请双击下面的英文字幕来播放视频。
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Translator: Joseph Geni
Reviewer: Joanna Pietrulewicz
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翻译人员: Junyi Sha
校对人员: Lipeng Chen
00:12
Science.
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科学。
00:14
The very word for many of you conjures
unhappy memories of boredom
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这个词对于你们中的很多人来说,
召唤了对于高中生物
00:18
in high school biology or physics class.
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或是物理课堂的苦闷记忆。
但是我向你们保证,
你们在那时经历的
00:21
But let me assure that what you did there
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00:24
had very little to do with science.
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与科学是大相径庭的。
00:26
That was really the "what" of science.
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那只是科学“是什么”。
00:28
It was the history
of what other people had discovered.
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那是前人发现的历史记载。
00:32
What I'm most interested in as a scientist
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我对于成为一名科学家
最感兴趣的地方
是科学的“为什么”。
00:35
is the "how" of science.
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00:37
Because science is knowledge in process.
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因为科学的知识是正在探寻中的。
我们进行观察,
对观察提出一种设想原因,
00:41
We make an observation,
guess an explanation for that observation,
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00:44
and then make a prediction
that we can test
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做一种可以通过实验或是
00:46
with an experiment or other observation.
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其他观察论证的假设。
举些例子。
00:49
A couple of examples.
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00:50
First of all, people noticed
that the Earth was below, the sky above,
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首先,人们注意到了
大地在脚下,天空在头顶,
太阳和月亮都看似
围绕着它们在移动
00:54
and both the Sun and the Moon
seemed to go around them.
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00:58
Their guessed explanation
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他们提出的设想是
01:00
was that the Earth must be
the center of the universe.
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地球一定是宇宙的中心。
01:04
The prediction: everything
should circle around the Earth.
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预测即为:一切都是围绕着地球运动的。
当伽里略着手于第一台望远镜,
01:08
This was first really tested
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01:09
when Galileo got his hands
on one of the first telescopes,
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望向天空的时候,这件事第一次
01:12
and as he gazed into the night sky,
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被真正测试了,
他发现的是一颗行星,木星,
01:15
what he found there was a planet, Jupiter,
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01:18
with four moons circling around it.
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周围还有四颗卫星环绕着它。
01:23
He then used those moons
to follow the path of Jupiter
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之后,他又利用这些卫星
去跟踪木星的轨道
发现木星也不是围绕地球运动的
01:28
and found that Jupiter
also was not going around the Earth
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01:31
but around the Sun.
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而是围绕太阳运动的。
所以说这个假说测试就失败了。
01:35
So the prediction test failed.
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01:38
And this led to
the discarding of the theory
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这就导致了地球是宇宙的中心
01:40
that the Earth was the center
of the universe.
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这个理论被推翻。
01:42
Another example: Sir Isaac Newton
noticed that things fall to the Earth.
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另一个例子:艾萨克·牛顿爵士
注意到了东西都是向地面坠落的。
01:46
The guessed explanation was gravity,
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设想原因是引力,
01:50
the prediction that everything
should fall to the Earth.
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预测是万物都会落向地面。
01:53
But of course, not everything
does fall to the Earth.
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但是当然,并不是
所有东西都落向地面的。
01:58
So did we discard gravity?
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但是我们就抛弃引力吗?
02:00
No. We revised the theory and said,
gravity pulls things to the Earth
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不。我们重新改写理论,
说引力将万物拉向地面,
02:05
unless there is an equal
and opposite force in the other direction.
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除非事物还受到大小相同
方向相反的力的作用。
02:10
This led us to learn something new.
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这引领我们学到了新的东西。
02:12
We began to pay more attention
to the bird and the bird's wings,
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我们开始更多的关注
鸟儿和它们的翅膀,
02:16
and just think of all the discoveries
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想一想从那条思路
02:18
that have flown
from that line of thinking.
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引出的一系列发现。
02:21
So the test failures,
the exceptions, the outliers
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所以那些测试的
失败,意外,异常值
02:26
teach us what we don't know
and lead us to something new.
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给我们传授了未知,
引领我们去发现新的东西。
科学就是这样不断前行。
科学就是这样不断学习。
02:32
This is how science moves forward.
