Jenna C. Lester: Why skin disease is often misdiagnosed in darker skin tones | TED

譯者: Sichen Wei 審譯者: Helen Chang

The skin is the human body's largest organ

皮膚是人身體上面積最大的器官，

and one of the most powerful predictors of our health.

並且是人類最強大的 健康晴雨表之一。

This is erythema migrans, a hallmark feature of Lyme disease,

遊走性紅斑， 萊姆病的標誌性特徵，

a tick-borne illness present in over 80 countries

一種出現在80多個國家的 蜱傳播疾病，

and estimated to affect 476,000 people in the United States each year.

並且預計每年會影響 在美國的47萬6000人。

Dermatologists like me are doctors of the skin

皮膚科專家，也就是 和我一樣的管理皮膚的醫生，

trained to diagnose and treat skin disease.

訓練有素的診斷和治療皮膚疾病。

And this is how we're trained to see erythema migrans,

這是我們被訓練 如何看待遊走性紅斑的，

as a bullseye-shaped rash that ranges from red to pink.

就像是牛眼形狀的粉色到紅色的皮疹。

But this is not at all what it looks like in dark skin.

但在深色的皮膚上， 完全不是一個樣子。

As you can see here,

就像你能看到的一樣，

there are hues of violet, of magenta, and even dark brown.

它是很多種深淺不一的紫羅蘭色， 洋紅色，甚至是深棕色。

If we were to rely only on dermatology textbooks

如果我們只依賴皮膚科的教科書

to teach us how to identify skin disease,

來教我們如何識別皮膚疾病，

we would frequently misdiagnose it in patients of color.

我們會經常對有色人種患者診斷失誤。

And this is a huge problem because Lyme disease needs to be treated.

因為萊姆病需要被治療， 這便成了一個大問題。

Left untreated, Lyme disease has significant health ramifications

如果不去治療， 萊姆病將對身體健康產生巨大影響，

including arthritis and even nerve damage.

包括關節炎，甚至是神經損傷。

And what's more,

另外，

as we've seen an increase in the incidence of Lyme disease,

我們可以看到 萊姆病傳播增長地非常快，

a phenomenon attributed in part to climate change,

這個現象部分歸因於氣候變化，

as we continue to see and experience the effects of climate change,

因為我們持續目睹和經歷 氣候變化所造成的影響，

we may see more people infected with Lyme disease,

我們可能會看到更多人感染萊姆病，

making it even more important that we're able to accurately diagnose it.

讓我們能夠準確診斷它 變得更加重要。

Now, this story of erythema migrans is emblematic of a larger issue.

現在，遊走性紅斑的故事 其實是一個更大問題的象徵性縮影。

In the United States, 47 percent of graduating dermatology residents

在美國 47% 即將畢業的 皮膚科住院醫師稱

report feeling uncomfortable diagnosing skin disease in patients with dark skin.

當他們為深膚色患者 診斷皮膚疾病時感覺不自在。

47 percent. I just want that to sink in for a second.

47%，我想讓我們為此沈思一下。

This is a staggering statistic,

這是一個令人震驚的數據，

and this means that the people who have just undergone

這意味著那些才剛剛受了大量培訓，

their most intensive training to become doctors of the skin

最終成為皮膚科醫生的人們

don't feel comfortable diagnosing and treating all patients.

在診斷和治療病人時，並不完全適應。

And even so, they graduate from residency,

即使這樣， 他們通過住院醫師實習期，

and they're eligible to become board-certified dermatologists,

有資格成為通過認證的 皮膚科執業醫師，

qualified to care for all people.

被准許去治療所有人。

Now, I wonder, could this be why we still see and experience

現在我很想知道，這是不是 我們為什麼仍在醫學領域各個方面

health care disparities in all aspects of medicine,

看到、經歷到衛生保健差異的原因，

including dermatology?

其中包括皮膚科？

I believe there's a connection between the fact

我相信與下列事實有關：

that almost half of dermatology residents

近一半的皮膚科住院醫師

feel uncomfortable diagnosing and treating certain patients

對診斷和治療特定群體的病人 感到不自在，

and the poorer health outcomes of those same patients.

而且這一群體的病人 通常健康預後較差。

I speak to patients of color all the time

我和有色人種的病人一直在溝通，

who express an awareness of the fact

他們會感受到這一現實情況：

that their dermatologist is unfamiliar

他們的皮膚科專家對於

with diagnosing skin disease in their skin tone

診斷他們膚色的皮膚疾病 並不是很熟悉，

or uncomfortable teaching them how to care for their hair or scalp.

