SD冠军锦标赛｜美国藤校演讲与辩论赛中国选拔赛

我童年一些最美好的时光 是和我奶奶一块儿 在我们纽约，布鲁克林的四口之家度过的。 她的公寓就像一个乐园。

Paula Johnson: His and hers healthcare男性与女性的健康护理

Some of my most wonderful memories of childhood are of spending time with my grandmother, Mamar, in our four-family home in Brooklyn, New York. Her apartment was an oasis. It was a place where I could sneak a cup of coffee, which was really warm milk with just a touch of caffeine. She loved life. And although she worked in a factory, she saved her pennies and she traveled to Europe. And I remember poring over those pictures with her and then dancing with her to her favorite music.
我童年一些最美好的时光 是和我奶奶一块儿 在我们纽约，布鲁克林的四口之家度过的。 她的公寓就像一个乐园。 在那儿我可以偷着喝点咖啡， 其实就是热牛奶兑了一点点咖啡。 她热爱生活。 尽管她只在一个工厂上班， 她还是一点一滴攒下钱去欧洲旅游。 记得那会儿我和她一起细细品味那些照片， 然后伴着她最喜欢的音乐一起跳舞。

And then, when I was eight and she was 60, something changed. She no longer worked or traveled. She no longer danced. There were no more coffee times. My mother missed work and took her to doctors who couldn’t make a diagnosis. And my father, who worked at night, would spend every afternoon with her, just to make sure she ate.
后来，当我8岁，她60岁的时候， 这一切都变了。 她不再上班或者旅游了。 也不再跳舞了。 我们再也没有咖啡时间了。 我妈妈请了假带奶奶去看医生， 却无法得到一个诊断。 我爸爸上夜班，他每个下午都陪着奶奶， 就为了保证她吃了东西。

Her care became all-consuming for our family. And by the time a diagnosis was made, she was in a deep spiral.
全家人一门心思地扑到了奶奶身上。 当终于有一个诊断的时候， 她的情况已经岌岌可危了。

Now many of you will recognize her symptoms. My grandmother had depression. A deep, life-altering depression, from which she never recovered. And back then, so little was known about depression.
现在在座的很多人能推断出她的症状。 我奶奶得的是抑郁症。 颠覆了她生活的重度抑郁症， 她再也没有恢复过来。 当时，人们对抑郁症知之甚少。

But even today, 50 years later, there’s still so much more to learn. Today, we know that women are 70 percent more likely to experience depression over their lifetimes compared with men. And even with this high prevalence, women are misdiagnosed between 30 and 50 percent of the time.
但即使是50年以后的今天， 也还有很多需要去了解。 如今，我们知道，一生中女性患上抑郁症 的几率比男性高出 70%。 而即使有这样高的患病率， 30% 到 50%的女性还是会被误诊。

Now we know that women are more likely to experience the symptoms of fatigue, sleep disturbance, pain and anxiety compared with men. And these symptoms are often overlooked as symptoms of depression.
现在我们知道，与男性相比， 女性更可能会出现疲劳、 睡眠紊乱、 疼痛、以及焦虑的症状。 这些症状往往被忽视 而未能推断出是抑郁症的症状。

And it isn’t only depression in which these sex differences occur, but they occur across so many diseases.
这类性别差异并非只存在于抑郁症中， 还存在于很多其他疾病中。

So it’s my grandmother’s struggles that have really led me on a lifelong quest. And today, I lead a center in which the mission is to discover why these sex differences occur and to use that knowledge to improve the health of women.
所以，正是由于我奶奶的种种挣扎 促使了我进行终身探索。 如今，我带领着一个团队，其使命 就是去探寻出现这些性别差异的原因 并利用这些知识 来改善女性健康。

Today, we know that every cell has a sex. Now, that’s a term coined by the Institute of Medicine. And what it means is that men and women are different down to the cellular and molecular levels. It means that we’re different across all of our organs. From our brains to our hearts, our lungs, our joints.
今天，我们知道每个细胞都有性别。 这是个由医学机构所创造的词。 它的意思是，男人和女人的区别， 直达细胞和分子的层面。 这意味着我们之间的区别反映在各个器官上。 从我们的大脑、到我们的心脏、 我们的肺部、 我们的关节。

