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IvanOransky_2012P-_是否我们过分医疗化了_
Those of you who have seen the film "Moneyball," 在座看过电影“点球成金”的
or have read the book by Michael Lewis, will be familiar with the story of Billy Beane. 又或者读过麦克·路易斯的书的, 会对比利·比恩的故事很熟悉。
familiar:adj.熟悉的;常见的;亲近的;n.常客;密友;
Billy was supposed to be a tremendous ballplayer; all the scouts told him so. 比利应该是一个非常好的球员;所以的球探都这么跟他说。
supposed:adj.误信的;所谓的;v.认为;假设;设想;(suppose的过去分词和过去式) tremendous:adj.极大的,巨大的;惊人的;极好的; scouts:n.童子军,童军(scout的复数);侦察兵;v.侦察;搜索(scout的三单形式);
They told his parents that they predicted that he was going to be a star. 他们告诉他的父母, 他们预测他会变成一个明星。
predicted:v.预言;预告;预报;(predict的过去分词和过去式)
But what actually happened when he signed the contract -- and by the way , he didn't want to sign that contract, he wanted to go tocollege -- which is what my mother, who actually doeslove me, said that I should do too, and I did -- well, he didn't do very well. He struggledmightily. 但事实上当他签约后 -- 其实他并不想 签约,他想去上大学 -- 而这是真的爱我的母亲 说我应该做的,而我也这么做了 -- 但其实他没做多好。他挣扎着去适应。
contract:v.收缩;感染;订约;n.合同;婚约; by the way:顺便说一下;
He got traded a couple of times, he ended up in the Minors for most of his career , and he actually ended up in management . He ended up as a General Manager of the 他被交易了几次,并在小联盟打了他大部分的职业球赛, 最终来到了管理层。它做了奥克兰运动家球队
Minors:n.未成年人(minor的复数); career:n.职业;事业;生涯;经历; management:n.管理;管理人员;管理部门;操纵;经营手段;
Oakland A's. 的总经理。
Oakland:n.奥克兰(美国加州西部城市);
Now for many of you in this room, ending up in management, which is also what I've done, is seen as a success. 对于在座的大多数人来说,像我一样成为管理层的一部分 会被看做是成功。
I can assure you that for a kid trying to make it in the Bigs , going into management ain't no success story . It's a failure. 我可以向你保证,对于一个试图在大联盟打出名声的孩子来说, 进入管理层不是一个成功的故事。它是一种失败。
assure:vt.保证;担保;使确信;弄清楚; Bigs:n.大人物;重要组织(big的复数形式); success story:n.获得巨大成功的人(或事物);
And what I want to talk to you about today, and share with you, is that our healthcare system, our medical system, isjust as bad at predicting what happens to people in it -- patients ,others -- as those scouts were at predicting what would happen to Billy Beane. 而我今天想和你说的,便是 我们的医保系统,医疗系统,在对于预测 将发生在人身上的事情也很差 -- 病患,其他的 -- 就像那些预测比利·比恩会成功的球探一样。
healthcare:n.医疗保健;健康护理,健康服务;卫生保健; predicting:v.预言;预告;预报;(predict的现在分词) patients:n.接受治疗者,病人;(patient的复数)
And yet, every day thousands of people in this country are diagnosed with preconditions . 但每一天 在这个国家里仍然有上千个人 被诊断出疾病前兆。
diagnosed:v.诊断(疾病);判断(问题的原因);(diagnose的过去分词和过去式) preconditions:n.先决条件(precondition的复数); v.预先安排好;
We hear about pre-hypertension, we hear about pre-dementia, we hear about pre-anxiety, and I'm pretty sure that I diagnosed myself with that in the green room . 我们听到高血压前兆,痴呆症前兆, 焦虑症前兆,而我确定我在那绿色的房间里 给了自己这个诊断。
green room:n.[戏,影视]演员休息室;
We also refer to subclinical conditions. 同样的,我们也提到亚临床症状。
refer:v.参考;涉及;提到;查阅; subclinical:adj.亚临床的;临床症状不明显的;
There's subclinical atherosclerosis , subclinical hardening of the arteries , obviously linked to heart attacks, potentially . 我们有亚临床动脉硬化, 潜在的联系到心力衰竭。
atherosclerosis:n.[内科]动脉粥样硬化;动脉硬化; hardening:n.硬化;淬火;锻炼;v.硬化;使强壮(harden的ing形式); arteries:n.[解剖]动脉(artery的复数);v.给…提供动脉(artery的单数第三人称); potentially:adv.可能地,潜在地;
