健康。

We know that every cell has a sex.

我们知道每个细胞都男女有别。

We know that these differences are often overlooked.

我们知道这些差异往往被忽视。

And therefore we know that women are not getting the full benefit

因此我们知道女性没有得到今时今日

of modern science and medicine today.

现代科学和医学的充分好处。

We have the tools

我们有工具，

but we lack the collective will and momentum.

但我们缺乏集体意志和势头。

Women's health is an equal rights issue

女性的健康是一个平等权利问题，

as important as equal pay.

和同工同酬一样重要。

And it's an issue of the quality

这是一个科学和医学的

and the integrity of science and medicine.

质量以及廉正性的问题。

(Applause)

（掌声）

So imagine the momentum we could achieve

所以想象一下我们在推进女性的健康上

in advancing the health of women

可以达到的势头，

if we considered whether these sex differences were present

假如我们在开始设计研究的时候

at the very beginning of designing research.

就考虑了这些性别差异是否存在，

Or if we analyzed our data by sex.

或者，我们根据性别分析了我们的数据。

So, people often ask me:

所以，人们常常问我：

What can I do?

我能做什么？

And here's what I suggest:

这里是我的建议：

First, I suggest that you think about women's health

第一，我建议你们看待女性健康

in the same way

就如同看待

that you think and care about other causes that are important to you.

其他任何对你重要的事业一样，进行思考和关注。

And second, and equally as important,

第二，同样重要的是，

that as a woman,

作为一名女性，

you have to ask your doctor

你得问问治疗你

and the doctors who are caring for those who you love:

和你身边的人的医生：

Is this disease or treatment different in women?

这个疾病，或者治疗，在女性中有不同之处吗？

Now, this is a profound question because the answer is likely yes,

这是一个深刻的问题，答案很可能是肯定的，

but your doctor may not know the answer, at least not yet.

但你的医生可能不知道答案，至少现在还不知道。

But if you ask the question, your doctor will very likely

但如果你问了这个问题，你的医生很有可能

go looking for the answer.

会去寻找答案。

And this is so important,

这是如此重要，

not only for ourselves,

不仅仅对我们自己而言，

but for all of those whom we love.

对我们身边的人也是如此。

Whether it be a mother, a daughter, a sister,

无论是一个母亲、 一个女儿、 一个姐妹、

a friend or a grandmother.

一位朋友或祖母。

It was my grandmother's suffering

我奶奶遭受的痛苦

that inspired my work

激励了我致力于

to improve the health of women.

提高女性健康的工作。

That's her legacy.

这就是她留给我的。

Our legacy can be to improve the health of women

而我们留给后人的可以是提高女性健康，

for this generation

为这一代，

and for generations to come.

也为子孙后代。

Thank you.

谢谢。

(Applause)

（掌声）