ABOUT THE SPEAKER
Kevin B. Jones - Cancer researcher
Kevin B. Jones is a life-long student of human nature, fascinated most by the decision-making capacity intrinsic to each of us.

Why you should listen

Kevin B. Jones diagnoses and performs surgeries to remove rare cancers called sarcomas from the limbs of children and adults. Counseling patients -- especially teenagers with bone cancers -- about the decisions they must make with regard to their bodies has brought the uncertainties of medicine into keen focus for him. How does a person decipher what medicine has told her? How can a person choose among options given very limited understanding of the implications of each? Intrigued by these riddles and conundrums that patient-physician communication frequently creates, Jones wrote a book, What Doctors Cannot Tell You: Clarity, Confidence and Uncertainty in Medicine.

Jones also runs a scientific research laboratory focused on the biology of sarcomas. Here, his team studies the decisions cells make on the way to becoming a cancer. Again the complexities and uncertainties inherent to these decisions are in full relief.

Jones sees patients and does surgery as an associate professor at the University of Utah in the Department of Orthopaedics, working at both Primary Children's Hospital and the Huntsman Cancer Institute. His laboratory is in the Huntsman Cancer Institute, where he is an adjunct faculty member in the Department of Oncological Sciences.

Jones studied English literature at Harvard, medicine at Johns Hopkins, orthopedic surgery at the University of Iowa, and musculoskeletal oncology at the University of Toronto. He lives in Salt Lake City with his wife and four children.

More profile about the speaker
Kevin B. Jones | Speaker | TED.com
TEDxSaltLakeCity

Kevin B. Jones: Why curiosity is the key to science and medicine

凯文・琼斯: 为什么好奇心是科学与医药的钥匙?

Filmed:
979,652 views

科学是一个包括实验,失败与改写的学习过程--关于医药的科学就更不例外。癌症研究员凯文・琼斯以一种简单的答案面对关于手术和医疗领域最深奥的未知:诚实。在这个围绕知识本质的令人深思的演讲中,琼斯展示了,当科学家们谦逊的承认他们所不明白的东西时,科学是如何做到更好的。
- Cancer researcher
Kevin B. Jones is a life-long student of human nature, fascinated most by the decision-making capacity intrinsic to each of us. Full bio

Double-click the English transcript below to play the video.

