TEDMED 2014
Barbara Natterson-Horowitz: What veterinarians know that physicians don't
芭芭拉．奈特森-赫洛維茨: 獸醫知道些什麼醫師不知道的東西
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你會把只能夠照顧某一物種的獸醫叫做甚麼？一位醫師。在這個引人入勝的演講中，芭芭拉．奈特森-赫洛維茨跟我們分享運用跨越物種的方式處理健康問題，能如何改善人類的醫療—尤其是涉及到心理健康。
Barbara Natterson-Horowitz - Cardiologist
Barbara Natterson-Horowitz, Professor of Medicine in the Division of Cardiology at UCLA Medical School, provides a unique perspective on how human well-being, including mental health, can be improved by insights into animal health. Full bio
Barbara Natterson-Horowitz, Professor of Medicine in the Division of Cardiology at UCLA Medical School, provides a unique perspective on how human well-being, including mental health, can be improved by insights into animal health. Full bio
Double-click the English transcript below to play the video.
00:13
Ten years ago,
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十年前，
00:15
I got a phone call that
changed my life.
changed my life.
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我接到了一通電話，改變了一生，
00:18
At the time, I was
cardiologist at UCLA,
cardiologist at UCLA,
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那時我是加州大學
洛杉磯分校的心臟病學家，
洛杉磯分校的心臟病學家，
00:22
specializing in cardiac
imaging techniques.
imaging techniques.
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專門從事於心臟影像技術，
00:26
The call came from a veterinarian
at the Los Angeles Zoo.
at the Los Angeles Zoo.
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這通電話由洛杉磯動物園
的一位獸醫師打過來，
的一位獸醫師打過來，
00:31
An elderly female chimpanzee
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有一隻年老的母猩猩
00:34
had woken up with a facial droop
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睡醒時面部下垂，
00:37
and the veterinarians were worried
that she'd had a stroke.
that she'd had a stroke.
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獸醫師擔心牠中風。
00:40
They asked if I'd
come to the zoo
come to the zoo
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他們問我可否去一趟動物園，
00:43
and image the animal's heart
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給母猩猩的心臟拍一張照片，
00:45
to look for a possible
cardiac cause.
cardiac cause.
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看看心臟有沒有問題。
00:49
Now, to be clear, North American
zoos are staffed
zoos are staffed
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先說明一下，
北美洲的動物園都會雇用
高水準兼持有執照的獸醫師，
高水準兼持有執照的獸醫師，
00:52
by highly qualified,
board-certified veterinarians
board-certified veterinarians
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00:57
who take outstanding
care of their animal patients.
care of their animal patients.
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為生病的動物提供良好照顧，
01:01
But occasionally, they do reach into
the human medical community,
the human medical community,
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但是他們偶爾也會向
照顧人類的醫師尋求協助，
照顧人類的醫師尋求協助，
01:05
particularly for some
speciality consultation,
speciality consultation,
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特別是一些專業的諮詢，
01:10
and I was one of the lucky physicians
who was invited in to help.
who was invited in to help.
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而我是有幸受邀前去
幫助他們的其中一位醫師，
幫助他們的其中一位醫師，
01:16
I had a chance to rule out
a stroke in this chimpanzee
a stroke in this chimpanzee
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因此我有機會為這隻猩猩
排除中風的疑慮，
排除中風的疑慮，
01:22
and make sure that this gorilla
didn't have a torn aorta,
didn't have a torn aorta,
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確保這隻大猩猩的主動脈未曾破裂，
01:28
evaluate this macaw
for a heart murmur,
for a heart murmur,
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替這隻金剛鸚鵡測量心跳聲，
01:33
make sure that this California sea lion's
paricardium wasn't inflamed,
paricardium wasn't inflamed,
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確保這隻加州海獅沒有患上心包炎，
01:41
and in this picture, I'm listening
to the heart of a lion
to the heart of a lion
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在這張照片裡，
我正在給一隻獅子聽診，
我正在給一隻獅子聽診，
01:45
after a lifesaving,
collaborative procedure
collaborative procedure
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這是在獸醫師和內科醫師合作
01:48
with veterinarians and physicians
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進行了一次救生之後，
01:51
where we drained 700 cc's of
fluid from the sac
fluid from the sac
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我們從這隻獅子心臟的心包
01:56
in which this lion's
heart was contained.
heart was contained.
