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  • Some of my most wonderful memories of childhood

    我童年時最美好的回憶

  • are of spending time with my grandmother, Mamar,

    有許多是和祖母共度,

  • in our four-family home in Brooklyn, New York.

    在我們位於紐約布魯克林的四口之家。

  • Her apartment was an oasis.

    她的公寓就像綠洲。

  • It was a place where I could sneak a cup of coffee,

    是個我能偷偷喝杯咖啡的地方,

  • which was really warm milk with just a touch of caffeine.

    其實是一杯摻有一點點咖啡因的熱牛奶。

  • She loved life.

    她熱愛生命。

  • And although she worked in a factory,

    雖然她在工廠上班,

  • she saved her pennies and she traveled to Europe.

    但是她還是存到了錢去歐洲旅行。

  • And I remember poring over those pictures with her

    我記得會和她一起端詳這些照片,

  • and then dancing with her to her favorite music.

    接著和她聽著最喜愛的音樂共舞。

  • And then, when I was eight and she was 60,

    然而在我 8 歲,她 60 歲時,

  • something changed.

    事情有了變化。

  • She no longer worked or traveled.

    她不再工作或旅行。

  • She no longer danced.

    她不再跳舞。

  • There were no more coffee times.

    再也沒有咖啡時光了。

  • My mother missed work and took her to doctors

    我的母親請了假,帶她去看過很多醫生,

  • who couldn't make a diagnosis.

    但是都診斷不出來。

  • And my father, who worked at night, would spend every afternoon with her,

    而我在夜間工作的父親,每天下午都會陪她,

  • just to make sure she ate.

    只為了確定她真的有吃飯。

  • Her care became all-consuming for our family.

    照顧她成了家人們全心投入的事。

  • And by the time a diagnosis was made,

    最後診斷出病因,

  • she was in a deep spiral.

    她的情況急轉直下。

  • Now many of you will recognize her symptoms.

    現在在座很多人認得出她的症狀。

  • My grandmother had depression.

    我祖母得了憂鬱症,

  • A deep, life-altering depression,

    一種會完全改變一生的憂鬱症,

  • from which she never recovered.

    後來她沒能從此病中痊癒。

  • And back then, so little was known about depression.

    當時我們對憂鬱症所知甚少。

  • But even today, 50 years later,

    即使到 50 年後的今日,

  • there's still so much more to learn.

    仍有許多需要學習。

  • Today, we know that women are 70 percent more likely

    今天,我們知道女性在一生中

  • to experience depression over their lifetimes

    較男性多 70% 的可能性

  • compared with men.

    得到憂鬱症。

  • And even with this high prevalence,

    即使如此普遍,

  • women are misdiagnosed between 30 and 50 percent of the time.

    女性卻有 30% 至 50% 的可能性被誤診。

  • Now we know that women are more likely

    現在我們知道相較於男性

  • to experience the symptoms of fatigue, sleep disturbance,

    女性有較高的機率經歷疲勞、睡眠障礙、

  • pain and anxiety compared with men.

    疼痛和焦慮。

  • And these symptoms are often overlooked

    而這些是憂鬱症的症狀

  • as symptoms of depression.

    卻常常被忽略。

  • And it isn't only depression in which these sex differences occur,

    這些性別的差異 不只發生在憂鬱症,

  • but they occur across so many diseases.

    也發生在許多疾病中。

  • So it's my grandmother's struggles

    因此我祖母遭遇的困難

  • that have really led me on a lifelong quest.

    讓我花一輩子的時間去探尋。

  • And today, I lead a center in which the mission

    現在,我帶領一個研究中心,

  • is to discover why these sex differences occur

    目的在找到這些 性別差異發生的原因,

  • and to use that knowledge

    並運用那學問

  • to improve the health of women.

    改善女性的健康。

  • Today, we know that every cell has a sex.

    現今,我們知道每個細胞都有性別。

  • Now, that's a term coined by the Institute of Medicine.

    這是由醫學研究院創造的名詞。

  • And what it means is that men and women are different

    意謂著男人和女人的不同

  • down to the cellular and molecular levels.

    是在細胞與分子的層面。

  • It means that we're different across all of our organs.

    那代表我們的差異遍及所有的器官。

  • From our brains to our hearts, our lungs, our joints.

    從我們的腦、心、肺,到關節。

  • Now, it was only 20 years ago

    而距今僅 20 年前,

  • that we hardly had any data on women's health

    我們沒有任何女性健康的資訊,

  • beyond our reproductive functions.

    除了我們的生育機能。

  • But then in 1993,

    但是在 1993 年時,

  • the NIH Revitalization Act was signed into law.

