What really happens when you mix medications? | Russ Altman

188,476 views ・ 2016-03-23

TED


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譯者: 易帆 余 審譯者: Adrienne Lin
00:12
So you go to the doctor and get some tests.
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你去看醫生,接受了一些檢查。
00:16
The doctor determines that you have high cholesterol
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醫生診斷出你的膽固醇過高,
00:19
and you would benefit from medication to treat it.
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建議你服藥治療可能有幫助。
00:22
So you get a pillbox.
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所以,你拿到了藥罐子。
00:25
You have some confidence,
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你有點信心,
00:26
your physician has some confidence that this is going to work.
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你的醫師也有信心,認為這藥會有效。
00:29
The company that invented it did a lot of studies, submitted it to the FDA.
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發明這個藥的公司做了很多的研究, 然後呈送給食品藥物管理局。
00:33
They studied it very carefully, skeptically, they approved it.
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他們很仔細、審慎地研究, 並核准了這藥物上市。
00:36
They have a rough idea of how it works,
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他們大概知道這藥物如何運作,
00:38
they have a rough idea of what the side effects are.
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也大略知道會有什麼副作用,
00:40
It should be OK.
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應該沒問題。
00:42
You have a little more of a conversation with your physician
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你跟醫師又多聊了一會,
00:45
and the physician is a little worried because you've been blue,
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而醫師有點擔心,因為你很憂鬱,
00:48
haven't felt like yourself,
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精神欠佳。
00:50
you haven't been able to enjoy things in life quite as much as you usually do.
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無法像平常一樣盡情享受生活點滴。
00:53
Your physician says, "You know, I think you have some depression.
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你的醫師說: 「我認為你有一點精神憂鬱,
00:57
I'm going to have to give you another pill."
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我再開個藥給你。」
01:00
So now we're talking about two medications.
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所以,我們現在有兩種藥了。
01:03
This pill also -- millions of people have taken it,
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這個藥也有好幾百萬人服用過,
01:06
the company did studies, the FDA looked at it -- all good.
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公司做了研究,食品藥物管理局 也檢查過,全部都沒問題。
01:10
Think things should go OK.
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想一下,這東西沒問題,OK的。
01:12
Think things should go OK.
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想一下,這東西沒問題,OK的。
01:15
Well, wait a minute.
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但,請等一下。
01:16
How much have we studied these two together?
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我們對這兩種藥混在一起吃 做了多少研究?
01:20
Well, it's very hard to do that.
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其實,這很難評估。
01:22
In fact, it's not traditionally done.
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事實上,傳統上都不會做。
01:25
We totally depend on what we call "post-marketing surveillance,"
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在藥物上市後,我們完全倚賴一種
叫做「上市後監察系統」的機制,
01:30
after the drugs hit the market.
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01:32
How can we figure out if bad things are happening
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我們要如何確認,兩種藥之間
01:35
between two medications?
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是否有什麼不好的事會發生?
01:37
Three? Five? Seven?
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三種?五種?七種呢?
01:39
Ask your favorite person who has several diagnoses
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問你身邊有各種疾病在身的人,
01:42
how many medications they're on.
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他們正在吃多少藥。
01:44
Why do I care about this problem?
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為什麼我在乎這個問題?
01:46
I care about it deeply.
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我非常在乎。
01:47
I'm an informatics and data science guy and really, in my opinion,
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我是念資訊和數據科學的人, 真的,在我看來,
01:51
the only hope -- only hope -- to understand these interactions
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了解藥物彼此間的交互影響 唯一的希望只有
01:55
is to leverage lots of different sources of data
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運用不同來源的龐大資料,
01:58
in order to figure out when drugs can be used together safely
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才能找出這些藥 何時可以安全地一起服用,
02:02
and when it's not so safe.
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以及何時不行。
02:04
So let me tell you a data science story.
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所以,讓我來告訴各位 一個數據科學的故事。
02:06
And it begins with my student Nick.
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這要從我的學生尼克開始講起。
02:08
Let's call him "Nick," because that's his name.
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我們就稱呼他為尼克吧, 因為那就是他的本名。
02:11
(Laughter)
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(笑聲)
02:12
Nick was a young student.
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尼克很年輕,
02:14
I said, "You know, Nick, we have to understand how drugs work
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我說:「尼克, 我們必須了解藥物如何運作,
02:17
and how they work together and how they work separately,
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以及藥物在一起會如何運作、 分開會如何運作,
02:19
and we don't have a great understanding.