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排掉700毫升的液體，
02:00
And this procedure, which I have
done on many human patients,
done on many human patients,
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這個步驟跟我曾在很多病人身上
實施過的完全相同，
實施過的完全相同，
02:05
was identical, with the exception
of that paw and that tail.
of that paw and that tail.
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除了那隻爪子和尾巴。
02:14
Now most of the time, I was working
at UCLA Medical Center with physicians,
at UCLA Medical Center with physicians,
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現在我經常會跟加州大學洛杉磯分校
醫學中心的內科醫師共事，
醫學中心的內科醫師共事，
02:21
discussing symptoms
and diagnoses and treatments
and diagnoses and treatments
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討論我們病「人」的
症狀、診斷和療法，
02:26
for my human patients,
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02:29
but some of the time,
I was working at the Los Angeles Zoo
I was working at the Los Angeles Zoo
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但是有時候我會到洛杉磯動物園工作，
02:32
with veterinarians, discussing
symptoms and diagnoses and treatments
symptoms and diagnoses and treatments
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為了他們的動物患者，
和那裡的獸醫師一起
和那裡的獸醫師一起
02:38
for their animal patients.
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討論症狀、診斷和療法，
02:40
And occasionally, on
the very same day,
the very same day,
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偶爾在同一天，
02:45
I went on rounds at
UCLA Medical Center
UCLA Medical Center
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我會在加州大學洛杉磯分校的醫學中心
02:49
and at the Los Angeles Zoo.
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和洛杉磯動物園之間來回跑，
02:52
And here's what started coming
into very clear focus for me.
into very clear focus for me.
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而在這裡開始變得非常明確清晰，
02:58
Physicians and veterinarians
were essentially taking care
were essentially taking care
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就是醫師和獸醫師
根本在處理同樣的疾病，
根本在處理同樣的疾病，
03:03
of the same disorders in their
animal and human patients:
animal and human patients:
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不管在人類還是動物身上：
03:08
congestive heart failure, brain tumors,
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充血性心臟衰竭、腦部腫瘤、
03:12
leukemia, diabetes,
arthritis, ALS, breast cancer,
arthritis, ALS, breast cancer,
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白血病、糖尿病、關節炎、
漸凍症、乳癌，
漸凍症、乳癌，
03:21
even psychiatric syndromes
like depression, anxiety,
like depression, anxiety,
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甚至精神病症狀如憂鬱症、焦慮症、
03:26
compulsions, eating disorders
and self-injury.
and self-injury.
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強迫症、飲食障礙症或自我傷害。
03:32
Now, I've got a confession to make.
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現在我必須承認，
03:35
Even though I studied comparative
physiology and evolutionary biology
physiology and evolutionary biology
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雖然我在大學主修
對比生理學和演化生物學—
對比生理學和演化生物學—
03:42
as an undergrad --
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03:44
I had even written my senior
thesis on Darwinian theory --
thesis on Darwinian theory --
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甚至畢業論文寫的是
關於達爾文理論—
關於達爾文理論—
03:49
learning about the
significant overlap
significant overlap
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當理解到動物和人類疾病之間
03:51
between the disorders of
animals and humans,
animals and humans,
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存在著明顯的重疊部份時，
03:54
it came as a much needed
wake-up call for me.
wake-up call for me.
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我突然靈光乍現，
04:00
So I started wondering,
with all of these overlaps,
with all of these overlaps,
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於是我開始想，既然有這麼多的重疊，
04:04
how was it that I had never
thought to ask a veterinarian,
thought to ask a veterinarian,
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為甚麼從來沒想過請求獸醫師的意見，
或者查找獸醫方面的文獻，
04:10
or consult the veterinary literature,
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04:12
for insights into one
of my human patients?
of my human patients?
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以更好地瞭解我的病人呢？
04:17
Why had I never, nor had any of my
physician friends and colleagues
physician friends and colleagues
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為甚麼我或是我詢問過的
醫師朋友和同事
醫師朋友和同事
04:23
whom I asked, ever attended
a veterinary conference?
a veterinary conference?
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都沒參加獸醫學的會議呢？
04:30
For that matter, why was
any of this a surprise?
any of this a surprise?