Now, it was only 20 years ago that we hardly had any data on women’s health beyond our reproductive functions. But then in 1993, the NIH Revitalization Act was signed into law. And what this law did was it mandated that women and minorities be included in clinical trials that were funded by the National Institutes of Health. And in many ways, the law has worked. Women are now routinely included in clinical studies, and we’ve learned that there are major differences in the ways that women and men experience disease. But remarkably, what we have learned about these differences is often overlooked.
仅仅在20 年前， 我们还几乎没有任何关于女性健康的数据， 除了我们的生殖功能。 但后来在 1993 年， 《美国国家卫生研究院复兴法 》 通过签署成为法律。 这项法律规定 由国家卫生研究院资助的临床试验 需要包含女性和少数族裔。 从许多方面看，这项法律起到了作用。 现如今女性通常会参与临床研究， 我们也了解了男性和女性 在罹患疾病时的 主要区别。 但值得注意的是， 我们已知的这些区别往往被忽视。

So, we have to ask ourselves the question: Why leave women’s health to chance? And we’re leaving it to chance in two ways. The first is that there is so much more to learn and we’re not making the investment in fully understanding the extent of these sex differences. And the second is that we aren’t taking what we have learned, and routinely applying it in clinical care. We are just not doing enough.
所以，我们必须问自己这个问题： 为什么女性的健康得看运气？ 从两方面来看，我们在靠运气。 第一是要研究的内容甚多， 而我们并没有在这方面投资 以全面了解这些性别差异。 第二是我们是没有把已经学到的东西 应用在常规的临床护理中。 我们做得实在不够。

So, I’m going to share with you three examples of where sex differences have impacted the health of women, and where we need to do more.
所以，我要与你分享三个例子， 关于性别差异如何影响了女性的健康 以及我们需要努力的地方。

Let’s start with heart disease. It’s the number one killer of women in the United States today. This is the face of heart disease. Linda is a middle-aged woman, who had a stent placed in one of the arteries going to her heart. When she had recurring symptoms she went back to her doctor. Her doctor did the gold standard test: a cardiac catheterization. It showed no blockages. Linda’s symptoms continued. She had to stop working. And that’s when she found us. When Linda came to us, we did another cardiac catheterization and this time, we found clues. But we needed another test to make the diagnosis. So we did a test called an intracoronary ultrasound, where you use soundwaves to look at the artery from the inside out.
我们先看心脏疾病。 这是如今美国女性的头号杀手。 这是患心脏病的人。 琳达是一名中年女子， 在她到心脏的一根动脉中 做了一个血管支架。 当她有复发症状的时候，她再次回去看医生。 医生给她做了一个万无一失的标准测试： 心导管检查。 显示没有堵塞。 琳达的症状继续着。 她不得不停止了工作。 那时是她找上我们的时候。 当琳达来我们那儿的时候，我们做了另一次心导管检查 而这次，我们找到了些线索。 但我们需要另一个测试 才能做诊断。 于是我们做了一个叫冠状动脉内超声波的测试， 也就是用声波从里到外 来看动脉。

And what we found was that Linda’s disease didn’t look like the typical male disease. The typical male disease looks like this. There’s a discrete blockage or stenosis. Linda’s disease, like the disease of so many women, looks like this. The plaque is laid down more evenly, more diffusely along the artery, and it’s harder to see. So for Linda, and for so many women, the gold standard test wasn’t gold.
我们发现 琳达的病看起来不像 典型的男性心脏病。 典型的男性疾病看起来像这样。 会有离散堵塞或着狭窄症。 琳达的病，像很多女性的心脏病 看起来像这样。 匾沿着动脉分布得更均匀、 更扩散， 也更难看出来。 所以对琳达，和众多女性来说， 万无一失标准测试不那么万无一失了。

Now, Linda received the right treatment. She went back to her life and, fortunately, today she is doing well. But Linda was lucky. She found us, we found her disease.
如今，接受了正确的治疗之后， 琳达非常幸运地又回归了正常生活， 现在她情况不错。 但琳达是幸运的。 她找到了我们，我们搞清了她的疾病。

But for too many women, that’s not the case. We have the tools. We have the technology to make the diagnosis. But it’s all too often that these sex diffferences are overlooked.
但对于太多的女性而言，她们的遭遇并非如此。 我们有工具， 并有技术来做诊断。 但太多时候，这些性别上的区别 被忽略了。

