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DavidAsch_2018P-_为更好的医疗保健，请拥抱非理性_
It's April of 2007, and Jon Corzine, the Governor of New Jersey, is in this horrific car accident. 那是 2007 年的 4 月, 新泽西州的州长, 荣·科赞（Jon Corzine）, 陷入了一场可怕的车祸。
horrific:adj.可怕的;令人毛骨悚然的;
He's in the right front passenger seat of this SUV when it crashes on the Garden State Parkway . 当他乘坐的那辆 SUV 在花园州高速公路撞毁的时候, 他正坐在副驾驶的座位上。
passenger seat:n.(汽车驾驶员旁边的)乘客座位;副驾驶座; Parkway:n.驾车专用道路;[建]公园道路;
He's transported to a New Jersey trauma center with multiple broken bones and multiple lacerations . 他被转移到一家新泽西的 创伤治疗中心, 身上伴有多处骨折和撕裂。
transported:v.(用交通工具)运输,运送,输送;(transport的过去分词和过去式) trauma:n.[外科]创伤(由心理创伤造成精神上的异常);外伤; multiple:adj.数量多的;多种多样的;n.倍数; lacerations:n.[外科]撕裂伤(laceration的复数);
He needs immediate surgery , seven units of blood, a mechanical ventilator to help him breathe and several more operations along the way. 他需要立即接受手术、 7 品脱的输血、 一个帮助他呼吸的呼吸机, 以及即将面临的又几场手术。
surgery:n.外科;外科手术;手术室;诊疗室; mechanical:adj.机械的;力学的;呆板的;无意识的;手工操作的; ventilator:n.通风设备;换气扇;[医]呼吸机;
It's amazing he survived. 他能活下来真的令人震惊。
But perhaps even more amazing, he was not wearing a seat belt . 但可能更令人震惊的是, 他当时在车里根本没系安全带。
seat belt:n.(汽车或飞机上的)安全带;
And, in fact, he never wore a seat belt, and the New Jersey state troopers who used to drive Governor Corzine around used to beg him to wear a seat belt, but he didn't do it. 事实上,他之前从来不系安全带, 曾经开车载过科赞州长的 新泽西州巡逻队员 曾求着他系上安全带, 但是他从来没系过。
troopers:n.坦克兵;骑兵;(trooper的复数)
Now, before Corzine was Governor of New Jersey, he was the US Senator from New Jersey, and before that, he was the CEO of Goldman Sachs, responsible for taking Goldman Sachs public, making hundreds of millions of dollars. 其实,在科赞当上 新泽西州州长之前, 曾是新泽西州的联邦参议员, 再之前,是高盛投资公司的 CEO , 负责高盛的上市, 并为其赚取了上亿美元。
Senator:n.参议员; responsible:adj.负责的,可靠的;有责任的;
Now, no matter what you think of Jon Corzine politically or how he made his money, nobody would say that he was stupid. 不论你从政治上 还是挣钱方式上 是如何看待荣·科赞这个人的, 没人会说他是个蠢人。
no matter what:不管什么…; politically:adv.政治上;
But there he was, an unrestrained passenger in a car accident, at a time when every American knows that seat belts save lives. 但是你瞧他, 在每一个美国人都知道 安全带能救命的时候, 他就是那个车祸现场中 不系安全带的人。
unrestrained:adj.自然的;无限制的;放纵的; belts:n.皮带(belt的复数);带子;v.用皮带等围绕;用带扎牢(belt的三单形式);
This single story reflects a fundamental weakness in our approach to improving health behavior. 这个简单的故事反映出
reflects:v.反映;映出(影像);反射;表明,表达;(reflect的第三人称单数) fundamental:n.基础; adj.十分重大的; approach:n.方法;路径;v.接近;建议;着手处理; improving:v.改进;改善;(improve的现在分词)
Nearly everything we tell doctors and everything we tell patients is based on the idea that we behave rationally . 我们告诉医生和病人的 一切东西几乎 都是基于“人类行为是理性的”观点。
patients:n.接受治疗者,病人;(patient的复数) behave:v.表现;(机器等)运转;举止端正;(事物)起某种作用; rationally:adv.理性地;讲道理地;
If you give me information, I will process that information in my head, and my behavior will change as a result . 如果你给我信息, 我会在脑袋里分析那个信息, 然后我的行为会随之改变。
process:v.处理;加工;列队行进;n.过程,进行;方法,adj.经过特殊加工(或处理)的; as a result:结果;
Do you think Jon Corzine didn't know that seat belts save lives? 你觉得荣·科赞 不知道安全带能救命吗？
Do you think he, like, just didn't get the memo ? 你觉得他只是没收到提示便笺吗？
memo:n.备忘录;
(Laughter) （笑声）
Jon Corzine did not have a knowledge deficit , he had a behavior deficit. 荣·科赞没有知识缺失, 他有的是行为上的缺失。
deficit:n.赤字;逆差;亏损;不足额;
It's not that he didn't know better. 他不是知道的少,
He knew better. 他知道的并不少。
It's that he didn't do better. 而他,没能做好。