One of my favorites is calledsubclinical acne . 我最喜欢的叫做亚临床粉刺。
acne:n.[皮肤]痤疮,[皮肤]粉刺;
If you look up subclinical acne, you may find a website, which I did, which says that this is the easiest type of acne to treat . 如果你搜索亚临床粉刺,你可能会像我一样找到一个网站, 上面说这种粉刺最容易被治疗。
treat:v.治疗;处理;招待;款待;n.款待;乐事;乐趣;
You don't have the pustules or the redness and inflammation . 你不会有脓包,红肿或炎症。
pustules:n.[皮肤]脓疱(pustule的复数); redness:n.红;红色; inflammation:n.[病理]炎症;[医]发炎;燃烧;发火;
Maybe that's because you don't actuallyhave acne. 但这也有可能是因为你并没有粉刺。
I have a name for all of these conditions, it's another precondition: 我给这些病症起了个名字,它也是一种前兆症:
I call them preposterous . 我叫它们 ”荒谬绝伦“。
preposterous:adj.荒谬的;可笑的;
In baseball, the game follows the pre-game. 在棒球中,正式比赛在热身赛后开始。
Season follows the pre-season . 赛季在赛前季后。
pre-season:赛季前;
But with a lot of these conditions, that actually isn't the case, or at least it isn't the case all the time. It's as if there's a rain delay, every single time in many cases. 但对于这些疾病来说,这大多数情况 并不成立。在很多病例中它就像在球赛被下雨取消了一般。
We have pre-cancerous lesions , which often don't turn into cancer. 我们有癌前病变, 但它们经常不会转化为癌症。
pre-cancerous:变肿瘤前的; lesions:[生物]损伤;
And yet, if you take, for example, subclinicalosteoporosis, a bone thinning disease , the precondition, otherwise known as osteopenia , you would have to treat 270women for three years in order to prevent one broken bone. 然而, 如果你拿亚临床骨质疏松症做例子, 它的前兆症状, 被称为骨质减少, 你必须为270个女人提供长达3年的治疗, 来防止一个断裂的骨头。
disease:n.病,[医]疾病;弊病;vt.传染;使…有病; osteopenia:n.骨量减少;骨质缺乏;
That's an awful lot of women when you multiply by the number of womenwho were diagnosed with this osteopenia. 当你用时间乘以被诊断为骨质减少的 女人人数时, 这个数字是相当庞大的。
multiply:vt.乘; vi.乘; v.多样地; adj.多层的;
And so is it any wonder, given all of the costs and the side effects of the drugs that we're using to treat these preconditions, that every year we're spending more than two trillion dollars on healthcare and yet 所以,看看每年 我们花费在这些病症前兆上的 药物的费用以及它们导致的副作用, 我们每年都要在医保上花费2万亿美元以上的钱,
trillion:n.[数]万亿;adj.万亿的;num.[数]万亿;
100,000 people a year -- and that's a conservative estimate -- are dying not because of the conditions they have, but because of the treatments that we're giving them and the complications of those treatments? 但每年仍然有10万人 死亡-- 而这只是一个保守的估计, 不是因为他们所有的病症, 而是因为我们所给他们的疗程以及这些疗程带来的并发症。
conservative:adj.保守的;n.保守派,守旧者; estimate:v.估计;估算;估价;n.估价;(对大小、数量、成本等的)估计;估计的成本; treatments:n.治疗;疗法;对待;处理;讨论;(treatment的复数)
We've medicalized everything in this country. 我们医疗化了这个国家 的一切。
medicalized:vt.用医学方法处理;
Women in the audience, I havesome pretty bad news that you already know, and that's that every aspect of yourlife has been medicalized. 在座的女性们,我有一些 你已经知道的坏消息, 那就是你们生活的每一部分 都被医疗化了。
aspect:n.方面;层面;外观;方位;
Strike one is when you hit puberty . 第一次是当你来到青春期。
puberty:n.青春期;开花期;
You now have something that happens to you once a month that has been medicalized. 你现在有了一个被医疗化的,每月都发作一次的东西。
It's a condition; it has to be treated . Strike two is if you get pregnant . 它变成了一个病症; 它必须被治疗。第二次是 当你怀孕的时候。
treated:v.以…态度对待;把…看作;(treat的过去分词和过去式) pregnant:adj.怀孕的;富有意义的;
That's been medicalized aswell. 那也被医疗化了。
You have to have a high-tech experience of pregnancy , otherwise something might go wrong. 你必须使用高科技 来保护孕期,不然有些地方可能会出错。