So what about treatment? A landmark study that was published two years ago asked the very important question: What are the most effective treatments for heart disease in women? The authors looked at papers written over a 10-year period, and hundreds had to be thrown out. And what they found out was that of those that were tossed out, 65 percent were excluded because even though women were included in the studies, the analysis didn’t differentiate between women and men. What a lost opportunity. The money had been spent and we didn’t learn how women fared. And these studies could not contribute one iota to the very, very important question, what are the most effective treatments for heart disease in women?
那么治疗呢？ 一篇两年前发表的标志性研究 问了个很重要的问题： 对女性而言，最有效的治疗心脏病的方法是什么？ 其作者搜索了10 年的文献， 而不得不弃用其中数百个文献。 他们发现弃用的文献中， 有65%必须弃用是由于 即使其中的研究包括了女性， 分析部分也没有区分女性和男性。 真是个错失了的机会。 钱用掉了 而我们却不知道女性的情况如何。 这些研究无法对这一个非常、非常重要的问题 作出丝毫的贡献： 治疗女性心脏病 最有效的方法是什么？

I want to introduce you to Hortense, my godmother, Hung Wei, a relative of a colleague, and somebody you may recognize — Dana, Christopher Reeve’s wife. All three women have something very important in common. All three were diagnosed with lung cancer, the number one cancer killer of women in the United States today. All three were nonsmokers. Sadly, Dana and Hung Wei died of their disease. Today, what we know is that women who are nonsmokers are three times more likely to be diagnosed with lung cancer than are men who are nonsmokers. Now interestingly, when women are diagnosed with lung cancer, their survival tends to be better than that of men. Now, here are some clues. Our investigators have found that there are certain genes in the lung tumor cells of both women and men. And these genes are activated mainly by estrogen. And when these genes are over-expressed, it’s associated with improved survival only in young women. Now this is a very early finding and we don’t yet know whether it has relevance to clinical care. But it’s findings like this that may provide hope and may provide an opportunity to save lives of both women and men.
我想向你们介绍我的教母霍滕斯， 一位同事的亲戚，洪魏， 还有一位你也许认得 — — 达娜，克里斯托弗 · 里夫的妻子。 这三位女性都有一个很重要的共同点。 她们三位都诊断为患有肺癌， 这是如今美国女性的 头号癌症杀手。 她们三个人都不抽烟。 可悲的是，达娜和洪魏死于肺癌。 今天，我们知道，不抽烟的女性 得到肺癌的诊断要比不抽烟的男性 高三倍。 有趣的是，当女性诊断为患有肺癌时， 他们的生存率往往比男性好。 那么这其中有些线索。 我们的调查人员 在女性和男性的肺肿瘤细胞中发现了某些基因。 这些基因主要 是由雌激素来激活。 而当这些基因过度释放时， 它与提升生存率的关联 只存在于年轻女性中。 现在这还是个非常早期的发现， 我们还不知道它对临床护理 是否有意义。 但像这样的研究结果或许能创造希望 并且提供机会来拯救女性和男性 的生命。

Now, let me share with you an example of when we do consider sex differences, it can drive the science. Several years ago a new lung cancer drug was being evaluated, and when the authors looked at whose tumors shrank, they found that 82 percent were women. This led them to ask the question: Well, why? And what they found was that the genetic mutations that the drug targeted were far more common in women. And what this has led to is a more personalized approach to the treatment of lung cancer that also includes sex.
现在，让我与大家分享一个例子， 说的是我们对性别差异的考虑能够驱动科学发展。 前几年，一种新的肺癌药物 正接受评估， 当研究人员观察哪些人的肿瘤缩小的时候， 他们发现 82% 是女性。 这使得他们提出了这个问题： 这是为什么呢？ 他们发现的是 这种药物针对的的基因突变 在女性中更为常见。 这带出的结果是 对肺癌的治疗更加个人化的方法 也需考虑性别差异。

This is what we can accomplish when we don’t leave women’s health to chance. We know that when you invest in research, you get results. Take a look at the death rate from breast cancer over time. And now take a look at the death rates from lung cancer in women over time. Now let’s look at the dollars invested in breast cancer — these are the dollars invested per death — and the dollars invested in lung cancer. Now, it’s clear that our investment in breast cancer has produced results. They may not be fast enough, but it has produced results. We can do the same for lung cancer and for every other disease.
这就是我们能做到的， 只要我们不放任女性健康于运气。 我们知道当你投资在研究上， 你就会有收获。 来看看乳腺癌随着时间推移的死亡率。 再看看女性肺癌 随着时间推移的死亡率。 现在再看看投在乳腺癌上的金额 — 这些是每个死亡人数的投资金额数 — 对比投在肺癌上的金额数。 那么显然，我们在乳腺癌的投资 取得了成果。 或许不足够快， 但确实有成果。 而我们也能 为肺癌以及其他各种疾病创造出同样的成果。