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既然人類和動物的疾病是重疊的，
那麼又有甚麼奇怪的呢？
那麼又有甚麼奇怪的呢？
04:36
I mean, look, every single physician
accepts some biological connection
accepts some biological connection
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我的意思是每位醫師都知道
動物和人類之間有著生物學上的聯繫。
04:42
between animals and humans.
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04:45
Every medication that we prescribe
or that we've taken ourselves
or that we've taken ourselves
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我們所處方的每份藥物，
或者我們自己的用藥，
或者我們自己的用藥，
04:50
or we've given to our families
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或者給我們家人的用藥，
04:52
has first been tested on an animal.
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都曾經先在動物身上進行試驗。
04:56
But there's something very different
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但是情況也有很大的不同，
04:58
about giving an animal a
medication or a human disease
medication or a human disease
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給動物用一種藥或是患上人類疾病時，
05:04
and the animal developing
congestive heart failure
congestive heart failure
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及動物得了充血性心臟衰竭、
05:08
or diabetes or breast cancer
on their own.
on their own.
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或糖尿病、乳癌。
05:15
Now, maybe some of the surprise
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但現在讓我們感到驚訝的是，
05:17
comes from the increasing
separation in our world
separation in our world
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也許在我們這個世界裡
05:21
between the urban and the nonurban.
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城市與鄉郊之間日漸擴大的隔閡，
05:25
You know, we hear about these city kids
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我們聽說過那些城市裡的孩子，
05:28
who think that wool grows on trees
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他們認為羊毛是在樹上生長的，
05:32
or that cheese comes from a plant.
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或者乳酪從植物長出來的。
05:36
Well, today's human hospitals,
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今天人類的醫院
05:38
increasingly, are turning into these
gleaming cathedrals of technology.
gleaming cathedrals of technology.
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正逐漸變成一些閃耀的科技教堂，
05:45
And this creates a psychological
distance between the human patients
distance between the human patients
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使在醫院治療的病人
05:50
who are being treated there
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跟生活在海洋、農田和森林間
05:53
and animal patients who
are living in oceans
are living in oceans
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的動物患者
05:57
and farms and jungles.
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產生一種心理上的距離感。
06:01
But I think there's an
even deeper reason.
even deeper reason.
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但我認為還有一個更深層次的原因，
06:06
Physicians and scientists, we accept
intellectually that our species,
intellectually that our species,
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我們作為醫師和科學家，
理智上明白到
理智上明白到
人類作為一個物種，
也只不過是一個物種，
也只不過是一個物種，
06:13
Homo sapiens, is merely
one species,
one species,
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06:17
no more unique or
special than any other.
special than any other.
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並不比其他物種更為獨特。
06:22
But in our hearts, we don't
completely believe that.
completely believe that.
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但其實在我們內心，
我們並不完全認同。
我們並不完全認同。
06:28
I feel it myself when I'm
listening to Mozart
listening to Mozart
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當我聽莫扎特的音樂時，
06:32
or looking at pictures of the
Mars Rover on my MacBook.
Mars Rover on my MacBook.
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或在蘋果電腦上看火星探測器的照片，
我自己是這麼感覺的。
我自己是這麼感覺的。
06:38
I feel that tug of
human exceptionalism,
human exceptionalism,
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我感受到人類特殊論的勝利，
06:43
even as I recognize the
scientifically isolating cost
scientifically isolating cost
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即使我意識到人類以科學方式
孤立自身所付出的代價，
孤立自身所付出的代價，
06:48
of seeing ourselves as a
superior species, apart.
superior species, apart.
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把自己隔開看做一種上等的物種。
06:54
Well, I'm trying these days.
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現時我正在嘗試，
06:57
When I see a human patient
now, I always ask,
now, I always ask,
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當我替病人看病時，我總會問，
07:02
what do the animal doctors know
about this problem that I don't know?
about this problem that I don't know?
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獸醫對這個問題會否知道
那些我不知道的事嗎？
那些我不知道的事嗎？
07:07
And, might I be taking better
care of my human patient
care of my human patient
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還有如果我把病人看做人類動物患者，
07:12
if I saw them as a human
animal patient?
animal patient?
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能否給他們更好的治療？
07:19
Here are a few examples of the
kind of exciting connections
kind of exciting connections
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下面是幾個讓人興奮的聯繫的例子，
07:24
that this kind of
thinking has led me to.
thinking has led me to.
