ABOUT THE SPEAKER
David Casarett - Physician
David Casarett asks: What if mainstream health care operated more like a medical marijuana dispensary?

Why you should listen

In his third book, Stoned: A Doctor's Case for Medical Marijuana, palliative care physician David Casarett takes a first-person investigative journalist's approach to making sense of marijuana's therapeutic potential and adverse effects. He shares what he's learned about this chronically misunderstood drug -- including the control it gives patients over their health and the educational atmosphere of dispensaries -- and outlines what we still need to do to explore its potential health benefits.

Casarett is a professor of medicine at the Duke University School of Medicine and chief of palliative care for the Duke Health System. He is the author of more than 100 journal articles, numerous magazine articles, and Shocked, another nonfiction book about the science of resuscitation. Casarett's first novel in the Ethical Chiang Mai Detective Agency series, Murder at the House of Rooster Happiness, was published in September 2016. The next installment, The Missing Guests of the Magic Grove Hotel, will be published in the fall of 2017.

More profile about the speaker
David Casarett | Speaker | TED.com
TEDMED 2016

David Casarett: A doctor's case for medical marijuana

大衛·卡薩雷特: 一位醫生對藥用大麻的探討

Filmed:
2,801,315 views

大衛·卡薩雷特醫師過去對於藥用大麻的大肆宣揚和懷疑不堪其擾,於是他抱著懷疑的態度,進行了調查。他得到了一些很有意義的結果──關於我們知道的,我們不知道的,以及主流醫療系統,應該向藥用大麻藥局學習的課題。
- Physician
David Casarett asks: What if mainstream health care operated more like a medical marijuana dispensary? Full bio

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

我想跟你們說說,
在我擔任臨終關懷治療師的時候,
00:13
I would like to tell you
about the most embarrassing尷尬 thing
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00:17
that has ever happened發生 to me in my years年份
of working加工 as a palliative治標不治本 care關心 physician醫師.
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曾經發生過最尷尬的一件事。
那是在好幾年前發生的。
00:22
This happened發生 a couple一對 of years年份 ago.
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我受託去見一位 70 多歲的女士,
擔任她的醫療顧問──
00:24
I was asked as a consultant顧問
to see a woman女人 in her 70s --
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她是一位退休的英文教授,
罹患胰腺癌。
00:28
retired退休 English英語 professor教授
who had pancreatic cancer癌症.
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我被找去是因為她覺得
疼痛、噁心、想吐......
00:32
I was asked to see her because
she had pain疼痛, nausea噁心, vomiting嘔吐 ...
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00:37
When I went to see her,
we talked about those symptoms症狀
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當我去見她的時候,
我們談論了這些症狀;
而在諮詢的過程中,
00:40
and in the course課程 of that consultation會診,
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00:42
she asked me whether是否 I thought
that medical marijuana大麻 might威力 help her.
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她問我是否認為
藥用大麻能幫助到她。
00:48
I thought back to everything
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我回想了所有在醫學院學過的,
關於藥用大麻的知識;
00:50
that I had learned學到了 in medical school學校
about medical marijuana大麻,
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這並不需要很多時間,
00:54
which哪一個 didn't take very long
because I had learned學到了 absolutely絕對 nothing.
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因為我完全沒學過
任何藥用大麻的知識。
00:58
And so I told her that as far as I knew知道,
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所以我告訴她:
據我所知,藥用大麻
並沒有什麼用處。
01:01
medical marijuana大麻
had no benefits好處 whatsoever任何.
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她微笑並點點頭,
然後從床邊的提袋裡,
01:05
And she smiled笑笑 and nodded點頭 and reached到達
into the handbag手提包 next下一個 to the bed,
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拿出將近一打的
隨機對照試驗報告,
01:09
and pulled out a stack of about a dozen
randomized隨機 controlled受控 trials試驗
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結果都顯示藥用大麻有助於減緩
噁心、疼痛、焦慮等症狀。
01:13
showing展示 that medical
marijuana大麻 has benefits好處
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01:16
for symptoms症狀 like nausea噁心
and pain疼痛 and anxiety焦慮.
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她把那些報告遞給我,並且說:
01:20
She handed me those articles用品 and said,
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01:23
"Maybe you should read these
before offering an opinion意見 ...
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「或許你應該先讀讀這些,
再發表意見......醫生。」
01:28
doctor醫生."
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(笑聲)
01:30
(Laughter笑聲)
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於是我照做了。
01:31
So I did.
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那天晚上,我把那些報告全讀過了,
01:33
That night I read all of those articles用品
and found發現 a bunch more.