high-tech:adj.高科技的,高技术的;仿真技术的;n.高科技; pregnancy:n.怀孕;丰富,多产;意义深长;
Strike three is menopause . 第三次是更年期。
menopause:n.更年期;活动终止期;
We all know what happened when millions of women were given hormone replacement therapy for menopausal symptoms for decades until all of a sudden we realized, because a study came out, a big one, 我们都知道,几十年来我们给了几百万的女人激素取代疗法 来治疗更年期症状, 直到我们突然明白了一个由国家卫生研究所 （NIH）资助的研究
hormone:n.[生理]激素,荷尔蒙; replacement:n.替换;更换;替代品;接替者; therapy:n.治疗,疗法; menopausal:adj.绝经期的,更年期的; symptoms:n.症状;征候;征兆;(symptom的复数) all of a sudden:突然地,出乎意料地;
NIH-funded. 得出来的结果。
It said, actually, a lot of that hormone replacement therapy may be doing more harm than good for many of those women. 研究说, 其实太多的激素取代疗法对于很多女人来说 坏处可能多于好处。
Just in case , 为了以防万一,
Just in case:以防万一;作为准备;
I don't want to leave the men out -- 我不想把男人置身事外 --
I am one, after all -- 毕竟我也是其中一份子 --
I have really bad news for all of you inthis room, and for everyone listening and watching elsewhere : 对于在座的给位以及正在收听和 收看的观众, 我有很坏的消息:
elsewhere:adv.在别处;到别处;
You all have a universally fatal condition. 你们都有 一个普遍的致命病症。
universally:adv.普遍地;人人;到处; fatal:adj.致命的;灾难性的;毁灭性的;导致失败的;
So, just take a moment. 所以,请深呼吸一下。
It's called pre-death. 他叫死亡前兆。
Every single one of you has it, becauseyou have the risk factor for it, which is being alive. 你们每个人都有,因为你们都有它的危险因素, 那就是活着。
factor:n.因素;要素;[物]因数;代理人;v.做代理商;v.把…作为因素计入;
But I have some good news for you,because 但我也有些好消息,因为我是
I'm a journalist , I like to end things in a happy way or a forward-thinking way. 一个新闻记者,我喜欢以一种开心和积极的心态来结尾。
journalist:n.新闻工作者;报人;记日志者; forward-thinking:adj.前瞻的,有远见的;
And that good news is that if you can survive to the end of my talk, which we'll see if that happens for everyone, you will be a pre-vivor. 这个好的信息便是,如果你可以成功的活到我的演讲的结束, 这点我相信大家都可以, 你会是一个前存者 (pre-vivor)。
I made up pre-death. 死亡前兆是我编的。
If I used someone else's pre-death, I apologize, 如有雷同,对不起,
I think I made it up. 但我想这的确是我编的。
I didn't make up pre-vivor. 但我没有编出前存者 (pre-vivor)。
Pre-vivor is what a particular cancer advocacy group would like everyone who just has a risk factor, but hasn't actually had that cancer, to call themselves. 前存者（其实指癌症高危人群） 是一个癌症宣传组织, 它是指某些人有癌症高发因素, 但却还没发展成癌症 他们就这么称呼他们自己。
advocacy:n.主张;拥护;辩护;
You are a pre-vivor. 你们都是前存者（癌症高危人群）。
We've had HBO here this morning. I'm wondering if Mark Burnett is anywhere in the audience, I'd like to suggest a reality TV show called "Pre-vivor." 家庭票房（HBO）今早还在这里。我不知道Mark Burnett（英国著名电视制作人）是否 现在在观众席中。我建议开办一个 叫做“前存者”的真人秀节目。
reality TV:n.(电视)真人秀;
If you develop a disease, you're offthe island. 谁患上了一种疾病,就要从岛上退出。
But the problem is, we have a system that is completely -- basically promoted this. 但问题是,我们的系统 完完全全的 -- 时时刻刻地在促进它的发生。
basically:adv.主要地,基本上; promoted:v.促进:促销:提升:(promote的过去分词和过去式)
We've selected, at every point in this system, to do what we do, and to give everyone aprecondition and then eventually a condition, in some cases. 我们在这个系统的每个时刻都选择了 我们在做什么,于是它给了每一个人一个前兆 而最终,其中某些前兆转变为病症。
eventually:adv.最后,终于;
Start with the doctor-patientrelationship. Doctors, most of them, are in a fee-for-service system. They arebasically incentivized to do more -- procedures , tests, prescribe medications . 让我们从医患关系说起。大多数医生, 服从一种一次一付的医疗付费系统。越是给的多,他们就做得越多。 比如步骤,检测, 还有开处方。