Instead, I think the mind is a high-resistance pathway . 另外,我认为人的思想 是个抵御性很强的东西。
pathway:n.路,道;途径,路径;
Changing someone's mind with information is hard enough. 用信息改变一个人的思想 已经够难的了,
Changing their behavior with information is harder still. 用信息改变他们的行为 更是难上加难。
The only way we're going to make substantial improvements in health and health care is to make substantial improvements in the behavior of health and health care. 我们能在健康和医疗保健方面 做出较大改善的唯一方法, 就是尽可能改善人们 在健康和医疗保健方面的行为方式。
substantial:adj.大量的;实质的;内容充实的;n.本质;重要材料; improvements:n.改善;改进;改善的事物;(improvement的复数) health care:n.卫生保健;
If you hit my patellar tendon with a reflex hammer , my leg is going to jerk forward, and it's going to jerk forward a lot faster and a lot more predictably than if I had to think about it myself. 如果你用一个反射锤 敲击我的膑腱, 我的腿会向前弹起, 而且会比我自己 想着让它弹起的时候 弹得更快,更具可预测性。
patellar:adj.膝盖骨的; tendon:n.[解剖]腱; reflex:n.反射;反映;映像;回复;习惯性思维;adj.反射的;反省的;反作用的;优角的; hammer:n.锤子; v.锤打; jerk:v.猛拉;n.混蛋;突然而剧烈的动作;adj.卤的; predictably:adv.可预言地;
It's a reflex. 这是一种反射行为。
We need to look for the equivalent behavioral reflexes and hitch our health care wagon to those. 我们得找到相似的反射行为, 并把我们的医疗保健 都靠到这些反射行为上来。
equivalent:adj.等价的,相等的;同意义的;n.等价物,相等物; behavioral:adj.行为的; reflexes:n.反应;条件反射;扑救反应(守门员);放射(reflex的复数形式); hitch:n.故障; vt.搭便车; vi.被钩住; wagon:n.(铁路)货车车厢; v.用运货马车[货车,手推车等]运送;
Turns out, though, that most conventional approaches to human motivation are based on the idea of education. 但实际上, 最常规的激励人们的举措 却是建立在“教育”这一理念上的。
conventional:adj.符合习俗的,传统的;常见的;惯例的; approaches:v.靠近,接近; n.方式,方法,态度; motivation:n.动机;积极性;推动;
We assume that if people don't behave as they should, it's because they didn't know any better. 我们假定如果人们 没有做出他们应有的行为 是因为他们缺乏知识。
assume:v.承担;假定;采取;呈现;
'"If only people knew that smoking was dangerous, they wouldn't smoke." “如果人们知道抽烟很危险, 他们就不会抽烟了。”
Or, we think about economics. 或者,我们会从经济的角度思考。
The assumption there is that we're all constantly calculating the costs and benefits of every one of our actions and optimizing that to make the perfectly right, rational decision. 我们假定自己会不断地计算 我们每一个行为蕴含的 成本和收益, 以及为了收益最大化, 我们会做出完全正确且理性的决定。
assumption:n.假定;设想;担任;采取; constantly:adv.不断地;时常地; optimizing:n.[数]优化,最佳化;adj.最佳的;v.最佳化(optimize的现在分词);
If that were true, then all we need to do is to find the perfect payment system for doctors or the perfect co-payments and deductibles for patients, and everything would work out. 如果这是真的,所有我们需要的 仅仅是给医生找到 一个完美的付费系统, 或是能给患者完美计算出 部分承担费用和免赔额, 然后一切就自然解决了。
co-payments:共同支付; deductibles:n.[保险]免赔额(deductible的复数);自付额;
A better approach lies in behavioral economics. 行为经济学中 有一个更好的方法。
Behavioral economists recognize that we are irrational . 行为经济学家意识到 我们其实是非理性的。
recognize:v.认识;认出;辨别出;承认;意识到; irrational:adj.不合理的;无理性的;荒谬的;n.[数]无理数;
Our decisions are based on emotion , or they're sensitive to framing or to social context . 我们的决定是建立在情绪上的, 或是被社会环境 或规则框架所影响的。
emotion:n.强烈的感情;激情;情感; sensitive:adj.敏感的;感觉的;易受影响的;n.敏感的人;有灵异能力的人; framing:v.给…做框;作伪证陷害;制订;拟订;n.框架;结构;骨骼;(frame的现在分词) context:n.环境;上下文;来龙去脉;
We don't always do what's in our own long-term best interests. 我们不总是会做出 有利于我们长远利益的行为。
long-term:adj.长期的;从长远来看;
But the key contribution to behavioral economics is not in recognizing that we are irrational; it's recognizing that we are irrational in highly predictable ways. 但是,对行为经济学最主要的贡献 不是对“人类是非理性的”认识, 而是意识到 “人类的非理性行为是高度可预测的”。
contribution:n.捐款;捐资;定期缴款;贡献;促成作用;稿件; recognizing:v.认识;认出;承认;接受,赞成(recognize的现在分词) highly:adv.高度地;非常;非常赞许地; predictable:adj.可预言的;