This is how science learns.
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02:35
Sometimes in the media,
and even more rarely,
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有的时候在媒体当中,
甚至更罕见的,
有时甚至科学家们会说
02:38
but sometimes even scientists will say
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02:40
that something or other
has been scientifically proven.
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这个或是那个
已经被科学证明了。
02:43
But I hope that you understand
that science never proves anything
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但是,我希望你们能够明白,
科学从不能证明任何东西,
02:48
definitively forever.
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永远都不可能。
02:51
Hopefully science remains curious enough
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希望科学始终保持那种好奇感
02:55
to look for
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让我们去探寻,
02:56
and humble enough to recognize
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和那种谦逊感,
02:58
when we have found
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当我们发现下一个异常值,
03:00
the next outlier,
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下一个特例,
就像木星的卫星
那样的东西的时候,
03:02
the next exception,
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03:03
which, like Jupiter's moons,
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能够让我们去认识,
03:05
teaches us what we don't actually know.
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教会我们那些我们并不了解的东西。
我们要在这里变换一小会儿主题了。
03:09
We're going to change gears
here for a second.
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03:11
The caduceus, or the symbol of medicine,
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墨丘利的节杖,
或者说是医药的象征,
03:13
means a lot of different things
to different people,
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对于不同的人,有着不同的意义,
但是我们的普遍公共医学论述
03:16
but most of our
public discourse on medicine
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03:18
really turns it into
an engineering problem.
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却将它转变为了一个工程问题。
03:21
We have the hallways of Congress,
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我们的国会长廊,
还有保险公司的董事会
都试图找到支付它们的途径
03:23
and the boardrooms of insurance companies
that try to figure out how to pay for it.
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03:27
The ethicists and epidemiologists
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伦理学家和流行病学家
03:29
try to figure out
how best to distribute medicine,
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试图找到如何更好分配药物的方法,
医院和医生们却完全沉迷于
03:32
and the hospitals and physicians
are absolutely obsessed
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03:34
with their protocols and checklists,
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他们的协议和清单,
03:36
trying to figure out
how best to safely apply medicine.
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试图找到更安全应用药物的方法。
03:40
These are all good things.
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这些都是好事。
03:42
However, they also all assume
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但是,他们也都在
03:45
at some level
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一定程度上假定了
03:47
that the textbook of medicine is closed.
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医学教科书是封闭的。
我们就开始以我们能
多快速的得到医疗服务
03:51
We start to measure
the quality of our health care
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03:53
by how quickly we can access it.
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来衡量我们的医疗质量。
03:56
It doesn't surprise me
that in this climate,
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在这种风气下,
许多机构
03:58
many of our institutions
for the provision of health care
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为寻求医疗服务,
开始大批搜寻润滑油的行为,
04:01
start to look a heck of a lot
like Jiffy Lube.
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一点儿也不使我惊讶。
04:03
(Laughter)
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(笑声)
04:06
The only problem is that
when I graduated from medical school,
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唯一的问题是,
当我从医学院毕业的时候,
我并没有得到那个
像是你的机械师
04:10
I didn't get one of those
little doohickeys
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04:12
that your mechanic
has to plug into your car
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一插进你的汽车里就能知道
04:14
and find out exactly what's wrong with it,
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车子哪里出问题的小窍门,
因为医学课本
04:17
because the textbook of medicine
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04:19
is not closed.
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并非是封闭的。
04:21
Medicine is science.
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医药是科学。
04:23
Medicine is knowledge in process.
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医药是正在进程中的知识。
我们先观察现象,
04:27
We make an observation,
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04:28
we guess an explanation
of that observation,
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然后猜测现象背后的解释,
04:30
and then we make a prediction
that we can test.
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之后我们作出一个
能够被测试的假设
04:33
Now, the testing ground
of most predictions in medicine
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当下,我们在医药领域
大多数的测试场地就是
群体。
04:37
is populations.
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04:38
And you may remember
from those boring days in biology class
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然后也许你还记得
在那些无聊的生物课上
04:42
that populations tend to distribute
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关于群体倾向于呈现
04:44
around a mean
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围绕平均值的
04:45
as a Gaussian or a normal curve.
