Why Medicine Often Has Dangerous Side Effects for Women | Alyson McGregor | TED Talks

譯者: YUJIA ZHAI 審譯者: Max Chern

We all go to doctors.

生病了我們都會去看醫生

And we do so with trust and blind faith

因為我們深信不疑

that the test they are ordering and the medications they're prescribing

醫生們所開出的檢查及用藥

are based upon evidence --

都是基於

evidence that's designed to help us.

為了要幫我們恢復健康

However, the reality is that that hasn't always been the case for everyone.

然而，事實並非全然如此

What if I told you

如果我告訴你

that the medical science discovered over the past century

過去一百年的醫學研究

has been based on only half the population?

都只針對半數的人口，你會怎麼想?

I'm an emergency medicine doctor.

我是個急診醫生

I was trained to be prepared in a medical emergency.

我受的是醫療急救的專業訓練

It's about saving lives. How cool is that?

就是有關拯救生命的工作 聽起來很 “酷” 吧

OK, there's a lot of runny noses and stubbed toes,

好，那兒有很多流鼻水和腳趾踢傷的病人

but no matter who walks through the door to the ER,

但無論是那一個走進急診大門的病人

we order the same tests,

我們都開同樣的檢查

we prescribe the same medication,

開同樣的藥

without ever thinking about the sex or gender of our patients.

連想都不去想病人的性別

Why would we?

為什麼?

We were never taught that there were any differences between men and women.

因為從來沒有人教過我們 男女病患會有什麼不一樣

A recent Government Accountability study revealed that 80 percent of the drugs

最近一份政府責任署的統計調查顯示

withdrawn from the market

在所有下架的藥中有80%

are due to side effects on women.

是因為對女性有副作用

So let's think about that for a minute.

所以讓我們想一下

Why are we discovering side effects on women

為什麼我們會在藥品上市之後

only after a drug has been released to the market?

才發現它們會對女性有副作用?

Do you know that it takes years for a drug to go from an idea

要知道一種藥從一個概念

to being tested on cells in a laboratory,

到在實驗室對細胞進行測試

to animal studies,

到對動物進行測試

to then clinical trials on humans,

再到人體臨床測試

finally to go through a regulatory approval process,

最終到獲得上市許可

to be available for your doctor to prescribe to you?

再被醫生開出處方 通常需要很多年的時間

Not to mention the millions and billions of dollars of funding

更不用說在研究過程中

it takes to go through that process.

所投入數百萬、數十億的研究經費

So why are we discovering unacceptable side effects

為什麼我們在經過以上所有程序後

on half the population after that has gone through?

才發現有半數人口 無法容忍的副作用呢?

What's happening?

出什麼問題了?

Well, it turns out that those cells used in that laboratory,

原來是因為那些在實驗室 被用來做檢測的細胞

they're male cells,

都是男性的細胞

and the animals used in the animal studies were male animals,

動物檢測用的細胞 也都是雄性動物的細胞

and the clinical trials have been performed almost exclusively on men.

就連臨床測試也幾乎都針對男性

How is it that the male model became our framework for medical research?

男性為什麼會成為我們 醫療研究的主要對象?

Let's look at an example that has been popularized in the media,

我們來看看這個 在媒體上很受歡迎的例子

and it has to do with the sleep aid Ambien.

幫助睡眠的安眠藥- Ambien

Ambien was released on the market over 20 years ago,

這藥已經上市超過20年

and since then, hundreds of millions of prescriptions have been written,

從上市至今已開出數億的處方簽

primarily to women, because women suffer more sleep disorders than men.

大多都是開給女性 因為女性較易有睡眠問題

But just this past year,

但就在去年

the Food and Drug Administration recommended cutting the dose in half

食品藥物管理局提出建議

for women only,

女性病患用藥量應減半

because they just realized that women metabolize the drug

因為他們發現女性代謝安眠藥的速度

at a slower rate than men,

比男性慢

causing them to wake up in the morning

這使得女性病患在起床後

with more of the active drug in their system.

身體中仍有藥物作用

And then they're drowsy and they're getting behind the wheel of the car,

因此她們在開車時仍昏昏欲睡

and they're at risk for motor vehicle accidents.