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還找到了更多的資料。
01:36
When I came來了 to see her the next下一個 morning早上,
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當我第二天去見她的時候,
我不得不承認,
01:38
I had to admit承認 that it looks容貌 like
there is some evidence證據
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看起來的確有一些證據,
支持大麻具有醫療效果;
01:42
that marijuana大麻 can offer提供 medical benefits好處
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01:46
and I suggested建議 that if she
really was interested有興趣,
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於是我建議,
如果她真的有意願的話,
她應該試一試。
01:49
she should try it.
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01:51
You know what she said?
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你知道她怎麼回答嗎?
01:54
This 73-year-old-歲,
retired退休 English英語 professor教授?
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那位 73 歲的退休英文教授?
01:58
She said, "I did try it
about six months個月 ago.
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她說:「我大約六個月前就試過了。
它超級棒。
02:00
It was amazing驚人.
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之後我每天都用,
02:02
I've been using運用 it every一切 day since以來.
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這是我所發現過最棒的藥。
02:04
It's the best最好 drug藥物 I've discovered發現.
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我不曉得為何花了 73 年
才發現這個東西,它棒極了。」
02:07
I don't know why it took me 73 years年份
to discover發現 this stuff東東. It's amazing驚人."
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(笑聲)
02:11
(Laughter笑聲)
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那時我才意識到,
02:12
That was the moment時刻 at which哪一個 I realized實現
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我需要學習藥用大麻相關的知識,
02:14
I needed需要 to learn學習 something
about medical marijuana大麻
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因為我在醫學院裡所學到的,
02:17
because what I was prepared準備 for
in medical school學校
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02:20
bore no relationship關係 to reality現實.
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已經和現實脫節了。
於是我開始閱讀更多資料,
開始和研究人員交流,
02:23
So I started開始 reading more articles用品,
I started開始 talking to researchers研究人員,
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開始和醫生們交流,
02:27
I started開始 talking to doctors醫生,
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02:28
and most importantly重要的,
I started開始 listening to patients耐心.
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更重要的是,
我開始傾聽患者的聲音。
基於那些對話,我後來寫了一本書,
02:32
I ended結束 up writing寫作 a book
based基於 on those conversations對話,
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那本書以三件
「意料之外」的事件為中心──
02:35
and that book really revolved圍繞
around three surprises驚喜 --
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反正對我來說是意料之外的,
02:38
surprises驚喜 to me, anyway無論如何.
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第一件事我剛剛已經提到了──
02:40
One I already已經 alluded暗示 to --
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藥用大麻的確是有一些效果的。
02:41
that there really are some benefits好處
to medical marijuana大麻.
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或許那些藥用大麻的成效,
02:45
Those benefits好處 may可能 not be
as huge巨大 or as stunning令人驚嘆
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並不像某些積極擁護者
所希望我們相信的──
02:48
as some of the most avid狂熱 proponents支持者
of medical marijuana大麻
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藥用大麻具有顯著或者驚人的效果,
02:51
would have us believe,
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02:52
but they are real真實.
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但是它真的有效。
02:54
Surprise number two:
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第二個意料之外是:
藥用大麻也具有某些危害。
02:56
medical marijuana大麻 does have some risks風險.
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但那些危害並沒有嚴重或者恐怖到,
02:59
Those risks風險 may可能 not be
as huge巨大 and as scary害怕
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藥用大麻的反對者
想讓我們相信的程度,
03:02
as some of the opponents對手 of medical
marijuana大麻 would have us believe,
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儘管如此,它的確具有危害。
03:05
but they are real真實 risks風險, nonetheless儘管如此,.
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03:08
But it was the third第三 surprise
that was most ...
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但第三個意料之外,
是最令人驚訝的。
03:10
surprising奇怪.
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許多我曾經接觸過,
03:12
And that is that a lot
of the patients耐心 I talked with
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求助於藥用大麻的患者,
03:15
who've誰一直 turned轉身 to medical
marijuana大麻 for help,
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並不是為了療效而使用藥用大麻的,
03:18
weren't turning車削 to medical marijuana大麻
because of its benefits好處
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也不是基於危害和效用的平衡,
03:21
or the balance平衡 of risks風險 and benefits好處,
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更不是因為他們覺得
那是一種特效藥,
03:23
or because they thought
it was a wonder奇蹟 drug藥物,
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而是因為能給予他們
對疾病的控制感,
03:25
but because it gave them
control控制 over their illness疾病.
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讓他們能用有效果、有效率、
03:29
It let them manage管理 their health健康
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03:31
in a way that was productive生產的 and efficient高效
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有效益、覺得舒服的方式,
來管控自己的健康。
03:34
and effective有效 and comfortable自在 for them.
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03:38
To show顯示 you what I mean,
let me tell you about another另一個 patient患者.
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為了表達的更清楚,
讓我來聊聊另一位患者。
我遇到羅繽的時候她 40 多歲,
03:41
Robin知更鳥 was in her early 40s when I met會見 her.