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高斯或是正态分布曲线。
04:47
Therefore, in medicine,
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因此,在医药领域,
04:49
after we make a prediction
from a guessed explanation,
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在我们用一种可能的原因
作出预测之后,
04:52
we test it in a population.
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我们就在群体中测试它。
这就意味着,我们
关于医药学习的知识,
04:55
That means that what we know in medicine,
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04:58
our knowledge and our know-how,
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我们的所有知识,
05:00
comes from populations
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都来自于群体,
05:02
but extends only as far
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而只有当达到
下一个异常值的时候,
下一个特例,
05:05
as the next outlier,
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就像是木星卫星
那样的特例的时候,
05:07
the next exception,
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05:08
which, like Jupiter's moons,
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我们的知识才会扩张,
05:10
will teach us what we don't actually know.
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它们教会了我们并不了解的东西。
现在,我是一名外科医生,
05:14
Now, I am a surgeon
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05:15
who looks after patients with sarcoma.
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正在寻找肉瘤病人。
05:17
Sarcoma is a very rare form of cancer.
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肉瘤是一种极其罕见的癌症。
05:20
It's the cancer of flesh and bones.
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是骨与肌肉的癌变。
05:23
And I would tell you that every one
of my patients is an outlier,
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然后我会告诉你,
我的每一位病人都是异常值,
05:27
is an exception.
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都是特例。
我为这些肉瘤患者做的手术,
没有任何一个是对照着,
05:30
There is no surgery I have ever performed
for a sarcoma patient
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05:33
that has ever been guided
by a randomized controlled clinical trial,
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临床实验案例,就是那些
我们认识中最适合医药的
05:37
what we consider the best kind
of population-based evidence in medicine.
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以群体为基础的实验证据,
没有任何一个是被其指导着完成的。
05:42
People talk about thinking
outside the box,
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人们总说要跳出定式思维,
05:44
but we don't even have a box in sarcoma.
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但是在肉瘤病症上,我们没有定式。
05:47
What we do have as we take
a bath in the uncertainty
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当我们沐浴在
关于肉瘤的,环绕我们的,
05:50
and unknowns and exceptions
and outliers that surround us in sarcoma
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那些未知,不确定,
特例,异常值中的时候,
我们所拥有的,是我眼中
对于任何一种科学,
05:55
is easy access to what I think
are those two most important values
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05:59
for any science:
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最重要的两种价值观:
谦逊和好奇心。
06:01
humility and curiosity.
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因为如果我是谦逊的,好奇心强的,
06:04
Because if I am humble and curious,
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06:06
when a patient asks me a question,
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当病人询问我问题的时候,
06:08
and I don't know the answer,
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如果我不知道问题的答案,
06:10
I'll ask a colleague
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我就会去询问有着相似的,
尽管是不同的肉瘤病人的同事。
06:12
who may have a similar
albeit distinct patient with sarcoma.
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06:15
We'll even establish
international collaborations.
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我们甚至会建立国际间的合作。
06:17
Those patients will start
to talk to each other through chat rooms
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那些病人也会开始
在聊天室和支持团体中
互相交流。
06:21
and support groups.
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06:22
It's through this kind
of humbly curious communication
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是通过这种谦逊的,
好奇的交流过程,
06:26
that we begin to try and learn new things.
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我们开始去尝试并学习新的知识。
06:31
As an example, this is a patient of mine
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作为例子,这是我的一位病人
06:33
who had a cancer near his knee.
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他在膝盖附近长了一个肿瘤。
06:35
Because of humbly curious communication
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正因为那种在国际合作中谦逊的
06:37
in international collaborations,
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好奇心驱使的沟通,
我们学习到了如果必须
在移除肿瘤的同时移除膝盖,
06:40
we have learned that we can repurpose
the ankle to serve as the knee
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那么我们可以用踝关节
代替膝关节的位置。
06:44
when we have to remove the knee
with the cancer.
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06:46
He can then wear a prosthetic
and run and jump and play.
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这样他就可以带着假肢
跑,跳,玩耍了。
06:50
This opportunity was available to him
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是国际间合作
06:53
because of international collaborations.
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给了他这样的机会。
06:56
It was desirable to him
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这也是他所希望的,
06:57
because he had contacted other patients
who had experienced it.
