Thomas Goetz: It's time to redesign medical data

Translator: Vikki Leung Reviewer: Chitmin Ng

I'm going to be talking to you

我將會同大家講吓

about how we can tap

我哋點樣可以有效利用

a really underutilized resource in health care,

一種絕對被忽視嘅醫療上嘅資源。

which is the patient,

呢種資源就係病人本身，

or, as I like to use the scientific term,

或者﹐以科學術語嚟講 ——

people.

人。

Because we are all patients, we are all people.

因為我哋都係病人，我們亦都係人。

Even doctors are patients at some point.

就連醫生﹐有時都可以係病人。

So I want to talk about that

所以我想討論呢種資源

as an opportunity

可帶嚟嘅良機﹐

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

一項我哋國家﹐甚至全世界

and, in fact, worldwide.

都冇足夠善用到嘅良機。

If you want to get at the big part --

如果你想由大局嚟睇 --

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

由公共醫療嘅角度﹐即係我嘅職業範圍 --

you're looking at behavioral issues.

我哋就見到行為上嘅問題，

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

你會發現人得到訊息之後﹐

and they're not following through with it.

並冇妥善跟進。

It's a problem that manifests itself in diabetes,

呢個問題﹐於糖尿病﹑

obesity, many forms of heart disease,

肥胖症以及多種嘅心臟病﹐

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

甚至﹐如果考慮到吸煙問題﹐於癌症方面﹐都有存在。

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

所有人都知道應該要點樣做先至正確﹐

They know what they're supposed to be doing,

雖然知道應該要點樣做﹐

but they're not doing it.

但佢哋冇去做到。

Now behavior change is something

要將行為改變﹐

that is a long-standing problem in medicine.

一直都係醫學上長期存在嘅問題。

It goes all the way back to Aristotle.

遠至亞里士多德嘅時代都有存在。

And doctors hate it, right?

而且醫生都討厭呢種行為，係嗎？

I mean, they complain about it all the time.

我意思係﹐醫生經常都抱怨呢個問題。

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

我哋通常歸納為留心聽取﹐以及唔聽指示。

When people don't take their pills,

當有人唔食藥﹑

when people don't follow doctors' orders --

唔聽醫生吩咐﹐

these are behavior problems.

呢啲都係行為問題。

But for as much as clinical medicine

但係無論臨床醫學專家點樣

agonizes over behavior change,

為改變病人行為嘅問題而煩惱﹐

there's not a lot of work done

要解決呢個問題﹐

in terms of trying to fix that problem.

我哋能力根本有限。

So the crux of it

因此解決問題嘅關鍵

comes down to this notion of decision-making --

在於助人去作出正確嘅判斷 --

giving information to people in a form

即是於提供信息嘅時候﹐

that doesn't just educate them

不單只教育病人﹐

or inform them,

或者通知佢哋，

but actually leads them to make better decisions,

而係實際上引導佢哋去作更好嘅決定﹐

better choices in their lives.

於生活上作更好嘅選擇。

One part of medicine, though,

其實﹐喺醫學上有一個領域

has faced the problem of behavior change pretty well,

已經比較成功解決到行為改變方面嘅問題﹐

and that's dentistry.

就係牙科。

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

好多人眼中﹐包括我自己﹐

many dentists would have to acknowledge

而且好多牙醫都承認，

it's somewhat of a mundane backwater of medicine.

牙科於某程度係醫學上一個沉悶嘅死角。

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

牙科嘅領域一般都冇任何新奇有趣嘅事發生。

But they have really taken this problem of behavior change

但係佢哋確實有將改變行為嘅問題作出研究

and solved it.

而且解決咗呢個問題。

It's the one great preventive health success

呢個係我哋嘅醫療保體系統中

we have in our health care system.

一個非常成功嘅疾病預防嘅例子。

People brush and floss their teeth.

每個人都刷牙﹐而且用牙線剔牙。

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

佢哋雖然做得唔夠多﹐但係都總算有做。

So I'm going to talk about one experiment

所以我就想同大家分享一個實驗。

that a few dentists in Connecticut

呢個係一個30年前﹐幾個喺美國康州嘅牙醫

cooked up about 30 years ago.