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但她看起來像是快要 70 歲了。
03:43
She looked看著 though雖然
like she was in her late晚了 60s.
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過去的 20 年,她受到
類風濕性關節炎的折磨,
03:46
She had suffered遭遇 from rheumatoid類風濕 arthritis關節炎
for the last 20 years年份,
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她的手因為關節炎扭曲,
03:50
her hands were gnarled粗糙 by arthritis關節炎,
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脊柱也彎了,
03:52
her spine脊柱 was crooked,
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她必須靠輪椅來移動。
03:54
she had to rely依靠
on a wheelchair輪椅 to get around.
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她在外表上、身體上
03:56
She looked看著 weak and frail脆弱,
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看起來很虛弱,一碰即碎;
03:58
and I guess猜測 physically物理 she probably大概 was,
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但是在精神上、意識上、心理上,
04:00
but emotionally感情上,
cognitively認知, psychologically心理,
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她是我所遇到過最堅強的人。
04:03
she was among其中 the toughest最艱難的
people I've ever met會見.
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04:08
And when I satSAT down next下一個 to her
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當我在她身邊坐下,
那是在加州北部
一間藥用大麻藥局裡,
04:09
in a medical marijuana大麻 dispensary藥房
in Northern北方 California加州
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我問她為什麼開始使用藥用大麻,
04:12
to ask her about why she turned轉身
to medical marijuana大麻,
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這對她有什麼作用?如何幫助了她?
04:15
what it did for her and how it helped幫助 her,
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她告訴我一些事,
04:18
she started開始 out by telling告訴 me things
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那些也是我從許多患者那裡聽過的:
04:20
that I had heard聽說
from many許多 patients耐心 before.
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04:22
It helped幫助 with her anxiety焦慮;
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它有助於解決焦慮;
有助於解決疼痛;
04:24
it helped幫助 with her pain疼痛;
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當疼痛減緩時,她就能睡得比較好。
04:26
when her pain疼痛 was better,
she slept better.
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這些原因都是我聽過的。
04:28
And I'd heard聽說 all that before.
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然而她接下來說的,
我卻從來沒聽過:
04:29
But then she said something
that I'd never heard聽說 before,
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藥用大麻讓她能掌控
04:32
and that is that it gave her
control控制 over her life
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自己的生活和健康。
04:36
and over her health健康.
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04:37
She could use it when she wanted,
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她可以在想用的時候就用,
以她想要的方式、
04:39
in the way that she wanted,
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以適合她的用量和頻率使用。
04:41
at the dose劑量 and frequency頻率
that worked工作 for her.
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如果沒有效果,她可以做出調整。
04:43
And if it didn't work for her,
then she could make changes變化.
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所有的事她都能自己作主。
04:47
Everything was up to her.
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最重要的就是,她說:
04:48
The most important重要 thing she said
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她不需要得到其他人的允許──
04:50
was she didn't need
anybody任何人 else's別人的 permission允許 --
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不需要預約診所,
不需要醫生的處方,
04:53
not a clinic診所 appointment約定,
not a doctor's醫生 prescription處方,
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不需要向藥劑師購買。
04:55
not a pharmacist's藥師 order訂購.
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一切都由她作主。
04:57
It was all up to her.
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她說了算。
04:59
She was in control控制.
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05:01
And if that seems似乎 like a little thing
for somebody with chronic慢性 illness疾病,
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對於罹患慢性病的人來說,
這是一件小事嗎?
不是的,完全不是。
05:05
it's not -- not at all.
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05:07
When we face面對 a chronic慢性 serious嚴重 illness疾病,
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當我們面對嚴重的慢性疾病時,
不論是類風濕性關節炎、
狼瘡、癌症、糖尿病
05:09
whether是否 it's rheumatoid類風濕 arthritis關節炎
or lupus狼瘡 or cancer癌症 or diabetes糖尿病,
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還是肝硬化,
05:14
or cirrhosis硬化,
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我們都失去了控制權。
05:16
we lose失去 control控制.
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注意我是說「當」你患病的時候,
而不是用「如果」。
05:18
And note注意 what I said: "when," not "if."
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我們所有人,到了人生的某個階段,
都要面對嚴重的慢性病,
05:20
All of us at some point in our lives生活
will face面對 a chronic慢性 serious嚴重 illness疾病
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這導致我們失去控制權。
05:25
that causes原因 us to lose失去 control控制.
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我們看著自己的機能衰退,
有的人還會經歷智力衰退,
05:27
We'll see our function功能 decline下降,
some of us will see our cognition認識 decline下降,
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我們不再有能力照顧自己,
05:31
we'll be no longer able能夠
to care關心 for ourselves我們自己,
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做我們自己想做的事。
05:34
to do the things that we want to do.