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因为他与经历过这些的
其他病人联系过了。
07:01
And so exceptions and outliers in medicine
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所以在医药领域的特例与异常值
教会了我们那些不了解的东西,
同时也引发了我们作出新的思考。
07:06
teach us what we don't know,
but also lead us to new thinking.
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现在,非常重要的是,
07:11
Now, very importantly,
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07:12
all the new thinking that outliers
and exceptions lead us to in medicine
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所有这些在医药领域
关于异常值和特例的新的思考
07:16
does not only apply
to the outliers and exceptions.
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并非只能运用于那些特例的情况中。
07:20
It is not that we only learn
from sarcoma patients
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我们从肉瘤病人身上学习到的,
并非仅仅是治疗肉瘤病人的方法。
07:24
ways to manage sarcoma patients.
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07:26
Sometimes, the outliers
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有的时候,这些异常情况,
这些特例,
07:29
and the exceptions
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07:30
teach us things that matter quite a lot
to the general population.
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也教会了我们一些,对大众
同样十分重要的事情。
就像是身处树林之外的一棵树,
07:35
Like a tree standing outside a forest,
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07:37
the outliers and the exceptions
draw our attention
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这些外围的,特例般的存在,
吸引了我们的注意力,
07:41
and lead us into a much greater sense
of perhaps what a tree is.
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并能够引领我们得到一个,像是
“树是什么”,这种更为宏观的认识。
07:45
We often talk about
losing the forests for the trees,
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我们经常说,树木们失去了森林,
但是,我们也会
07:48
but one also loses a tree
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失去森林里的树木。
07:50
within a forest.
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那些独自站立的树,
07:53
But the tree that stands out by itself
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07:54
makes those relationships
that define a tree,
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它们同样,甚至以一种更加明确的方式
07:57
the relationships between trunk
and roots and branches,
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定义了树木的概念,
树干,树根与树枝间的联系。
08:01
much more apparent.
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08:03
Even if that tree is crooked
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即使那颗树是弯曲的,
或者甚至它的树干,树根与树枝
08:05
or even if that tree
has very unusual relationships
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之间的联系是非同寻常的,
08:08
between trunk and roots and branches,
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08:10
it nonetheless draws our attention
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它吸引了我们的注意力,
让我们作出了观察,
08:13
and allows us to make observations
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然后能够在普试群体中进行测试。
08:15
that we can then test
in the general population.
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我告诉过你们了,肉瘤是罕见的。
08:18
I told you that sarcomas are rare.
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它们只在所有癌症中占有1%
08:20
They make up about one percent
of all cancers.
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08:23
You also probably know that cancer
is considered a genetic disease.
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你也许还知道癌症是一种基因疾病。
08:27
By genetic disease we mean
that cancer is caused by oncogenes
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基因疾病是指癌症是由于
08:31
that are turned on in cancer
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原癌基因的触发和
08:32
and tumor suppressor genes
that are turned off to cause cancer.
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抑癌基因的失效所诱发的。
你也许会认为我们
是从那先常见癌症,
08:36
You might think
that we learned about oncogenes
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08:38
and tumor suppressor genes
from common cancers
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像是乳腺癌,前列腺癌,
08:40
like breast cancer and prostate cancer
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1976
肺癌中,
发现原癌基因与抑癌基因的,
08:42
and lung cancer,
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08:44
but you'd be wrong.
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但是,那样想你就错了。
我们是从那些
极少数的,1%的肉瘤中
08:46
We learned about oncogenes
and tumor suppressor genes
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2895
08:48
for the first time
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第一次的,
学习到了原癌基因和抑癌基因的。
08:50
in that itty-bitty little one percent
of cancers called sarcoma.
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08:54
In 1966, Peyton Rous got the Nobel Prize
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1966年,佩顿·劳斯获得了诺贝尔奖
08:57
for realizing that chickens
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2016
他发现了鸡群中一种
08:59
had a transmissible form of sarcoma.
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3120
传染性的肉瘤。
三十年之后,哈罗德·瓦尔姆斯
与麦克·毕晓普发现了
09:03
Thirty years later, Harold Varmus
and Mike Bishop discovered
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那种传染性的因子究竟是什么。
09:06
what that transmissible element was.