諗出嚟嘅實驗。

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

呢個實驗雖然古老，但係的確唔錯

because it was very simple,

因為佢非常簡單，

so it's an easy story to tell.

所以亦好容易說明。

So these Connecticut dentists decided

話說﹐呢班康州嘅牙醫決定

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

想令到病人更頻密地刷牙﹐而且用牙線清理牙齒。

and they were going to use one variable:

而佢哋利用咗一個變量﹕

they wanted to scare them.

佢哋想要令人驚怕。

They wanted to tell them how bad it would be

佢哋想講給病人知道

if they didn't brush and floss their teeth.

如果唔刷牙﹑唔用牙線﹐後果將會點樣嚴重。

They had a big patient population.

佢哋當時有好多病人。

They divided them up into two groups.

於是將呢些病人分成兩組。

They had a low-fear population,

一組是低恐慌組，

where they basically gave them a 13-minute presentation,

佢哋比呢組人睇一段13分鐘

all based in science,

有科學根據嘅講解，

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

但係亦講比佢哋知道，如果唔刷牙﹑唔用牙線，

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

可能就會得到牙周病，而如果得到牙周病，就會失去牙齒，

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

但係重可以戴假牙，情況就唔會太差。

So that was the low-fear group.

呢個就是低恐慌組嘅部份。

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

對於高恐慌組﹐佢哋就落足料。

They showed bloody gums.

佢哋比呢一組睇見血淋淋嘅牙肉﹑

They showed puss oozing out from between their teeth.

牙縫之間流膿嘅口腔。

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

佢哋對實驗者講牙齒會脫落﹑

They said that they could have infections

佢哋會受到細菌感染

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

而細菌會由嘴巴擴散到身體其他部份，

and ultimately, yes, they would lose their teeth.

同埋最後﹐佢哋當然會失去牙齒。

They would get dentures, and if you got dentures,

雖然都可以戴假牙，但是戴假牙

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

就再唔可以食原條粟米﹑

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

唔可以食蘋果﹑

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

唔可以食牛扒。

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

下半世就只好食糊狀嘅食物。

So go brush and floss your teeth.

所以快去刷牙同埋用牙線啦。

That was the message. That was the experiment.

呢個就係其中嘅信息，實驗就係咁樣進行。

Now they measured one other variable.

跟住佢哋測試咗另一個變量。

They wanted to capture one other variable,

佢哋想要研究嘅變量就係

which was the patients' sense of efficacy.

病人自認為嘅能動性。

This was the notion of whether the patients felt

即係話﹐病人自己認為佢哋會唔會

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

真係去刷牙同埋用牙線。

So they asked them at the beginning,

所以於實驗嘅開始﹐佢哋問病人﹐

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

「你哋認為自己的確會依照呢個計劃進行嗎？」

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

回答「會﹑一定會﹐呢方面我好在行」嘅參加者﹐

they were characterized as high efficacy,

都被列入高能動性嘅一組。

and the people who said,

而回答「噢﹐我從來都無法養成

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

刷牙﹑用牙線嘅習慣」嘅人﹐

they were characterized as low efficacy.

都被列入缺乏能動性嘅一組。

So the upshot was this.

終於得到嘅結論就係咁樣。

The upshot of this experiment

呢個實驗證實

was that fear was not really a primary driver

恐懼其實完全唔係帶動行為的

of the behavior at all.

主要因素。

The people who brushed and flossed their teeth

照指示刷牙﹑用牙線嘅人

were not necessarily the people

並唔一定係

who were really scared about what would happen --

對可能帶來嘅後果感到恐懼嘅人﹐

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

而係只需要係認為自己有能力

to change their behavior.

去改變自己行為嘅人。

So fear showed up as not really the driver.

因此顯示到﹐能夠改變行為嘅原動力並唔係恐懼，

It was the sense of efficacy.

而係病人自認為嘅能動性。

So I want to isolate this,

所以我想特別談及呢個例子，

because it was a great observation --

因為呢個確實係非常唔錯嘅觀察結果，

30 years ago, right, 30 years ago --

30年前﹐冇錯﹐係30年前嘅結論﹐

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

而一直冇被發揮﹑利用嘅﹐就係呢個結論。

It was a notion that really came out

呢個想法其實起源於

of Albert Bandura's work,

Albert Bandura 嘅研究之中﹐

who studied whether

佢曾研究

people could get a sense of empowerment.