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我們的身體終將背叛我們,
05:36
Our bodies身體 will betray背叛 us,
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而在那個過程中,
我們失去了控制權。
05:38
and in that process處理, we'll lose失去 control控制.
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這挺嚇人的。
05:41
And that's scary害怕.
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不止是嚇人,簡直令人恐懼,
05:43
Not just scary害怕 -- that's frightening可怕的,
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寢食難安。
05:45
it's terrifying可怕的.
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我和我的病患,
也就是臨終關懷患者交流時,
05:46
When I talk to my patients耐心,
my palliative治標不治本 care關心 patients耐心,
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他們之中有許多人
正面臨將奪走他們生命的疾病,
05:49
many許多 of whom are facing面對 illnesses疾病
that will end結束 their lives生活,
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他們對很多事情感到恐懼──
05:53
they have a lot of be frightened受驚 of --
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痛楚、噁心、嘔吐、便秘、疲倦、
05:55
pain疼痛, nausea噁心, vomiting嘔吐,
constipation便秘, fatigue疲勞,
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即將到來的死亡。
05:59
their impending即將到來的 mortality死亡.
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但和其他所有事相比,
06:00
But what scares恐慌 them
more than anything else其他
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他們更恐懼的事情,
是可能在某個時候,
06:03
is this possibility可能性 that at some point,
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也許是明天,或是下個月,
06:05
tomorrow明天 or a month from now,
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06:07
they're going to lose失去
control控制 of their health健康,
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他們將會失去對自己健康的控制權,
對生活的控制權,
06:10
of their lives生活,
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對醫療的控制權,
06:12
of their healthcare衛生保健,
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06:13
and they're going to become成為
dependent依賴的 on others其他,
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他們變得必須依賴他人,
這是很可怕的。
06:16
and that's terrifying可怕的.
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06:18
So it's no wonder奇蹟 really
that patients耐心 like Robin知更鳥,
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所以像羅繽這樣的患者,
就是我剛剛告訴過你們的,
06:22
who I just told you about,
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在診所裡遇到的那一位,
06:24
who I met會見 in that clinic診所,
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不意外的,她會選擇使用藥用大麻,
06:25
turn to medical marijuana大麻
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06:27
to try to claw back
some semblance外表 of control控制.
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是為了試圖抓住
一些表面上的控制權。
但他們怎麼做到的呢?
06:30
How do they do it though雖然?
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這些販售藥用大麻的藥局,
06:32
How do these medical
marijuana大麻 dispensaries藥房 --
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例如我遇到羅繽的那一間,
06:34
like the one where I met會見 Robin知更鳥 --
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他們是如何讓羅繽這樣的患者
06:36
how do they give patients耐心 like Robin知更鳥
back the sort分類 of control控制 that they need?
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獲得所需要的控制權呢?
他們是如何做到那些,
06:43
And how do they do it
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06:44
in a way that mainstream主流
medical hospitals醫院 and clinics診所,
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主流的醫院和診所
無法對羅繽做的?
06:48
at least最小 for Robin知更鳥, weren't able能夠 to?
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他們的秘密是什麼?
06:51
What's their secret秘密?
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我決定要搞清楚。
06:53
So I decided決定 to find out.
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我去了位於加州威尼斯海灘
一間破破的診所,
06:55
I went to a seedy襤褸的 clinic診所
in Venice威尼斯 Beach海灘 in California加州
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拿到一份同意書,
06:59
and got a recommendation建議
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07:01
that would allow允許 me
to be a medical marijuana大麻 patient患者.
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允許我成為一名使用
藥用大麻的病患。
07:04
I got a letter of recommendation建議
that would let me buy購買 medical marijuana大麻.
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我拿到了一份同意書,
能讓我購買藥用大麻。
我用不合法的方式拿到同意書,
07:08
I got that recommendation建議 illegally非法,
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07:10
because I'm not
a resident居民 of California加州 --
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因為我並不是加州居民──
我應該先聲明這點。
07:12
I should note注意 that.
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07:14
I should also note注意, for the record記錄,
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我還要聲明,以供紀錄,
07:15
that I never used that letter
of recommendation建議 to make a purchase採購,
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就是我從未使用
那份同意書購買大麻,
以上的聲明是要給
美國緝毒局的調查員的──
07:19
and to all of you DEA數據包絡分析 agents代理 out there --
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(笑聲)
07:22
(Laughter笑聲)
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要熱愛你們的工作,
07:23
love the work that you're doing,
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繼續堅持下去!
07:24
keep it up.
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(笑聲)
07:26
(Laughter笑聲)
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儘管我並沒有
用這份同意書進行購買,
07:27
Even though雖然 it didn't let me
make a purchase採購 though雖然,
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07:30
that letter was priceless無價
because it let me be a patient患者.