In fact, it's the predictability of our psychological foibles that allows us to design strategies to overcome them. 事实上,正是我们心理上 那些小缺陷的可预测性 使我们能设计出策略来攻克它们。
predictability:n.可预测性;可预言; psychological:adj.心理的;心理学的;精神上的; foibles:n.弱点;小缺点;癖好; strategies:n.策略;行动计划;部署;战略;(strategy的复数) overcome:vt.克服;胜过;vi.克服;得胜;
Forewarned is forearmed . 预先警告就宛如事先武装。
Forewarned:vt.预先警告; forearmed:adj.预先准备的;v.预先准备(forearm的过去式和过去分词);
In fact, behavioral economists often use precisely the same behavioral reflexes that get us into trouble and turn them around to help us, rather than to hurt us. 事实上,行为经济学家 经常精准利用 那些让我们陷入麻烦的 行为反射, 转而让它们来帮助我们, 而不是伤害我们。
We see irrationality play out in something called "present bias ," 我们可以在一种叫做“即时偏误”的 现象中看见非理性的作用,
irrationality:n.不合理,无理性; bias:adv.使有偏见;n.偏见;偏心;偏爱;v.使有偏见;使偏向;adj.斜的;[电]偏动的;
where the outcomes in front of us are much more motivating than even more important outcomes far in the future. 这种现象,是我们正在面对的结果 比将来会出现的更重要的结果 更能调动我们的积极性。
outcomes:n.结果;成果;后果;出路;(outcome的复数) motivating:v.激励;刺激;调动…的积极性(motivate的ing形式);
If I'm on a diet -- and I'm always on a diet -- 如果我在节食—— 其实我一直在节食——
on a diet:节食;
(Laughter) （笑声）
and someone offers me a luscious-looking piece of chocolate cake, 这时有人给了我一个 看上去很美味的巧克力蛋糕,
I know I should not eat that chocolate cake. 我知道我不应该吃那个蛋糕。
That chocolate cake will land on that part of my body -- permanently -- where that kind of food naturally settles . 那块巧克力蛋糕会沉积在 我身体中——永远—— 就在这类食物会自然沉积 的身体部位上。
permanently:adv.永久地,长期不变地; naturally:adv.自然地;自然而然地;轻而易举;天生地;大方地; settles:v.结束;解决;决定,确定;定居;n.高背长椅;(settle的第三人称单数和复数)
But the chocolate cake looks so good and delicious, and it's right in front of me, and the diet can wait 'til tomorrow. 但是那块巧克力蛋糕 看起来如此美味, 而且它就在我的眼前, 那节食可以明天再说了。
I used to love the comedian Steven Wright . 我曾经很喜欢一个喜剧演员, 史蒂文·赖特。
comedian:n.滑稽演员;喜剧演员; Wright:n.制作者;工人;
He would have these Zen-like quips . 他经常说些很有禅意的玩笑话。
quips:n.妙语;嘲弄;讽刺语;vi.嘲弄;讥讽;vt.嘲弄;
My favorite one was this: "Hard work pays off in the future, but laziness pays off right now." 我最喜欢的是这个: “努力了将来会有回报, 但是懒惰了现在就会有回报。”
laziness:n.怠惰;无精打采;
(Laughter) （笑声）
And patients also have present bias. 患者也有即时偏误。
If you have high blood pressure , even if you would desperately like to avoid a stroke , and you know that taking your antihypertensive medications is one of the best ways to reduce that risk, the stroke you avoid is far in the future and taking medications is right now. 如果你有高血压, 即使你极度想避免中风, 而且你知道吃降血压药 是降低这种风险最有效的方式之一, 然而,中风是很久以后可能发生的事, 而吃药则是现在要做的。
blood pressure:n.[医]血压; desperately:adv.拼命地;绝望地;不顾一切地;极度地; stroke:n.中风;笔画;钟声;抚摩;v.抚摩(动物的毛皮);轻抚;轻挪;轻触; antihypertensive:adj.抗高血压的;n.抗高血压药; medications:n.药;药物;(medication的复数)
Almost half of the patients who are prescribed high blood pressure pills stop taking them within a year. 几乎有一半开了降血压药的患者 在一年内就停止了服药。
prescribed:v.给…开(药); (prescribe的过去式和过去分词) pills:n.药丸; v.起球; (pill的第三人称单数和复数)
Think of how many lives we could save if we could solve just that one problem. 想想如果我们单单解决这一个问题 就能拯救多少生命。
We also tend to overestimate the value of small probabilities . 我们也容易高估小概率事件的价值。
overestimate:v.高估;n.过高的评估; probabilities:可能性;[统计]概率(probability的复数);
This actually explains why state lotteries are so popular, even though they return pennies on the dollar. 这也许能解释为什么国营彩票 即使回报极小, 却依旧这么受欢迎。
lotteries:彩票;
Now, some of you may buy lottery tickets -- it's fun, there's the chance you might strike it rich ... 在座的一些人可能会买彩票—— 买彩票挺有意思的, 你有可能中大奖、变富有——