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而我們並沒有了解很深。」
02:21
But the FDA has made available an amazing database.
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但食品藥物管理局已經 有一個很驚人的資料庫,
02:24
It's a database of adverse events.
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是一個藥物不良反應通報資料庫。
02:26
They literally put on the web --
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資料真的直接放在網路上
02:27
publicly available, you could all download it right now --
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供大眾查詢,你現在就可以全部下載,
02:31
hundreds of thousands of adverse event reports
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從病人、醫生、公司、藥劑師通報上來
02:34
from patients, doctors, companies, pharmacists.
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好幾百萬個的藥物不良反應通報。
02:38
And these reports are pretty simple:
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這些報告都相當簡單:
02:40
it has all the diseases that the patient has,
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上面有病人所有疾病
02:43
all the drugs that they're on,
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及所有藥物的使用狀況,
02:44
and all the adverse events, or side effects, that they experience.
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還有他們經歷過的 所有不良反應事件或副作用。
02:48
It is not all of the adverse events that are occurring in America today,
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雖然沒有現今在美國 發生的所有不良反應事件,
02:52
but it's hundreds and hundreds of thousands of drugs.
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但卻有上百萬種藥物資科。
02:54
So I said to Nick,
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所以,我跟尼克說:
02:56
"Let's think about glucose.
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「我們來想一想葡萄糖。
02:57
Glucose is very important, and we know it's involved with diabetes.
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葡萄糖非常重要,而且 大家都知道它與糖尿病有關。
03:01
Let's see if we can understand glucose response.
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讓我們來看看是否可以 了解葡萄糖的反應。」
03:05
I sent Nick off. Nick came back.
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我請尼克去找資料,
03:08
"Russ," he said,
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他回來後說:「洛斯,
03:10
"I've created a classifier that can look at the side effects of a drug
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我已經建造了一個分辨器, 可以透過這個資料庫
03:15
based on looking at this database,
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來檢視一種藥物的副作用,
03:17
and can tell you whether that drug is likely to change glucose or not."
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而且還可以告訴你,這個藥 會否改變病人血糖狀況。」
03:21
He did it. It was very simple, in a way.
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他用一個方法做到了,很簡單。
03:23
He took all the drugs that were known to change glucose
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他把所有已知會改變葡萄糖的藥物
03:26
and a bunch of drugs that don't change glucose,
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及所有不會改變的藥物拿出來做比較,
03:28
and said, "What's the difference in their side effects?
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「它們之間的副作用有什麼分別?
03:31
Differences in fatigue? In appetite? In urination habits?"
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疲勞狀況上的差異?食慾上的差異? 排尿習慣上的差異?」
03:36
All those things conspired to give him a really good predictor.
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所有這些事情都可以協助他 做出一個很棒的預測器。
03:39
He said, "Russ, I can predict with 93 percent accuracy
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他說:「洛斯,我能預測 哪種藥可改變血糖,
03:42
when a drug will change glucose."
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準確率可以高達93%。」
03:43
I said, "Nick, that's great."
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我說:「尼克,這太棒了!」 他是個年輕的學生,
03:45
He's a young student, you have to build his confidence.
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你必須建立他的信心。
03:48
"But Nick, there's a problem.
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「但,尼克,有一個問題。
03:49
It's that every physician in the world knows all the drugs that change glucose,
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就是全世界的醫師都知道 這些藥會改變葡萄糖,
03:53
because it's core to our practice.
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因為這是我們實務上的核心。
03:55
So it's great, good job, but not really that interesting,
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所以,你很棒,幹得好, 但並沒有人對這有興趣,
03:59
definitely not publishable."
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絕對還不適合公布你的研究結果。」
04:01
(Laughter)
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(笑聲 )
04:02
He said, "I know, Russ. I thought you might say that."
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他說:「我知道,洛斯。 我知道你可能會這麼說。」
04:04
Nick is smart.
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尼克很聰明。
04:06
"I thought you might say that, so I did one other experiment.
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「我知道你會這麼說, 所以我多做了另一項實驗。
04:09
I looked at people in this database who were on two drugs,
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我仔細觀察資料庫裡 同時服用兩種藥的人,
04:11
and I looked for signals similar, glucose-changing signals,
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然後尋找他們之間
葡萄糖改變的相似訊號,
04:16
for people taking two drugs,
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04:18
where each drug alone did not change glucose,
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但前提是,這些藥單獨服用 不會改變葡萄糖,
04:23
but together I saw a strong signal."
