families are forced to make impossible choices

在這個國家，每一天

when it comes to their health care.

都有許多家庭被迫

Like Kimberly, who said,

在醫療上做艱困的抉擇。

"There was times I had to choose between my food and my pills.

像是金柏莉所描述的：

It wasn't luxury stuff, because I didn't make that much.

「有時候，在食物和藥物 兩者之間，我只能選一樣。

It was like, 'Can I get shampoo or conditioner?'

我並不是在選奢侈品， 我沒賺那麼多。

Things you take for granted."

而更是像衡量著：『我可以 買洗髮精或潤絲精嗎？』

And Debbie, who said,

那種大家認為理所當然的東西。」

"You put your medicine in one hand,

還有黛比，她說：

your living costs in the other.

「這邊是必須吃的藥所需要的錢，

OK. Well, what am I going to do?

那邊是生活費。

Am I going to get my medicine

好，你說我該怎麼選？

or am I going to pay my bills?

我是要買這些藥

Well, I can't live without my medicine,

還是要付清帳單？

but I can't live if I don't pay my bills."

沒這些藥我活不了，

Ten thousand people die every month in this country,

但要是不付帳單， 我也生活不下去。」

because they don't take the medicine that they need.

這個國家每個月有一萬人

More people die from not taking medications

死於沒吃他們所需要的藥物。

than opioid overdoses and car accidents combined.

死於沒吃藥的人數

But you can't take medicine if you can't afford it.

多過死於吸食鴉片類藥物過量 加上死於車禍的人數的總和。

Today, the average household spends 3,000 dollars a year

然而你若是負擔不起，便沒藥可吃。

on medications.

現今一個家庭每年 平均花 3,000 美元

About a third of folks who are uninsured

在藥物上。

said that they stopped taking medicine as prescribed

沒醫療保險的人中，大約有三分之一

because of cost.

說他們已經不再按照 醫囑吃處方藥，

Even folks with insurance,

因為花費太高。

if they make under 35,000 dollars a year,

即使是有保險的人，

half of them report skipping the medications

如果他們的年收入低於 3 萬 5 千美元，

if their insurance doesn't cover it.

有一半的人也說他們不吃

So there are 10 million adults like Kimberly and like Debbie

保險沒給付的藥。

who are forced to make impossible choices every day.

因此有一千萬個像金柏莉 及黛比那樣的成年人，

We all know that prescription drug prices are too high.

每天被迫要做很艱難的抉擇。

And our health care system,

大家都知道處方藥的價格太高。

that makes some folks uninsured and other folks underinsured,

而我們的醫療系統，

doesn't prioritize people who need access now

這個讓一些人沒保險、 而另一些人保險涵蓋範圍不足的系統，

and need medications now.

不會優先照顧需要馬上看病

Ten million -- it's a big number,

和需要馬上用藥的人。

but it's also a solvable number,

一千萬是個很大的數字，

because there's also 10 billion dollars

但它也是個解決得了的數字，

of perfectly good, unused medication

因為有價值一百億美元

that goes to waste.

完好且沒使用過的藥物

So this is an injustice on two sides:

被白白浪費掉。

people not getting the medicine that they need to survive and to thrive,

因此有兩個方面的不公平：

and that very same medication being sent to a medical waste incinerator

一方面有人得不到他們 賴以生存和發展的藥物，

to be destroyed.

而另一方面，同樣的藥物 正被送進醫療廢料焚化爐

This waste is unconscionable, but it also offers an opportunity.

去銷毀。

I started SIRUM,

這樣的浪費不合情理， 但它也給了我們一個契機。

a not-for-profit technology company, with my cofounders Adam and George,

我開辦了 SIRUM，

to turn discarded medications into a lifeline,

我與和亞當及喬治共同 創辦了這一家非營利科技公司，

just like the medications in this warehouse.

將廢棄的藥品轉為救人的生命線，

We may not be able to fix

這個庫房裡的這些藥品就是例子。

all the ways in which our health care system is failing us,

我們也許沒法修好

but we can fix this one.

醫療系統裡所有的失敗之處，

Medications come from manufacturers and wholesalers who have safety stock,

但我們可以解決這一個問題。

and when it's short-dated, they destroy it.

這些藥品來自製藥廠 和批發商的安全庫存。

It also comes from health care facilities

當有效期快到了， 藥品便會被銷毀 。

like hospitals, pharmacies and nursing homes,

也有些藥品來自醫療單位，

who end up with surplus when a patient stops taking medication

像是醫院、藥局，以及療養院。

or when they pass away.

有多餘的藥物是因為 病人停用這些藥物了

We can use this untapped source of medications

或者病人已經去世。

to supply all 10 million people who need medications.

我們可以利用這個 未開發的藥品來源，

And we can do this today.

來提供給需要這些藥的一千萬人。

SIRUM gets surplus medications

而且我們今天就做得到。

by putting recycling bins into these hundreds of facilities

SIRUM 取得剩餘藥品的方式

that have surplus.

是在有剩餘藥品的數百家機構

They fill the bin, and when the box is full,

放置回收容器。

SIRUM initiates a courier pickup to pick up that medication,

他們將剩餘藥品放入容器。

and we handle the shipping, the tracking, the manifests and the tax receipt.