00:12
Science科学.
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科学。
00:14
The very word for many许多 of you conjures浮现
unhappy不快乐 memories回忆 of boredom无聊
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这个词对于你们中的很多人来说,
召唤了对于高中生物
00:18
in high school学校 biology生物学 or physics物理 class.
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或是物理课堂的苦闷记忆。
00:21
But let me assure保证 that what you did there
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但是我向你们保证,
你们在那时经历的
00:24
had very little to do with science科学.
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与科学是大相径庭的。
00:26
That was really the "what" of science科学.
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那只是科学“是什么”。
00:28
It was the history历史
of what other people had discovered发现.
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那是前人发现的历史记载。
我对于成为一名科学家
最感兴趣的地方
00:32
What I'm most interested有兴趣 in as a scientist科学家
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00:35
is the "how" of science科学.
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是科学的“为什么”。
00:37
Because science科学 is knowledge知识 in process处理.
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因为科学的知识是正在探寻中的。
00:41
We make an observation意见,
guess猜测 an explanation说明 for that observation意见,
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我们进行观察,
对观察提出一种设想原因,
00:44
and then make a prediction预测
that we can test测试
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做一种可以通过实验或是
00:46
with an experiment实验 or other observation意见.
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其他观察论证的假设。
00:49
A couple一对 of examples例子.
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举些例子。
00:50
First of all, people noticed注意到
that the Earth地球 was below下面, the sky天空 above以上,
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首先,人们注意到了
大地在脚下,天空在头顶,
00:54
and both the Sun太阳 and the Moon月亮
seemed似乎 to go around them.
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太阳和月亮都看似
围绕着它们在移动
他们提出的设想是
00:58
Their guessed explanation说明
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01:00
was that the Earth地球 must必须 be
the center中央 of the universe宇宙.
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地球一定是宇宙的中心。
01:04
The prediction预测: everything
should circle around the Earth地球.
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预测即为:一切都是围绕着地球运动的。
当伽里略着手于第一台望远镜,
01:08
This was first really tested测试
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01:09
when Galileo伽利略 got his hands
on one of the first telescopes望远镜,
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望向天空的时候,这件事第一次
01:12
and as he gazed凝视 into the night sky天空,
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被真正测试了,
01:15
what he found发现 there was a planet行星, Jupiter木星,
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他发现的是一颗行星,木星,
01:18
with four moons月亮 circling盘旋 around it.
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周围还有四颗卫星环绕着它。
之后,他又利用这些卫星
去跟踪木星的轨道
01:23
He then used those moons月亮
to follow跟随 the path路径 of Jupiter木星
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01:28
and found发现 that Jupiter木星
also was not going around the Earth地球
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发现木星也不是围绕地球运动的
01:31
but around the Sun太阳.
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而是围绕太阳运动的。
01:35
So the prediction预测 test测试 failed失败.
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所以说这个假说测试就失败了。
01:38
And this led to
the discarding丢弃 of the theory理论
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这就导致了地球是宇宙的中心
01:40
that the Earth地球 was the center中央
of the universe宇宙.
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这个理论被推翻。
01:42
Another另一个 example: Sir先生 Isaac艾萨克 Newton牛顿
noticed注意到 that things fall秋季 to the Earth地球.
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另一个例子:艾萨克·牛顿爵士
注意到了东西都是向地面坠落的。
01:46
The guessed explanation说明 was gravity重力,
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设想原因是引力,
01:50
the prediction预测 that everything
should fall秋季 to the Earth地球.
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预测是万物都会落向地面。
01:53
But of course课程, not everything
does fall秋季 to the Earth地球.
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但是当然,并不是
所有东西都落向地面的。
01:58
So did we discard丢弃 gravity重力?
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但是我们就抛弃引力吗?
02:00
No. We revised修订 the theory理论 and said,
gravity重力 pulls things to the Earth地球
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不。我们重新改写理论,
说引力将万物拉向地面,
02:05
unless除非 there is an equal等于
and opposite对面 force in the other direction方向.
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除非事物还受到大小相同
方向相反的力的作用。
02:10
This led us to learn学习 something new.
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这引领我们学到了新的东西。
02:12
We began开始 to pay工资 more attention注意
to the bird and the bird's鸟类 wings翅膀,
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我们开始更多的关注
鸟儿和它们的翅膀,
02:16
and just think of all the discoveries发现
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想一想从那条思路
02:18
that have flown飞行
from that line线 of thinking思维.
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引出的一系列发现。
02:21
So the test测试 failures故障,
the exceptions例外, the outliers离群
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所以那些测试的
失败,意外,异常值
02:26
teach us what we don't know
and lead us to something new.
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给我们传授了未知,
引领我们去发现新的东西。
科学就是这样不断前行。
科学就是这样不断学习。
02:32
This is how science科学 moves移动 forward前锋.
This is how science科学 learns获悉.
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有的时候在媒体当中,
甚至更罕见的,
02:35
Sometimes有时 in the media媒体,
and even more rarely很少,
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02:38
but sometimes有时 even scientists科学家们 will say
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有时甚至科学家们会说
02:40
that something or other
has been scientifically科学 proven证明.
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这个或是那个
已经被科学证明了。
02:43
But I hope希望 that you understand理解
that science科学 never proves证明 anything
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但是,我希望你们能够明白,
科学从不能证明任何东西,
02:48
definitively明确 forever永远.
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永远都不可能。
希望科学始终保持那种好奇感
02:51
Hopefully希望 science科学 remains遗迹 curious好奇 enough足够
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02:55
to look for
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让我们去探寻,
02:56
and humble谦卑 enough足够 to recognize认识
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和那种谦逊感,
02:58
when we have found发现
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当我们发现下一个异常值,
03:00
the next下一个 outlier局外人,
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下一个特例,
就像木星的卫星
那样的东西的时候,
03:02
the next下一个 exception例外,
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03:03
which哪一个, like Jupiter's木星 moons月亮,
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能够让我们去认识,
03:05
teaches us what we don't actually其实 know.
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教会我们那些我们并不了解的东西。