189
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09:08
It was a virus
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1576
那是一种病毒
09:10
carrying a gene,
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1416
它携带一种基因,
09:11
the src oncogene.
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那就是肉瘤原癌基因。
09:13
Now, I will not tell you
that src is the most important oncogene.
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现在,我不会说肉瘤原癌基因
是最重要的原癌基因。
09:17
I will not tell you
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我也不会告诉你
09:18
that src is the most frequently
turned on oncogene in all of cancer.
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肉瘤原癌基因是最常见的原癌基因。
09:22
But it was the first oncogene.
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但是,它是第一个
被发现的原癌基因。
09:25
The exception, the outlier
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2336
那个特例,那个异常值,
09:28
drew our attention and led us to something
198
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2520
它吸引了我们的注意力,
并引领了我们,
09:31
that taught us very important things
about the rest of biology.
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4040
教会了我们关于整个
生物领域重要的东西。
09:36
Now, TP53 is the most important
tumor suppressor gene.
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576880
4096
当下,肿瘤抑制蛋白p53
是最重要的抑癌因子。
它是最常见的失效
而引发各种肿瘤的
09:41
It is the most frequently turned off
tumor suppressor gene
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581000
2736
09:43
in almost every kind of cancer.
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1800
抑癌基因。
09:46
But we didn't learn about it
from common cancers.
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2296
但是我们并不是从
一般的癌症当中发现它的。
09:48
We learned about it
when doctors Li and Fraumeni
204
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2416
是当李医生和弗劳梅尼医生
在关注家庭史过程中,
09:51
were looking at families,
205
591120
1576
09:52
and they realized that these families
206
592720
2016
发现有些家庭患肉瘤病人
概率远高于其他家庭时
09:54
had way too many sarcomas.
207
594760
2520
我们才发现的p53。
09:57
I told you that sarcoma is rare.
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1776
我告诉过你们了,肉瘤很罕见。
09:59
Remember that a one
in a million diagnosis,
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3176
记住,百万分之一的诊断率,
10:02
if it happens twice in one family,
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2136
如果在同一个家庭中出现两例,
那就已经远高于其他家庭了。
10:05
is way too common in that family.
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2400
10:08
The very fact that these are rare
212
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就是因为它们十分罕见的特性,
10:11
draws our attention
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1440
吸引了我们的注意力,
10:13
and leads us to new kinds of thinking.
214
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2240
并引发了我们作出新的思考。
你们中的很多人可能会说,
10:17
Now, many of you may say,
215
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1456
10:18
and may rightly say,
216
618960
1536
或者现在正在说,
10:20
that yeah, Kevin, that's great,
217
620520
1896
嗯,凯文,这听起来不错,
10:22
but you're not talking
about a bird's wing.
218
622440
2056
但是你所说的并非是鸟的翅膀,
10:24
You're not talking about moons
floating around some planet Jupiter.
219
624520
3480
或者是卫星围绕着木星漂行。
10:28
This is a person.
220
628520
1536
这是一个人。
这种特例,这种异常值,
也许会引领我们科学的进步,
10:30
This outlier, this exception,
may lead to the advancement of science,
221
630080
3256
10:33
but this is a person.
222
633360
1200
但是,这是一个人。
而我能说的只是,
10:36
And all I can say
223
636280
1616
10:37
is that I know that all too well.
224
637920
2360
我太了解了。
我与这些患有罕见的,
致命的疾病的患者交流过。
10:41
I have conversations with these patients
with rare and deadly diseases.
225
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3400
10:45
I write about these conversations.
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645800
1936
我记录下了我们的对话。
10:47
These conversations are terribly fraught.
227
647760
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这些谈话都是极度令人担忧的。
它们充满了那些可怕的短语
10:50
They're fraught with horrible phrases
228
650080
1816
10:51
like "I have bad news"
or "There's nothing more we can do."
229
651920
3240
像是“我有一个坏消息”
或是“我们已经尽力了”
10:55
Sometimes these conversations
turn on a single word:
230
655760
3200
有的时候,这些对话就带来了一个词:
10:59
"terminal."
231
659760
1200
“晚期。”
11:04
Silence can also be rather uncomfortable.
