Thomas Goetz: It's time to redesign medical data

譯者: April Zhang 審譯者: Joan Liu

I'm going to be talking to you

我來和大家聊一聊

about how we can tap

我們如何解決一個醫保方面

a really underutilized resource in health care,

一直沒有被利用到的資源問題，

which is the patient,

這個問題就是病人，

or, as I like to use the scientific term,

或者按照科學術語——

people.

人。

Because we are all patients, we are all people.

因為我們都是病人，但我們也都是普通人。

Even doctors are patients at some point.

在某種程度上，醫生也是病人。

So I want to talk about that

我想藉此機會

as an opportunity

說明

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

我們其實在密切關心我們的國家，甚至整個世界方面

and, in fact, worldwide.

做得並不好。

If you want to get at the big part --

如果你想從大的方面來看——

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

從公眾健康的層面來看，我將要

you're looking at behavioral issues.

討論的是一個行為學問題，

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

你會發現人們得到的信息

and they're not following through with it.

並非全部都能理解。

It's a problem that manifests itself in diabetes,

這個問題在糖尿病，

obesity, many forms of heart disease,

肥胖症和很多其他的疾病上都得到了證實，

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

當考慮到吸煙問題，在某些癌症上也存在這樣的問題。

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

對於這些疾病的預防，人們都知道應該怎樣去做才有好處。

They know what they're supposed to be doing,

儘管他們知道應該怎麼做，

but they're not doing it.

但他們並沒有那麼做。

Now behavior change is something

這樣一來，行為變化就成了

that is a long-standing problem in medicine.

醫學上一個長期存在的問題。

It goes all the way back to Aristotle.

這就回到了亞里士多德的行為學觀點：人的行為總是一再重復的。

And doctors hate it, right?

顯然醫生很討厭這種行為，對嗎？

I mean, they complain about it all the time.

因為醫生們總是抱怨。

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

我們可以從約定和不服從的方面來看，

When people don't take their pills,

如果人們不吃藥，

when people don't follow doctors' orders --

不遵醫囑。

these are behavior problems.

這些都是行為問題。

But for as much as clinical medicine

和臨床醫學一樣，

agonizes over behavior change,

醫生們對於行為的改變的問題都很頭痛，

there's not a lot of work done

但是在試圖解決這個問題上，

in terms of trying to fix that problem.

人們並沒有做什麼努力。

So the crux of it

因此解決這個問題的關鍵

comes down to this notion of decision-making --

落到了做決定的方法上——

giving information to people in a form

應該以某種方式給人們提供信息，

that doesn't just educate them

這種方式不僅僅是教育

or inform them,

或者告知他們，

but actually leads them to make better decisions,

而實際上是引導他們在生活中做出更好的決定

better choices in their lives.

和選擇。

One part of medicine, though,

其中行為改變的問題在

has faced the problem of behavior change pretty well,

體現最明顯到的一個醫學分支

and that's dentistry.

便是牙科。

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

我認為，

many dentists would have to acknowledge

當然很多牙醫自己也承認，

it's somewhat of a mundane backwater of medicine.

牙科學在某種程度上是醫學的一個普遍的死角。

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

那些又酷又帥的醫生並非無緣無故的混在牙科。

But they have really taken this problem of behavior change

他們確實把行為變化做爲一個問題來研究

and solved it.

並解決這些問題。

It's the one great preventive health success

這在我們的醫保體系中的確

we have in our health care system.

是個很好的健康預防的成功案例。

People brush and floss their teeth.

人們都刷牙並且用牙線剔牙。

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

他們並沒有按照所需要的那麼多次來刷牙，但是他們確實刷牙了。

So I'm going to talk about one experiment

接下來我想和大家分享一個實驗，

that a few dentists in Connecticut

這是一個30年前在美國康州

cooked up about 30 years ago.

做的實驗。

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

看起來這的確是個老試驗了，但他確實很能說明問題。

because it was very simple,

因為它很簡單，

so it's an easy story to tell.