人是否可取得賦能感。

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

能動性嘅理念最後可以總結為﹕

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

一個人是否相信﹐自己有能力去改變自己嘅行為。

In health care terms, you could characterize this

以醫療角度，我哋可以將呢個概括爲

as whether or not somebody feels

人是否能夠意識到

that they see a path towards better health,

佢哋改善健康狀況嘅途徑，

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

以至佢哋能夠確實為自己健康作出改善。

and that's a very important notion.

而呢個係非常重要嘅一個觀點。

It's an amazing notion.

係一個奇妙嘅觀點。

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

只不過我哋未懂得點樣去有效利用佢。

Except, maybe we do.

又或者﹐我哋已經懂得。

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

恐懼起唔到作用。係﹐恐懼起唔到作用。

And this is a great example

而呢個係個非常好嘅例子，

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

證明我哋完全唔會接受教訓。

This is a campaign from the American Diabetes Association.

以下係美國糖尿病協會嘅一個宣傳活動。

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

亦都係目前醫療健康方面仍然採用來傳達信息嘅方法。

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

我想講嘅係，我昨晚比我三歲嘅孩子睇咗呢張幻燈片，

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

然後佢話：「爸爸，點解呢啲人屋企裡面會有救護車呢？」

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

我只能解釋：「呢個只係用來嚇人。」

And I don't know if it works.

我都唔知道呢個做法有效與否。

Now here's what does work:

而以下才是有效嘅方法。

personalized information works.

就係個人化嘅信息。

Again, Bandura recognized this

又是 Bandura﹐喺幾十年前

years ago, decades ago.

認出了呢一點。

When you give people specific information

當您向他人提供具體嘅﹑

about their health, where they stand,

關乎佢哋健康嘅﹑佢哋目前病情嘅信息﹐

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

以及佢哋可以達到嘅狀況﹑可能會出現嘅情況嘅信息﹐

that path, that notion of a path --

就是呢條路途﹑呢條路途嘅理念﹐

that tends to work for behavior change.

令到人嘅行為作出改變。

So let me just spool it out a little bit.

請等我詳盡少少去解釋。

So you start with personalized data, personalized information

您可以由一個人身上得到嘅

that comes from an individual,

個人化嘅數據﹑個人化嘅資料開始﹐

and then you need to connect it to their lives.

然後將呢啲跟每個人的生活聯繫起來。

You need to connect it to their lives,

您要將資訊跟佢哋嘅生活聯繫起來。

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

最好係以一種唔會令人感到恐懼嘅方式﹐而係一種佢哋可以理解嘅方式。

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

好喇﹐我已知道自己嘅立場。我已知道自己嘅位置。

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

而用抽象嘅數目子作根基的話﹐對我毫無意義﹐

this overload of health information

呢啲過多嘅有關健康嘅資訊

that we're inundated with.

實在氾濫得令我哋應付不來﹐

But it actually hits home.

但係佢哋其實係解決問題嘅根源。

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

佢哋不單止影響我哋嘅思想﹐亦都帶動我哋嘅情緒。

There's an emotional connection to information

我哋對呢啲信息有不解嘅情結，

because it's from us.

因為呢啲信息起源自我哋本身。

That information then needs to be connected to choices,

然後﹐呢啲資料需要與選擇串連起來，

needs to be connected to a range of options,

需要與各種各樣嘅選摘連貫起來，

directions that we might go to --

包括有可能嘅發生嘅情況 --

trade-offs, benefits.

各種利弊。

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

最後，我哋需要被清楚地告知﹐要採取點樣嘅行動。

We need to connect the information

我哋需要每次都將信息

always with the action,

跟行動串連起來﹐

and then that action feeds back

然後果個行動再反饋成

into different information,

另一份信息

and it creates, of course, a feedback loop.

而當然，咁樣因此形成一個反饋循環。

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

其實呢一套理念﹐已經係一套相當有根據﹑廣泛被公認嘅﹑

for behavior change.

用作行為改變嘅理念。

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

但問題係，圖中右上角嘅

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

個人數據﹐因為通常都係難以取得嘅。

It's a difficult and expensive commodity,

個人數據係一種難以得到嘅奢侈品﹐

until now.