lottery:n.彩票;碰运气的事,难算计的事;抽彩给奖法;
But let's face it: this would be a horrible way to invest your retirement savings . 但是咱们清醒一点吧: 这可能是个花掉你养老金的 很糟糕的方式。
horrible:可怕的,极讨厌的, invest:v.投资;(把资金)投入;投入(时间、精力等);授予; retirement:n.退休;退职;退休年龄;退休生活; savings:n.节省物;节省;节约;储蓄金;存款;(saving的复数)
I once saw a bumper sticker -- I am not making this up -- that said, "State lotteries are a special tax on people who can't do math." 我曾经看到过一张车尾贴—— 这不是我编的——写着, “国营彩票是向不会 数学计算的人征收的智商税”。
bumper:adj.丰盛的,丰富的;n.缓冲器,保险杆,减震物;vt.装满;为…祝酒;vi.干杯; sticker:n.粘贴标签;贴纸;
(Laughter) （笑声）
It's not that we can't do the math , it's that we can't feel the math. 我们并不是不会做数学计算, 我们是感受不到这种计算。
do the math:盘算一下;
And we also pay much too much attention to regret. 而且我们花太多精力在后悔上。
We all hate the feeling of missing out. 我们都痛恨错过机会的感觉。
So, actually, there was this recent lottery, a mega-jackpot lottery, that had a huge payoff , something like over a billion dollars. 所以,事实上,最近有个彩票, 大乐透彩票, 回报超高,大概超过 10 亿美元。
payoff:n.报酬;结果;发工资;结算;adj.支付的;决定性的;产生结果的;
And everyone in my office is pooling money to buy lottery tickets, and I'm not having any of this. 我办公室里的每个人都在 掏钱集资买彩票, 我一点都不理解。
There I am, like, swaggering around the office, "Lotteries are a special tax on people who can't do math." 我在办公室里转悠,嚷嚷着: “彩票是向不会数学计算的人 征收的智商税。”
swaggering:v.神气十足地走;大摇大摆地走;(swagger的现在分词)
(Laughter) （笑声）
And then it hits me: uh oh. 然后一个想法击中了我: 啊呀,
What if they win? 万一他们中奖了呢？
What if:如果…怎么办?
(Laughter) （笑声）
I'm the only one who shows up at work the next day. 我就成了第二天唯一来上班的人了。
(Laughter) （笑声）
Now, it's not that I didn't want my colleagues to win. 不是我不想让我的同事中奖。
colleagues:n.同事;同行(colleague的复数);
I just didn't want them to win without me. 我只是不想让他们丢下我,自己中奖。
Now, it would have been easier if I had just taken my 20-dollar bill and put it into the office shredder , and the results would have been the same. 如果我当初拿出一张 20 美元钞票 直接塞进办公室的碎纸机里, 事情本会简单很多, 而且结果也会是一样的。
shredder:n.碎纸机;撕碎者;切菜器;
Even though I knew I shouldn't participate , 即使我知道我不应该参与,
participate:v.参加;参与;
I handed over my 20-dollar bill, and I never saw it again. 我还是递出了 20 美元钞票, 之后我再也没见过它。
(Laughter) （笑声）
We've done a bunch of experiments with patients in which we give them these electronic pill bottles so we can tell whether they're taking their medication or not. 我们和患者做过一些实验。 我们给患者们电子药瓶, 以便于知道他们是否在吃药。
a bunch of:一群;一束;一堆; electronic:adj.电子的;电子器件的;电子设备的;
And we reward them with a lottery. 我们用彩票奖励他们。
reward:n.[劳经]报酬;报答;酬谢;v.[劳经]奖励;奖赏;
They get prizes. 他们能得到奖品。
But they only get prizes if they had taken their medication the day before. 但他们只有在前一天吃药的情况下 才能得到奖品。
If not, they get a message that says something like, "You would have won a hundred dollars, but you didn't take your medicine yesterday, so you don't get it." 如果没吃,他们会收到 一条诸如此类的信息: “你本来能赢 100 美金, 但是你昨天没吃药, 所以你没法得到这笔钱。”
Well, it turns out, patients hate that. 事实证明,患者们痛恨那种感觉。
They hate the sense of missing out, and because they can anticipate that feeling of regret and they'd like to avoid it, they're much more likely to take their medications. 他们痛恨错过的感觉, 而且因为他们能预判到 那种悔恨的感觉, 于是想要尽量避开它, 所以他们更有可能会吃药了。
anticipate:v.预期,期望;占先,抢先;提前使用;
Harnessing that sense of hating regret works. 掌控那种痛恨后悔的感觉是有用的。
Harnessing:v.给(马等)装上挽具(harness的现在分词);治理,利用;
And it leads to the more general point, which is: once you recognize how people are irrational, you're in a much better position to help them. 它引出了更一般化的观点, 即:一旦你认识到人是非理性的, 你就会处于一个 能够更好地帮助他们的位置。