也很容易說明。

So these Connecticut dentists decided

這些康州牙醫的目的是

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

讓人們更頻繁的刷牙並且使用牙線清理牙齒。

and they were going to use one variable:

他們需要用一個變量來分析這個實驗。

they wanted to scare them.

他們想要嚇唬人們。

They wanted to tell them how bad it would be

他們想要告訴人們

if they didn't brush and floss their teeth.

如果不刷牙和不用牙線洗牙將會有多麼糟糕。

They had a big patient population.

他們有很多病人可以參與這個實驗。

They divided them up into two groups.

實驗人員將這些病人分成兩組。

They had a low-fear population,

一組是低恐慌人群，

where they basically gave them a 13-minute presentation,

實驗員給這組人看了一段13分鐘的講解，

all based in science,

都是基於科學的，

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

但是只告訴他們，如果不刷牙不用牙線洗牙，

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

那麽可能會的牙周病，如果得了牙周病，就會失去牙齒，

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

但是還可以戴假牙，情況就沒那麼可怕。

So that was the low-fear group.

這就是低恐慌人群實驗。

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

下面是高恐慌人群組，實驗人員在這一組下了猛料。

They showed bloody gums.

他們給這一組看了血淋淋的牙齦，

They showed puss oozing out from between their teeth.

看了牙縫參差不齊的口腔，

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

告訴被實驗者的牙齒即將脫落，

They said that they could have infections

告訴他們可能會得傳染病

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

而且病菌可能從他們的嘴巴擴散到身體的其他部位，

and ultimately, yes, they would lose their teeth.

最總，他們將會失去牙齒。

They would get dentures, and if you got dentures,

雖然也可以戴假牙，但是帶假牙

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

就不能再吃烤甜玉米，

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

不能吃蘋果，

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

不能吃牛排；

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

下半輩子將只能吃濃粥度日。

So go brush and floss your teeth.

所以趕緊去刷牙去剔牙線吧。

That was the message. That was the experiment.

情況就是這樣，實驗就是這麽進行的。

Now they measured one other variable.

接著他們測試了另一個變量。

They wanted to capture one other variable,

他們想要得到的變量是

which was the patients' sense of efficacy.

病人們自己的主觀能動性。

This was the notion of whether the patients felt

這是一種意識，就是病人們是否意識到

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

他們實際上願意去刷牙並剔牙縫。

So they asked them at the beginning,

所以實驗的開始醫生就會問病人們：

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

「你們確定可以堅持到底嗎？」

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

如果有人回答：「沒問題，我可以做到」，

they were characterized as high efficacy,

他們就屬於能夠發揮主觀能動性的一組，

and the people who said,

如果有人回答：

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

「額，我們從來沒考慮過要刷那麼多次牙並且剔牙線」，

they were characterized as low efficacy.

那麽，他們就屬於缺乏主觀能動性的一組。

So the upshot was this.

由此得到的結論是這樣的。

The upshot of this experiment

實驗表明

was that fear was not really a primary driver

恐懼並非行為的

of the behavior at all.

主要動機。

The people who brushed and flossed their teeth

按要求刷牙和剔牙的人

were not necessarily the people

並不一定是

who were really scared about what would happen --

對不刷牙肯可能帶來的後果感到恐懼的人——

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

而僅僅是認為自己有能力

to change their behavior.

來改變自己行為的人。

So fear showed up as not really the driver.

因此說明恐懼並不能成為改變行為的動機，

It was the sense of efficacy.

而這個動機應該是人們自己的主觀能動性。

So I want to isolate this,

我特別拿出這個例子來看，

because it was a great observation --

是因為這的確是個很棒的觀察結果，

30 years ago, right, 30 years ago --

沒錯，是30年前的結論，

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

也是一直深藏在研究界中的結論。

It was a notion that really came out

這個想法來源於

of Albert Bandura's work,

Albert Bandura的著作，

who studied whether

該著作研究的是

people could get a sense of empowerment.