03:09
We're going to change更改 gears齿轮
here for a second第二.
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我们要在这里变换一小会儿主题了。
03:11
The caduceus手杖, or the symbol符号 of medicine医学,
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墨丘利的节杖,
或者说是医药的象征,
03:13
means手段 a lot of different不同 things
to different不同 people,
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对于不同的人,有着不同的意义,
03:16
but most of our
public上市 discourse演讲 on medicine医学
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但是我们的普遍公共医学论述
03:18
really turns it into
an engineering工程 problem问题.
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却将它转变为了一个工程问题。
03:21
We have the hallways走廊 of Congress国会,
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我们的国会长廊,
03:23
and the boardrooms会议室 of insurance保险 companies公司
that try to figure数字 out how to pay工资 for it.
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还有保险公司的董事会
都试图找到支付它们的途径
伦理学家和流行病学家
03:27
The ethicists伦理学家 and epidemiologists流行病学家
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03:29
try to figure数字 out
how best最好 to distribute分发 medicine医学,
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试图找到如何更好分配药物的方法,
03:32
and the hospitals医院 and physicians医师
are absolutely绝对 obsessed痴迷
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医院和医生们却完全沉迷于
03:34
with their protocols协议 and checklists清单,
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他们的协议和清单,
03:36
trying to figure数字 out
how best最好 to safely安然 apply应用 medicine医学.
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试图找到更安全应用药物的方法。
03:40
These are all good things.
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这些都是好事。
03:42
However然而, they also all assume承担
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但是,他们也都在
03:45
at some level水平
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一定程度上假定了
03:47
that the textbook教科书 of medicine医学 is closed关闭.
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医学教科书是封闭的。
我们就开始以我们能
多快速的得到医疗服务
03:51
We start开始 to measure测量
the quality质量 of our health健康 care关心
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03:53
by how quickly很快 we can access访问 it.
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来衡量我们的医疗质量。
03:56
It doesn't surprise me
that in this climate气候,
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在这种风气下,
许多机构
03:58
many许多 of our institutions机构
for the provision规定 of health健康 care关心
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为寻求医疗服务,
开始大批搜寻润滑油的行为,
04:01
start开始 to look a heck赫克 of a lot
like Jiffy瞬间 Lube润滑油.
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一点儿也不使我惊讶。
04:03
(Laughter笑声)
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(笑声)
04:06
The only problem问题 is that
when I graduated毕业 from medical school学校,
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唯一的问题是,
当我从医学院毕业的时候,
我并没有得到那个
像是你的机械师
04:10
I didn't get one of those
little doohickeysdoohickeys
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04:12
that your mechanic机械
has to plug插头 into your car汽车
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一插进你的汽车里就能知道
04:14
and find out exactly究竟 what's wrong错误 with it,
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车子哪里出问题的小窍门,
04:17
because the textbook教科书 of medicine医学
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因为医学课本
04:19
is not closed关闭.
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并非是封闭的。
04:21
Medicine医学 is science科学.
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医药是科学。
04:23
Medicine医学 is knowledge知识 in process处理.
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医药是正在进程中的知识。
我们先观察现象,
04:27
We make an observation意见,
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04:28
we guess猜测 an explanation说明
of that observation意见,
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然后猜测现象背后的解释,
04:30
and then we make a prediction预测
that we can test测试.
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之后我们作出一个
能够被测试的假设
04:33
Now, the testing测试 ground地面
of most predictions预测 in medicine医学
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当下,我们在医药领域
大多数的测试场地就是
04:37
is populations人群.
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群体。
04:38
And you may可能 remember记得
from those boring无聊 days in biology生物学 class
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然后也许你还记得
在那些无聊的生物课上
04:42
that populations人群 tend趋向 to distribute分发
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关于群体倾向于呈现
围绕平均值的
04:44
around a mean
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04:45
as a Gaussian高斯 or a normal正常 curve曲线.
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高斯或是正态分布曲线。
04:47
Therefore因此, in medicine医学,
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因此,在医药领域,
04:49
after we make a prediction预测
from a guessed explanation说明,
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在我们用一种可能的原因
作出预测之后,
04:52
we test测试 it in a population人口.
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我们就在群体中测试它。
这就意味着,我们
关于医药学习的知识,
04:55
That means手段 that what we know in medicine医学,
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04:58
our knowledge知识 and our know-how知识,
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我们的所有知识,
05:00
comes from populations人群
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都来自于群体,
而只有当达到
下一个异常值的时候,
05:02
but extends扩展 only as far
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下一个特例,
05:05
as the next下一个 outlier局外人,
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就像是木星卫星
那样的特例的时候,
05:07
the next下一个 exception例外,
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05:08
which哪一个, like Jupiter's木星 moons月亮,
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我们的知识才会扩张,
它们教会了我们并不了解的东西。
05:10
will teach us what we don't actually其实 know.
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05:14
Now, I am a surgeon外科医生
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现在,我是一名外科医生,
05:15
who looks容貌 after patients耐心 with sarcoma肉瘤.
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正在寻找肉瘤病人。
05:17
Sarcoma肉瘤 is a very rare罕见 form形成 of cancer癌症.
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肉瘤是一种极其罕见的癌症。
05:20
It's the cancer癌症 of flesh and bones骨头.
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是骨与肌肉的癌变。
05:23
And I would tell you that every一切 one
of my patients耐心 is an outlier局外人,
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然后我会告诉你,
我的每一位病人都是异常值,
05:27
is an exception例外.
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都是特例。
我为这些肉瘤患者做的手术,
没有任何一个是对照着,
05:30
There is no surgery手术 I have ever performed执行
for a sarcoma肉瘤 patient患者
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05:33
that has ever been guided引导
by a randomized随机 controlled受控 clinical临床 trial审讯,
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临床实验案例,就是那些
我们认识中最适合医药的
05:37
what we consider考虑 the best最好 kind
of population-based以人群为基础 evidence证据 in medicine医学.
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以群体为基础的实验证据,
没有任何一个是被其指导着完成的。
人们总说要跳出定式思维,
05:42