    簽署了國家衛生研究院的新生法,

  • And what this law did was it mandated

    這項法律主要在明文規定

  • that women and minorities be included in clinical trials

    將女性和少數族群納入臨床試驗,

  • that were funded by the National Institutes of Health.

    由國家衛生研究院提供資金。

  • And in many ways, the law has worked.

    這項法律在許多方面起了效用。

  • Women are now routinely included in clinical studies,

    現在女性已固定納入臨床研究,

  • and we've learned that there are major differences

    我們得知兩性

  • in the ways that women and men

    體驗疾病的方式

  • experience disease.

    有很大的差異。

  • But remarkably,

    然而驚人的是

  • what we have learned about these differences is often overlooked.

    我們發現這些差異常被忽略。

  • So, we have to ask ourselves the question:

    因此我們必須自問:

  • Why leave women's health to chance?

    為什麼要讓女性的健康碰運氣?

  • And we're leaving it to chance in two ways.

    我們用兩種方式碰運氣。

  • The first is that there is so much more to learn

    首先,我們需要學習的甚多,

  • and we're not making the investment

    但是我們卻沒投入

  • in fully understanding the extent of these sex differences.

    在全盤了解這些性別差異的程度。

  • And the second is that we aren't taking what we have learned,

    第二,我們未採納所學,

  • and routinely applying it in clinical care.

    並例行地運用在臨床照顧中。

  • We are just not doing enough.

    我們做得還是不夠。

  • So, I'm going to share with you three examples

    因此我想和各位分享三個例子,

  • of where sex differences have impacted the health of women,

    其中性別差異影響了女性的健康,

  • and where we need to do more.

    而我們應該要做得更多。

  • Let's start with heart disease.

    讓我們以心臟病開始。

  • It's the number one killer of women in the United States today.

    心臟病是目前美國女性的頭號殺手。

  • This is the face of heart disease.

    這是心臟病的面容。

  • Linda is a middle-aged woman,

    琳達是中年婦女,

  • who had a stent placed in one of the arteries

    她在其中一條通往心臟的動脈內

  • going to her heart.

    植入支架。

  • When she had recurring symptoms she went back to her doctor.

    當她有復發的症狀時,她回到醫院。

  • Her doctor did the gold standard test:

    她的醫生做了黃金標準測試:

  • a cardiac catheterization.

    心導管。

  • It showed no blockages.

    但是沒顯示出阻塞。

  • Linda's symptoms continued.

    琳達的症狀持續,

  • She had to stop working.

    她必須停止工作。

  • And that's when she found us.

    那時她找上我們。

  • When Linda came to us, we did another cardiac catheterization

    當琳達向我們求助, 我們做了另一次心導管,

  • and this time, we found clues.

    而這次我們找到了線索。

  • But we needed another test

    但是我們需要另一項測試

  • to make the diagnosis.

    來做出診斷。

  • So we did a test called an intracoronary ultrasound,

    我們做了冠狀動脈內超音波,

  • where you use soundwaves to look at the artery

    你可以運用音波檢視動脈,

  • from the inside out.

    從裡到外。

  • And what we found

    我們發現

  • was that Linda's disease didn't look like

    琳達的病看起來不像

  • the typical male disease.

    典型的男性疾病。

  • The typical male disease looks like this.

    典型的男性疾病看起來像這樣。

  • There's a discrete blockage or stenosis.

    有不連續的阻塞或狹窄。

  • Linda's disease, like the disease of so many women,

    琳達的病就和許多女性的一樣,

  • looks like this.

    看起來像這樣。

  • The plaque is laid down more evenly, more diffusely

    血小板沿著動脈分布更平均、更擴散,

  • along the artery, and it's harder to see.

    也更難看得出來。

  • So for Linda, and for so many women,

    因此對琳達和許多女性來說,

  • the gold standard test wasn't gold.

    這黃金標準測試並非黃金。

  • Now, Linda received the right treatment.

    現在琳達獲得正確的治療。

  • She went back to her life and, fortunately, today

    她恢復生活,而且幸運的是

  • she is doing well.

    至今她的狀況依然良好。

  • But Linda was lucky.

    但那是琳達幸運。

  • She found us, we found her disease.

    她找到我們,我們找出她的疾病。

  • But for too many women, that's not the case.

    但是對太多女性來說, 可不是那麼一回事。

  • We have the tools.

    我們有工具。

  • We have the technology to make the diagnosis.

    我們有科技能做出診斷。

  • But it's all too often that these sex diffferences

    但是這些性別差異

  • are overlooked.

    都太常被忽視了。

  • So what about treatment?