人們是否有行動力。

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

能動性的概念基本上歸結爲

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

人們是否相信他們有改變自己行為的能力。

In health care terms, you could characterize this

在醫療方面，我們可以概括爲

as whether or not somebody feels

人們是否意識到

that they see a path towards better health,

獲得健康的途徑，

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

也就是說人們可以實實在在的看到自己正在朝著越來越健康的方向發展。

and that's a very important notion.

這的確是很重要的一個觀點。

It's an amazing notion.

也是一個驚人的觀點。

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

我們也不知道如何很好的運用這個觀點，

Except, maybe we do.

除非我們嘗試者去做。

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

所以恐懼看起來並不起作用。

And this is a great example

這也是個很好的例子，

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

說明我們根本還沒意識到這個層面。

This is a campaign from the American Diabetes Association.

下面是美國糖尿病協會的一張運動。

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

也是目前醫療健康方面仍舊使用的一種信息交流方式。

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

可以來看這張圖，我昨天晚上給三歲的孩子看了這張幻燈片，

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

然後他說：「爸爸，為什麼救護車會在人們的家裡呢？」

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

我只能解釋：「這是在嚇唬人們而已。」

And I don't know if it works.

其實我也不知道這樣是否有用。

Now here's what does work:

那麽怎樣才能有用呢？

personalized information works.

答案就是給人們提供個性化的參考數據。

Again, Bandura recognized this

同樣，Bandura在幾十年前

years ago, decades ago.

就認識到了整個方法。

When you give people specific information

當給人們提供一些具體的信息，

about their health, where they stand,

可以使關於他們健康的，關於目前所處情況的，

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

和他們想要得到的以及可能得到的健康狀況的信息。

that path, that notion of a path --

也就是通過這種途徑給人們展示個性化的信息概念，

that tends to work for behavior change.

將會在行為改變上起作用。

So let me just spool it out a little bit.

接著，我會把整個概念更加清晰化。

So you start with personalized data, personalized information

當開始從每個個體得到個人化的數據

that comes from an individual,

和信息後，

and then you need to connect it to their lives.

接著需要做的是將這些數據和信息跟每個人的生活聯繫起來。

You need to connect it to their lives,

沒錯，需要和每個人的生活聯繫起來才行，

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

當然不能以一種令人感到恐慌的方式，而是一種人們可以理解的方式聯繫起來。

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

這樣一來，人們就可以知道自己所處的情況和所面臨的問題。

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

而那些以抽象的數字存在的信息對我們來說就根本沒用了，

this overload of health information

雖然這種我們本來就不懂的健康信息

that we're inundated with.

總是像洪水一樣向我們撲來，

But it actually hits home.

但是這些信息的確反映的是根源。

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

這些信息不僅在思維上影響我們，也在心理上給我們警示。

There's an emotional connection to information

這就是所謂的在情緒上和客觀信息達到了相通，

because it's from us.

也正是因為這些信息來源於我們自己。

That information then needs to be connected to choices,

接著這些信息需要和選擇聯繫起來，

needs to be connected to a range of options,

需要和各種各樣的選項聯繫起來，

directions that we might go to --

並且引導我們的行動——

trade-offs, benefits.

也許要權衡各種利益。

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

最後，我們需要看到一個清晰的行動方向。

We need to connect the information

一直伴隨我們的應該是把信息

always with the action,

和行動聯繫起來，

and then that action feeds back

接著行動再反饋成

into different information,

不同的信息，

and it creates, of course, a feedback loop.

當然，這樣最終就形成了一個反饋環。

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

這樣就形成了一套便於觀察和建立的方法，

for behavior change.

專門用於行為改變。

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

但問題是，圖中右上角的

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

個人數據總是難以獲得的。

It's a difficult and expensive commodity,

到目前為止，個人數據還是一種非常難以取得

until now.

