A smarter, more precise way to think about public health | Sue Desmond-Hellmann

譯者: 易帆 余 審譯者: Helen Chang

OK, first, some introductions.

OK，首先，先自我介紹一下。

My mom, Jennie, took this picture.

這張照片是我母親珍妮拍的，

That's my dad, Frank, in the middle.

在中間的是我爸，法蘭克。

And on his left, my sisters:

在他左邊的是我姊姊：

Mary Catherine, Judith Ann, Theresa Marie.

瑪莉凱瑟琳、僑蒂絲安、 泰瑞莎馬瑞。

John Patrick's sitting on his lap and Kevin Michael's on his right.

約翰派崔克坐在他腳上， 凱文麥克在他右邊。

And in the pale-blue windbreaker,

穿著淺藍色防風夾克的

Susan Diane. Me.

就是在下我，蘇珊黛安娜。

I loved growing up in a big family.

我很開心可以在大家庭長大。

And one of my favorite things was picking names.

而我最喜歡的事就是命名。

But by the time child number seven came along,

但到了第七個孩子出生時，

we had nearly run out of middle names.

我們家幾乎已經用光所有的名字，

It was a long deliberation

我們考慮了很久，

before we finally settled on Jennifer Bridget.

最後才把珍妮佛布里茲 的名字定下來。

Every parent in this audience

在場的每位爸爸媽媽

knows the joy and excitement

都很了解幫寶寶命名時的

of picking a new baby's name.

幸福與興奮。

And I was excited and thrilled

而我竟然可以在這種 喜慶的時刻幫助我媽

to help my mom in that special ceremonial moment.

自然是興奮又激動的。

But it's not like that everywhere.

但世界上的其它地方 就不一定是如此了。

I travel a lot and I see a lot.

我時常旅行，見聞豐富。

But it took me by surprise to learn

但令我吃驚的是，

in an area of Ethiopia,

在伊索比亞的地方，

parents delay picking the names for their new babies

父母不會馬上為孩子命名，

by a month or more.

有時會拖延到一個月或更久之後。

Why delay?

為什麼要拖延？

Why not take advantage of this special ceremonial time?

為什麼不把握特別的一刻？

Well, they delay because they're afraid.

其實，他們拖延的原因是害怕。

They're afraid their baby will die.

他們害怕寶寶會死亡。

And this loss might be a little more bearable without a name.

如果不幸過世，寶寶沒有名字 他們比較不會那麼難過。

A face without a name might help them feel

不取名字能幫助他們

just a little less attached.

減少一點對新生兒的不捨。

So here we are in one part of the world --

世上有一部分父母是

a time of joy, excitement, dreaming of the future of that child --

——沉浸在幸福裡， 夢想著寶寶的未來——

while in another world,

而另一個世界的父母......

parents are filled with dread,

卻是擔心受怕，

not daring to dream of a future for their child

不敢在那寶貴的幾個星期裡，

beyond a few precious weeks.

夢想著他們小孩的未來。

How can that be?

怎麼會這樣？

How can it be that 2.6 million babies

為什麼世界上有

260 萬個小寶寶

die around the world

會在出生頭一個月去世？

before they're even one month old?

2.6 million.

260萬！

That's the population of Vancouver.

這可是溫哥華的總人口啊！

And the shocking thing is:

令人震驚的是：

Why?

為什麼？

In too many cases, we simply don't know.

很多時候，我們真的束手無策。

Now, I remember recently seeing an updated pie chart.

我記得最近看到一張 最新的圓形圖表，

And the pie chart was labeled,

圖表的主題是，

"Causes of death in children under five worldwide."

《全世界低於五歲小孩的死亡原因》

And there was a pretty big section of that pie chart, about 40 percent --

圖表上有很大部分，大約40%，

40 percent was labeled "neonatal."

有 40% 的原因是「初生」，

Now, "neonatal" is not a cause of death.

「初生」不是一種死因

Neonatal is simply an adjective,

「初生」只是一個形容詞，

an adjective that means that the child is less than one month old.

是用來形容 剛出生不到一個月的新生兒。

For me, "neonatal" said: "We have no idea."

對我而言，這像是對著新生兒們說： 「我們無能為力」。

Now, I'm a scientist. I'm a doctor.

我是一位科學家，我是醫生。

I want to fix things.

我想要做點事改善這個狀況。

But you can't fix what you can't define.