直到目前為止。

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

我再來向大家講解一個例子，一個非常簡單嘅例子﹐去說明呢個原理。

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

我哋每個人都見過呢啲標示牌。呢啲係顯示「你的時速」嘅標示牌。

You've seen them all around,

大家喺任何地方都一定見過，

especially these days as radars are cheaper.

尤其是而家雷達儀器比較便宜嘅時代。

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

而以下就係佢哋點樣牽涉反饋循環嘅現象。

So you start with the personalized data

一開始﹐您所得嘅個人化數據﹐就係

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

您當時於路面嘅時速限制﹐

is 25,

25﹐

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

而當然﹐您當時正超速。

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

我哋﹐永遠都會超速。

The choice in this case is pretty simple.

呢個例子中嘅選擇係非常簡單。

We either keep going fast, or we slow down.

我哋一係就繼續超速，一係就將速度減慢。

We should probably slow down,

其實我哋應該要將速度減慢。

and that point of action is probably now.

而且大概要立刻行動。

We should take our foot off the pedal right now,

我們應該立刻將腳從油門鬆開。

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

而通常我哋都會咁樣做。呢類設備﹐通常都有效令到

in terms of getting people to slow down.

司機將行車速度減慢。

They reduce speeds by about five to 10 percent.

佢哋有效將車速減慢百分之五到百分之十。

They last for about five miles,

而且有效持續五英哩左右。

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

之後我哋又再將腳踩落油門。

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

但至少起作用﹐甚至帶嚟一啲健康嘅效應。

Your blood pressure might drop a little bit.

您嘅血壓可能會降低些少。

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

亦可能會減少意外發生，因此對大眾健康帶來益處。

But by and large, this is a feedback loop

但具體嚟講﹐呢類一流嘅反饋環

that's so nifty and too rare.

係少之又少嘅。

Because in health care, most health care,

因為喺醫療系統中，又或者大部份醫療系統中，

the data is very removed from the action.

數據已經被行動所分離。

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

因此好難將事件每部份清晰串連起嚟。

But we have an opportunity.

但係我哋有呢個機會。

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

因此我而家想轉話題去討論

how we deliver health information in this country,

我哋國家係點樣去將有關醫療信息傳達﹑

how we actually get information.

我哋點樣取得呢啲信息。

This is a pharmaceutical ad.

呢個係一個西藥嘅廣告。

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

其實呢個係一個諷刺廣告，而唔係真嘅藥品廣告。

Nobody's had the brilliant idea

到目前為止﹐未有人聰明到用

of calling their drug Havidol quite yet.

「Havidol」為藥品命名。

But it looks completely right.

但係佢看似完全冇問題。

So it's exactly the way we get

我哋就係以呢種方法

health information and pharmaceutical information,

取得有關健康同藥品嘅資訊﹐

and it just sounds perfect.

而且看似非常完美。

And then we turn the page of the magazine,

跟住我哋翻到雜誌嘅下一頁，

and we see this --

係喇﹐我們可以見到呢個情況。

now this is the page the FDA requires pharmaceutical companies

呢一頁就係食物及藥物管制局﹐要求製藥公司

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

放入廣告內或附加到廣告後面嘅說明。

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

而對我而言，呢個動作﹐係醫學界其中一種多餘嘅動作。

Because we know.

因為我哋知道

Who among us would actually say that people read this?

在座中﹐我哋邊個真係會去睇呢些啲說明呢？

And who among us would actually say

又或者在座中﹐我哋邊個真係認為

that people who do try to read this

會有人試圖去睇呢啲說明﹐

actually get anything out of it?

而又真係從中獲益呢?

This is a bankrupt effort

呢個係一個完全殘缺嘅﹑

at communicating health information.

去企圖將醫療信息轉達嘅方法。

There is no good faith in this.

呢種做法欠缺誠意。

So this is a different approach.

以下就係另外一種方法。

This is an approach that has been developed

係達特茅斯醫學院嘅兩位研究員

by a couple researchers at Dartmouth Medical School,

想出嚟嘅辦法。

Lisa Schwartz and Steven Woloshin.