並且昂貴的商品。

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

那麽我就來展示一個非常簡單的例子，說明一下這項工作是如何進行的。

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

我們都看過這個圖，限速標誌。

You've seen them all around,

這是大家在任何地方都能看到的，

especially these days as radars are cheaper.

特別是在雷達越來越便宜的今天。

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

下面我們可以看一下在反饋環中如何實現這項任務。

So you start with the personalized data

一開始你的個人數據是這樣的，

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

當你到這個限速牌的時候你的車速是32，

is 25,

而限速牌上的標識是25，

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

顯然，你超速了。

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

我們總是超速。

The choice in this case is pretty simple.

在這個例子中選擇是非常簡單的。

We either keep going fast, or we slow down.

我們要麽繼續超速，要麼減速。

We should probably slow down,

我們可能應該減速，

and that point of action is probably now.

那麽就馬上行動。

We should take our foot off the pedal right now,

我們應該立刻把腳從油門上鬆開。

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

我們通常就是這麼做的，從讓人們減速這件事來看，

in terms of getting people to slow down.

這幅圖顯示的閉環方案非常有用。

They reduce speeds by about five to 10 percent.

這個方法使人們減速了百分之五到百分之十。

They last for about five miles,

並且保持大約五英哩，

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

然後才把腳踩回油門上。

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

但這的確起作用了，甚至還帶來了一些健康的效應。

Your blood pressure might drop a little bit.

血壓可能也降低了一些吧。

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

可能也減少了事故，因此的確給公眾健康帶來了益處。

But by and large, this is a feedback loop

但是大體上，這是一個很漂亮也很罕見的

that's so nifty and too rare.

反饋環。

Because in health care, most health care,

因為在醫療保健中，或者說大多數醫保中，

the data is very removed from the action.

數據是和行動分開來的。

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

這就很難把各項事物分得如此清晰。

But we have an opportunity.

但是我們是有這樣的機會的。

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

那麽接下來我就要轉而談談

how we deliver health information in this country,

在這個國家我們是如何傳達這些健康信息的，

how we actually get information.

以及我們如何能得到這些信息。

This is a pharmaceutical ad.

我們來看一個藥的廣告。

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

其實這是個欺詐廣告，而非真的藥品廣告。

Nobody's had the brilliant idea

到目前為止還沒有什麼好辦法

of calling their drug Havidol quite yet.

能做到Havidol真的宣稱能做到的那樣。（Havidol號稱是目前唯一一種能治療由於社會關注度缺乏而造成的焦慮症的藥）

But it looks completely right.

但是這廣告看起來好極了。

So it's exactly the way we get

這也正是得到

health information and pharmaceutical information,

我們的健康信息和藥物信息的方法，

and it just sounds perfect.

而這看上去的確很好。

And then we turn the page of the magazine,

接著我們翻到雜誌的這一頁，

and we see this --

我们可以看到這樣的情況。

now this is the page the FDA requires pharmaceutical companies

沒錯，這就是食品及藥物管理局要求製藥公司

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

放在廣告裡或者寫在廣告後面的說明。

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

在我看來，這是對醫藥體系的一種諷刺。

Because we know.

因為我們都知道這些。

Who among us would actually say that people read this?

而在座的各位誰會去真的閱讀這些說明呢？

And who among us would actually say

或者在座的各位有誰

that people who do try to read this

試圖去讀這些說明

actually get anything out of it?

並且從中獲益呢?

This is a bankrupt effort

這些信息在獲得醫療信息上

at communicating health information.

簡直就是徒勞。

There is no good faith in this.

所以根本沒人信這玩意。

So this is a different approach.

接下來是另一種不同的辦法。

This is an approach that has been developed

是達特茅斯醫學院的一些專家們

by a couple researchers at Dartmouth Medical School,

想出來的辦法。

Lisa Schwartz and Steven Woloshin.