incentivized:v.对…实行物质刺激;(incentivize的过去式和过去分词) procedures:n.程序;规程(procedure的复数); prescribe:v.给…开(药);让…采用(疗法);开(处方);命令; medications:n.药;药物;(medication的复数)
Patients come to them, they want to do something. We'reAmericans, we can't just stand there, we have to do something. And sothey want a drug. 病人来找医生, 就是想要到一些东西。我们美国人不能只是傻傻地站在那儿吧, 我们得做些什么啊。他们只是想要药物。
They want a treatment. They want to be told, this is what you have and this is how you treat it. If the doctordoesn't give you that, you go somewhere else. 他们只是想要得到治疗。他们想被告知,这就是你得的病, 这就是你的治疗方法。如果医生没能给你这些, 你会到别处就医。
That's not very good for doctors'business. 这对医生的生意是很不利的噢。
Or even worse, if you are diagnosed with somethingeventually, and the doctor didn't order that test, you get sued . 更坏的是, 如果你最终被诊断出来真的患有某病,而医生当时却没有要求你做相应的检测, 你会起诉他。
sued:v.控告;提起诉讼;提出请求;(sue的过去分词和过去式)
We have pharmaceutical companies that areconstantly trying to expand the indications , expand the number of people who are eligible for a given treatment, 我们有些制药公司一直在试图扩大用药指征, 好让更多的人有理由接受它的治疗。
pharmaceutical:adj.制药(学)的;n.药物; expand:v.扩张;使膨胀;详述;发展;张开,展开; indications:n.适应症,显示;标志(indication复数形式); eligible for:合格;够资格;
because that obviously helps their bottom line .We have advocacy groups, like the one that's come up withpre-vivor, who want to make more and more people feel they are at risk, or might have a condition, so that they can raise more funds and raise visibility , et cetera . 因为这样明显会有利于他们盈利。我们有一些宣传组织, 就像刚刚那个想出来前存者的组织, 他们想让越来越多的人觉得自己有高发因素,或是有症状, 好让他们募得更多的资金, 或是提高知名度或获取其他利益。
bottom line:n.底线;归根结底;账本底线,盈亏一览结算线; funds:n.[会计]资金,现金(fund的复数);基金;v.资助(fund的三单形式);提供资金; visibility:n.可见性;能见度;能见距离 et cetera:na.以及其他;
But this isn't actually, despite what journalists typically do,this isn't actually about blaming particular players. 这其实并不实际, 尽管这是典型的新闻人会干的事,但我其实并不是 在责怪某些人。
despite:prep.尽管,不管;n.轻视;憎恨;侮辱; journalists:n.新闻记者(journalist的复数); typically:adv.代表性地;作为特色地;
We are all responsible . 我们对此都有责任。
responsible:adj.负责的,可靠的;有责任的;
I'm responsible. 我也要对此负责。
I actually root for the Yankees , I mean talkabout rooting for the worstpossible offender when it comes to doingeverything you can do. 我其实支持Yankee队,我的意思是说 在有能力做任何事情的情况下 支持最可能的罪犯
Yankees:扬基债; offender:n.罪犯;冒犯者;违法者;
Thank you. 谢谢。
But everyone is responsible. 但是的确人人有责。
I went to medical school, and I didn't have a course called How to Think Skeptically , or How Not to Order Tests. 我在上医学院的时候, 并没有一门课程叫做“如何抱有怀疑态度地思考” 或是“如何选择检测方法”
Skeptically:adv.怀疑地;
We have this system where that's what you do. 我们的这个体制就这样, 你还得继续你应该做的事。
And it actually took being a journalist to understand all these incentives . You know, economists like to say, there are no bad people, there are just bad incentives . 不过好像只有新闻人才懂得这些诱因。 知道吗,经济学家说, 世上本无坏人, 只有坏念头。
incentives:n.激励;奖励;诱因(incentive的复数形式);奖励措施;
And that's actually true. 这绝对是真理。
Because what we've created is a sort of Field of Dreams, when it comes to medical technology . 因为我们已经创造出了医学界的《梦幻成真》（1989年4月21日在美国上映的一部电影）。
technology:n.技术;工艺;术语;
So when you put another MRI inevery corner, you put a robot in every hospital saying that everyone has to have robotic surgery . 所以当你在每个角落都装备了MRI,却在每个医院又装备机器人 并且说每个人都只能进行机器人手术。