232
664920
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沉默也是同等的令人难受的。
医药中的空白和我们在这些
11:09
Where the blanks are in medicine
233
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11:11
can be just as important
234
671960
1856
对话中用语的间隙,
11:13
as the words that we use
in these conversations.
235
673840
2240
是同等重要的。
什么是未知的?
11:17
What are the unknowns?
236
677080
1536
11:18
What are the experiments
that are being done?
237
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2200
有哪些实验是正在做的?
11:21
Do this little exercise with me.
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681680
1696
和我一起做一个小练习。
11:23
Up there on the screen,
you see this phrase, "no where."
239
683400
3216
在屏幕上,你可以看到
这个短语,“没有地方“
11:26
Notice where the blank is.
240
686640
1280
注意一下间歇的地方。
11:28
If we move that blank one space over
241
688680
3200
如果我们移动一格那个空隙,
11:32
"no where"
242
692640
1576
“没有地方”
11:34
becomes "now here,"
243
694240
2696
就变成了“现在在这”
11:36
the exact opposite meaning,
244
696960
1896
正好是相反的意思,
11:38
just by shifting the blank one space over.
245
698880
2200
仅仅是移动一个空格。
11:43
I'll never forget the night
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我永远不会忘记走进
11:45
that I walked into
one of my patients' rooms.
247
705280
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我的一位病人房间的那个夜晚。
11:48
I had been operating long that day
248
708280
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虽然一整天都在做手术,
11:49
but I still wanted to come and see him.
249
709960
2016
我还是想要过去看看他。
他是个孩子,在几天前被诊断出了骨癌。
11:52
He was a boy I had diagnosed
with a bone cancer a few days before.
250
712000
3200
11:55
He and his mother had been meeting
with the chemotherapy doctors
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715840
3056
他和他的妈妈在那天早些时候
11:58
earlier that day,
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718920
1216
见了负责他的化疗医生,
他被允许进入医院开始化疗。
12:00
and he had been admitted
to the hospital to begin chemotherapy.
253
720160
2976
当我进入他的房间的时候,
已经是将近午夜了。
12:03
It was almost midnight
when I got to his room.
254
723160
2176
12:05
He was asleep, but I found his mother
255
725360
2176
他睡着了,但是我发现他的妈妈
12:07
reading by flashlight
256
727560
1576
还在他的床边,
在灯光下阅读着。
12:09
next to his bed.
257
729160
1456
12:10
She came out in the hall
to chat with me for a few minutes.
258
730640
2800
她出来和我在走廊里聊了几分钟。
12:14
It turned out that
what she had been reading
259
734280
2096
结果得知她在阅读的是当天
12:16
was the protocol
that the chemotherapy doctors
260
736400
2176
化疗医生给她的一份
12:18
had given her that day.
261
738600
1240
协议书。
12:20
She had memorized it.
262
740200
1240
她记住了里面的内容。
她说,“琼斯医生,你告诉我们,
12:23
She said, "Dr. Jones, you told me
263
743200
3536
12:26
that we don't always win
264
746760
2176
我们并不是总能战胜
12:28
with this type of cancer,
265
748960
1280
这种癌症,
12:31
but I've been studying this protocol,
and I think I can do it.
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751680
3480
但是我很仔细的研究了
这份协议,我认为我们能做到的。
12:35
I think I can comply
with these very difficult treatments.
267
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3576
我认为我们可以应对
这些非常困难的治疗
12:39
I'm going to quit my job.
I'm going to move in with my parents.
268
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2976
我要辞掉我的工作。
我会搬去和我的父母一起住。
12:42
I'm going to keep my baby safe."
269
762560
1960
我要保护我的孩子。”
我没有告诉她。
12:47
I didn't tell her.
270
767320
1200
12:49
I didn't stop to correct her thinking.
271
769840
2920
我没有纠正她的想法。
12:53
She was trusting in a protocol
272
773680
2256
她正在相信一份协议书,
12:55
that even if complied with,
273
775960
3216
即使遵守了,
12:59
wouldn't necessarily save her son.
274
779200
2400
也不一定能挽救她的儿子。
13:03
I didn't tell her.