Lisa Schwartz和Steven Woloshin教授研究出來的辦法。

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

他們把這種辦法稱之為藥物成分表。

They took inspiration from, of all things,

他們主要是從脆谷樂

Cap'n Crunch.

得到的靈感。

They went to the nutritional information box

他們看到脆谷樂盒子上的營養信息說明欄，

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

現實了各類食品的成分以及我們吃的食物的成分，

actually helps people understand what's in their food.

這些信息幫人們知道了自己吃的東西里都有些什麽。

God forbid we should use that same standard

天曉得我們也可以把脆谷樂的

that we make Cap'n Crunch live by

方法和標準

and bring it to drug companies.

帶到藥品公司來。

So let me just walk through this quickly.

我們來很快看一下這是如何實現的。

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

在藥物成份表中，很清楚地表明某種藥是用來治療什麽病的，它的好處在哪裡，

so you can start to personalize your understanding

這樣你就可以根據自己的理解

of whether the information is relevant to you

標註這些信息是否和你有關，

or whether the drug is relevant to you.

或者說這種藥是否和你的健康狀況有關。

You can understand exactly what the benefits are.

這樣你就能清楚的知道藥的益處到底在哪裡。

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

就不像從前那樣含糊的給你保證無論如何肯定對你的健康有好處，

but you get the statistics for how effective it is.

而是你自己根據這些清晰的數據來決定到底有什麼好處。

And finally, you understand what those choices are.

最後，你就會明白怎麽選擇自己需要的藥品。

You can start to unpack the choices involved

你可以還可以根據副作用的情況

because of the side effects.

來選擇你需要的藥品。

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

當然無論吃什麼藥，都是可能會產生副作用的。

So it spells those out in very clean terms,

但是你可以清晰的看到這些副作用是什麼，

and that works.

這樣就很有幫助。

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

我很喜歡藥物成份表的這一點。

And so I was thinking about,

接著我開始思考，

what's an opportunity that I could have

怎樣可以讓我幫助

to help people understand information?

大家理解這些信息呢？

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

有什麼其他潛在的信息

that people are really not putting to use?

人們可能沒有意識到呢？

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

由此我得到了這個：實驗測試結果。

Blood test results are this great source of information.

血液檢測報告就是這類當中最重要的信息。

They're packed with information.

血液測試報告的信息量很大。

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

但這種報告不是給我們的，不是給普通人的，也不是給病人的。

They go right to doctors.

只有醫生可以看懂。

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

而天知道，我覺得你要是真去問，恐怕很多醫生

they don't really understand all this stuff either.

也不一定能懂這些測試數據。

This is the worst presented information.

如果你去問Tufte，他肯定會說，

You ask Tufte, and he would say,

這是給人們看的最差的信息設計了。

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

（Edward Tufte，美國著名的數據學家，以信息設計著稱。）

What we did at Wired

在Wired做的就是

was we went, and I got our graphic design department

讓我們的圖形設計部門

to re-imagine these lab reports.

重新設計這些實驗報告。（Wired是美國一家著重於科技如何影響文化、經濟和政治的雜誌。）

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

這也是我想讓在座各位看到的。

So this is the general blood work before,

這是之前看到的那張血液檢測報告，

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

而這張是經過我們重新設計的檢查報告。

The after takes what was four pages --

後者其實一共有四頁－

that previous slide was actually

幻燈片

the first of four pages of data

只顯示了

that's just the general blood work.

概括的血液分析信息。

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

來來回回都是這些你不懂的測試值和數字。

This is our one-page summary.

而這就是我們的一頁彙總。

We use the notion of color.

我們用顔色加以區分。

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

其實能用顔色特征加以區分是很棒的。

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

在最上面一欄是你的總體檢查結果，

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

這些要點可能很吸引你。

Then you can drill down

然後你可以詳細往下看，

and understand how actually we put your level in context,

弄明白我們是如何把你的情況寫在報告裡的，

and we use color to illustrate

通過顔色來表明

exactly where your value falls.