People talk about thinking思维
outside the box,
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05:44
but we don't even have a box in sarcoma肉瘤.
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但是在肉瘤病症上,我们没有定式。
05:47
What we do have as we take
a bath in the uncertainty不确定
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当我们沐浴在
关于肉瘤的,环绕我们的,
05:50
and unknowns未知数 and exceptions例外
and outliers离群 that surround环绕 us in sarcoma肉瘤
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那些未知,不确定,
特例,异常值中的时候,
05:55
is easy简单 access访问 to what I think
are those two most important重要 values
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我们所拥有的,是我眼中
对于任何一种科学,
最重要的两种价值观:
05:59
for any science科学:
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06:01
humility谦逊 and curiosity好奇心.
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谦逊和好奇心。
06:04
Because if I am humble谦卑 and curious好奇,
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因为如果我是谦逊的,好奇心强的,
06:06
when a patient患者 asks me a question,
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当病人询问我问题的时候,
06:08
and I don't know the answer回答,
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如果我不知道问题的答案,
我就会去询问有着相似的,
06:10
I'll ask a colleague同事
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06:12
who may可能 have a similar类似
albeit尽管 distinct不同 patient患者 with sarcoma肉瘤.
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尽管是不同的肉瘤病人的同事。
06:15
We'll even establish建立
international国际 collaborations合作.
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我们甚至会建立国际间的合作。
06:17
Those patients耐心 will start开始
to talk to each other through通过 chat rooms客房
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那些病人也会开始
在聊天室和支持团体中
06:21
and support支持 groups.
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互相交流。
06:22
It's through通过 this kind
of humbly虚心 curious好奇 communication通讯
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是通过这种谦逊的,
好奇的交流过程,
06:26
that we begin开始 to try and learn学习 new things.
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我们开始去尝试并学习新的知识。
06:31
As an example, this is a patient患者 of mine
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作为例子,这是我的一位病人
06:33
who had a cancer癌症 near his knee膝盖.
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他在膝盖附近长了一个肿瘤。
06:35
Because of humbly虚心 curious好奇 communication通讯
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正因为那种在国际合作中谦逊的
06:37
in international国际 collaborations合作,
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好奇心驱使的沟通,
06:40
we have learned学到了 that we can repurpose重新规划
the ankle to serve服务 as the knee膝盖
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我们学习到了如果必须
在移除肿瘤的同时移除膝盖,
那么我们可以用踝关节
代替膝关节的位置。
06:44
when we have to remove去掉 the knee膝盖
with the cancer癌症.
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06:46
He can then wear穿 a prosthetic假肢
and run and jump and play.
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这样他就可以带着假肢
跑,跳,玩耍了。
06:50
This opportunity机会 was available可得到 to him
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是国际间合作
06:53
because of international国际 collaborations合作.
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给了他这样的机会。
06:56
It was desirable合意 to him
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这也是他所希望的,
06:57
because he had contacted联系 other patients耐心
who had experienced有经验的 it.
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因为他与经历过这些的
其他病人联系过了。
07:01
And so exceptions例外 and outliers离群 in medicine医学
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所以在医药领域的特例与异常值
07:06
teach us what we don't know,
but also lead us to new thinking思维.
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教会了我们那些不了解的东西,
同时也引发了我们作出新的思考。
07:11
Now, very importantly重要的,
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现在,非常重要的是,
07:12
all the new thinking思维 that outliers离群
and exceptions例外 lead us to in medicine医学
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所有这些在医药领域
关于异常值和特例的新的思考
07:16
does not only apply应用
to the outliers离群 and exceptions例外.
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并非只能运用于那些特例的情况中。
07:20
It is not that we only learn学习
from sarcoma肉瘤 patients耐心
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我们从肉瘤病人身上学习到的,
07:24
ways方法 to manage管理 sarcoma肉瘤 patients耐心.
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并非仅仅是治疗肉瘤病人的方法。
07:26
Sometimes有时, the outliers离群
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有的时候,这些异常情况,
07:29
and the exceptions例外
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这些特例,
07:30
teach us things that matter quite相当 a lot
to the general一般 population人口.
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也教会了我们一些,对大众
同样十分重要的事情。
就像是身处树林之外的一棵树,
07:35
Like a tree standing常设 outside a forest森林,
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07:37
the outliers离群 and the exceptions例外
draw our attention注意
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这些外围的,特例般的存在,
吸引了我们的注意力,
07:41
and lead us into a much greater更大 sense
of perhaps也许 what a tree is.
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并能够引领我们得到一个,像是
“树是什么”,这种更为宏观的认识。
07:45
We often经常 talk about
losing失去 the forests森林 for the trees树木,
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我们经常说,树木们失去了森林,
07:48
but one also loses失去 a tree
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但是,我们也会
07:50
within a forest森林.
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失去森林里的树木。
那些独自站立的树,
07:53
But the tree that stands站立 out by itself本身
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07:54
makes品牌 those relationships关系
that define确定 a tree,
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它们同样,甚至以一种更加明确的方式
07:57
the relationships关系 between之间 trunk树干
and roots and branches分支机构,
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定义了树木的概念,
树干,树根与树枝间的联系。
08:01
much more apparent明显的.
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08:03
Even if that tree is crooked
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即使那颗树是弯曲的,
08:05
or even if that tree
has very unusual异常 relationships关系
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或者甚至它的树干,树根与树枝
08:08
between之间 trunk树干 and roots and branches分支机构,
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之间的联系是非同寻常的,
08:10
it nonetheless尽管如此, draws our attention注意
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它吸引了我们的注意力,
08:13
and allows允许 us to make observations意见
168
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让我们作出了观察,
08:15
that we can then test测试
in the general一般 population人口.
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然后能够在普试群体中进行测试。
08:18
I told you that sarcomas肉瘤 are rare罕见.
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我告诉过你们了,肉瘤是罕见的。
08:20
They make up about one percent百分
of all cancers癌症.
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它们只在所有癌症中占有1%
08:23
You also probably大概 know that cancer癌症
is considered考虑 a genetic遗传 disease疾病.
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你也许还知道癌症是一种基因疾病。
08:27