當容器滿了，SIRUM 便派快遞 去收回這些藥品，

Medicine donors want to donate because it's actually cheaper and easier

所有的運送、追蹤、貨單， 及稅務收據都由我們處理。

than the highly regulated medicine destruction process.

有剩餘藥品的人會更願意捐贈，

And there are strong tax incentives to actually donate.

因為相較於管制嚴格的藥品銷毀過程， 捐贈藥品實際上更便宜又方便，

We then deliver those donated medications to people who need it.

而且捐贈又有引人的稅務優惠。

A new prescription comes in,

其後我們將這些捐贈來的 藥品遞送給需要的人。

and our platform matches that patient need with the inventory that's available.

每收到一份新處方，

Our platform then generates a warehouse pick list,

我們的平台便在現有庫存中去匹配。

the medications are picked and the prescriptions filled.

平台輸出一份庫房配藥單後，

We are building the 21st-century pharmacy experience

這些藥便被挑出來配好處方。

that low-income families deserve.

我們創建的是低收入家庭所應享有的

Patients can register in under five minutes

21 世紀藥局的體驗。

and have access to over 500 different medications,

病人只需花不到 5 分鐘來註冊，

a stable list of medications for everything from heart disease

便可以取得超過 500 種不同的藥物。

to mental health conditions,

穩定供應的藥品中，

actually representing over 75 percent of all prescriptions prescribed

從心臟病到心理病症的藥都有。

in the United States today.

實際上包括了

We also partner with a network of doctors, nurses and case managers

超過 75% 現今全美國開出的處方藥。

at community health centers and free clinics

我們合作夥伴有一整個網路的 醫生、護士，和個案負責人。

that refer patients to the service.

他們在社區健康中心和免費診所

We make it as easy for these health care providers

將病人轉介到我們的服務。

to have a prescription filled with donated medications

我們為這些醫護人員提供方便，

as it is to send a prescription to a local pharmacy.

讓他們使用捐來的藥品配處方，

And patients can pick up medications on-site at one of our partners

就像讓當地的藥局配處方一樣容易。

or have medications delivered directly to their home.

病人可以在我們的 合作夥伴那裡取藥，

By circumventing the traditional supply chain,

或者讓藥直接送到他們家裡。

we're able to offer flat, transparent pricing --

因為繞過了傳統供應鏈，

about two dollars for a month's supply of most medications.

我們的收費平價又透明──

And that allows a predictable, affordable price

大部分藥物一個月份 只要大約 2 美元。

that folks can actually budget for.

這樣清楚又容易負擔的價格

We've already supplied enough medication for 150,000 people.

讓大家都可以輕易 把藥品放進預算。

But we can do more.

我們已經給 15 萬人 供應了足夠多的藥品，

Our goal is to reach one million people

但我們能做的不只如此。

with approaching a billion dollars of unused medicine

我們的目標是要 在接下來 5 年內，

in the next five years,

把將近十億元未使用的藥

scaling our program to 12 states.

提供給一百萬人，

At this scale, we can actually cover communities that are home

並將規模擴大到 12 個州。

to 40 percent of the 10 million people

在那個規模，我們涵蓋的社區將包含

who lack consistent, affordable access.

現在沒有，但是需要穩定可負擔藥物的

Our direct service to one million people

一千萬人中的 40%。

will drive price competition for so many more.

而我們對一百萬人提供的直接服務，

Walmart launched one of the only price innovations in pharmacy

也會引發價格競爭， 而有助於更多的人。

in 2006,

沃爾瑪曾推出藥局極其罕見的 價格創新活動之一。

by offering a limited list of medications

那是在 2006 年，

for a flat fee of four dollars.

他們將有限幾樣藥物的價格

This sparked incredible change.

定在一律 4 美元。

It sparked competitors to offer other lists

這引發了難以置信的改變。

and price match guarantees.

競爭者也開始推出自己的平價藥物，

By targeting transparent, affordable medications

並且有價格保護保證。

into these new states,

我們將透明又可負擔的藥品

we can actually drive regional price competition

推進這些新的州內，

that drives down the prices for entire low-income communities.

實際上可以推動地區性的競價，

Our health care system is complex.

從而降低整個低收入地區的價格。

It is daunting.

我們的醫療系統很複雜，

It feels impossible to make headway.

令人望而生畏，

But we can completely reimagine medicine access.

讓人覺得根本搞不過它，

By using surplus medications as a beachhead to force change

但我們可以重新構思取藥的這部分。

into this multibillion dollar industry,

利用剩餘藥品作為改革的灘頭堡，

we can create radical access to medications

我們可以推動這個數十億美元的 產業進行改革。

based on a fundamental belief

憑著一個根本的信念，

that people who live in one of the wealthiest nations in the world

我們可以創造藥業的激變。

can and should have access to medicine that they need

這個信念就是住在全世界 最富裕國家之一的人

to survive and to thrive.

都應該能取得他們所需的藥物

I do not pretend to have all of the answers

來生存發展。

to fix all of the problems in our health care system.

我不會假裝我有所有的方案

But getting medications to the millions of people

來解決我們醫療系統所有的問題。

who need it to live a healthy life,

但為數百萬人提供藥品，

saving medicine to save lives --

讓他們能夠活得健康，

that is something we can do today.

救回要被扔掉的藥物來救人──

Thank you.

這是我們今天就能做得到的。