但你無法改善你不理解的事。

So our first step in restoring the dreams of those parents

所以，要重建那些父母親的夢想，

我們第一步就是要回答這個問題：

is to answer the question:

Why are babies dying?

為什麼寶寶會死亡？

So today, I want to talk about a new approach,

所以，今天，我想要來談談 一個新的方法，

an approach that I feel

一個我覺得不只可以幫助我們了解

will not only help us know why babies are dying,

為什麼寶寶會死亡，

but is beginning to completely transform

也讓我們可以開始動手 徹底改革全球醫療系統。

the whole field of global health.

It's called "Precision Public Health."

這個方法叫做「精準公共醫療」。

For me, precision medicine comes from a very special place.

我對「精準醫學」的知識 來自一個特別的地方。

I trained as a cancer doctor, an oncologist.

我是一位癌症及腫瘤醫師。

I got into it because I wanted to help people feel better.

我會進入這一個領域的原因， 是因為我想要讓病人更舒服。

But too often my treatments made them feel worse.

但很多時候，我的治療方式 只會讓他們更痛苦。

I still remember young women being driven to my clinic

我仍記得那些年輕女孩們 被她們的媽媽載來我診所的那一幕，

by their moms --

adults, who had to be helped into my exam room by their mothers.

這些成年人，被她們的媽媽們 載來我的診療室尋求幫助。

They were so weak

我的治療方式讓她們變得很虛弱。

from the treatment I had given them.

But at the time, in those front lines in the war on cancer,

但在當時對抗癌症 這場戰役的前線，

we had few tools.

我們可用的工具極少。

And the tools we did have couldn't differentiate

而我們擁有的工具，

between the cancer cells that we wanted to hit hard

無法區別出需要消滅的癌症細胞

and those healthy cells that we wanted to preserve.

及想要保留的健康細胞。

And so the side effects that you're all very familiar with --

大家都相當了解這些治療方式 產生的副作用——

hair loss, being sick to your stomach,

掉髮、感到噁心、

having a suppressed immune system, so infection was a constant threat --

免疫系統不良， 於是常常別感染的威脅

were always surrounding us.

無時無刻潛伏在我們的身邊。

And then I moved to the biotechnology industry.

所以我轉到生物科技領域找方法，

And I got to work on a new approach for breast cancer patients

我全心投入到一個 治療乳癌病患的新方法，

that could do a better job of telling the healthy cells

這個方法比較能有效地分辨出

不健康的細胞或癌細胞。

from the unhealthy or cancer cells.

It's a drug called Herceptin.

這是一種叫「賀癌平」的藥。

And what Herceptin allowed us to do

賀癌平可以讓我們精準地

is to precisely target HER2-positive breast cancer,

標靶到當時最恐怖的 HER2 乳癌細胞，

at the time, the scariest form of breast cancer.

And that precision let us hit hard the cancer cells,

它能精準地攻擊癌症細胞，

while sparing and being more gentle on the normal cells.

且對正常細胞的傷害降到最低。

A huge breakthrough.

相當重大的突破，

It felt like a miracle,

感覺相當神奇，

so much so that today,

因此今日，

we're harnessing all those tools --

我們可以利用這些工具——

big data, consumer monitoring, gene sequencing and more --

大資料、消費監控、基因定序......等等

to tackle a broad variety of diseases.

來對抗各類疾病。

That's allowing us to target individuals

它可以讓我們用精準的療程

及時對個人做治療。

with the right remedies at the right time.

Precision medicine revolutionized cancer therapy.

「精準醫學」變革了癌症治療的方式。

Everything changed.

每件事都改變了，

And I want everything to change again.

而我希望每件事能再次改變。

So I've been asking myself:

所以，我一直在問我自己：

Why should we limit

為什麼我們把

this smarter, more precise, better way to tackle diseases

這種較聰明的、較精準的 對抗疾病的方式，

to the rich world?

限制在富人階層？

Now, don't misunderstand me --

千萬別誤會我的意思——

I'm not talking about bringing expensive medicines like Herceptin

我不是在談，把類似「賀癌平」 這種貴重的藥，

to the developing world,

帶到開發中國家去，

although I'd actually kind of like that.

雖然我是這麼希望。

What I am talking about

我說的是，

is moving from this precise targeting for individuals

把這種精準的個人醫療方式，

to tackle public health problems

轉移去解決公共醫療問題。

in populations.