Now, this kind of irrationality works out even in men's restrooms. 这种非理性 甚至在男厕所也能用得上。
So, for those of you who don't frequent urinals , let me break this down for you. 在座的不常光顾小便池的人, 让我给你们解析一下。
frequent:adj.频繁的;经常发生的;v.常到(某处); urinals:n.男用小便器(urinal的复数);
(Laughter) （笑声）
There is pee all over the floor. 地板上全是尿。
pee:n.小便;撒尿;v.撒尿;
(Laughter) （笑声）
And it turns out that you can solve this problem by etching the image of a fly in the back of the urinal. 事实证明,你只要在小便池上 蚀刻一个苍蝇的形象,
etching:n.蚀刻; v.蚀刻; (etch的现在分词)
(Laughter) (Applause) （笑声） （掌声）
And it makes perfect sense. 这完全说得通。
(Laughter) （笑声）
If I see a fly, 如果我看见一只苍蝇,
I'm gonna get that fly. 我一定要射中那只苍蝇。
(Laughter) （笑声）
That fly is going down. 那只苍蝇会被冲入下水道。
(Laughter) （笑声）
Now, this naturally begs the question that if men can aim, why were they peeing on the floor in the first place ? 这自然地引出了一个问题: 如果男人们上厕所时能瞄准, 他们一开始为什么要尿到地上？
peeing:v.撒尿;(pee的现在分词) in the first place:首先;起初;
In fact, if they were going to pee on the floor, why pee in front of the urinal? 实际上,如果他们 本来就打算尿到地上, 又为什么要跑到小便池前面去尿？
You could pee anywhere. （笑声）
(Laughter) （笑声）
And the same thing works in health care. 同样的道理也适用于医疗保健。
We had a problem in our hospital in which the physicians were prescribing brand-name drugs when a generic drug was available. 我们医院当时有个这样的问题: 当普通药可供选择的时, 医生们却一直在开品牌药。
physicians:n.[内科]内科医生(physician的复数); prescribing:v.给…开(药);让…采用(疗法);开(处方);命令;(prescribe的现在分词) brand-name:adj.著名品牌的; generic:adj.类的;一般的;属的;非商标的;
Each one of the lines on this graph represents a different drug. 这张图上的每条线 代表一种不同的药物。
represents:v.代表;维护…的利益;相当于;(represent的第三人称单数)
And they're listed according to how often they're prescribed as generic medications. 这些药根据被当做普通药开 的频率被列了出来。
according to:根据,据说;
Those are the top are prescribed as generics 100 percent of the time. 位于顶部的, 是一直都被当做普通药开的。
generics:n.非专利药物;通用术语(generic的复数);
Those down at the bottom are prescribed as generics less than 20 percent of the time. 下面那些, 不到 20% 的机率 是被当做普通药开的。
And we'd have meetings with clinicians and all sorts of education sessions , and nothing worked -- all the lines are pretty much horizontal . 我们跟临床医师们开过会, 也办过各种教学会议, 但是都没用—— 所有的这些线,几乎都没变。
clinicians:临床医生(clinician的名词复数); sessions:n.会议;会期(session的复数); horizontal:n.水平线;水平面;横线;水平位置;adj.水平的;与地面平行的;横的;
Until, someone installed a little piece of software in the electronic health record that defaulted the prescriptions to generic medications instead of the brand-name drugs. 直到,有个人在电子健康记录表里 安装了一个小软件, 把处方设置为默认开普通药, 而非品牌药。
installed:v.安装;设置;使就职(install的过去分词和过去式) defaulted:v.违约;不履行义务;默认;预设;预置;(default的过去式和过去分词) prescriptions:n.医药处方,[医]药方(prescription复数形式);
Now, it doesn't take a statistician to see that this problem was solved overnight , and it has stayed solved ever since. 现在,不用统计分析员 也能看出来, 问题一夜之间就解决了, 而且之后再没有出现此类问题。
statistician:n.统计学家,统计员; overnight:adj.夜间的; v.在夜间; n.(美)前一天的晚上;
In fact, in the two and a half years since this program started, our hospital has saved 32 million dollars. 事实上, 在这个项目上线的两年半内, 我们医院 已经省下了 3200 万美元。
Let me say that again: 32 million dollars. 让我再说一遍: 3200 万美元。
And all we did was make it easier for the doctors to do what they fundamentally wanted to do all along. 我们所做的,只不过是 把医生们一直以来想做的事
fundamentally:adv.从根本上;基础地;重要地
It also works to play into people's notions of loss. 利用人们对损失的概念也有用。
notions:n.观念(notion的复数);小商品;