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就是這種想法讓我聯想到那些點子。
07:28
Fear-induced heart failure.
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恐懼誘發心臟衰竭—
07:30
Around the year 2000,
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2000年左右，
07:33
human cardiologists "discovered"
emotionally induced heart failure.
emotionally induced heart failure.
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人類心臟學家「發現」
情緒會誘發心臟衰竭，
情緒會誘發心臟衰竭，
07:40
It was described in a gambling father
who had lost his life's savings
who had lost his life's savings
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文獻曾經記述過一個嗜賭成性的父親，
他一次擲骰子就輸光畢生積蓄，
07:46
with a roll of the dice,
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07:49
in a bride who'd
been left at the alter.
been left at the alter.
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一個在聖壇前面被離棄的新娘，
07:53
But it turns out, this
"new" human diagnosis
"new" human diagnosis
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但最後我們發現
這種「全新」的人類疾病，
這種「全新」的人類疾病，
07:58
was neither new, nor
was it uniquely human.
was it uniquely human.
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既不新奇又不為人類所獨有，
08:02
Veterinarians had been diagnosing,
treating and even preventing
treating and even preventing
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獸醫早就已經在診斷、治療甚至防止
08:08
emotionally induced
symptoms in animals
symptoms in animals
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動物身上的情緒誘發症狀，
08:12
ranging from monkeys to flamingos,
from to deer to rabbits,
from to deer to rabbits,
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從猴子到火烈鳥、從鹿到兔子，
08:18
since the 1970s.
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乃自 19 世紀 70 年代起開始。
08:22
How many human lives
might have been saved
might have been saved
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如果急診室和心臟專科醫師能運用
08:26
if this veterinary knowledge
had been put into the hands
had been put into the hands
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這一點獸醫學的知識，
08:29
of E.R. docs and cardiologists?
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那麼有多少人類生命可被拯救？
08:35
Self-injury.
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自殘—
08:37
Some human patients
harm themselves.
harm themselves.
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有些病人會傷害自己，
08:41
Some pluck out patches of hair,
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有些會拔出整把頭髮，
08:45
others actually cut themselves.
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有些會實際地切割自己。
有些動物患者也傷害自己，
08:50
Some animal patients
also harm themselves.
also harm themselves.
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有些鳥類會拔掉自己的羽毛，
08:54
There are birds that
pluck out feathers.
pluck out feathers.
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08:57
There are stallions that repetitively
bite their flanks until they bleed.
bite their flanks until they bleed.
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有些成年公馬反覆地咬
自己的側腹直到流血。
自己的側腹直到流血。
09:05
But veterinarians have very specific
and very effective ways
and very effective ways
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但是獸醫師使用
一些特定且有效的方式
一些特定且有效的方式
09:10
of treating and even
preventing self-injury
preventing self-injury
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去治療甚至防止自我傷害的動物
09:14
in their self-injuring animals.
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在身上自殘。
09:18
Shouldn't this veterinary knowledge
be put into the hands
be put into the hands
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難道這些有關獸醫學的知識
09:21
of psychotherapists and
parents and patients
parents and patients
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不該被努力對抗自殘的精神治療師、
09:25
struggling with self-injury?
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父母和病人所運用嗎？
09:29
Postpartum depression and
postpartum psychosis.
postpartum psychosis.
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產後抑鬱症和產後精神錯亂—
09:34
Sometimes, soon after giving birth,
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有時就在生產之後不久，
09:37
some women become depressed,
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有些婦女會變得憂鬱，
09:39
and sometimes they become seriously
depressed and even psychotic.
depressed and even psychotic.
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有時她們患上嚴重憂鬱症
甚至精神錯亂，
甚至精神錯亂，
09:44
They may neglect their newborn,
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她們或者會忽視剛出生的寶寶，
09:46
and in some extreme cases,
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在些極端的案例中，
09:48
even harm the child.
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甚至會傷害她們的孩子。
09:52
Equine veterinarians also
know that occasionally,
know that occasionally,
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馬專科獸醫師也知道
偶爾一頭母馬剛剛生產後，
09:56
a mare, soon after giving birth,
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09:59
will neglect the foal,
refusing to nurse,
refusing to nurse,
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也會忽視小馬，拒絕餵奶，
10:02
and in some instances,
kick the foal, even to death.
kick the foal, even to death.