Now, OK, I know probably you're thinking, "She's crazy.

我知道，你們可能在想， 「這女的瘋了，

You can't do that. That's too ambitious."

不能這樣搞，這樣太大膽了！」

But here's the thing:

但事情是這樣的：

we're already doing this in a limited way,

在資源有限的情況下， 我們已經開始在做這件事，

and it's already starting to make a big difference.

而且已經有很大的成效了。

So here's what's happening.

我接下來談談成效如何，

Now, I told you I trained as a cancer doctor.

我剛跟各位提到， 我是一位癌症醫師，

But like many, many doctors who trained in San Francisco in the '80s,

但就如同在 80 年代 舊金山受訓的醫師們一樣，

I also trained as an AIDS doctor.

我也是一位愛滋病治療醫師，

It was a terrible time.

那段時間，情況非常糟糕。

AIDS was a death sentence.

感染愛滋病等同宣判死亡，

All my patients died.

我所有的愛滋病人都死了。

Now, things are better,

現在，情況好轉了，

but HIV/AIDS remains a terrible global challenge.

但愛滋病仍然是全球艱苦的挑戰。

Worldwide, about 17 million women are living with HIV.

全世界，目前約有1700萬 女人感染愛滋病。

We know that when these women become pregnant,

我們都曉得，當這些女人懷孕時，

they can transfer the virus to their baby.

她們會把病毒傳染給小孩。

We also know in the absence of therapy,

我們也清楚，因缺乏治療的方式，

half those babies will not survive until the age of two.

一半的愛滋寶寶活不到 2 歲。

But we know that antiretroviral therapy can virtually guarantee

但我們知道抗逆轉錄病毒療法可以保證

that she will not transmit the virus to the baby.

她們不會把病毒傳染給孩子。

So what do we do?

所以，我們要怎麼做？

Well, a one-size-fits-all approach, kind of like that blast of chemo,

我們要找出一個 一體適用的方法，

意思就是要找到一個可以檢測並 治療全世界女人的方法。

would mean we test and treat every pregnant woman in the world.

That would do the job.

這樣才能達到目標，

But it's just not practical.

但有點不實際。

So instead, we target those areas where HIV rates are the highest.

所以，我們把目標轉到 愛滋病率最高的區域。

We know in certain countries in sub-Saharan Africa

我們知道在撒哈拉南邊的 某些非洲國家有相當高的愛滋病感染率，

we can test and treat pregnant women where rates are highest.

我們可以在這裡檢測並 治療到最多的女人。

This precision approach to a public health problem

這個針對性的公共醫療方式，

has cut by nearly half

在最近這五年，解決了將近一大半

HIV transmission from mothers to baby

從母親身上傳染愛滋病到 孩童身上的公共醫療問題。

in the last five years.

(Applause)

（掌聲）

Screening pregnant women in certain areas in the developing world

篩檢這些開發中國家懷孕的女人，

is a powerful example

充分展示了精準公共醫療

of how precision public health can change things on a big scale.

可以如何大規模改善現狀。

So ...

所以，

How do we do that?

我們要怎麼做？

We can do that because we know.

因為我們知道，我們做的到。

We know who to target,

我們知道要治療誰、

what to target,

要治療甚麼病、

where to target and how to target.

去哪治療、如何治療。

And that, for me, are the important elements of precision public health:

對我而言，這些是 精準公共醫療的重要元素：

who, what, where and how.

（治療）誰、甚麼、去哪、如何。

But let's go back to the 2.6 million babies

但讓我們回到 260 萬個 活不到一個月的寶寶身上。

who die before they're one month old.

Here's the problem: we just don't know.

問題是這樣的：我們只是不了解。

It may seem unbelievable,

這聽起來好像不可思議。

but the way we figure out the causes of infant mortality

但我們想到一個方法，

就是直接找

in those countries with the highest infant mortality

有最高嬰兒死亡率國家的母親對話。

is a conversation with mom.

A health worker asks a mom who has just lost her child,

醫療人員會問 寶寶剛過世的母親一個問題，

"Was the baby vomiting? Did they have a fever?"

「寶寶有嘔吐嗎？有發高燒嗎？」

And that conversation may take place

對話也許就在

as long as three months after the baby has died.

寶寶去世後的三個月。

Now, put yourself in the shoes of that mom.

現在，各位換位思考一下 那位母親的感受，

It's a heartbreaking, excruciating conversation.