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一起服用時,會有強烈訊號的藥物。」
04:26
And I said, "Oh! You're clever. Good idea. Show me the list."
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我說:「喔!你真聰明, 好主意,讓我看一下清單。」
04:29
And there's a bunch of drugs, not very exciting.
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有一大堆藥,並沒有令人非常興奮。
04:31
But what caught my eye was, on the list there were two drugs:
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但引起我注意的是,清單上有兩種藥:
04:35
paroxetine, or Paxil, an antidepressant;
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帕羅西汀或稱克憂果, 這是一種治療憂鬱症的藥,
04:39
and pravastatin, or Pravachol, a cholesterol medication.
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還有普伐他汀或稱美百樂, 一種治療心臟疾病的藥。
04:43
And I said, "Huh. There are millions of Americans on those two drugs."
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然後我說:「哈!有上百萬 美國人正在服用這兩種藥」。
04:48
In fact, we learned later,
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事實上,我們之後才知道,
04:49
15 million Americans on paroxetine at the time, 15 million on pravastatin,
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當時有1500萬美國人正在服用帕羅西汀, 1500萬人正在服用普伐他汀,
04:55
and a million, we estimated, on both.
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而我們預估有100萬人, 同時服用這兩個藥。
04:58
So that's a million people
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所以,有100萬人
05:00
who might be having some problems with their glucose
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可能有葡萄糖上的問題,
05:02
if this machine-learning mumbo jumbo that he did in the FDA database
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如果他用食品藥物管理局的資料庫
05:05
actually holds up.
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做的機械學習判讀器真的有用的話。
05:07
But I said, "It's still not publishable,
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但我說:「還是不能發表,
05:08
because I love what you did with the mumbo jumbo,
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因為我雖然喜歡你做的
05:11
with the machine learning,
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機械學習判讀器,
05:12
but it's not really standard-of-proof evidence that we have."
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但我們沒有真正的證明標準 來證明我們是正確的。」
05:17
So we have to do something else.
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所以,我們來必須做些其他事來驗證。
05:19
Let's go into the Stanford electronic medical record.
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我們去找史丹佛的電子病例紀錄。
05:22
We have a copy of it that's OK for research,
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我們有一個副本,可以用來研究,
05:24
we removed identifying information.
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我們移除了病人個資。
05:26
And I said, "Let's see if people on these two drugs
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我說:「讓我們來看看, 服用這兩種藥的人
05:29
have problems with their glucose."
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是否有葡萄糖上的疾病。」
05:31
Now there are thousands and thousands of people
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在史丹佛病例紀錄中有成千上萬的人
05:33
in the Stanford medical records that take paroxetine and pravastatin.
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同時服用這兩種藥。
05:36
But we needed special patients.
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但我們需要特定病患。
05:38
We needed patients who were on one of them and had a glucose measurement,
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我們需要已經做葡萄糖檢測 且服用其中一種藥的病人,
05:43
then got the second one and had another glucose measurement,
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另外再找到另一個已經做過 另一個葡萄糖檢測的病人,
05:46
all within a reasonable period of time -- something like two months.
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全部都在合理期間做的, 例如兩個月內。
05:50
And when we did that, we found 10 patients.
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當我們開始著手進行時, 我們找到十個病人。
05:54
However, eight out of the 10 had a bump in their glucose
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然而,十個人裡面 有八個葡萄糖異常增加現象,
05:59
when they got the second P -- we call this P and P --
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在他們服用第二個P時 ─我們稱呼這個叫 P&P─
06:01
when they got the second P.
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當他們服用了第二個 P。
06:03
Either one could be first, the second one comes up,
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哪一個先服用都行, 當第二個藥服用後,
06:05
glucose went up 20 milligrams per deciliter.
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葡萄糖濃度每公升會增加20毫克。
06:08
Just as a reminder,
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提醒各位一下,
06:09
you walk around normally, if you're not diabetic,
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如果你能正常走動,沒有糖尿病,
06:12
with a glucose of around 90.
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你的葡萄糖濃度約90毫克/公升。
06:13
And if it gets up to 120, 125,
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如果上升到120、125,
06:15
your doctor begins to think about a potential diagnosis of diabetes.