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有些時候會踢牠，甚至把牠們踢死。
10:09
But veterinarians have devised
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但是獸醫師設計出
10:11
an intervention to deal with
this foal rejection syndrome
this foal rejection syndrome
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一種介入方法以處理
這類馬駒抗拒症狀，
這類馬駒抗拒症狀，
10:17
that involves increasing
oxytocin in the mare.
oxytocin in the mare.
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就是增加母馬體內的催產素。
10:21
Oxytocin is the bonding hormone,
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催產素是一種跟聯繫有關的荷爾蒙，
10:24
and this leads to renewed interest,
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它會給母馬重新
10:27
on the part of the mare, in her foal.
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感到對小馬的興趣。
10:31
Shouldn't this information
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難道這種知識不應該
10:33
be put into the hands of ob/gyn's
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被正在與產後憂鬱症和精神錯亂抗爭的
10:36
and family doctors and patients
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婦產管理者、醫師
10:39
who are struggling with postpartum
depression and psychosis?
depression and psychosis?
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和病人所運用嗎？
10:47
Well, despite all of this promise,
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好吧，即使這些都已實現，
10:49
unfortunately the gulf between
our fields remains large.
our fields remains large.
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不幸地在我們領域間的鴻溝還很大，
10:57
To explain it, I'm afraid I'm going
to have to air some dirty laundry.
to have to air some dirty laundry.
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為了解釋這一點，
我恐怕要揭露一些陰暗面，
我恐怕要揭露一些陰暗面，
11:02
Some physicians can be real snobs
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有些醫師是完完全全的勢利眼，
11:07
about doctors who are not M.D.'s.
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他們看不起不是醫學博士的醫師，
11:09
I'm talking about dentists and
optometrists and psychologists,
optometrists and psychologists,
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我指的是牙醫、配鏡師和心理醫師，
11:15
but maybe especially animal doctors.
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也尤其指獸醫師。
11:20
Of course, most physicians
don't realize that it is harder
don't realize that it is harder
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當然大多數醫師意識不到
現在進入獸醫學院較進入醫學院更難，
11:24
to get into vet school these
days than medical school,
days than medical school,
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11:28
and that when we go
to medical school,
to medical school,
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而且當我們上醫學院時，
11:30
we learn everything
there is to know
there is to know
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我們在那裡所學的全部東西
11:33
about one species, Homo sapiens,
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都只為瞭解一個物種—人類，
11:36
but veterinarians need to learn
about health and disease
about health and disease
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但是獸醫師需要學習哺乳動物、
11:40
in mammals, amphibians,
reptiles, fish and birds.
reptiles, fish and birds.
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兩棲動物、爬行動物、魚類和
鳥類的健康和疾病，
鳥類的健康和疾病，
11:45
So I don't blame the vets
for feeling annoyed
for feeling annoyed
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因此我不會責怪獸醫師，
11:50
by my profession's
condescension and ignorance.
condescension and ignorance.
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因著我的專業所帶來的
優越感與無知而感到厭煩，
優越感與無知而感到厭煩，
11:56
But here's one from the vets:
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但是獸醫有個說法:
11:59
What do you call a veterinarian
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你會把一個只能照顧
12:02
who can only take
care of one species?
care of one species?
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某一物種的獸醫師叫做甚麼？
12:08
A physician. (Laughter)
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一位醫師（笑聲）
12:11
Closing the gap has become
a passion for me,
a passion for me,
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將兩者的差距縮小變成我的熱情，
12:17
and I'm doing this
through programs
through programs
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而我正在通過一些專案來做這件事，
12:20
like Darwin on Rounds at UCLA,
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比如加州大學洛杉磯分校的
「達爾文巡邏員」專案，
「達爾文巡邏員」專案，
12:23
where we're bringing animal experts
and evolutionary biologists
and evolutionary biologists
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我們把動物專家和演化生物學家找來，
12:29
and embedding them
on our medical teams
on our medical teams
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安插在我們的醫療隊伍中，
12:33
with our interns and our residents.
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跟我們的實習生和住院醫師一起工作。
12:37
And through Zoobiquity conferences,
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而且通過「人獸同源學」會議，
12:41
where we bring medical schools
together with veterinary schools
together with veterinary schools
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我們讓醫學院和獸醫學院聚在一起，
12:45
for collabortive discussions
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討論動物患者
12:47
of the shared diseases and disorders
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和人類病者之間
12:50
of animal and human patients.