那會是一場多麼令人心碎 與備受折磨的對話啊...

And even worse -- it's not that helpful,

更糟糕的是，這一點也沒有幫助，

because we might know there was a fever or vomiting,

因為，我們只知道 有發燒嘔吐的情況發生，

but we don't know why.

但我們不知道為什麼。

So in the absence of knowing that knowledge,

因為缺乏這方面的知識，

we cannot prevent that mom, that family,

我們就無法阻止那位母親、家庭

or other families in that community

或在那個社區的其他家庭

from suffering the same tragedy.

悲劇繼續發生。

But what if we applied a precision public health approach?

但如果我們應用 精準公共醫療的治療方式呢？

Let's say, for example,

舉個例子，

we find out in certain areas of Africa

我們在非洲發現到某些特定區域，

that babies are dying because of a bacterial infection

有母親傳染細菌給寶寶 而造成寶寶死亡的案例，

transferred from the mother to the baby,

known as Group B streptococcus.

而這細菌也就是 大家所孰悉的 B 型鏈球菌。

In the absence of treatment, mom has a seven times higher chance

因缺乏治療，這些母親的 下一個寶寶死亡率

that her next baby will die.

會比正常高出七倍。

Once we define the problem, we can prevent that death

一旦我們找出問題的核心， 我們就可以利用便宜又安全

with something as cheap and safe as penicillin.

類似青黴素的藥物來避免死亡。

We can do that because then we'll know.

我們這樣做之後就能夠了解 致病的根本原因，

And that's the point:

這才是重點：

once we know, we can bring the right interventions

一旦我們了解了， 我們就能用正確的治療方式，

to the right population in the right places

對特定區域的人做精準且即時的治療， 來完成救人的目的。

to save lives.

With this approach, and with these interventions

有了這個方法、這些介入的方式

and others like them,

及其它類似的方法，

I have no doubt

我深信，

that a precision public health approach

精準公共醫療方法

can help our world achieve our 15-year goal.

可以幫助我們完成 「15 年目標」。

And that would translate into a million babies' lives saved

我們也可以把它解讀成

每年可以拯救一百萬個寶寶。

every single year.

One million babies every single year.

每年一百萬個寶寶。

And why would we stop there?

為什麼我們要停下來？

A much more powerful approach to public health --

一個對公眾健康這麼有幫助的方法——

imagine what might be possible.

想像一下，還有甚麼病 也可以用這種方式來解決？

Why couldn't we more effectively tackle malnutrition?

為什麼我們不可以更有效地 解決營養不良問題？

Why wouldn't we prevent cervical cancer in women?

為什麼我們不能防止 女性的子宮頸癌？

And why not eradicate malaria?

為什麼不能根除瘧疾？

(Applause)

（掌聲）

Yes, clap for that!

是的，為這件事用力鼓掌吧！

(Applause)

（掌聲）

So, you know, I live in two different worlds,

各位知道嗎，我們住在 兩個截然不同的世界裡，

one world populated by scientists,

一個世界充滿了科學家，

and another world populated by public health professionals.

而另一個世界卻 到處是公共醫療專家。

The promise of precision public health

精準公共醫療的承諾，

is to bring these two worlds together.

就是把這兩個世界結合在一起。

But you know, we all live in two worlds:

但各位要知道， 我們都住在這兩個世界裡：

the rich world and the poor world.

富人與窮人的世界。

And what I'm most excited about about precision public health

我對精準公共醫療 最興奮的地方，

is bridging these two worlds.

就是將這兩個世界連結一起。

Every day in the rich world,

在富人世界的每一天，

we're bringing incredible talent and tools --

這些完美的天分與工具， 在我們的掌控下，

everything at our disposal --

to precisely target diseases in ways I never imagined

用前所未有的精準方式 治療富人的疾病。

would be possible.

Surely, we can tap into that kind of talent and tools

當然，我們也要運用這些天分與工具

to stop babies dying in the poor world.

來阻止窮人世界寶寶的死亡。

If we did,

如果我們能做到，

then every parent would have the confidence

如此，每個爸爸媽媽都可以在 寶寶出生的那一刻，

to name their child the moment that child is born,

更有信心地幫寶寶命名，

daring to dream that that child's life will be measured in decades,

大膽地夢想寶寶未來的十幾年，

not days.

而不是只有幾天而已。

Thank you.

謝謝各位！

(Applause)

（掌聲）