或是對教他們如何護理 頭髮和頭皮覺得彆扭。

And I wonder, what does this awareness that your doctor is uncomfortable with you

而且我納悶是什麼使你覺察到 醫生和你之間彆扭呢？

due to the physician-patient relationship;

是源自於醫師和病患的關係，

to trust in the medical establishment;

源自於對醫療機構的信任，

or to the likelihood that someone returns for additional care?

還是源自於可能得要回診 接受額外的治療呢？

A problem in dermatology is

皮膚科存在的一個問題是

that we're not taught how skin disease appears in all skin tones.

我們並沒被教皮膚疾病 在各種膚色中顯現的樣子。

As a medical student, my classmates and I quickly realized

我和我的醫學生同學們 很快就意識到

that we only saw dark skin when we were learning about syphilis.

我們只有在學習梅毒的時候 看到過深色皮膚。

And this observation is supported by research that I published

我於 2019 年發表在 《英國皮膚病學雜誌》上的研究

in the British Journal of Dermatology in 2019

支持這一觀察結果，

that shows an overrepresentation of dark skin in chapters

發表的論文表明

在性傳播感染的章節中 黑皮膚的比例過高，

focused on sexually transmitted infections,

even while those same skin tones are underrepresented elsewhere

然而這些相同的膚色 在同一本教科書中的其他地方

in the same textbook.

出現得太少。

What does this do to impressionable learners?

這給學習的人留下了什麼樣的印象呢？

Does it make them think that someone with dark skin

他們會不會覺得有著深色皮膚的人

更可能通過性傳播感染疾病？

is more likely to have a sexually transmitted infection?

Now, I know some of you may be thinking,

現在，我知道你們當中肯定有人在想

I know an algorithm that can solve this or machine learning to the rescue.

我知道有個算法可以解決這件事 或者機器學習可以對此進行補救。

And I'm here to gently disagree.

在這裡我提出一些異議。

And that's because the data from which these algorithms learn

這是因為那些算法學習的數據

are the same photos that overrepresent dark skin

都是在特定情況下， 相同類型的被過度濫用的

in certain skin conditions,

深色皮膚的照片，

even while underrepresenting them in others.

同時在別的地方又被引用的過少。

In other words, these algorithms will be as biased as we are

換句話說， 這些算法會和我們一樣充滿偏見，

unless we make significant change.

除非我們做出巨大的改變。

I started the Skin of Color program

我在三藩市的加州大學

at the University of California, San Francisco,

開始多彩膚色的項目，

where I work with medical students and residents

與和我共同工作的醫學生和住院醫師

in an effort to begin to help them unlearn some of these harmful patterns

齊心合力的去除這些有害的圖案學習，

that make it easier to see some things,

這樣把看到一些事情變得更容易，

like dark skin with syphilis,

像是有梅毒的深膚色，

and harder to see others, like dark skin with erythema migrans.

以及那些很難被看到的其他圖片， 像是存在遊走性紅斑的深膚色。

I teach everything from how to identify inflammation in dark skin

我教授從如何在深膚色上識別發炎，

to how to talk to a Black woman about her hair care practices.

到与黑人女性去談論 如何做頭髮護理。

And one important fact that I always make sure to mention

一個重要的事實， 我每次都確保自己提及到：

is that it's neither good nor common

對黑人女性每天洗頭髮，

for Black women to wash their hair every day.

即不好也不常見。

And any treatment regimen

任何一種注重保護

focused on taking care of the hair and scalp

頭髮和頭皮的治療規劃，

should reflect this important understanding.

都應反映出對此的重要性的理解。

My work at the Skin of Color program,

我在色彩膚色項目中的工作，

as well as the work of similar programs across the country,

和國內其他類似項目的工作，

demonstrate the importance of creating a dedicated educational environment

都展示出了為住院醫師和醫學生 創造專注的學術環境的重要性。

for residents and medical students to learn the full spectrum of skin disease

使他們能夠學習到 皮膚疾病的方方面面，

as they appear in all patients, regardless of skin tone.

因為不管膚色如何， 這些疾病可能會出現在所有病人身上。

This is an important first step

這是消除皮膚健康保健差異這條長路中

on a long road towards eliminating health care disparities in dermatology.

至關重要的第一步。

But let's commit to taking this journey together.

但是來讓我們共同開啟這段旅程。

Thank you.

謝謝。

(Applause)

（掌聲）