By genetic遗传 disease疾病 we mean
that cancer癌症 is caused造成 by oncogenes癌基因
173
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基因疾病是指癌症是由于
08:31
that are turned转身 on in cancer癌症
174
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原癌基因的触发和
08:32
and tumor suppressor抑制器 genes基因
that are turned转身 off to cause原因 cancer癌症.
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抑癌基因的失效所诱发的。
你也许会认为我们
是从那先常见癌症,
08:36
You might威力 think
that we learned学到了 about oncogenes癌基因
176
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08:38
and tumor suppressor抑制器 genes基因
from common共同 cancers癌症
177
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像是乳腺癌,前列腺癌,
肺癌中,
08:40
like breast乳房 cancer癌症 and prostate前列腺 cancer癌症
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1976
发现原癌基因与抑癌基因的,
08:42
and lung cancer癌症,
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08:44
but you'd be wrong错误.
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1199
但是,那样想你就错了。
08:46
We learned学到了 about oncogenes癌基因
and tumor suppressor抑制器 genes基因
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我们是从那些
极少数的,1%的肉瘤中
08:48
for the first time
182
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第一次的,
08:50
in that itty-bitty一丁点儿 little one percent百分
of cancers癌症 called sarcoma肉瘤.
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学习到了原癌基因和抑癌基因的。
1966年,佩顿·劳斯获得了诺贝尔奖
08:54
In 1966, Peyton佩顿 Rous劳斯 got the Nobel诺贝尔 Prize
184
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08:57
for realizing实现 that chickens
185
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2016
他发现了鸡群中一种
08:59
had a transmissible传播 form形成 of sarcoma肉瘤.
186
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传染性的肉瘤。
三十年之后,哈罗德·瓦尔姆斯
与麦克·毕晓普发现了
09:03
Thirty三十 years年份 later后来, Harold哈罗德 Varmus瓦尔穆斯
and Mike麦克风 Bishop主教 discovered发现
187
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09:06
what that transmissible传播 element元件 was.
188
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那种传染性的因子究竟是什么。
09:08
It was a virus病毒
189
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那是一种病毒
09:10
carrying携带 a gene基因,
190
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它携带一种基因,
09:11
the srcSRC oncogene癌基因.
191
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1440
那就是肉瘤原癌基因。
09:13
Now, I will not tell you
that srcSRC is the most important重要 oncogene癌基因.
192
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3656
现在,我不会说肉瘤原癌基因
是最重要的原癌基因。
09:17
I will not tell you
193
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1216
我也不会告诉你
09:18
that srcSRC is the most frequently经常
turned转身 on oncogene癌基因 in all of cancer癌症.
194
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3496
肉瘤原癌基因是最常见的原癌基因。
09:22
But it was the first oncogene癌基因.
195
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但是,它是第一个
被发现的原癌基因。
09:25
The exception例外, the outlier局外人
196
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2336
那个特例,那个异常值,
09:28
drew德鲁 our attention注意 and led us to something
197
556320
2520
它吸引了我们的注意力,
并引领了我们,
09:31
that taught us very important重要 things
about the rest休息 of biology生物学.
198
559520
4040
教会了我们关于整个
生物领域重要的东西。
09:36
Now, TPTP53 is the most important重要
tumor suppressor抑制器 gene基因.
199
564880
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当下,肿瘤抑制蛋白p53
是最重要的抑癌因子。
09:41
It is the most frequently经常 turned转身 off
tumor suppressor抑制器 gene基因
200
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它是最常见的失效
而引发各种肿瘤的
09:43
in almost几乎 every一切 kind of cancer癌症.
201
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1800
抑癌基因。
09:46
But we didn't learn学习 about it
from common共同 cancers癌症.
202
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2296
但是我们并不是从
一般的癌症当中发现它的。
09:48
We learned学到了 about it
when doctors医生 Li and Fraumeni佛美尼
203
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2416
是当李医生和弗劳梅尼医生
09:51
were looking at families家庭,
204
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1576
在关注家庭史过程中,
09:52
and they realized实现 that these families家庭
205
580720
2016
发现有些家庭患肉瘤病人
概率远高于其他家庭时
09:54
had way too many许多 sarcomas肉瘤.
206
582760
2520
我们才发现的p53。
我告诉过你们了,肉瘤很罕见。
09:57
I told you that sarcoma肉瘤 is rare罕见.
207
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1776
09:59
Remember记得 that a one
in a million百万 diagnosis诊断,
208
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3176
记住,百万分之一的诊断率,
10:02
if it happens发生 twice两次 in one family家庭,
209
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2136
如果在同一个家庭中出现两例,
10:05
is way too common共同 in that family家庭.
210
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2400
那就已经远高于其他家庭了。
就是因为它们十分罕见的特性,
10:08
The very fact事实 that these are rare罕见
211
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2696
10:11
draws our attention注意
212
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1440
吸引了我们的注意力,
10:13
and leads引线 us to new kinds of thinking思维.
213
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2240
并引发了我们作出新的思考。
你们中的很多人可能会说,
10:17
Now, many许多 of you may可能 say,
214
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1456
10:18
and may可能 rightly正当地 say,
215
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1536
或者现在正在说,
10:20
that yeah, Kevin凯文, that's great,
216
608520
1896
嗯,凯文,这听起来不错,
10:22
but you're not talking
about a bird's鸟类 wing翅膀.
217
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2056
但是你所说的并非是鸟的翅膀,
10:24
You're not talking about moons月亮
floating漂浮的 around some planet行星 Jupiter木星.
218
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3480
或者是卫星围绕着木星漂行。
10:28
This is a person.
219
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1536
这是一个人。
10:30
This outlier局外人, this exception例外,
may可能 lead to the advancement进步 of science科学,
220
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3256
这种特例,这种异常值,
也许会引领我们科学的进步,
10:33
but this is a person.
221
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1200
但是,这是一个人。
而我能说的只是,
10:36
And all I can say
222
624280
1616
10:37
is that I know that all too well.
223
625920
2360
我太了解了。
我与这些患有罕见的,
致命的疾病的患者交流过。
10:41
I have conversations对话 with these patients耐心
with rare罕见 and deadly致命 diseases疾病.
224
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3400
我记录下了我们的对话。
10:45
I write about these conversations对话.
225
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1936
10:47
These conversations对话 are terribly可怕 fraught误人子弟.
226
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2296
这些谈话都是极度令人担忧的。
10:50
They're fraught误人子弟 with horrible可怕 phrases短语
227
638080
1816
它们充满了那些可怕的短语
10:51
like "I have bad news新闻"
or "There's nothing more we can do."
228
639920
3240
像是“我有一个坏消息”
或是“我们已经尽力了”
10:55
Sometimes有时 these conversations对话
turn on a single word:
229
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3200
有的时候,这些对话就带来了一个词:
10:59
"terminal终奌站."
230
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1200
“晚期。”
11:04
Silence安静 can also be rather uncomfortable不舒服.
231
652920
2920
沉默也是同等的令人难受的。
医药中的空白和我们在这些
11:09
Where the blanks空白 are in medicine医学
232
657360
2576
11:11