275
783960
1200
我没有告诉她。
13:06
I didn't fill in that blank.
276
786360
1400
我没有填补那个空隙。
但是一年半之后,
13:09
But a year and a half later
277
789080
1976
她的儿子还是死于了癌症。
13:11
her boy nonetheless died of his cancer.
278
791080
2720
13:15
Should I have told her?
279
795400
1320
我应该告诉她吗?
13:17
Now, many of you may say, "So what?
280
797360
2256
现在,你们中的很多人
可能会说,“那又怎样?”
13:19
I don't have sarcoma.
281
799640
1256
我有没有得肉瘤。
13:20
No one in my family has sarcoma.
282
800920
1896
我们家也没有人得肉瘤。
13:22
And this is all fine and well,
283
802840
1456
好吧,这也许是事实,
13:24
but it probably doesn't
matter in my life."
284
804320
2696
但它可能根本不会
出现在我的人生中。”
你说的没错。
13:27
And you're probably right.
285
807040
1256
13:28
Sarcoma may not matter
a whole lot in your life.
286
808320
2680
肉瘤也许与你的人生毫无关系。
但是那些存在于医药中的空白,
13:33
But where the blanks are in medicine
287
813040
2336
13:35
does matter in your life.
288
815400
1320
是影响你的人生的。
13:38
I didn't tell you one dirty little secret.
289
818520
2296
我没有告诉你们一个肮脏的小秘密。
13:40
I told you that in medicine,
we test predictions in populations,
290
820840
4376
我告诉了你们,在医药领域,
我们在人群中进行测试,
13:45
but I didn't tell you,
291
825240
1256
但是我没有告诉你们的是,
13:46
and so often medicine never tells you
292
826520
2216
在很多情况中,药物不会告诉你
13:48
that every time an individual
293
828760
2856
每当一个个体
13:51
encounters medicine,
294
831640
2096
遇见药物,
13:53
even if that individual is firmly
embedded in the general population,
295
833760
4040
即便是那个个体深信自己
隐藏于普试人群当中,
个体或是医生都不会知道,
13:59
neither the individual
nor the physician knows
296
839360
2376
14:01
where in that population
the individual will land.
297
841760
2680
实验最后降临在谁的头上。
因此,每次服用药物,
14:05
Therefore, every encounter with medicine
298
845040
2696
14:07
is an experiment.
299
847760
1440
都是一次实验。
14:09
You will be a subject
300
849920
2016
你就是那个实验中的
14:11
in an experiment.
301
851960
1680
被实验者。
14:14
And the outcome will be either
a better or a worse result for you.
302
854560
4840
而实验结果既可能是好的,
也可能是不好的。
只要药物起作用,
14:20
As long as medicine works well,
303
860320
2016
14:22
we're fine with fast service,
304
862360
3016
我们就能满足于这种快速的服务,
14:25
bravado, brimmingly
confident conversations.
305
865400
3440
自满的,充满自信的谈话。
14:29
But when things don't work well,
306
869720
1656
但是当事情进展不顺利,
14:31
sometimes we want something different.
307
871400
1840
有时我们就希望得到不同。
14:34
A colleague of mine
removed a tumor from a patient's limb.
308
874520
3280
我的一个同事从一位病人的
身上摘下了一个肿瘤。
14:38
He was concerned about this tumor.
309
878920
1816
他很担心这个肿瘤。
14:40
In our physician conferences,
he talked about his concern
310
880760
3016
在我们的研讨会上,
他谈论了自己的担忧,
14:43
that this was a type of tumor
311
883800
1416
这是一种,有着极高的
14:45
that had a high risk
for coming back in the same limb.
312
885240
2560
原位复发率的肿瘤。
14:48
But his conversations with the patient
313
888680
1976
但是他与病患的交流
14:50
were exactly what a patient might want:
314
890680
2096
却完全是病患想听到的那种:
14:52
brimming with confidence.
315
892800
1256
充满自信。
他说:“我已经把它搞定了,
你已经可以出院了。”
14:54
He said, "I got it all
and you're good to go."
316
894080
3016
她和她的丈夫为此十分兴奋。
14:57
She and her husband were thrilled.
317
897120
1736
14:58
They went out, celebrated, fancy dinner,
opened a bottle of champagne.