佢哋係 Lisa Schwartz 同埋 Steven Woloshin。

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

佢哋將呢個發明稱之為藥物成分說明表。

They took inspiration from, of all things,

有趣嘅係﹐佢哋主要係從

Cap'n Crunch.

Cap'n Crunch 取得靈感。

They went to the nutritional information box

佢哋見到﹐穀類早餐上嘅營養標籤

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

就如其他食物標籤一樣﹐實際上真可以有效幫助人

actually helps people understand what's in their food.

去瞭解自己嘅食物存有甚麼成份。

God forbid we should use that same standard

我哋點解未想過﹐

that we make Cap'n Crunch live by

將 Cap'n Crunch 嘅製造標準﹐

and bring it to drug companies.

帶到製藥公司﹖

So let me just walk through this quickly.

請等我簡短地講解。

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

佢會清楚說明藥物嘅用途﹐尤其是係使用對象。

so you can start to personalize your understanding

咁樣您就可以根據自己情況﹐

of whether the information is relevant to you

去理解究竟呢段資訊﹑

or whether the drug is relevant to you.

又或者呢項藥物﹐是否與您相關。

You can understand exactly what the benefits are.

於是您就能清楚知道﹐藥物對您有乜嘢幫助。

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

唔再係以往一般﹑含糊地向您保證﹐藥物無論如何都一定有效﹐

but you get the statistics for how effective it is.

而係透過統計數據令您知道佢點樣有效。

And finally, you understand what those choices are.

最後，您就會明白應該作甚麼選擇。

You can start to unpack the choices involved

您可以根據副作用的情況

because of the side effects.

去收窄要選擇嘅範圍。

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

每次無論食乜嘢藥，都可能會產生副作用。

So it spells those out in very clean terms,

呢個模式﹐可以清晰令您瞭解佢哋。

and that works.

而真係有效。

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

所以我非常鐘意呢個辦法。呢個藥物成分說明表。

And so I was thinking about,

跟住我開始思考，

what's an opportunity that I could have

我可以利用乜嘢良機

to help people understand information?

去幫其他人理解呢些信息呢？

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

有乜嘢其他潛在嘅信息

that people are really not putting to use?

係我哋未有善用呢﹖

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

於是我想到呢個：化驗結果。

Blood test results are this great source of information.

血液化驗報告就是這類相當有用嘅信息﹐

They're packed with information.

佢哋充滿一大堆嘅資料。

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

只不過呢種報告唔係比我哋嘅，唔係比普通人嘅，亦唔係比病人嘅。

They go right to doctors.

只有醫生才睇得明白。

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

而天知曉﹐我覺得如果你真係問到，恐怕多數醫生

they don't really understand all this stuff either.

都未必一定明白呢堆資料。

This is the worst presented information.

呢類嘅信息表達實在係最差嘅。

You ask Tufte, and he would say,

您去問 Tufte﹐佢亦會話﹕

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

「係呀﹐呢種信息表達﹐實在差到極點。」

What we did at Wired

喺《連線》雜誌社，

was we went, and I got our graphic design department

我利用我哋嘅圖表設計部

to re-imagine these lab reports.

去重新設計呢啲化驗報告。

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

呢啲亦都係我想比在座各位見到嘅。

So this is the general blood work before,

呢份係之前見到嘅血液化驗報告，

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

而呢張係經過我哋重新設計之後嘅報告。

The after takes what was four pages --

後者將原來嘅四頁紙 --

that previous slide was actually

其實上一張幻燈片

the first of four pages of data

只有顯示四頁資料嘅第一頁，

that's just the general blood work.

而呢份只不過係巡例嘅血液化驗部告。

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

呢啲數值﹑您唔明白嘅數字﹐無窮無盡地繼續。

This is our one-page summary.

而呢份就是我哋嘅一頁摘要。

We use the notion of color.

我哋用顔色加以區分。

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

其實用顔色作區分﹐係非常奇妙嘅概念。

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

於最上面一欄﹐係您報告結果嘅概況，

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

呢啲通常係字裡行間最顯眼嘅要點。

Then you can drill down

然後你可以更詳細看下去，

and understand how actually we put your level in context,

而實質瞭解﹐我哋點樣將資訊帶到您嘅水平。

and we use color to illustrate

我哋通過顔色來清晰表明

exactly where your value falls.