can be just as important重要
233
659960
1856
对话中用语的间隙,
11:13
as the words that we use
in these conversations对话.
234
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2240
是同等重要的。
11:17
What are the unknowns未知数?
235
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1536
什么是未知的?
11:18
What are the experiments实验
that are being存在 doneDONE?
236
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2200
有哪些实验是正在做的?
和我一起做一个小练习。
11:21
Do this little exercise行使 with me.
237
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1696
11:23
Up there on the screen屏幕,
you see this phrase短语, "no where."
238
671400
3216
在屏幕上,你可以看到
这个短语,“没有地方“
11:26
Notice注意 where the blank空白 is.
239
674640
1280
注意一下间歇的地方。
11:28
If we move移动 that blank空白 one space空间 over
240
676680
3200
如果我们移动一格那个空隙,
11:32
"no where"
241
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1576
“没有地方”
11:34
becomes "now here,"
242
682240
2696
就变成了“现在在这”
11:36
the exact精确 opposite对面 meaning含义,
243
684960
1896
正好是相反的意思,
11:38
just by shifting the blank空白 one space空间 over.
244
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2200
仅仅是移动一个空格。
我永远不会忘记走进
11:43
I'll never forget忘记 the night
245
691680
1576
11:45
that I walked into
one of my patients'耐心' rooms客房.
246
693280
2240
我的一位病人房间的那个夜晚。
11:48
I had been operating操作 long that day
247
696280
1656
虽然一整天都在做手术,
11:49
but I still wanted to come and see him.
248
697960
2016
我还是想要过去看看他。
11:52
He was a boy男孩 I had diagnosed确诊
with a bone cancer癌症 a few少数 days before.
249
700000
3200
他是个孩子,在几天前被诊断出了骨癌。
11:55
He and his mother母亲 had been meeting会议
with the chemotherapy化疗 doctors医生
250
703840
3056
他和他的妈妈在那天早些时候
见了负责他的化疗医生,
11:58
earlier that day,
251
706920
1216
12:00
and he had been admitted承认
to the hospital醫院 to begin开始 chemotherapy化疗.
252
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2976
他被允许进入医院开始化疗。
12:03
It was almost几乎 midnight午夜
when I got to his room房间.
253
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2176
当我进入他的房间的时候,
已经是将近午夜了。
12:05
He was asleep睡着, but I found发现 his mother母亲
254
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2176
他睡着了,但是我发现他的妈妈
12:07
reading by flashlight手电筒
255
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1576
还在他的床边,
12:09
next下一个 to his bed.
256
717160
1456
在灯光下阅读着。
12:10
She came来了 out in the hall大厅
to chat with me for a few少数 minutes分钟.
257
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2800
她出来和我在走廊里聊了几分钟。
12:14
It turned转身 out that
what she had been reading
258
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2096
结果得知她在阅读的是当天
12:16
was the protocol协议
that the chemotherapy化疗 doctors医生
259
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2176
化疗医生给她的一份
12:18
had given特定 her that day.
260
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1240
协议书。
12:20
She had memorized记忆 it.
261
728200
1240
她记住了里面的内容。
她说,“琼斯医生,你告诉我们,
12:23
She said, "Dr博士. Jones琼斯, you told me
262
731200
3536
12:26
that we don't always win赢得
263
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2176
我们并不是总能战胜
12:28
with this type类型 of cancer癌症,
264
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1280
这种癌症,
12:31
but I've been studying研究 this protocol协议,
and I think I can do it.
265
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3480
但是我很仔细的研究了
这份协议,我认为我们能做到的。
12:35
I think I can comply执行
with these very difficult treatments治疗.
266
743960
3576
我认为我们可以应对
这些非常困难的治疗
12:39
I'm going to quit放弃 my job工作.
I'm going to move移动 in with my parents父母.
267
747560
2976
我要辞掉我的工作。
我会搬去和我的父母一起住。
12:42
I'm going to keep my baby宝宝 safe安全."
268
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1960
我要保护我的孩子。”
我没有告诉她。
12:47
I didn't tell her.
269
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1200
我没有纠正她的想法。
12:49
I didn't stop to correct正确 her thinking思维.
270
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2920
她正在相信一份协议书,
12:53
She was trusting信任的 in a protocol协议
271
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2256
12:55
that even if complied编译过 with,
272
763960
3216
即使遵守了,
12:59
wouldn't不会 necessarily一定 save保存 her son儿子.
273
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2400
也不一定能挽救她的儿子。
我没有告诉她。
13:03
I didn't tell her.
274
771960
1200
我没有填补那个空隙。
13:06
I didn't fill in that blank空白.
275
774360
1400
13:09
But a year and a half later后来
276
777080
1976
但是一年半之后,
13:11
her boy男孩 nonetheless尽管如此, died死亡 of his cancer癌症.
277
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2720
她的儿子还是死于了癌症。
我应该告诉她吗?
13:15
Should I have told her?
278
783400
1320
13:17
Now, many许多 of you may可能 say, "So what?
279
785360
2256
现在,你们中的很多人
可能会说,“那又怎样?”
13:19
I don't have sarcoma肉瘤.
280
787640
1256
我有没有得肉瘤。
13:20
No one in my family家庭 has sarcoma肉瘤.
281
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1896
我们家也没有人得肉瘤。
13:22
And this is all fine and well,
282
790840
1456
好吧,这也许是事实,
13:24
but it probably大概 doesn't
matter in my life."
283
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2696
但它可能根本不会
出现在我的人生中。”
13:27
And you're probably大概 right.
284
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1256
你说的没错。
13:28
Sarcoma肉瘤 may可能 not matter
a whole整个 lot in your life.
285
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2680
肉瘤也许与你的人生毫无关系。
但是那些存在于医药中的空白,
13:33
But where the blanks空白 are in medicine医学
286
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2336
13:35
does matter in your life.
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是影响你的人生的。
我没有告诉你们一个肮脏的小秘密。
13:38
I didn't tell you one dirty little secret秘密.
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13:40
I told you that in medicine医学,
we test测试 predictions预测 in populations人群,
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我告诉了你们,在医药领域,
我们在人群中进行测试,
13:45
but I didn't tell you,
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但是我没有告诉你们的是,
13:46
and so often经常 medicine医学 never tells告诉 you
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在很多情况中,药物不会告诉你
13:48
that every一切 time an individual个人
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每当一个个体
13:51
encounters遭遇 medicine医学,
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遇见药物,
13:53
even if that individual个人 is firmly牢牢
embedded嵌入式 in the general一般 population人口,
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即便是那个个体深信自己
隐藏于普试人群当中,
个体或是医生都不会知道,
13:59
neither也不 the individual个人
nor也不 the physician医师 knows知道
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14:01
where in that population人口
the individual个人 will land土地.
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实验最后降临在谁的头上。
因此,每次服用药物,
14:05
Therefore因此, every一切 encounter遭遇 with medicine医学
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14:07
is an experiment实验.
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都是一次实验。
14:09
You will be a subject学科
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你就是那个实验中的
14:11
in an experiment实验.
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被实验者。
而实验结果既可能是好的,
也可能是不好的。
14:14
And the outcome结果 will be either
a better or a worse更差 result结果 for you.