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你的醫生會開始認為 你有潛在的糖尿病症狀。
06:19
So a 20 bump -- pretty significant.
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所以,一下子增加20是相當明顯的。
06:22
I said, "Nick, this is very cool.
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我說:「尼克,這很酷。
06:25
But, I'm sorry, we still don't have a paper,
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但,很抱歉,我們仍然沒辦法寫報告,
06:27
because this is 10 patients and -- give me a break --
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因為只有十個病人,饒了我吧,
06:30
it's not enough patients."
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病人樣本數根本不夠。」
06:31
So we said, what can we do?
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所以,那怎麼辦?
06:32
And we said, let's call our friends at Harvard and Vanderbilt,
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我們來打電話給哈佛 及范德堡大學的朋友,
06:35
who also -- Harvard in Boston, Vanderbilt in Nashville,
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就是波士頓的哈佛 及納許維爾的范德堡,
06:38
who also have electronic medical records similar to ours.
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他們都有跟我們很像的 電子病歷紀錄。
06:41
Let's see if they can find similar patients
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讓我們看看,他們是否 也可以找到相同的病人,
06:43
with the one P, the other P, the glucose measurements
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也有我們需要的已經服用這兩種藥,
06:46
in that range that we need.
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並做過葡萄糖檢測的病人。
06:48
God bless them, Vanderbilt in one week found 40 such patients,
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上天保佑,范德堡一個星期內找到40個
06:53
same trend.
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有同樣趨勢的病人。
06:55
Harvard found 100 patients, same trend.
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哈佛找到100個有同樣趨勢的病人。
06:59
So at the end, we had 150 patients from three diverse medical centers
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所以,最後,我們從三個不同的 醫學中心找到150個病人
07:03
that were telling us that patients getting these two drugs
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服用過這兩種藥,
然後有葡萄糖異常增加現象。
07:07
were having their glucose bump somewhat significantly.
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07:10
More interestingly, we had left out diabetics,
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有趣的是,我們沒有考慮糖尿病患者,
07:13
because diabetics already have messed up glucose.
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因為糖尿病患者本身的 血糖濃度就已經很混亂。
07:15
When we looked at the glucose of diabetics,
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當我們觀察糖尿病患者的血糖濃度時,
07:17
it was going up 60 milligrams per deciliter, not just 20.
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會上升到每公升60毫克, 不只20毫克。
07:21
This was a big deal, and we said, "We've got to publish this."
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這事情很重要,我們說: 「我們必須發佈這件事。」
07:25
We submitted the paper.
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我們遞交報告,
07:26
It was all data evidence,
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裡面全部都是資料證明,
07:28
data from the FDA, data from Stanford,
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有來自食品藥物管理局、史丹佛的資料、
07:31
data from Vanderbilt, data from Harvard.
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有來自范德堡、哈佛醫學院的資料,
07:33
We had not done a single real experiment.
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我們完全沒有做任何實驗。
07:36
But we were nervous.
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但我們很緊張。
07:38
So Nick, while the paper was in review, went to the lab.
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所以,當報告送去審核時, 尼克就去了實驗室。
07:41
We found somebody who knew about lab stuff.
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我們找到會做實驗的人。
07:44
I don't do that.
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我不做實驗的。
07:45
I take care of patients, but I don't do pipettes.
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我會看病人,但我不會做分量管。
07:49
They taught us how to feed mice drugs.
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他們教我們如何餵老鼠吃藥。
07:52
We took mice and we gave them one P, paroxetine.
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我們給第一組老鼠餵食帕羅西汀,
07:55
We gave some other mice pravastatin.
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給第二組老鼠餵食普伐他汀。
07:57
And we gave a third group of mice both of them.
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第三組的老鼠兩種藥都餵食。
08:01
And lo and behold, glucose went up 20 to 60 milligrams per deciliter
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驚奇的是,葡萄糖每公升上升20到60毫克,
老鼠也有相同的反應。
08:05
in the mice.
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08:07
So the paper was accepted based on the informatics evidence alone,
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所以,只有資料證據的報告被接受了,
但我們在最後加了註記說,
08:10
but we added a little note at the end,
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08:12
saying, oh by the way, if you give these to mice, it goes up.
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如果把藥物給老鼠,葡萄糖也會上升。
08:15
That was great, and the story could have ended there.
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太棒了,故事其實就到這裡結束。
08:17
But I still have six and a half minutes.