We did this with a contest to help people walk more. 我们办了场比赛 来帮助人们走更多路。
We wanted everyone to walk at least 7,000 steps, and we measured their step count with the accelerometer on their cell phone. 我们想让每个人至少走 7 千步, 我们也用他们手机上的计步器 以记录他们行走的步数。
measured:adj.缓慢谨慎的; v.测量; (measure的过去分词和过去式) accelerometer:n.[航][物]加速计;
Group A, the control group, just got told whether they had walked 7,000 steps or not. A 组,控制变量组, 仅被告知他们 是否走够 7 千步。
Group B got a financial incentive . B 组,有金钱刺激。
financial:adj.金融的;财政的,财务的; incentive:n.动机;刺激;adj.激励的;刺激的;
We gave them $1.40 for every day they walked 7,000 steps. 每天如果他们走了 7 千步, 我们就奖励他们 1.4 美金。
Group C got the same financial incentive, but it was framed as a loss rather than a gain: C组,有相同的金钱刺激, 但这种刺激被包装成损失 而不是收益:
framed:v.给…做框;给…镶边;制订;拟订;(frame的过去分词和过去式)
$1.40 a day is 42 dollars a month, so we gave these participants 42 dollars at the beginning of each month in a virtual account that they could see, and we took away $1.40 for every day they didn't walk 7,000 steps. 每天 1.4 美金 即 42 美金一个月, 所以在每个月的头一天 我们给这些参与者 42 美金, 就放在他们能看见的虚拟账户里, 然后如果他们每天没走够 7 千步, 我们就从账户里取走 1.4 美金。
participants:n.参与者(participant的复数形式); at the beginning of:在…的开始; virtual:adj.[计]虚拟的;实质上的,事实上的(但未在名义上或正式获承认);
Now, an economist would say that those two financial incentives are the same. 一个经济学家可能会说, 这两种金钱刺激的结果 是一样的。
incentives:n.激励;奖励;诱因(incentive的复数形式);奖励措施;
For every day you walk 7,000 steps, you're $1.40 richer. 因为每天你走够 7 千步的话, 你都能赚 1.4 美金。
But a behavioral economist would say that they're different, because we're much more motivated to avoid a $1.40 loss than we are motivated to achieve a $1.40 gain. 但是一个行为经济学家会说, 它们的结果是不同的, 因为我们为避免损失 1.4 美金 会比赚取 1.4 美金
motivated:adj.有动机的; v.使产生动机;
And that's exactly what happened. 实验结果也确实如此。
Those in the group that received $1.40 for every day they walked 7,000 steps were no more likely to meet their goal than the control group. 那些每天因为走 7 千步 而收到 1.4 美金的人 并不比控制变量组（没有金钱激励） 更能达到目标。
The financial incentive didn't work. 金钱刺激没能起作用。
But those who had a loss-framed incentive met their goal 50 percent more of the time. 而那些受到损失刺激的人 则有 50% 更高的可能 完成目标。
It doesn't make economic sense, but it makes psychological sense, because losses loom larger than gains. 这在经济学上说不通, 但在心理学上是说得通的, 因为损失比收益带来的刺激更大。
economic:adj.经济的,经济上的;经济学的; loom:n.织布机;v.(尤指)令人惊恐地隐现;显得突出;逼近
And now we're using loss-framed incentives to help patients walk more, lose weight and take their medications. 现在我们已经在用这种损失刺激法 去帮助患者走更多路、 减肥, 以及吃药了。
Money can be a motivator . 钱可以是一个激励因素,
motivator:n.动力;激励因素;
We all know that. 我们都知道这一点。
But it's far more influential when it's paired with psychology . 但当它与心理学配对使用时 更具有影响力。
influential:adj.有影响的;有势力的;n.有影响力的人物; psychology:n.心理学;心理状态;
And money, of course, has its own disadvantages . 当然,金钱有其自身缺点。
disadvantages:n.不利因素;障碍;不便之处;(disadvantage的复数)
My favorite example of this involves a daycare program. 我最喜欢的例子, 说的是一个日托项目。
involves:v.包含;需要;牵涉;牵连;影响;(使)参加,加入(involve的第三人称单数) daycare:n.日托;日间照管儿童;
The greatest sin you can commit in daycare is picking up your kids late. 你能在日托中犯下的最大的罪孽 就是接孩子接晚了。
commit:v.犯(罪等);干(坏事等);[法]提(审);判处;
No one is happy. 没人开心。
Your kids are crying because you don't love them. 你的孩子在哭,因为你不爱他们。
(Laughter) （笑声）
The teachers are unhappy because they leave work late. 老师不开心,因为他们下班晚了。
And you feel terribly guilty . 你也觉得极其内疚。
guilty:adj.有罪的;内疚的;