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但是它仍然無比珍貴,
因為它讓我成為一名患者,
讓我體驗到,
像羅繽這樣的患者所經歷的,
07:34
It let me experience經驗
what patients耐心 like Robin知更鳥 experience經驗
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體驗到她們在藥用大麻藥局
所得到的經驗。
07:38
when they go to a medical
marijuana大麻 dispensary藥房.
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而我所體驗到的──
07:41
And what I experienced有經驗的 --
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就如同成百上千位
07:43
what they experience經驗 every一切 day,
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07:45
hundreds數以百計 of thousands數千
of people like Robin知更鳥 --
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像羅繽一樣的人,
每天都在經歷的──
07:48
was really amazing驚人.
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簡直是棒極了。
我走進了藥局,
07:51
I walked into the clinic診所,
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從我走進這些
診所和藥局的那一刻起,
07:52
and from the moment時刻 that I entered進入
many許多 of these clinics診所 and dispensaries藥房,
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我感覺到,這間藥局、這間診所,
07:55
I felt like that dispensary藥房, that clinic診所,
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是為我設立的。
07:58
was there for me.
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08:00
There were questions問題
at the outset開始 about who I am,
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一開始的時候,
他們會詢問一些問題,
例如我是誰?我從事什麼工作?
08:03
what kind of work I do,
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我希望藉由藥用大麻處方或產品
08:05
what my goals目標 are in looking
for a medical marijuana大麻 prescription處方,
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達到什麼效果?
08:09
or product產品,
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08:12
what my goals目標 are,
what my preferences優先 are,
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我的目標是什麼?喜好是什麼?
我的期望是什麼?
08:15
what my hopes希望 are,
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我是怎麼想的?
我期望帶來什麼幫助?
08:16
how do I think, how do I hope希望
this might威力 help me,
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08:18
what am I afraid害怕 of.
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我擔心什麼?
像羅繽這樣的患者,
08:20
These are the sorts排序 of questions問題
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會不斷地被問到這些類型的問題。
08:22
that patients耐心 like Robin知更鳥
get asked all the time.
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08:24
These are the sorts排序 of questions問題
that make me confident信心
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像這樣的問題,會讓我有信心,
覺得這個和我談話的人,
是從內心關注我的利益,
08:27
that the person I'm talking with
really has my best最好 interests利益 at heart
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並且想要更瞭解我。
08:31
and wants to get to know me.
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08:34
The second第二 thing I learned學到了
in those clinics診所
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我從這些診所學到的第二件事,
是可以獲得許多指導。
08:36
is the availability可用性 of education教育.
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除了從櫃台裡的人得到指導,
08:39
Education教育 from the folks鄉親
behind背後 the counter計數器,
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也從等候室裡的其他人得到指導。
08:41
but also education教育
from folks鄉親 in the waiting等候 room房間.
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當我坐在他們旁邊時,
這些人都很高興──
08:45
People I met會見 were more than happy快樂,
as I was sitting坐在 next下一個 to them --
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3536
他們都是像羅繽那樣的人──
08:48
people like Robin知更鳥 --
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他們告訴我:他們是誰,
為什麼使用藥用大麻?
08:50
to tell me about who they are,
why they use medical marijuana大麻,
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3777
什麼幫助了他們?如何幫助了他們?
08:53
what helps幫助 them, how it helps幫助 them,
194
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並給我意見和建議。
08:56
and to give me advice忠告 and suggestions建議.
195
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1936
那些等候室就像是提供交流、
建議和支持的場所。
08:58
Those waiting等候 rooms客房 really are
a hive蜂巢 of interaction相互作用, advice忠告 and support支持.
196
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09:04
And third第三, the folks鄉親 behind背後 the counter計數器.
197
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第三,坐在櫃檯裡面的人,
讓我驚訝的是,
他們非常心甘情願的,
09:06
I was amazed吃驚 at how willing願意
those people were
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願意花一個小時甚至更多時間,
跟我討論許多細節,
09:10
to spend sometimes有時 an hour小時 or more
talking me through通過 the nuances細微之處
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像是這個品種和那個品種的比較,
09:14
of this strain應變 versus that strain應變,
200
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透過吸菸還是霧化方式,
09:16
smoking抽煙 versus vaporizing蒸發,
201
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食用的還是酊劑──
09:18
edibles零嘴 versus tinctures酊劑 --
202
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還記得嗎,這是在我還沒有
購買任何東西的情況下。
09:20
all, remember記得, without me
making製造 any purchase採購 whatsoever任何.