您嘅數值處於邊一個位置。

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

呢個例子裡面﹐據葡萄糖含量可見到

because of their glucose level.

呢個病人存有輕微患糖尿病嘅風險。

Likewise, you can go over your lipids

同樣，您可以見到您嘅血脂含量，

and, again, understand what your overall cholesterol level is

然後瞭解您總體嘅膽固醇含量，

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

再有興趣的話﹐進一步得知高密度膽固醇及低密度膽固醇嘅程度。

But again, always using color

但無論如何，都係以顔色

and personalized proximity

以及個人化關聯

to that information.

去表達信息。

All those other values,

所有其他嘅數值，

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

所有果啲無止境嘅一大堆數值，根本毫無意義﹐

we summarize.

而我哋將佢哋簡化。

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

我哋會比您知道你情況唔錯﹑一切正常。

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

而您無須喺數字堆之中尋覓﹑無須理會雜亂﹑無意義嘅信息。

And then we do two other very important things

根住我哋還會做兩件非常重要嘅事，

that kind of help fill in this feedback loop:

去填補呢個反饋循環存在嘅空隙。

we help people understand in a little more detail

我哋令人明白一點更多嘅細節，

what these values are and what they might indicate.

也即是呢啲數值代表甚麼﹑可能表明甚麼。

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

然後我哋更進一步﹕話比病人知道佢哋可以做甚麼。

We give them some insight

我哋會幫佢哋洞悉

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

從而更有效作出選擇﹑採取行動。

So that's our general blood work test.

呢份就係我哋嘅基本血液報告。

Then we went to CRP test.

跟住我哋再來睇一份C反應蛋白測試。

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

今次就係一個嚴重缺失嘅例子。

They have this huge amount of space,

呢度上面有一大片空白，

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

既然佢哋冇善用，我哋就嚟將空白加以利用。

Now the CRP test is often done

目前﹐C反應蛋白測試通常

following a cholesterol test,

都用作跟進膽固醇測試，

or in conjunction with a cholesterol test.

或者與膽固醇測試一齊進行。

So we take the bold step

因此我們大膽地

of putting the cholesterol information on the same page,

將膽固醇測試結果放於在同一頁上面，

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

因為醫生亦都係咁樣用資料作診斷。

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

所以我哋都覺得﹐病人亦都或者想知道有關來龍去脈。

It's a protein that shows up

呢個係當您血管有炎症嘅時候，

when your blood vessels might be inflamed,

一種會被驗出來嘅蛋白質，

which might be a risk for heart disease.

亦可能係存有患心臟病風險嘅反映。

What you're actually measuring

我哋用易明瞭嘅語言

is spelled out in clean language.

去顯示報告上嘅信息。

Then we use the information

然後我哋用上

that's already in the lab report.

化驗報告裡頭已存有嘅資訊。

We use the person's age and their gender

我哋以病人嘅年齡﹑性別

to start to fill in the personalized risks.

去將佢哋嘅風險作出個人化嘅評估。

So we start to use the data we have

我哋用手上掌握嘅数據

to run a very simple calculation

進行一個非常簡單嘅計算，

that's on all sorts of online calculators

網上已經有各式各樣類似嘅計算器﹐

to get a sense of what the actual risk is.

從而對實際風險作出預測。

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

最後我展示嘅﹐係前列腺特異性抗原測試。

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

呢份係修改之前嘅﹑呢份係修改之後嘅。

Now a lot of our effort on this one --

我哋喺呢一份化驗報告上﹐下咗好大功夫 --

as many of you probably know,

大概好多人都知道

a PSA test is a very controversial test.

前列腺特異性抗原測試﹐係一項具有極度爭議嘅測試。

It's used to test for prostate cancer,

佢係用來檢測病人是否患有前列腺癌﹐

but there are all sorts of reasons

但實際上有各種原因

why your prostate might be enlarged.

會導致前列腺腫脹。

And so we spent a good deal of our time

因此我哋花咗好多時間

indicating that.

去指出呢一點。

We again personalized the risks.

同樣我哋會根據個人情況﹐去評估風險。

So this patient is in their 50s,

例如呢位病人50幾歲﹐

so we can actually give them a very precise estimate

我哋就能夠精確估計到

of what their risk for prostate cancer is.