This daycare program in Israel decided they wanted to stop this problem, and they did something that many daycare programs in the US do, which is they installed a fine for late pickups . 以色列的这个日托项目 就想解决这个问题, 而且他们做的, 是许多美国日托项目也在做的事, 就是给晚接孩子的人设置罚款。
Israel:n.以色列(亚洲国家);犹太人,以色列人; pickups:n.拾音器;补拍镜头(pickup的复数);
And the fine they chose was 10 shekels , which is about three bucks . 他们把罚款定为 10 谢克尔（以色列货币单位）, 大概相当于 3 美元。
shekels:n.舍客勒(以色列货币单位)(Shekel的复数); bucks:n.元;雄鹿;(buck的复数)
And guess what happened? 猜猜然后发生了什么？
Late pickups increased. 晚接孩子的情况恶化了。
And if you think about it, it makes perfect sense. 如果你仔细想想的话, 这完全说得通。
What a deal! 多合适的买卖啊！
For 10 shekels -- 10 谢克尔——
(Laughter) （笑声）
you can keep my kids all night! 你就能一晚上不用接孩子！
(Laughter) （笑声）
They took a perfectly strong intrinsic motivation not to be late, and they cheapened it. 家长们卯足了内在动机, 准时接孩子, 结果日托机构 把这个动机因素变得廉价了。
intrinsic:adj.本质的,固有的; cheapened:vt.减去…的价格;贬低;vi.减价;跌价;
What's worse, when they realized their mistake and they took away the financial incentive, the late pickups still stayed at the high level. 更糟的是, 当日托机构意识到自己的错误, 把迟到罚款的规则撤回时, 晚接孩子的情况丝毫没有改观。
They had already poisoned the social contract . 他们已经毒害了社会契约。
social contract:n.社会契约;
Health care is full of strong intrinsic motivations . 医疗保健充满了强大的内在动机。
motivations:n.动机(motivation的复数);表明动机;
We have doctors and patients who already want to do the right thing. 医生和患者本身就想做正确的事。
Financial incentives can help, but we shouldn't expect money in health care to do all of the heavy lifting. 金钱刺激也有正面作用。 但是我们不能盼着 金钱能在医疗保健中 承担全部的重任。
Instead, perhaps the most powerful influencers of health behavior are our social interactions . 相反,对健康行为 最有效的影响因素 可能是我们的社会互动。
influencers:n.影响者;有影响力的人(influencer的复数); interactions:n.[计]交互,相互作用;相互交流;干扰;(interaction复数)
Social engagement works in health care, and it works in two directions. 社会参与在医疗保健中是起作用的, 主要体现在两个方面。
engagement:n.婚约;约会;交战;诺言;n.参与度;
First, we fundamentally care what others think of us. 第一,我们本能地在意 别人对我们的看法。
And so one of the most powerful ways to change our behavior is to make our activities witnessable to others. 所以改变我们行为 最有效的方法之一 就是让我们的行为能被别人看见。
We behave differently when we're being observed than when we're not. 我们在被观察, 和不在被观察时候的行为表现 是不同的。
observed:adj.观察的;观测的;v.观察;遵守;注意到(observe的过去分词形式);
I've been to some restaurants that don't have sinks in the bathrooms. 是不同的。
Instead, when you step out, the sink is outside in the main part of the restaurant, where everyone can see whether you wash your hands or not. 但当你走出来,水槽在外面, 在饭店的主要位置, 这时候所有人都能看见 你洗没洗手。
in the main:基本上;
Now, I don't know for sure, but I am convinced that handwashing is much greater in those particular settings. 我不是很确定, 但我敢保证在那些特定环境下 洗手的人变多了。
convinced:adj.坚信; v.使确信; (convince的过去分词和过去式) handwashing:洗手(handwash的现在分词);
We are always on our best behavior when we're being observed. 我们在被观察的时候, 总能表现出最好的行为。
In fact, there was this amazing study that was done in an intensive care unit in a Florida hospital. 事实上,在佛罗里达一家医院 的重症监护室里, 进行了一项很棒的研究。
intensive care:n.(医院里的)特别护理病房;重症监护;
The handwashing rates were very low, which is dangerous, of course, because it can spread infection . 这里的洗手率非常低, 当然,这很危险, 因为该行为 会传播疾病,导致感染。
infection:n.感染;传染;(身体某部位的)感染;传染病;
And so some researchers pasted a picture of someone's eyes over the sink. 所以一些研究员在水槽上 贴了一张人眼的照片。
pasted:adj.膏的(胶的;浆糊的);
It wasn't a real person, it was just a photograph. 那不是一个真人,只是一张照片。
In fact, it wasn't even their whole face, it was just their eyes looking at you. 实际上,那甚至都不是一整张脸, 只是一双眼睛看着你。