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但,我還有六分半鐘。
08:19
(Laughter)
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(笑聲)
08:22
So we were sitting around thinking about all of this,
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所以,我們坐下來想一下所有的事,
08:25
and I don't remember who thought of it, but somebody said,
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我忘記誰曾經說過,但有人說:
08:28
"I wonder if patients who are taking these two drugs
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「不曉得同時服用這兩種藥的病人,
08:31
are noticing side effects of hyperglycemia.
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是否有注意到高血糖症的副作用。
08:34
They could and they should.
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他們可能知道,也必須知道。
08:36
How would we ever determine that?"
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我們要如何確定?」
08:39
We said, well, what do you do?
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我們說,好吧,你會怎麼做?
08:41
You're taking a medication, one new medication or two,
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你服用了一種藥,一個或兩個新藥,
08:43
and you get a funny feeling.
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然後你感覺怪怪的。
08:45
What do you do?
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你會怎麼做?
08:46
You go to Google
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你會去問 Google,
08:47
and type in the two drugs you're taking or the one drug you're taking,
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然後搜尋你在服用的一或兩個藥名,
08:50
and you type in "side effects."
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然後加上「副作用」。
08:52
What are you experiencing?
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你會找到什麼?
08:54
So we said OK,
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所以,我們說,好,
08:55
let's ask Google if they will share their search logs with us,
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我們來問 Google 能否 跟我們分享搜尋紀錄,
08:58
so that we can look at the search logs
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讓我們可以觀察搜尋紀錄,
09:00
and see if patients are doing these kinds of searches.
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看是否有病人也在做同樣的搜尋。
09:02
Google, I am sorry to say, denied our request.
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很抱歉我得這麼說, 但 Google 拒絕了我們的請求。
09:06
So I was bummed.
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所以,我很煩惱。
09:07
I was at a dinner with a colleague who works at Microsoft Research
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我跟一個在微軟研究室的同事吃晚餐時,
09:11
and I said, "We wanted to do this study,
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我跟他說:「我們想做這個研究,
09:13
Google said no, it's kind of a bummer."
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Google 說不行,我有點煩惱。」
09:15
He said, "Well, we have the Bing searches."
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他說:「我們有 Bing 搜尋引擎啊。」
09:18
(Laughter)
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(笑聲)
09:22
Yeah.
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是啊!
09:24
That's great.
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太棒了。
09:25
Now I felt like I was --
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現在,我感覺...
09:26
(Laughter)
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(笑聲)
09:27
I felt like I was talking to Nick again.
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我好像又在鼓勵尼克一樣。
09:30
He works for one of the largest companies in the world,
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他在全世界數一數二的公司上班,
09:33
and I'm already trying to make him feel better.
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我已經開始要安慰他了。
09:35
But he said, "No, Russ -- you might not understand.
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但他說:「不,洛斯,你可能沒搞懂。
09:37
We not only have Bing searches,
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我們不只有 Bing 啊,
09:39
but if you use Internet Explorer to do searches at Google,
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如果你用 IE 在 Google、
09:42
Yahoo, Bing, any ...
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雅虎、Bing 等任何搜尋引擎,
09:44
Then, for 18 months, we keep that data for research purposes only."
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之後18個月,我們保留這些數據 僅做研究目的使用。
09:48
I said, "Now you're talking!"
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我說:「這才像話嘛!」
09:50
This was Eric Horvitz, my friend at Microsoft.
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這就是我的微軟朋友艾瑞克.霍維茲。
09:52
So we did a study
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我們做了一項研究,
09:54
where we defined 50 words that a regular person might type in
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我們定義出了50個
如果一般人有高血糖症時 會鍵入的關鍵字,
09:58
if they're having hyperglycemia,
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10:00
like "fatigue," "loss of appetite," "urinating a lot," "peeing a lot" --
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像是疲勞、沒食慾、頻尿等。
10:05
forgive me, but that's one of the things you might type in.
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請原諒我,但這些就是 你可能會鍵入的關鍵字。
10:08
So we had 50 phrases that we called the "diabetes words."
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所以,我們有了50個短語, 我們稱之為「糖尿病關鍵字」。
10:10
And we did first a baseline.
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我們先設定了一條基準線。
10:12
And it turns out that about .5 to one percent
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原來,網路上有包含這些關鍵字的搜尋
10:15
of all searches on the Internet involve one of those words.
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占了0.5~1%的比例。
10:18
So that's our baseline rate.