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只要药物起作用,
14:20
As long as medicine医学 works作品 well,
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14:22
we're fine with fast快速 service服务,
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我们就能满足于这种快速的服务,
14:25
bravado虚张声势, brimminglybrimmingly
confident信心 conversations对话.
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自满的,充满自信的谈话。
但是当事情进展不顺利,
14:29
But when things don't work well,
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14:31
sometimes有时 we want something different不同.
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有时我们就希望得到不同。
14:34
A colleague同事 of mine
removed去除 a tumor from a patient's耐心 limb.
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我的一个同事从一位病人的
身上摘下了一个肿瘤。
他很担心这个肿瘤。
14:38
He was concerned关心 about this tumor.
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14:40
In our physician医师 conferences会议,
he talked about his concern关心
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在我们的研讨会上,
他谈论了自己的担忧,
14:43
that this was a type类型 of tumor
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这是一种,有着极高的
14:45
that had a high risk风险
for coming未来 back in the same相同 limb.
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原位复发率的肿瘤。
但是他与病患的交流
14:48
But his conversations对话 with the patient患者
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14:50
were exactly究竟 what a patient患者 might威力 want:
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却完全是病患想听到的那种:
14:52
brimming充满 with confidence置信度.
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充满自信。
14:54
He said, "I got it all
and you're good to go."
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他说:“我已经把它搞定了,
你已经可以出院了。”
14:57
She and her husband丈夫 were thrilled高兴.
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她和她的丈夫为此十分兴奋。
14:58
They went out, celebrated著名, fancy幻想 dinner晚餐,
opened打开 a bottle瓶子 of champagne香槟酒.
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他们离开了,庆祝了,
美妙的晚餐,还开了一瓶香槟。
15:04
The only problem问题 was a few少数 weeks later后来,
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唯一的问题就在于几周之后,
15:06
she started开始 to notice注意
another另一个 nodule结核 in the same相同 area.
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她开始注意
到在同一片区域的另一个结节。
结果表明他没搞定肿瘤,
她也还不能出院。
15:09
It turned转身 out he hadn't有没有 gotten得到 it all,
and she wasn't good to go.
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4136
15:13
But what happened发生 at this juncture契机
absolutely绝对 fascinates着迷 me.
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但这个时候发生的事,
我却觉得十分有趣。
我的同事找到我,并说,
15:17
My colleague同事 came来了 to me and said,
322
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15:18
"Kevin凯文, would you mind心神
looking after this patient患者 for me?"
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“凯文,你愿意帮我照顾这个病人吗?”
15:22
I said, "Why, you know the right thing
to do as well as I do.
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我说:“为什么,你和我一样,
知道该怎么做啊。
15:25
You haven't没有 doneDONE anything wrong错误."
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你没做错任何事情。”
15:27
He said, "Please, just look
after this patient患者 for me."
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他说,“求你了,就帮我
照看一下这个病人吧。”
他感到脸红--
15:33
He was embarrassed尴尬 --
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15:34
not by what he had doneDONE,
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不是为他所做的,
而是为他所说的,
15:37
but by the conversation会话 that he had had,
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为他的过度自信。
15:39
by the overconfidence过度自信.
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所以我又做了一个
更加侵入性的手术
15:42
So I performed执行
a much more invasive侵入的 surgery手术
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15:45
and had a very different不同 conversation会话
with the patient患者 afterwards之后.
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在之后与病患做了
一个截然不同的对话。
15:48
I said, "Most likely容易 I've gotten得到 it all
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我说,“最可能的情况是,
我已经完全切除了,
15:50
and you're most likely容易 good to go,
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你应该可以走了,
15:53
but this is the experiment实验
that we're doing.
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但是这是我们的一个实验。
这是你需要继续观察的。
15:57
This is what you're going to watch for.
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15:59
This is what I'm going to watch for.
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这也是我需要继续观察的。
16:01
And we're going to work together一起
to find out if this surgery手术 will work
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然后我们会一起努力,
来探寻手术是否
16:04
to get rid摆脱 of your cancer癌症."
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成功解决了你的癌症。“
16:06
I can guarantee保证 you, she and her husband丈夫
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我可以向你们保证,
在这次谈话后,
16:08
did not crack裂纹 another另一个 bottle瓶子 of champagne香槟酒
after talking to me.
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2920
她和她的丈夫没有
再开一瓶香槟庆祝
16:13
But she was now a scientist科学家,
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但是,她却变为了一名科学家,
16:16
not only a subject学科 in her experiment实验.
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而不仅仅是实验中的实验对象。
所以,我鼓励你们去
16:21
And so I encourage鼓励 you
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16:23
to seek寻求 humility谦逊 and curiosity好奇心
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在你们的医生那儿,
寻找谦逊精神和好奇心。
16:27
in your physicians医师.
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16:28
Almost几乎 20 billion十亿 times each year,
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每年大概有200亿次,
16:31
a person walks散步 into a doctor's医生 office办公室,
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当一个人走进医生的办公室,
16:35
and that person becomes a patient患者.
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然后出来时就变成了一名患者。
16:39
You or someone有人 you love
will be that patient患者 sometime某时 very soon不久.
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你和你所爱的人很快
也会变成那个患者。
16:43
How will you talk to your doctors医生?
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你会如何和你的医生们说?
16:46
What will you tell them?
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1200
你会告诉他们什么?
他们会告诉你什么?
16:48
What will they tell you?
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16:52
They cannot不能 tell you
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他们不能告诉你
16:54
what they do not know,
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他们也不确定的事,
16:57
but they can tell you when they don't know
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但是他们也可以告诉你
他们不知道,
只有当你问的时候。
17:02
if only you'll你会 ask.
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17:04
So please, join加入 the conversation会话.
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所以,请你们加入谈话当中吧。
谢谢。
17:08
Thank you.
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17:09
(Applause掌声)
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(掌声)
Translated by Junyi Sha
Reviewed by Lipeng Chen