    那治療呢?

  • A landmark study that was published two years ago

    兩年前有一項重大的研究發表,

  • asked the very important question:

    其中提出一個非常重要的問題:

  • What are the most effective treatments for heart disease in women?

    對女性心臟病患者最有效的治療是什麼?

  • The authors looked at papers written over a 10-year period,

    作者研究這十年來發表的論文,

  • and hundreds had to be thrown out.

    有上百篇應該被扔掉。

  • And what they found out was that of those that were tossed out,

    他們發現其中被丟棄的

  • 65 percent were excluded

    有 65% 不應列入考慮的原因是

  • because even though women were included in the studies,

    雖然女性在這些研究中被列入考量,

  • the analysis didn't differentiate between women and men.

    但是分析並未區分出 男性與女性的差別。

  • What a lost opportunity.

    多可惜啊!

  • The money had been spent

    花了這麼多錢,

  • and we didn't learn how women fared.

    我們卻沒能學到女性遭遇的情況。

  • And these studies could not contribute one iota

    這些研究可能無法 對那非常重要的問題

  • to the very, very important question,

    做出任何一絲回應,

  • what are the most effective treatments

    對女性心臟病患者

  • for heart disease in women?

    最有效的治療是什麼?

  • I want to introduce you to Hortense, my godmother,

    我想介紹我的教母荷頓斯,

  • Hung Wei, a relative of a colleague,

    一位同事的親戚 ── 洪瑋(音譯),

  • and somebody you may recognize --

    以及你可能知道的──

  • Dana, Christopher Reeve's wife.

    黛娜,克里斯多福.李維的妻子。

  • All three women have something very important in common.

    這三位女性有極重要的相似處。

  • All three were diagnosed with lung cancer,

    她們都被診斷出肺癌,

  • the number one cancer killer of women

    而肺癌是現今美國女性

  • in the United States today.

    頭號癌症殺手。

  • All three were nonsmokers.

    她們三位都不吸煙。

  • Sadly, Dana and Hung Wei died of their disease.

    讓人難過的是,黛娜和洪瑋都因病去逝。

  • Today, what we know is that women who are nonsmokers are three times more likely

    現在,我們知道不抽煙的女性

  • to be diagnosed with lung cancer than are men

    被診斷罹患肺癌的機率

  • who are nonsmokers.

    是不抽煙男性的三倍。

  • Now interestingly, when women are diagnosed with lung cancer,

    有趣的是當女性被診斷出肺癌,

  • their survival tends to be better than that of men.

    她們的存活率通常較男性高。

  • Now, here are some clues.

    這裡有一些線索。

  • Our investigators have found that there are

    我們的研究員發現

  • certain genes in the lung tumor cells of both women and men.

    兩性的肺腫瘤細胞都有某種基因。

  • And these genes are activated

    這些基因主要

  • mainly by estrogen.

    被雌激素活化。

  • And when these genes are over-expressed,

    這些基因過度表現時,

  • it's associated with improved survival

    只會和改善年輕女性的

  • only in young women.

    存活率有關。

  • Now this is a very early finding

    這是很新的發現,

  • and we don't yet know whether it has relevance

    我們還不知道它是否

  • to clinical care.

    和臨床照護有關。

  • But it's findings like this that may provide hope

    但是就是像這樣的發現能帶來希望,

  • and may provide an opportunity to save lives

    並且能提供一個救命的機會,

  • of both women and men.

    不論是男是女。

  • Now, let me share with you an example

    讓我和大家分享關於

  • of when we do consider sex differences, it can drive the science.

    當我們考慮性別差異時, 就能帶動科學的例子。

  • Several years ago a new lung cancer drug

    幾年前,有一種新的肺癌藥

  • was being evaluated,

    被拿來評估,

  • and when the authors looked at whose tumors shrank,

    當研究者檢視看誰的腫瘤變小了,

  • they found that 82 percent were women.

    他們發現其中 82% 都是女性。

  • This led them to ask the question: Well, why?

    這讓他們想問:為什麼?

  • And what they found

    他們發現

  • was that the genetic mutations that the drug targeted

    藥物標靶的基因突變

  • were far more common in women.

    在女性中更常見。

  • And what this has led to

    這讓肺癌的治療方式

  • is a more personalized approach

    更能符合個人需求,

  • to the treatment of lung cancer that also includes sex.

    也能將性別列入考量。

  • This is what we can accomplish

    這是我們能做到的,

  • when we don't leave women's health to chance.

    我們讓女性的健康不是只能碰運氣。

  • We know that when you invest in research,

    我們知道當你投資研究

  • you get results.