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所以,這就是我們的基準線率,
10:20
If people type in "paroxetine" or "Paxil" -- those are synonyms --
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如果大家鍵入「帕羅西汀」或「克憂果」 ──這些是同義字──
10:24
and one of those words,
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以及剛剛其中一個關鍵字,
10:25
the rate goes up to about two percent of diabetes-type words,
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那糖尿病類型的基準線率會上升到2%,
10:30
if you already know that there's that "paroxetine" word.
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如果你已經知道 「帕羅西汀」這個字的話。
10:34
If it's "pravastatin," the rate goes up to about three percent from the baseline.
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如果是「普伐他汀」, 那比率會從基準線率上升到3%。
10:39
If both "paroxetine" and "pravastatin" are present in the query,
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如果「帕羅西汀」 和「普伐他汀」同時出現,
10:43
it goes up to 10 percent,
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那會上升到10%,
10:45
a huge three- to four-fold increase
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有3到4倍的增加,
10:48
in those searches with the two drugs that we were interested in,
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用這兩種藥搜尋,會出現 我們感興趣的字在裡面,
10:52
and diabetes-type words or hyperglycemia-type words.
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像是糖尿病類的字 或高血糖症類的字。
我們發佈了這個研究,
10:56
We published this,
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10:57
and it got some attention.
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並得到一些關注。
10:58
The reason it deserves attention
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它值得被關注的原因是,
11:00
is that patients are telling us their side effects indirectly
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病人會透過搜尋,
直接告訴我們藥物的副作用。
11:05
through their searches.
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11:06
We brought this to the attention of the FDA.
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我們得到了食品藥物管理局的關注。
11:08
They were interested.
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他們很感興趣。
11:09
They have set up social media surveillance programs
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他們已經成立社會媒體監測計畫,
11:13
to collaborate with Microsoft,
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與微軟展開合作,
11:15
which had a nice infrastructure for doing this, and others,
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他們有良好的設備來做這些事,
11:17
to look at Twitter feeds,
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可以觀察推特的動態、
11:19
to look at Facebook feeds,
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觀察臉書的動態、
11:21
to look at search logs,
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觀察搜尋日誌、
11:22
to try to see early signs that drugs, either individually or together,
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嘗試觀察引發問題的
無論單一藥物或混合藥物的早期症狀。
11:27
are causing problems.
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11:28
What do I take from this? Why tell this story?
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我從這件事學到什麼? 為什麼要講這個故事?
11:31
Well, first of all,
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首先,
11:32
we have now the promise of big data and medium-sized data
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我們現在有大數據及中型數據稱腰,
11:36
to help us understand drug interactions
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來幫助我們了解藥物的相互作用,
11:39
and really, fundamentally, drug actions.
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以及真實、基本的藥物作用。
11:41
How do drugs work?
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藥物是如何作用?
11:43
This will create and has created a new ecosystem
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這個將會創造一個新的生態系統,
11:46
for understanding how drugs work and to optimize their use.
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來幫助我們了解藥物如何運作 以及有效使用它們。
11:50
Nick went on; he's a professor at Columbia now.
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尼克繼續往前走, 他現在是哥倫比亞的教授。
11:52
He did this in his PhD for hundreds of pairs of drugs.
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他用好幾百對藥物做為博士研究。
11:57
He found several very important interactions,
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他找到一些非常重要的藥物交互作用,
11:59
and so we replicated this
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所以,我們複製這個模式,
12:00
and we showed that this is a way that really works
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展示出利用這樣做
12:03
for finding drug-drug interactions.
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來尋找藥與藥之間的作用真的有效。
12:06
However, there's a couple of things.
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然而,還有一些事。
12:08
We don't just use pairs of drugs at a time.
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我們不會同時一次只服用兩種藥。
12:11
As I said before, there are patients on three, five, seven, nine drugs.
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就如我之前所說的, 有病人一次是服用三、五、七、九種藥。
12:15
Have they been studied with respect to their nine-way interaction?
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他們有認真研究 這九種藥的相互作用嗎?
12:19
Yes, we can do pair-wise, A and B, A and C, A and D,
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沒錯,我們可以做成對的藥, A+B、A+C、A+D,
12:23
but what about A, B, C, D, E, F, G all together,
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但如果同一個病人 同時服用ABCDEFG,
12:28
being taken by the same patient,
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12:29
perhaps interacting with each other
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那可能會互相產生那些作用?