有出車禍的風險

And I can't help but think, as an emergency physician,

身為一個急診醫生，我不禁自問

how many of my patients that I've cared for over the years

多年來我所照顧過的

were involved in a motor vehicle accident

車禍病患

that possibly could have been prevented

有多少人其實是能避免意外發生的

if this type of analysis was performed and acted upon 20 years ago

如果早在藥物剛上市的20年前

when this drug was first released.

就能做這樣的分析研究的話

How many other things need to be analyzed by gender?

還有多少其他事需要做性別分析?

What else are we missing?

我們還遺漏了那些環節?

World War II changed a lot of things,

第二次世界大戰改變了許多事情

and one of them was this need to protect people

其中之一是保護人們

from becoming victims of medical research without informed consent.

免於在沒有 ‘知情同意’ 的情況下 成為醫學研究的受害者

So some much-needed guidelines or rules were set into place,

許多迫切需要的準則或規則被設定了

and part of that was this desire to protect women of childbearing age

而其中就有一些旨在保護生育年齡女性

from entering into any medical research studies.

避免進入任何醫學研究中

There was fear: what if something happened to the fetus during the study?

因為害怕，如果胎兒在研究中受到傷害

Who would be responsible?

要由誰負責?

And so the scientists at this time actually thought

所以當時的科學家認為

this was a blessing in disguise,

這是因禍得福

because let's face it -- men's bodies are pretty homogeneous.

因為事實上， 男性的生理非常平穩

They don't have the constantly fluctuating levels of hormones

他們不會有 賀爾蒙週期性波動的問題

that could disrupt clean data they could get if they had only men.

如果科學家只用純男性研究對象， 就不會因而干擾到研究數據。

It was easier. It was cheaper.

這樣比較簡單，也比較便宜

Not to mention, at this time, there was a general assumption

更不用說在那時候社會普遍認為

that men and women were alike in every way,

男女之間沒有太大的差別

apart from their reproductive organs and sex hormones.

除了生殖器官以及性賀爾蒙外

So it was decided:

所以達成共識

medical research was performed on men,

醫學研究只對男性進行測試

and the results were later applied to women.

研究結果再套用在女性身上

What did this do to the notion of women's health?

這對女性建康表達什麼樣的概念？

Women's health became synonymous with reproduction:

女性健康成為生殖的代名詞：

breasts, ovaries, uterus, pregnancy.

乳房、卵巢、子宮、懷孕。

It's this term we now refer to as "bikini medicine."

我們現在通稱為「比基尼醫學」

And this stayed this way until about the 1980s,

這樣的觀念一直持續到1980年代

when this concept was challenged by the medical community

才有醫界以及

and by the public health policymakers when they realized that

公衛決策者對此提出質疑。 當他們了解

by excluding women from all medical research studies

從所有醫學研究排除女性

we actually did them a disservice,

事實上是幫倒忙

in that apart from reproductive issues,

除了生殖議題外

virtually nothing was known about the unique needs

其實我們對女性病患的特殊需求

of the female patient.

一無所知

Since that time, an overwhelming amount of evidence has come to light

從那時起，大量的証據暴露無遺地

that shows us just how different men and women are in every way.

顯示男女之間有顯著的不同

You know, we have this saying in medicine:

你知道，在醫學界有此一說

children are not just little adults.

小孩並不是“小大人”

And we say that to remind ourselves

我們用此來提醒自己

that children actually have a different physiology than normal adults.

小孩子與大人的生理不同

And it's because of this that the medical specialty of pediatrics came to light.

也因此小兒專科才獨立出來

And we now conduct research on children in order to improve their lives.

現在，我們從事兒童醫學研究 以改善他們的生活

And I know the same thing can be said about women.

而我知道，女性也是一樣情況

Women are not just men with boobs and tubes.

女人並不只是多了胸部及「生殖腔」的男人

But they have their own anatomy and physiology

她們有自己的 解剖構造和生理狀況

that deserves to be studied with the same intensity.

需要有相同關注來研究

Let's take the cardiovascular system, for example.

我用心血管系統來說明

This area in medicine has done the most to try to figure out

醫學界在這方面作很多努力， 試圖找出

why it seems men and women have completely different heart attacks.

為什麼男性與女性 心臟病的發作完全不同

Heart disease is the number one killer for both men and women,

心臟病是導致男性及女性死亡的第一號殺手

but more women die within the first year of having a heart attack than men.