robotic:adj.机器人的,像机器人的;自动的;n.机器人学; surgery:n.外科;外科手术;手术室;诊疗室;
Well, we've created a system where if youbuild it, they will come. 接受现实吧,我们已经创造了这种体制,这些也是不可阻挡的现实。
But you can actually perversely tell people to come, convince them that they have to come. 当然你也可以倔强不屈, 告诉人们将发生什么, 让他们明白这一切是必须发生的。
perversely:adv.倔强地; convince:v.使确信;使相信;说服,劝说;
It was when I became a journalist that I really realized how I was part of this problem, and how we all are part of this problem. 我就是当了新闻人以后才真正意识到我也是这个问题的其中一员, 意识到我们是怎样都和这个问题有关的。
I was medicalizing every risk factor, I was writing stories, commissioning stories, every day, that were trying to, not necessarily make people worried, although that was what often happened. 我在医疗化每个危险因素,我在写故事,授权故事, 天天如此,目的就是 不让人们这么焦虑,虽然这通常都不管用。
medicalizing:vt.用医学方法处理; commissioning:v.正式委托;任命…为军官;(commission的现在分词) necessarily:adv.必要地;必定地,必然地;
But, you know, there are ways out. 但是知道吗,其实有解决的方法。
I saw my own internist last week, and he said to me, "You know," and he told me something that everyone in this audience could havetold me for free, but I paid him for the privilege , whichis that 上个星期我才见了我的内科医生, 他对我说, “你知道吗”, 这些话在座各位都可以告诉我而不收取任何费用, 而我却付给他钱让他来告诉我,
internist:n.[内科]内科医生; privilege:n.特权;优待;v.给与…特权;特免;
I need to lose some weight. 那就是我需要减肥。
Well, he's right. I've had honest-to-goodness high blood pressure for a dozen years now, same age my father got it, and it's a real disease. It's not pre-hypertension, it's actual hypertension , high blood pressure. 好吧,他是对的。我是如假包换的高血压患者, 已经是老油条了, 患病年龄跟我父亲一样。 这的确是一种疾病,这不是高血压前兆, 这的的确确就是高血压,高血压病。
honest-to-goodness:adj.真正的;纯洁的;未搀假的;adv.真正地;实实在在地; blood pressure:n.[医]血压; hypertension:n.高血压;过度紧张;
Well, he's right, but he didn't say to me, well, you have pre-obesity or you have pre-diabetes, or anything like that. He didn't say, better start taking this Statin , you need to lower your cholesterol . 好吧,他是对的, 但他没有告诉我说, 额,你有肥胖症前兆或是 你有糖尿病前兆或是其他种种,他都没说, 他也没说让我用抑制素来降低胆固醇。
Statin:n.他汀类;抑制素; cholesterol:n.[生化]胆固醇;
No, he said, "Go out and lose some weight. Come back and see me in a bit, or just give me a call and let me know how you're doing." 他只是说,‘出去走走,减减肥,回来让我好好看看你。 或者干脆给我打个电话让我知道你在做什么。“
So that's, to me, a way forward. 这就是对于我的 一个解决的方法。
Billy Beane, by the way, learned the samething. 同样地,Billy Beane（电影《点球成金》男主角）也学到了这点。
He learned, from watching this kid who he eventually hired, who was really successful for him, that it wasn't swinging for the fences, itwasn't swinging at every pitch 他学会了什么呢？ 通过观察他最终雇佣的那个为他赢得巨大成功的孩子, 他学会了要赢得比赛并不仅仅是把球挥出栅栏或是在球场上猛打就可以,
pitch:v.抛:用力扔:针对:触地:n.场地:程度:力度:推销的话:纵摇:
like the sluggers do, which is what all the expensive teams like the Yankees like to -- they like to pick up those guys. 就好比那些富队比如yankees会做的一样使用蛮力, 他们是用心去挑选球员,善用人才。
This kid told him, you know, you gotta watch the guys, and you gotta go out and find the guys who like to walk, because getting on base by a walk is just as good, and in our healthcaresystem we need to figure out, is that really a good pitch or should we let it go by and not swing at everything? 那孩子告诉他,你要看那些选手,你要到外面去看看, 哪些家伙喜欢走路, 因为步行上垒不失为一种好方法, 而在我们的医保体系里 我们得弄明白 这真的是医疗的一块好球场吗？ 或者我们就应该让他维持现状而不去作任何改变？
Thanks. 谢谢。