203
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3760
09:25
Think about the last time
you went to any hospital醫院 or clinic診所
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回憶一下你上次去醫院或診所,
以及上一次有人花了一個小時
向你詳細解釋,是什麼樣的情況?
09:29
and the last time anybody任何人 spent花費 an hour小時
explaining說明 those sorts排序 of things to you.
205
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4800
09:34
The fact事實 that patients耐心 like Robin知更鳥
are going to these clinics診所,
206
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3616
實際上像羅繽這樣的患者,
會去這些診所,
會去這些藥局,
09:38
are going to these dispensaries藥房
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1576
得到這種程度的關注、
09:39
and getting得到 that sort分類
of personalized個性化 attention注意
208
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2936
指導和服務,
09:42
and education教育 and service服務,
209
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1856
真是現今醫療系統的警鐘。
09:44
really should be a wake-up醒來 call
to the healthcare衛生保健 system系統.
210
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3416
09:48
People like Robin知更鳥 are turning車削 away
from mainstream主流 medicine醫學,
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像羅繽這樣的人,會放棄主流醫療,
轉向藥用大麻藥局尋求協助,
09:51
turning車削 to medical marijuana大麻 dispensaries藥房
212
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2336
是因為那些藥局
能給予他們真正需要的。
09:53
because those dispensaries藥房
are giving them what they need.
213
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3880
09:58
If that's a wake-up醒來 call
to the medical establishment編制,
214
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2576
如果那是對於現今醫療機構的警鐘,
那也是針對我那些不去聆聽,
10:01
it's a wake-up醒來 call that many許多
of my colleagues同事 are either not hearing聽力
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3776
或是不願聆聽的同僚。
10:04
or not wanting希望 to hear.
216
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1720
10:07
When I talk to my colleagues同事,
physicians醫師 in particular特定,
217
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2736
當我告訴我的同僚,特別是內科醫生
關於藥用大麻的事,
10:10
about medical marijuana大麻,
218
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1336
10:11
they say, "Oh, we need more evidence證據.
219
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2656
他們總是說:
「哦!我們需要更多證據。
我們需要更多關於成效的研究,
以及更多關於危害的證據。」
10:14
We need more research研究 into benefits好處,
we need more evidence證據 about risks風險."
220
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你知道嗎,他們是對的。
10:18
And you know what? They're right.
221
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他們絕對正確。
10:20
They're absolutely絕對 right.
222
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我們的確需要更多證據,
來證明藥用大麻的成效。
10:21
We do need much more evidence證據
about the benefits好處 of medical marijuana大麻.
223
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我們也需要要求聯邦政府,
把大麻重訂為二類藥物,
10:25
We also need to ask the federal聯邦 government政府
to reschedule改期 marijuana大麻 to Schedule時間表 IIII,
224
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5376
甚至是完全取消限制,
才能讓研究進行。
10:31
or to deschedule取消調度 it entirely完全
to make that research研究 possible可能.
225
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3560
10:35
We also need more research研究
into medical marijuana's大麻的 risks風險.
226
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3656
我們也需要針對藥用大麻的危害
進行更多研究。
關於藥用大麻的危害──
10:39
Medical marijuana's大麻的 risks風險 --
227
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對於一般娛樂用大麻的危害,
我們了解很多,
10:40
we know a lot about
the risks風險 of recreational休閒 use,
228
628840
2376
但是對於藥用大麻的危害,
我們幾乎一無所知。
10:43
we know next下一個 to nothing
about the risks風險 of medical marijuana大麻.
229
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2896
所以我們當然需要進行研究,
10:46
So we absolutely絕對 do need research研究,
230
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2576
但話說回來,我們需要研究
10:48
but to say that we need research研究
231
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2336
並不等於現在就不必做出改變,
10:51
and not that we need
to make any changes變化 now
232
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3056
這是完全忽略了重點。
10:54
is to miss小姐 the point entirely完全.
233
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1936
像羅繽那樣的人使用藥用大麻,
10:56
People like Robin知更鳥
aren't seeking out medical marijuana大麻
234
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2576
不是因為他們認為那是萬能藥,
10:58
because they think it's a wonder奇蹟 drug藥物,
235
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1856
也不是因為他們覺得沒有風險。
11:00
or because they think
it's entirely完全 risk-free沒有風險.
236
648640
2736
他們追求的原因,
是由於大麻被遞送、發放,
11:03
They seek尋求 it out because the context上下文
in which哪一個 it's delivered交付 and administered管理
237
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4656
以及使用的環境,
11:08
and used,
238
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1216
這樣的環境給予他們所需要的──
對生活的掌控權。
11:09
gives them the sort分類 of control控制
they need over their lives生活.
239
657320
3536
而這是我們真正需要關注的警鐘。
11:12
And that's a wake-up醒來 call
we really need to pay工資 attention注意 to.