    就會得到結果。

  • Take a look at the death rate from breast cancer over time.

    看看歷年來乳癌死亡率的改變。

  • And now take a look at the death rates

    再看看歷年來女性肺癌死亡率的改變。

  • from lung cancer in women over time.

    看看投資在乳癌研究的金額

  • Now let's look at the dollars invested in breast cancer --

    ──這是對每一位死亡病患的投資金額──

  • these are the dollars invested per death --

    以及投資在肺癌的金額。

  • and the dollars invested in lung cancer.

    顯然我們在乳癌的投資

  • Now, it's clear that our investment in breast cancer

    證明了這一點。

  • has produced results.

    雖然不見得夠快,

  • They may not be fast enough,

    但還是帶來成果。

  • but it has produced results.

    我們也可以同樣投資

  • We can do the same

    肺癌和每一種癌症。

  • for lung cancer and for every other disease.

    讓我們回到憂鬱症。

  • So let's go back to depression.

    憂鬱症是全球女性

  • Depression is the number one cause

    造成身心障礙最主要的因素。

  • of disability in women in the world today.

    我們的研究員發現

  • Our investigators have found

    男性與女性的腦部

  • that there are differences in the brains

    在與情緒相關的區塊有差異。

  • of women and men

    如果你把男性和女性

  • in the areas that are connected with mood.

    放入功能性磁振造影裝置

  • And when you put men and women

    ──這種裝置能在腦部被活化時 讓你看出它如何運作──

  • in a functional MRI scanner --

    因此當你把他們放入裝置,對他們施加壓力,

  • that's the kind of scanner that shows how the brain is functioning when it's activated --

    就能明顯地看出差異。

  • so you put them in the scanner and you expose them to stress.

    就是像這樣的研究

  • You can actually see the difference.

    讓我們相信掌握了些許線索,

  • And it's findings like this

    了解為什麼我們會看到 這些顯著的性別差異

  • that we believe hold some of the clues

    出現在憂鬱症中。

  • for why we see these very significant sex differences

    但是即使我們知道

  • in depression.

    這些差異會發生,

  • But even though we know

    有 66% 的動物腦部研究

  • that these differences occur,

    不是針對雄性動物,

  • 66 percent

    就是針對未驗明性別的動物。

  • of the brain research that begins in animals

    因此,我認為我們應該再次提問:

  • is done in either male animals

    為什麼要讓女性的健康碰運氣?

  • or animals in whom the sex is not identified.

    這個問題在科學與醫學界的我們心中

  • So, I think we have to ask again the question:

    徘徊不去,

  • Why leave women's health to chance?

    我們相信我們即將為女性的健康

  • And this is a question that haunts those of us

    帶來卓越的進展。

  • in science and medicine

    我們知道每個細胞都有性別。

  • who believe that we are on the verge of being able to dramatically improve

    我們知道這些差異常被忽略。

  • the health of women.

    因此我們知道女性在現代科學與醫學中,

  • We know that every cell has a sex.

    未能完全受惠。

  • We know that these differences are often overlooked.

    我們有工具,

  • And therefore we know that women are not getting the full benefit

    卻缺乏集體意願和動力。

  • of modern science and medicine today.

    女性健康是一項平權的議題,

  • We have the tools

    就和同工同酬一樣重要。

  • but we lack the collective will and momentum.

    而這項議題攸關

  • Women's health is an equal rights issue

    科學和醫學的品質與廉正。

  • as important as equal pay.

    (掌聲)

  • And it's an issue of the quality

    想像我們為了改善女性健康

  • and the integrity of science and medicine.

    能激發的動力,

  • (Applause)

    只要我們能多考量,不管是 在精心設計的研究之初

  • So imagine the momentum we could achieve

    呈現這些性別差異;

  • in advancing the health of women

    還是我們用性別來分析資料。

  • if we considered whether these sex differences were present

    大家常問我:

  • at the very beginning of designing research.

    我可以做什麼?

  • Or if we analyzed our data by sex.

    我建議你:

  • So, people often ask me:

    首先,我建議你把女性健康的重要性

  • What can I do?

    看得和其它你所重視、關心的事物

  • And here's what I suggest:

    一樣重要。

  • First, I suggest that you think about women's health

    第二點,同樣重要的是

  • in the same way

    身為一名女性,

  • that you think and care about other causes that are important to you.

    你應該要問你的醫生,

  • And second, and equally as important,

    以及那些照顧你所愛的人的醫生:

  • that as a woman,

    這個疾病或治療方式 是否因女性而不同?

  • you have to ask your doctor

    這是個深奧的問題, 因為答案很可能是肯定的,