但是在心臟病發作的第一年內 女性死亡多於男性

Men will complain of crushing chest pain --

發病時，男性會抱怨 壓迫性的胸口劇痛

an elephant is sitting on their chest.

像是有隻大象坐在胸口一般

And we call this typical.

我們稱之為典型心臟病

Women have chest pain, too.

女性也會感到胸痛

But more women than men will complain of "just not feeling right,"

但大多數女性只會說感覺「不對勁」

"can't seem to get enough air in,"

「吸不到空氣」

"just so tired lately."

「最近總是非常累」

And for some reason we call this atypical,

而不知道為什麼，即使女性占了半數人口

even though, as I mentioned, women do make up half the population.

我們仍稱之為非典型心臟病

And so what is some of the evidence to help explain some of these differences?

所以有什麼證據能解釋這些差異呢?

If we look at the anatomy,

讓我們看看解剖學

the blood vessels that surround the heart are smaller in women compared to men,

環繞在心臟周圍的血管， 女性比男性來得小

and the way that those blood vessels develop disease is different

血管病變發展的方式

in women compared to men.

男女相比，也不一樣

And the test that we use to determine if someone is at risk for a heart attack,

我們現在用來診斷潛在心臟病的方法

well, they were initially designed and tested and perfected in men,

當然，它當初也是針對 男性完美設計及測試的

and so aren't as good at determining that in women.

所以在診斷女性病患就不甚理想

And then if we think about the medications --

然後我們討論到藥品

common medications that we use, like aspirin.

一般常用的成藥，像是阿斯匹林

We give aspirin to healthy men to help prevent them from having a heart attack,

我們給健康男性 阿斯匹林來預防心臟病

but do you know that if you give aspirin to a healthy woman,

但是你知道嗎? 給健康女性阿斯匹林

it's actually harmful?

其實是有害的

What this is doing is merely telling us

這些都是在告訴我們

that we are scratching the surface.

我們了解的實在很淺

Emergency medicine is a fast-paced business.

急診醫學是一種快節奏的醫療事務!

In how many life-saving areas of medicine,

在挽救生命的醫療領域裡

like cancer and stroke,

像是癌症或中風

are there important differences between men and women that we could be utilizing?

有那些男女間重要差異 我們可用以改進醫學呢？

Or even, why is it that some people get those runny noses

或甚至為什麼有些人

more than others,

比別人更容易流鼻水

or why the pain medication that we give to those stubbed toes

或為什麼用在踢傷腳趾的止痛藥

work in some and not in others?

在一些人身上有較好的效果?

The Institute of Medicine has said every cell has a sex.

醫學研究所已經發現每個細胞都有生理性別

What does this mean?

這代表什麼?

Sex is DNA.

生理性別取決於DNA

Gender is how someone presents themselves in society.

社會性別則是 人們在社會上如何表現自己

And these two may not always match up,

這兩者並沒有絕對的等號

as we can see with our transgendered population.

所以社會上有跨性別的族群

But it's important to realize that from the moment of conception,

但我們要了解，在受孕的那一刻

every cell in our bodies --

我們身體上的每一個細胞

skin, hair, heart and lungs --

皮膚、頭髮、心臟或肺臟

contains our own unique DNA,

都有專屬於你的DNA

and that DNA contains the chromosomes that determine

而這些DNA則含有

whether we become male or female, man or woman.

決定你是男性或女性、男人或女人的染色體

It used to be thought

過去曾普遍認為

that those sex-determining chromosomes pictured here --

照片上這個決定性別的染色體

XY if you're male, XX if you're female --

男性是XY，女性是XX

merely determined whether you would be born with ovaries or testes,

只決定你會有卵巢或睪丸

and it was the sex hormones that those organs produced

而這些性器官製造的性賀爾蒙

that were responsible for the differences we see in the opposite sex.

則負責表現出我們看見的性別外貌

But we now know that that theory was wrong --

但我們現在知道這個理論是錯誤的－

or it's at least a little incomplete.