318
898880
4080
他们离开了,庆祝了,
美妙的晚餐,还开了一瓶香槟。
唯一的问题就在于几周之后,
15:04
The only problem was a few weeks later,
319
904040
2296
15:06
she started to notice
another nodule in the same area.
320
906360
3096
她开始注意
到在同一片区域的另一个结节。
15:09
It turned out he hadn't gotten it all,
and she wasn't good to go.
321
909480
4136
结果表明他没搞定肿瘤,
她也还不能出院。
15:13
But what happened at this juncture
absolutely fascinates me.
322
913640
2840
但这个时候发生的事,
我却觉得十分有趣。
我的同事找到我,并说,
15:17
My colleague came to me and said,
323
917200
1616
15:18
"Kevin, would you mind
looking after this patient for me?"
324
918840
2720
“凯文,你愿意帮我照顾这个病人吗?”
15:22
I said, "Why, you know the right thing
to do as well as I do.
325
922240
3216
我说:“为什么,你和我一样,
知道该怎么做啊。
15:25
You haven't done anything wrong."
326
925480
1616
你没做错任何事情。”
他说,“求你了,就帮我
照看一下这个病人吧。”
15:27
He said, "Please, just look
after this patient for me."
327
927120
4480
他感到脸红--
15:33
He was embarrassed --
328
933200
1536
15:34
not by what he had done,
329
934760
1400
不是为他所做的,
而是为他所说的,
15:37
but by the conversation that he had had,
330
937154
1926
15:39
by the overconfidence.
331
939760
1440
为他的过度自信。
15:42
So I performed
a much more invasive surgery
332
942600
2616
所以我又做了一个
更加侵入性的手术
15:45
and had a very different conversation
with the patient afterwards.
333
945240
3136
在之后与病患做了
一个截然不同的对话。
15:48
I said, "Most likely I've gotten it all
334
948400
2336
我说,“最可能的情况是,
我已经完全切除了,
15:50
and you're most likely good to go,
335
950760
2416
你应该可以走了,
15:53
but this is the experiment
that we're doing.
336
953200
3160
但是这是我们的一个实验。
这是你需要继续观察的。
15:57
This is what you're going to watch for.
337
957040
2016
这也是我需要继续观察的。
15:59
This is what I'm going to watch for.
338
959080
1896
然后我们会一起努力,
来探寻手术是否
16:01
And we're going to work together
to find out if this surgery will work
339
961000
3936
16:04
to get rid of your cancer."
340
964960
1320
成功解决了你的癌症。“
16:06
I can guarantee you, she and her husband
341
966920
1936
我可以向你们保证,
在这次谈话后,
16:08
did not crack another bottle of champagne
after talking to me.
342
968880
2920
她和她的丈夫没有
再开一瓶香槟庆祝
16:13
But she was now a scientist,
343
973600
2856
但是,她却变为了一名科学家,
16:16
not only a subject in her experiment.
344
976480
3360
而不仅仅是实验中的实验对象。
16:21
And so I encourage you
345
981960
1616
所以,我鼓励你们去
16:23
to seek humility and curiosity
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在你们的医生那儿,
寻找谦逊精神和好奇心。
16:27
in your physicians.
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16:28
Almost 20 billion times each year,
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每年大概有200亿次,
16:31
a person walks into a doctor's office,
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当一个人走进医生的办公室,
16:35
and that person becomes a patient.
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然后出来时就变成了一名患者。
16:39
You or someone you love
will be that patient sometime very soon.
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你和你所爱的人很快
也会变成那个患者。
16:43
How will you talk to your doctors?
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你会如何和你的医生们说?
16:46
What will you tell them?
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你会告诉他们什么?
16:48
What will they tell you?
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他们会告诉你什么?
16:52
They cannot tell you
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他们不能告诉你
16:54
what they do not know,
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他们也不确定的事,
16:57
but they can tell you when they don't know
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但是他们也可以告诉你
他们不知道,
只有当你问的时候。
17:02
if only you'll ask.
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所以,请你们加入谈话当中吧。
17:04
So please, join the conversation.
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谢谢。
17:08
Thank you.
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17:09
(Applause)
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(掌声)
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