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的共同疾病和失調，
12:54
At Zoobiquity conferences,
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在「人獸同源學」會議上，
12:57
participants learn how treating
breast cancer in a tiger
breast cancer in a tiger
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參與者學習到替老虎治療乳腺癌
13:02
can help us better treat breast cancer
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將會如何幫助我們更好地治療
13:05
in a kindergarten teacher;
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一位幼兒園老師的乳腺癌；
13:08
how understanding polycystic
overies in a Holstein cow
overies in a Holstein cow
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好好瞭解荷斯坦牛的多囊卵巢
13:13
can help us better take care
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將會如何幫助我們
13:15
of a dance instructor
with painful periods;
with painful periods;
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更好地照顧一位受經痛困擾的舞蹈老師；
13:20
and how better understanding the
treatment of separation anxiety
treatment of separation anxiety
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深入瞭解一隻患上分離焦慮症
13:25
in a high-strung Sheltie
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且高度緊張的喜樂蒂牧羊犬的治療，
13:27
can help an anxious young child
struggling with his first days of school.
struggling with his first days of school.
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將會如何幫助一個首天上學
就感費力的焦慮幼孩。
就感費力的焦慮幼孩。
13:34
In the United States and now
internationally, at Zoobiquity conferences
internationally, at Zoobiquity conferences
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在美國，而且現時在全球，
於「人獸同源學」會議上，
於「人獸同源學」會議上，
13:40
physicians and veterinarians check
their attitudes and their preconceptions
their attitudes and their preconceptions
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醫師和獸醫師會將態度
以及成見留在會議室外，
以及成見留在會議室外，
13:47
at the door and come
together as colleagues,
together as colleagues,
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然後以同行的身份、
13:53
as peers, as doctors.
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同輩的身份、
以及醫師的身份聚在一起。
以及醫師的身份聚在一起。
13:58
After all, we humans
are animals, too,
are animals, too,
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畢竟我們人類也是動物，
14:04
and it's time for us physicians to embrace
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是時候讓我們醫師去接受
14:07
our patients' and our own animal natures
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我們同時是病人和動物的本質，
14:12
and join veterinarians
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和獸醫師合作
14:14
in a species-spanning approach to health.
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以跨越物種的方式處理健康問題。
14:19
Because it turns out,
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因為最後證明是
14:21
some of the best and
most humanistic medicine
most humanistic medicine
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一些最好且最合乎人道主義
的藥物治療，
的藥物治療，
14:26
is being practiced by doctors
whose patients aren't human.
whose patients aren't human.
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正被患者並不是人類的醫師所使用，
14:32
And one of the best ways
we can take care
we can take care
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而我們照顧人類患者的最好方法之一
14:35
of the human patient is by
paying close attention
paying close attention
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就是密切注意
14:40
to how all the other
patients on the planet
patients on the planet
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在這星球上其他病患者
14:44
live, grow, get sick and heal.
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是如何生活、成長、患病以及康復。
14:51
Thank you.
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謝謝！
14:53
(Applause).
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（掌聲）
ABOUT THE SPEAKER
Barbara Natterson-Horowitz - CardiologistBarbara Natterson-Horowitz, Professor of Medicine in the Division of Cardiology at UCLA Medical School, provides a unique perspective on how human well-being, including mental health, can be improved by insights into animal health.
Why you should listen
Barbara Natterson-Horowitz is a cardiologist whose patients include gorillas, lions, wallabies and humans. Her medical rounds sometimes take place at the Los Angeles Zoo, or might include veterinarians in a discussion of human health at the Ronald Reagan UCLA Medical Center, but always channel the perspective of Charles Darwin. A professor in UCLA’s Division of Cardiology and in the Department of Ecology and Evolutionary Biology, Natterson-Horowitz's medical specialty is cardiac imaging -- but her academic passion is the evolutionary connection between human and animal bodies and minds. In 2012, she co-authored the book Zoobiquity: The Astonishing Connection Between Human and Animal Health, advocating a “One Health” approach to medicine. She founded the Zoobiquity Conferences to bring veterinarians and physicians together for “species-spanning” debates and collaborations.
More profile about the speakerBarbara Natterson-Horowitz | Speaker | TED.com