佢患前列腺癌嘅風險。

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

根據計算，呢個病例嘅風險大概係百分之二十五。

And then again, the follow-up actions.

然後又係要採取嘅對策。

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

我哋做這項工作嘅成本少於一萬美元。

That's what Wired magazine spent on this.

呢個數目就係《連線》雜誌於呢方面所花嘅成本。

Why is Wired magazine doing this?

點解《連線》雜誌要做呢項工作呢？

(Laughter)

（笑聲）

Quest Diagnostics and LabCorp,

Quest Diagnostics 以及 LabCorp﹐

the two largest lab testing companies --

兩間最大規模嘅化驗公司

last year, they made profits of over 700 million dollars

去年，佢哋分別賺得超過7億

and over 500 million dollars respectively.

以及5億美元。

Now this is not a problem of resources;

咁樣睇嚟﹐呢個根本唔係資源嘅問題，

this is a problem of incentives.

而係動機嘅問題。

We need to recognize that the target of this information

我哋要認清楚﹐呢啲信息嘅目標

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

並唔應該係醫生，亦唔應該係保險公司，

It should be the patient.

而應該係病人。

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

最後始終都係病人本身﹐

is going to be having to change their lives

要去為自己嘅人生作出改變﹐

and then start adopting new behaviors.

而開始去養成新嘅行為習慣。

This is information that is incredibly powerful.

呢啲係具有無窮力量嘅信息。

It's an incredibly powerful catalyst to change.

係能促使人類改變嘅強力催化劑。

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

佢近在咫尺，但係我哋一直冇去將佢善用。

It's being lost.

佢不斷流失。

So I want to just offer four questions

所以我只想提出四個問題

that every patient should ask,

每個病人都應該要問呢啲問題

because I don't actually expect people

因為我冇指望有人真的會

to start developing these lab test reports.

實質地去製造呢類化驗報告。

But you can create your own feedback loop.

但係您可以創造屬於自己嘅反饋環。

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

任何人都可以透過問以下幾個簡單嘅問題﹐來創造自己嘅反饋環：

Can I have my results?

我可以取回我嘅測試結果嗎？

And the only acceptable answer is --

而呢個問題只能有一個可接受嘅答案，就係 ——

(Audience: Yes.) -- yes.

（觀眾：可以）—— 可以。

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

呢份報告說明乜嘢﹖請幫我理解呢啲數據代表乜嘢。

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

我有邊啲選擇？邊啲做法係可行？

And then, what's next?

然後又點樣﹖

How do I integrate this information

於未來嘅日子﹐我點樣可以將呢啲資料

into the longer course of my life?

運用於生活當中﹖

So I want to wind up by just showing

結束之前﹐我想令大家知道，

that people have the capacity to understand this information.

每個人都有能力去理解呢啲信息。

This is not beyond the grasp of ordinary people.

呢個並非超出普通人可理解嘅範圍。

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

無須擁有像在座各位嘅教育程度，

Ordinary people are capable of understanding this information,

普通人已經可以理解呢啲信息，

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

只要我哋願意為信息嘅表達方面努力，

in a form that they can engage with.

做到可以容許病人參與嘅模式。

And engagement is essential here,

喺呢度﹐參與係關鍵因素，

because it's not just giving them information;

因為不單止關乎向病人提供信息﹐

it's giving them an opportunity to act.

更重要嘅係比佢哋行動嘅機會。

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

呢個就係參與嘅意義﹔與服從唔同。

It works totally different from the way we talk about behavior

呢個同我哋所討論有關現今醫學界嘅行為﹐

in medicine today.

完全唔同。

And this information is out there.

而呢啲信息就在眼前。

I've been talking today about latent information,

我今日一直講及潛在嘅信息，

all this information that exists in the system

呢啲信息存在於呢個體系之中，

that we're not putting to use.

而我們卻未有加以利用。

But there are all sorts of other bodies of information

但仍有大量各種其他信息

that are coming online,

正逐漸可於網上取得。

and we need to recognize the capacity of this information

我哋需要認清楚呢啲信息嘅力量，

to engage people, to help people

去吸引人去參與﹑去幫助人，

and to change the course of their lives.

而且去改變佢哋嘅生命路程。

Thank you very much.

多謝大家。

(Applause)

（掌聲）