你的測試結果是什麼。

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

在這個測試報告中，根據葡萄糖含量可以看到

because of their glucose level.

這個病人只有輕微的糖尿病。

Likewise, you can go over your lipids

同樣，你可以看到你的油脂含量，

and, again, understand what your overall cholesterol level is

然後知道你的總體膽固醇情況，

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

進而可以分解來看高密度膽固醇和低密度膽固醇程度。

But again, always using color

無論如何，都會用顔色標出

and personalized proximity

個人臨近的

to that information.

檢測信息。

All those other values,

所有其他的數值，

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

所有那些整頁整頁沒用的數值，

we summarize.

我們都會概括起來給予總結。

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

最終會告訴你情況不錯，你很正常。

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

你不用費力就把這些都看完了。

And then we do two other very important things

除此之外，我們還會做兩件很重要的事情，

that kind of help fill in this feedback loop:

也就是之前那個反饋環所缺少的部分。

we help people understand in a little more detail

我們讓人們來明白一些更多的細節，

what these values are and what they might indicate.

也就是這些數值是什麼和他們有什麼涵義。

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

更進一步，我們告訴人們能做什麼。

We give them some insight

我們會給大家進一步看看

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

有什麼選擇，可以採取什麼樣的行動。

So that's our general blood work test.

這就是一份基本的血液測試報告。

Then we went to CRP test.

我們再來看一份C反應蛋白測試。

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

上面這張報告簡直就是巨大的疏漏。

They have this huge amount of space,

紙張下面這麼大一張空白居然什麽也沒有，

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

既然他們不利用，那我們來利用這一片空白地。

Now the CRP test is often done

目前C反應蛋白測試通常

following a cholesterol test,

都緊跟著膽固醇測試後面做，

or in conjunction with a cholesterol test.

或者和膽固醇測試一並進行。

So we take the bold step

因此我們大膽的

of putting the cholesterol information on the same page,

把膽固醇測試結果和C反應蛋白測試結果放在同一頁上，

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

這樣一來，醫生也方便評估。

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

當然，病人也想知道這些內容實際上都是些什麽.

It's a protein that shows up

這是一種蛋白質，當你的血管有炎症的時候，

when your blood vessels might be inflamed,

它就會被測試出來，

which might be a risk for heart disease.

這也是可能得心臟疾病的一種反映。

What you're actually measuring

這樣一來病人們正在做的一些測試是什麼

is spelled out in clean language.

就可以容易的講清楚了。

Then we use the information

接著我們可以用一些

that's already in the lab report.

實驗室報告中已經有的信息。

We use the person's age and their gender

我們可以用人們的年齡和性別信息

to start to fill in the personalized risks.

來幫他們弄清楚個人患病的風險。

So we start to use the data we have

我們把這些已有的數據

to run a very simple calculation

在各種各樣的網上計算器上

that's on all sorts of online calculators

做一個簡單的計算，

to get a sense of what the actual risk is.

就可以得到實際的風險到底有多少。

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

最後要給大家看的是前列腺特異性抗原測試。

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

這是我們修改之前的，這是修改之後的。

Now a lot of our effort on this one --

我們在這一項測試報告上花了很大功夫——

as many of you probably know,

可能很多人都知道，

a PSA test is a very controversial test.

前列腺特異性抗原測試是一項頗有爭議的測試。

It's used to test for prostate cancer,

它是用來做前列腺癌症的測試，

but there are all sorts of reasons

但是實際上有各種各樣的原因

why your prostate might be enlarged.

可能導致前列腺放大。

And so we spent a good deal of our time

因此我們花了很多時間

indicating that.

來向患者指出這一點。

We again personalized the risks.

同樣我們會給出個人的患病風險。

So this patient is in their 50s,

根據這位病人50多歲，

so we can actually give them a very precise estimate

我們可以精確估計出

of what their risk for prostate cancer is.