240
660880
3040
好消息是,今天我們能從
11:17
The good news新聞 though雖然 is that
there are lessons教訓 we can learn學習 today今天
241
665040
3736
藥用大麻的藥局學到這一課。
11:20
from those medical marijuana大麻 dispensaries藥房.
242
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2976
而那些正是我們應該學習的。
11:23
And those are lessons教訓
we really should learn學習.
243
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2136
這些藥局通常是小型的、家庭式的,
11:25
These are often經常 small,
mom-and-pop媽媽和流行 operations操作
244
673960
2736
11:28
run by people with no medical training訓練.
245
676720
2456
由未曾受過醫療訓練的人士所經營。
想到就令我們感到羞愧,
11:31
And while it's embarrassing尷尬 to think
246
679200
2576
這些診所和藥局
一直在為患者提供服務、支持,
11:33
that many許多 of these clinics診所
and dispensaries藥房 are providing提供 services服務
247
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4056
並滿足他們的需求,
11:37
and support支持 and meeting會議 patients'耐心' needs需求
248
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2376
以一種數百億規模的醫療系統
都做不到的方式──
11:40
in ways方法 that billion-dollar十億美元
healthcare衛生保健 systems系統 aren't --
249
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4016
我們應該對此感到羞愧──
11:44
we should be embarrassed尷尬 by that --
250
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1696
但我們也應該向它學習。
11:46
but we can also learn學習 from that.
251
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1896
我們能向這些小型藥局學習的
11:47
And there are probably大概
three lessons教訓 at least最小
252
695960
2136
11:50
that we can learn學習
from those small dispensaries藥房.
253
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2240
至少有三個課題:
11:52
One: we need to find ways方法
to give patients耐心 more control控制
254
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3656
第一,我們需要找到
小巧但是重要的方法,
來給予患者更多的控制權。
11:56
in small but important重要 ways方法.
255
704520
2016
11:58
How to interact相互作用 with healthcare衛生保健 providers供應商,
256
706560
2056
例如如何與醫療人員溝通,
什麼時候溝通,
12:00
when to interact相互作用
with healthcare衛生保健 providers供應商,
257
708640
2176
如何以對患者有效的方式開藥。
12:02
how to use medications藥物治療
in ways方法 that work for them.
258
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3616
在我自己的診間裡,
12:06
In my own擁有 practice實踐,
259
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1216
我已經找出更有創意和彈性的方式,
12:07
I've gotten得到 much more
creative創作的 and flexible靈活
260
715720
2736
12:10
in supporting支持 my patients耐心
in using運用 drugs毒品 safely安然
261
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3136
支持患者安全地使用藥物
來控制他們的症狀──
12:13
to manage管理 their symptoms症狀 --
262
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1496
同時能強調安全性。
12:15
with the emphasis重點 on safely安然.
263
723160
1376
我所開立的很多處方,
是屬於鴉片類或苯二氮䓬類藥物,
12:16
Many許多 of the drugs毒品 I prescribe規定
are drugs毒品 like opioids阿片類藥物 or benzodiazepines苯二氮卓
264
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4456
這些藥物過量使用會有危險。
12:21
which哪一個 can be dangerous危險 if overused過度使用.
265
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2776
但這就是重點。
12:23
But here's這裡的 the point.
266
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當他們過量使用時,會造成危險;
12:25
They can be dangerous危險 if they're overused過度使用,
267
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但如果不能依照
患者的意願與需求來使用,
12:27
but they can also be ineffective不靈
if they're not used in a way
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結果也是無效的。
12:30
that's consistent一貫 with
what patients耐心 want and need.
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所以在安全使用的前提下,
12:32
So that flexibility靈活性,
if it's delivered交付 safely安然,
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「提供彈性」對於患者和家屬,
具有非常重要的意義。
12:36
can be extraordinarily異常 valuable有價值
for patients耐心 and their families家庭.
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以上是第一點。
12:39
That's number one.
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第二個課題:指導。
12:40
Number two: education教育.
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12:42
Huge巨大 opportunities機會
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這是個大好機會,
12:43
to learn學習 from some of the tricks技巧
of those medical marijuana大麻 dispensaries藥房
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去向藥用大麻藥局學習
如何提供更多指導的技巧;
12:47
to provide提供 more education教育
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這並不會佔用醫師太多時間,
12:48
that doesn't require要求
a lot of physician醫師 time necessarily一定,
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甚至根本不會佔用任何時間,
12:51
or any physician醫師 time,
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卻能給我們一個機會了解:
我們正在用什麼藥物,
12:53
but opportunities機會 to learn學習
about what medications藥物治療 we're using運用
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以及為何用這些藥物,
12:57
and why,
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12:58
prognoses預後, trajectories軌跡 of illness疾病,
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如何預測判斷疾病的預後,
以及最重要的,
13:00
and most importantly重要的,
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這是患者之間彼此學習的機會。
13:02
opportunities機會 for patients耐心
to learn學習 from each other.