或者至少是不完整的

And thankfully, scientists like Dr. Page from the Whitehead Institute,

幸好有懷特黑德生物醫學研究所 的科學家們（如：Page博士）

who works on the Y chromosome,

一直在研究Y染色體

and Doctor Yang from UCLA,

以及來自加州大學洛杉磯分校的楊博士

they have found evidence that tells us that those sex-determining chromosomes

他們找到證據說明 決定我們性別的染色體

that are in every cell in our bodies

存在於身體裡的每一個細胞

continue to remain active for our entire lives

終身活躍

and could be what's responsible for the differences we see

也能說明這些染色體和

in the dosing of drugs,

用藥劑量上的差異是有關的

or why there are differences between men and women

同時說明了為什麼男性和女性

in the susceptibility and severity of diseases.

在疾病的敏感度和嚴重度是不同的

This new knowledge is the game-changer,

這個新知將徹底改變以往的認知

and it's up to those scientists that continue to find that evidence,

現在，科學家的責任 是要繼續發現証據

but it's up to the clinicians to start translating this data

而臨床醫生的責任是 要解讀運用這些數據

at the bedside, today.

在臨床上

Right now.

現在

And to help do this, I'm a co-founder of a national organization

為了協助這項研究， 我協同創立了一個全國性組織

called Sex and Gender Women's Health Collaborative,

生理性別和社會性別女性健康協會

and we collect all of this data so that it's available for teaching

我們收集所有相關的 研究數據用於教學

and for patient care.

及病人照護

And we're working to bring together the medical educators to the table.

我們努力聚集 醫學教育家們一起研議

That's a big job.

這是一項大工程

It's changing the way medical training has been done since its inception.

從成立日起，它正改變 醫學訓練的方式

But I believe in them.

但我相信我們能成功

I know they're going to see the value of incorporating the gender lens

他們會看到將性別研究

into the current curriculum.

納入現有課程的意義所在

It's about training the future health care providers correctly.

這事關正確教導未來的醫護人員

And regionally,

在當地

I'm a co-creator of a division within the Department of Emergency Medicine

我是布朗大學急診醫學科的

here at Brown University,

“生理和社會性别急救醫學部門”

called Sex and Gender in Emergency Medicine,

的聯合創始人

and we conduct the research to determine the differences between men and women

我們致力於研究男性和女性

in emergent conditions,

在緊急情況下的不同反應

like heart disease and stroke and sepsis and substance abuse,

比如心臟病和中風、 敗血症和藥物濫用

but we also believe that education is paramount.

但我們始終相信 教育才是最重要的

We've created a 360-degree model of education.

我們建立了全方位的教學模式

We have programs for the doctors, for the nurses, for the students

我們有針對醫生、護士、學生

and for the patients.

以及病人的課程

Because this cannot just be left up to the health care leaders.

因為我們不能把問題 都留給醫療保健的管理者

We all have a role in making a difference.

我們都有一份責任來改變現狀

But I must warn you: this is not easy.

但要提醒的是：改變並不簡單

In fact, it's hard.

實際上，非常困難

It's essentially changing the way we think about medicine

基本上，它改變我們對醫學、健康和研究

and health and research.

的思考方式

It's changing our relationship to the health care system.

它也正在改變我們和醫療保健系统之間的關係

But there's no going back.

這已沒有退路可選

We now know just enough

我們現在知道的

to know that we weren't doing it right.

僅能理解我們以前做的是錯誤的

Martin Luther King, Jr. has said,

馬丁路德金曾說過

"Change does not roll in on the wheels of inevitability,

改變並不會自然而然發生

but comes through continuous struggle."

而是經過持續不斷的奮鬥

And the first step towards change is awareness.

改變的第一步就是覺醒

This is not just about improving medical care for women.

這不僅僅指改善女性的醫療保健

This is about personalized, individualized health care for everyone.

更指的是每個人的個別化醫療保健

This awareness has the power to transform medical care for men and women.

覺醒的力量能轉變 對男性或女生的醫療照護

And from now on, I want you to ask your doctors

從現在起 我希望你詢問你的醫生

whether the treatments you are receiving are specific to your sex and gender.

你所接受的治療是否是針對 你的生理和社會性別的

They may not know the answer --

他們也許並不知道答案

yet.

至少現在是

But the conversation has begun, and together we can all learn.

但至少這有了個開始， 我們可以一起學習

Remember, for me and my colleagues in this field,

記住，對於我和我的同事而言

your sex and gender matter.

你的性別是重要的

Thank you.

謝謝

(Applause)

（鼓掌）