他患前列腺癌的機率。

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

根據測試結果，這個案例大約是25%的機率。

And then again, the follow-up actions.

接著還是跟蹤的情況。

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

我們在跟蹤病人這方面的花費不到10000美金。

That's what Wired magazine spent on this.

這也正是在線雜志花錢做的事兒。

Why is Wired magazine doing this?

為什麼在線雜誌要做這些呢？

(Laughter)

（笑聲）

Quest Diagnostics and LabCorp,

Quest Diagnostics和LabCorp

the two largest lab testing companies --

是兩個最大的實驗室測試公司。

last year, they made profits of over 700 million dollars

去年，它們分別掙了超過7億

and over 500 million dollars respectively.

和5億美金。

Now this is not a problem of resources;

這麽看來資源根本不是問題，

this is a problem of incentives.

問題在於動機。

We need to recognize that the target of this information

我們需要意識到這些信息的目標

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

不是醫生，也不是保險公司，

It should be the patient.

而是病人，

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

實際上目標應該是人，

is going to be having to change their lives

是讓人們能夠改變他們的生活

and then start adopting new behaviors.

並且開始適應新的行為方式。

This is information that is incredibly powerful.

這些信息有很強大的力量

It's an incredibly powerful catalyst to change.

來敦促人們改變自己的行為。

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

然而這些信息一直在那兒，只是我們沒用而已。

It's being lost.

漸漸的可能這些信息也就丟了。

So I want to just offer four questions

因此我提出四個問題，

that every patient should ask,

這些問題每個病人都應該要問，

because I don't actually expect people

因為實際上我並沒有期待人們真的開始

to start developing these lab test reports.

像這樣來做實驗測試報告。

But you can create your own feedback loop.

但是你可以創建屬於自己的反饋環。

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

任何人可以通過問以下幾個簡單的問題來獲得自己的反饋環：

Can I have my results?

我能拿回我的測試結果嗎？

And the only acceptable answer is --

這個問題只可能有一個答案，那就是——

(Audience: Yes.) -- yes.

（觀眾：可以）——是的。

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

這項測試是什麼意思？幫我弄清楚這些數據是什麼意思吧。

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

我有什麼選擇嗎？表格上有什麼我能做的嗎？

And then, what's next?

接著下面這一項呢？我能做什麼呢？

How do I integrate this information

我怎樣可以在我以後的生活中

into the longer course of my life?

利用這些信息呢？

So I want to wind up by just showing

最後結束之前我想告訴大家，

that people have the capacity to understand this information.

每個人都有能力來理解這些信息。

This is not beyond the grasp of ordinary people.

這並非超出普通人可理解的範圍。

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

不需要像今天在座各位的教育程度，

Ordinary people are capable of understanding this information,

普通人就可以理解這些信息，

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

只要我們盡力去表達這些信息，

in a form that they can engage with.

當然要用一種人們可以做到的方式。

And engagement is essential here,

讓人們參與進來至關重要，

because it's not just giving them information;

因為這不僅僅是提供一些信息，

it's giving them an opportunity to act.

更重要的是給他們機會行動。

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

這就是參與行動，這和簡單的承諾是不同的。

It works totally different from the way we talk about behavior

這和在當今醫學上我們做討論的行為

in medicine today.

是完全不同的。

And this information is out there.

這些信息就是這樣。

I've been talking today about latent information,

我今天談到了潛在的信息，

all this information that exists in the system

就是存在於我們的系統中但是並沒有

that we're not putting to use.

被用起來的信息。

But there are all sorts of other bodies of information

還有各種各樣網上即將會有的

that are coming online,

大量的信息。

and we need to recognize the capacity of this information

我們需要認識到這些信息的力量是可以

to engage people, to help people

吸引人們參與進來，幫助人們，

and to change the course of their lives.

並且改變大家的生活道路。

Thank you very much.

謝謝大家。

(Applause)

（掌聲）