12:32
in ways that either makes them more effective or less effective
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藥效更好或更不好?
12:35
or causes side effects that are unexpected?
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或造成那些意想不到的副作用呢?
12:38
We really have no idea.
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我們真的不知道。
12:40
It's a blue sky, open field for us to use data
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它是個開放式的藍天領域, 讓我們可以使用數據,
12:43
to try to understand the interaction of drugs.
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來嘗試了解藥物彼此間的作用。
12:46
Two more lessons:
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另外兩件事:
12:48
I want you to think about the power that we were able to generate
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我想要各位去想想 我們所創造出來的力量,
12:52
with the data from people who had volunteered their adverse reactions
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就是我們已經可以透過藥劑師、 病人本身、病人的醫師,
12:57
through their pharmacists, through themselves, through their doctors,
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來取得自願者身上 他們的藥物不良反應,
13:00
the people who allowed the databases at Stanford, Harvard, Vanderbilt,
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這些人同意他們的資料可以被 史丹佛、哈佛、范德堡醫學院
13:04
to be used for research.
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來做研究使用。
13:05
People are worried about data.
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大家都擔心個資問題。
13:07
They're worried about their privacy and security -- they should be.
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他們擔心自己的隱私及安全 ──他們必須要擔心。
我們需要保全系統。
13:10
We need secure systems.
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13:11
But we can't have a system that closes that data off,
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但我們不能有一個 把資料關起來的系統,
13:15
because it is too rich of a source
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因為它的資源太豐盛了,
13:17
of inspiration, innovation and discovery
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它對醫學界的鼓舞、 創新、發現新事物
13:21
for new things in medicine.
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實在太重要了。
13:24
And the final thing I want to say is,
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最後,我想說的是,
13:26
in this case we found two drugs and it was a little bit of a sad story.
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我們發現這兩個藥的案例, 的確是令人難過的故事。
13:29
The two drugs actually caused problems.
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這兩個藥一起服用真的會有問題。
13:31
They increased glucose.
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同時服用會增加葡萄糖,
13:33
They could throw somebody into diabetes
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會造成一個原本沒糖尿病的人
13:35
who would otherwise not be in diabetes,
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發生糖尿病情形,
13:37
and so you would want to use the two drugs very carefully together,
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所以,各位如果想一起使用 這兩種藥,一定要非常小心,
13:41
perhaps not together,
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最好不要一起服用,
13:42
make different choices when you're prescribing.
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當你要開處方簽時, 看看有沒有不同的選擇。
13:44
But there was another possibility.
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但,也有其他的可能。
13:46
We could have found two drugs or three drugs
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我們或許能找到兩或三種藥,
13:48
that were interacting in a beneficial way.
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一起服用時也許可以更有效。
13:51
We could have found new effects of drugs
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我們或許也可以找到
13:54
that neither of them has alone,
305
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藥物本身沒有的作用,
13:56
but together, instead of causing a side effect,
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但在一起服用時不但沒有產生副作用,
13:59
they could be a new and novel treatment
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2425
反而產生新作用,有可能變成最新的
14:01
for diseases that don't have treatments
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絕症疾病治療方式,
14:03
or where the treatments are not effective.
309
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2007
或者原本的治療方式完全是無效的。
14:05
If we think about drug treatment today,
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如果我們想想現今的藥物治療方式,
14:07
all the major breakthroughs --
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所有的重大突破──
14:09
for HIV, for tuberculosis, for depression, for diabetes --
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愛滋病、肺結核、 憂鬱症,糖尿病──
14:13
it's always a cocktail of drugs.
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總像是藥物雞尾酒。
14:16
And so the upside here,
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這件事的好處是,
14:18
and the subject for a different TED Talk on a different day,
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也許哪一天不同的TED主題, 我們又會來到這裡分享,
14:21
is how can we use the same data sources
316
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我們要如何用同樣的資料來源
14:24
to find good effects of drugs in combination
317
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來找到藥物混用時產生的好效果,
14:27
that will provide us new treatments,
318
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它將提供我們新的治療方式,
14:29
new insights into how drugs work
319
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以及對藥物如何作用提供新的見解,
14:31
and enable us to take care of our patients even better?
320
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並且讓我們的病人得到更好的照顧。
14:35
Thank you very much.
321
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非常謝謝各位。
14:36
(Applause)
322
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(掌聲)
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