So let’s go back to depression. Depression is the number one cause of disability in women in the world today. Our investigators have found that there are differences in the brains of women and men in the areas that are connected with mood. And when you put men and women in a functional MRI scanner — that’s the kind of scanner that shows how the brain is functioning when it’s activated — so you put them in the scanner and you expose them to stress. You can actually see the difference. And it’s findings like this that we believe hold some of the clues for why we see these very significant sex differences in depression.
那么，让我们回来说说抑郁症。 抑郁症是导致当今世界女性 残疾的第一大原因 我们的调查人员发现 女性和男性大脑中 的区别存在于 与情绪相关的区域。 当你把男人和女人 放入功能性磁共振成像扫描仪中 — — 这是那种显示被激活的大脑是如何工作的扫描仪 — — 把这些人放在扫描仪中，然后给他们压力。 你真的可以看到其中的区别。 我们相信像这样的研究结果， 对于为什么在抑郁症上 我们观察到这些非常显著的性别差异 提供着某些思路。

But even though we know that these differences occur, 66 percent of the brain research that begins in animals is done in either male animals or animals in whom the sex is not identified.
但即使我们知道 这类差异的存在， 66% 的 动物大脑研究 是在雄性动物中完成的 或是在未鉴定性别的动物中完成的。

So, I think we have to ask again the question: Why leave women’s health to chance? And this is a question that haunts those of us in science and medicine who believe that we are on the verge of being able to dramatically improve the health of women. We know that every cell has a sex. We know that these differences are often overlooked. And therefore we know that women are not getting the full benefit of modern science and medicine today. We have the tools but we lack the collective will and momentum.
所以，我认为我们要再次问这个问题： 为什么女性的健康得看运气？ 这是一个萦绕在我们 科学界和医学界的问题， 我们相信我们即将有能力去显著改进 女性健康。 我们知道每个细胞都男女有别。 我们知道这些差异往往被忽视。 因此我们知道女性没有得到今时今日 现代科学和医学的充分好处。 我们有工具， 但我们缺乏集体意志和势头。

Women’s health is an equal rights issue as important as equal pay. And it’s an issue of the quality and the integrity of science and medicine. (Applause) So imagine the momentum we could achieve in advancing the health of women if we considered whether these sex differences were present at the very beginning of designing research. Or if we analyzed our data by sex.
女性的健康是一个平等权利问题， 和同工同酬一样重要。 这是一个科学和医学的 质量以及廉正性的问题。 （掌声） 所以想象一下我们在推进女性的健康上 可以达到的势头， 假如我们在开始设计研究的时候 就考虑了这些性别差异是否存在， 或者，我们根据性别分析了我们的数据。

So, people often ask me: What can I do? And here’s what I suggest: First, I suggest that you think about women’s health in the same way that you think and care about other causes that are important to you. And second, and equally as important, that as a woman, you have to ask your doctor and the doctors who are caring for those who you love: Is this disease or treatment different in women? Now, this is a profound question because the answer is likely yes, but your doctor may not know the answer, at least not yet. But if you ask the question, your doctor will very likely go looking for the answer. And this is so important, not only for ourselves, but for all of those whom we love. Whether it be a mother, a daughter, a sister, a friend or a grandmother.
所以，人们常常问我： 我能做什么？ 这里是我的建议： 第一，我建议你们看待女性健康 就如同看待 其他任何对你重要的事业一样，进行思考和关注。 第二，同样重要的是， 作为一名女性， 你得问问治疗你 和你身边的人的医生： 这个疾病，或者治疗，在女性中有不同之处吗？ 这是一个深刻的问题，答案很可能是肯定的， 但你的医生可能不知道答案，至少现在还不知道。 但如果你问了这个问题，你的医生很有可能 会去寻找答案。 这是如此重要， 不仅仅对我们自己而言， 对我们身边的人也是如此。 无论是一个母亲、 一个女儿、 一个姐妹、 一位朋友或祖母。

It was my grandmother’s suffering that inspired my work to improve the health of women. That’s her legacy. Our legacy can be to improve the health of women for this generation and for generations to come.
我奶奶遭受的痛苦 激励了我致力于 提高女性健康的工作。 这就是她留给我的。 而我们留给后人的可以是提高女性健康， 为这一代， 也为子孙后代。

Thank you. (Applause)
谢谢。 （掌声）