(Laughter) （笑声）
Handwashing rates more than doubled. 洗手率翻了不止一倍。
It seems we care so much what other people think of us that our behavior improves even if we merely imagine that we're being observed. 我们似乎是如此在意 别人对我们的看法, 以至于我们的行为会就此改进, 即使我们仅仅只是 想象我们在被别人观察着。
improves:v.改进;改善;(improve的第三人称单数) merely:adv.仅仅,只不过;只是;
And not only do we care what others think of us, we fundamentally model our behaviors on what we see other people do. 而且我们不只是在意 别人怎么看我们, 我们还会本能地模仿他人行为。
And it all comes back to seat belts. 这一切又回到安全带上来了。
When I was a kid, I used to love the " Batman " TV series with Adam West. 我小的时候,喜欢看亚当·韦斯特 演的电视剧《蝙蝠侠》。
Batman:n.勤务兵;传令兵;蝙蝠侠; series:n.系列,连续;[电]串联;级数;丛书;
Everything that Batman and Robin did was so cool, and, of course, the Batmobile was the coolest thing of all. 蝙蝠侠和罗宾做的所有事都特酷, 当然了,蝙蝠车是所有事情里最酷的。
Robin:知更鸟,罗宾(人名)
and at that time, seat belts were optional accessories in cars. 在那个年代,安全带 还是车里可有可无的配件。
optional:adj.可选择的,随意的;n.选修科目; accessories:n.附件(accessory的复数形式);辅助程序;
But the producers of that show did something really important. 但是那个电视剧的出品人 做了一件非常重要的事。
When Batman and Robin got in the Batmobile, the camera would focus on their laps, and you would see Batman and Robin put on their seat belts. 当蝙蝠侠和罗宾坐上那辆蝙蝠车时, 相机会聚焦到他们腿上, 然后你会看到蝙蝠侠和罗宾 系上了他们的安全带。
Now, if Batman and Robin put on their seat belts, you can bet that I was going to wear my seat belt, too. 如果蝙蝠侠和罗宾 系上了安全带, 你可以打赌 我也会系上我的安全带。
bet:n.打赌;赌注;预计;估计;v.下赌注(于);用…打赌;敢说;八成儿;
I bet that show saved thousands of lives. 我打赌那个电视剧 拯救了上千条生命。
And again, it works in health care, too. 再次,这在医疗保健中也能起作用。
Doctors use antibiotics more appropriately when they see how other doctors use them. 在看见别的医生如何使用抗生素后, 医生自己能更加适当地使用抗生素。
antibiotics:n.抗菌素;抗生素(如青霉素);(antibiotic的复数) appropriately:adj.适当地;合适地;相称地;
So many activities in health care are hidden, they're unwitnessed , but doctors are social animals, and they perform better when they see what other doctors do. 医疗保健中的许多行动 是隐匿的,别人看不见。 但医生是社会动物, 因此当他们能看见其他医生的做法时, 他们自己也能表现得更好。
unwitnessed:adj.无证人签署的;未注意到的,未察觉到的; perform:v.表演;执行;履行;演出;工作,运转(好/不好);
So social influence works in health care. 所以社会影响在医疗保健中 是有积极作用的,
So does tying it to notions of regret or to loss aversion . 把它与后悔感和损失规避 联系起来也是大有裨益的。
aversion:n.厌恶;讨厌的人;
We would never think of using these tools if we thought that everyone was rational all the time. 如果我们认为每个人 时刻都是理性的,
Now, just to be clear: I am not condemning rationality. 这里我要澄清一点: 我不是在指责理性。
condemning:n.谴责;处刑;v.谴责;(condemn的现在分词)
I mean, that really would be irrational. 这才会是真正的不理性。
But we all know that it's the nonrational parts of our minds where we get courage, creativity, inspiration and everything else that sparks passion . 但我们都知道, 正是我们思想中那些不理性的部分 给予我们勇气、创造力、灵感, 以及其他一切能激发激情的东西。
sparks:n.(船或飞机上的)无线电通信师; passion:n.激情;热情;酷爱;盛怒;
And we know something else, too. 我们还知道一些别的。
We know that we can be much more effective at improving health behavior if we work with the irrational parts of our nature instead of ignoring them or fighting against them. 我们知道如果我们能 与天性中不理性的部分合作, 而不是忽视、或跟它们反着来, 我们就能更有效地改善 我们的健康行为。
effective:adj.有效的,起作用的;实际的,实在的;给人深刻印象; ignoring:v.忽略,忽视;(ignore的现在分词);
When it comes to health care, understanding our irrationality is just another tool in our toolbox . 当谈到医疗保健时, 理解我们的非理性 只是工具箱中的一个工具。
toolbox:n.工具箱;
And harnessing that irrationality -- that may be the most rational move of all. 而掌控这种非理性—— 或许才是所有行为中最理性的。
Thank you. 谢谢。
(Applause) （掌声）