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ABOUT THE SPEAKER
Kevin B. Jones - Cancer researcher
Kevin B. Jones is a life-long student of human nature, fascinated most by the decision-making capacity intrinsic to each of us.

Why you should listen

Kevin B. Jones diagnoses and performs surgeries to remove rare cancers called sarcomas from the limbs of children and adults. Counseling patients -- especially teenagers with bone cancers -- about the decisions they must make with regard to their bodies has brought the uncertainties of medicine into keen focus for him. How does a person decipher what medicine has told her? How can a person choose among options given very limited understanding of the implications of each? Intrigued by these riddles and conundrums that patient-physician communication frequently creates, Jones wrote a book, What Doctors Cannot Tell You: Clarity, Confidence and Uncertainty in Medicine.

Jones also runs a scientific research laboratory focused on the biology of sarcomas. Here, his team studies the decisions cells make on the way to becoming a cancer. Again the complexities and uncertainties inherent to these decisions are in full relief.

Jones sees patients and does surgery as an associate professor at the University of Utah in the Department of Orthopaedics, working at both Primary Children's Hospital and the Huntsman Cancer Institute. His laboratory is in the Huntsman Cancer Institute, where he is an adjunct faculty member in the Department of Oncological Sciences.

Jones studied English literature at Harvard, medicine at Johns Hopkins, orthopedic surgery at the University of Iowa, and musculoskeletal oncology at the University of Toronto. He lives in Salt Lake City with his wife and four children.

More profile about the speaker
Kevin B. Jones | Speaker | TED.com