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我們如何複製出
13:04
How can we replicate複製 what goes on
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13:06
in those clinic診所 and medical
dispensary藥房 waiting等候 rooms客房?
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在藥用大麻藥局等候室
所出現的情境呢?
病人如何互相學習?
人們如何彼此分享?
13:10
How patients耐心 learn學習 from each other,
how people share分享 with each other.
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13:14
And last but not least最小,
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最後但同樣重要的一點,
就是像那些藥用大麻藥局所做的,
把病患放在第一位,
13:15
putting patients耐心 first the way
those medical marijuana大麻 dispensaries藥房 do,
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讓病患能感覺到,
13:19
making製造 patients耐心 feel
legitimately合理地 like what they want,
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我們這些醫療從業人員,
正是為了他們的期待
13:24
what they need,
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和他們的需求而存在的。
13:26
is why, as healthcare衛生保健 providers供應商,
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13:27
we're here.
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13:29
Asking patients耐心 about their hopes希望,
their fears恐懼, their goals目標 and preferences優先.
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向患者詢問他們的
期望、恐懼、目標和偏好。
身為臨終關懷從業人員,
13:33
As a palliative治標不治本 care關心 provider提供商,
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我會詢問所有的患者:
他們想要什麼?擔心什麼?
13:35
I ask all my patients耐心 what they're
hoping希望 for and what they're afraid害怕 of.
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13:39
But here's這裡的 the thing.
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而這就是重點。
病人們不該等到罹患慢性絕症,
13:40
Patients耐心 shouldn't不能 have to wait
until直到 they're chronically長期地 seriously認真地 ill生病,
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不該等到接近生命的盡頭,
13:44
often經常 near the end結束 of life,
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不該等到他們需要尋求
像我這類的醫師,
13:46
they shouldn't不能 have to wait
until直到 they're seeing眼看 a physician醫師 like me
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才有人問他們:
13:50
before somebody asks them,
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「你想要什麼?」
13:52
"What are you hoping希望 for?"
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「你擔心什麼?」
13:53
"What are you afraid害怕 of?"
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這應該融入整個醫療體系的
提供項目之中。
13:54
That should be baked烘烤的 into the way
that healthcare衛生保健 is delivered交付.
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13:59
We can do this --
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我們可以做到這些──
真的可以。
14:01
we really can.
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全國各地的藥用大麻藥局和診所
14:02
Medical marijuana大麻 dispensaries藥房
and clinics診所 all across橫過 the country國家
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都很清楚這件事。
14:05
are figuring盤算 this out.
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規模更大、更主流的醫療系統
14:07
They're figuring盤算 this out
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14:08
in ways方法 that larger, more mainstream主流
health健康 systems系統 are years年份 behind背後.
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在這方面落後他們許多。
14:14
But we can learn學習 from them,
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但我們可以向他們學習,
而且我們必須向他們學習。
14:15
and we have to learn學習 from them.
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1536
我們需要做的
就是放下我們的驕傲──
14:17
All we have to do is swallow our pride自豪 --
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14:19
put aside在旁邊 the thought for a minute分鐘
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暫時放下我們的想法,
14:21
that because we have
lots of letters after our name名稱,
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放下我們名字後面的
一大堆頭銜,
放下我們的專家身份,
14:23
because we're experts專家,
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放下我們在大型
醫療機構裡的主管權力,
14:25
because we're chief首席 medical officers長官
of a large healthcare衛生保健 system系統,
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我們所應該知道的,
是如何滿足病患的需求。
14:28
we know all there is to know
about how to meet遇到 patients'耐心' needs需求.
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4176
我們需要放下驕傲。
14:32
We need to swallow our pride自豪.
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我們需要去拜訪幾間藥用大麻藥局。
14:34
We need to go visit訪問
a few少數 medical marijuana大麻 dispensaries藥房.
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我們需要搞清楚他們在做什麼。
14:37
We need to figure數字 out what they're doing.
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1976
我們需要搞清楚
為什麼很多像羅繽一樣的病人,
14:39
We need to figure數字 out
why so many許多 patients耐心 like Robin知更鳥
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會放棄主流醫療院所,
14:41
are leaving離開 our mainstream主流 medical clinics診所
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轉向藥用大麻藥局。
14:43
and going to these medical
marijuana大麻 dispensaries藥房 instead代替.
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871920
3376
我們需要搞清楚他們的秘訣,
14:47
We need to figure數字 out
what their tricks技巧 are,
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他們使用的工具,
14:49
what their tools工具 are,
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我們需要向他們學習。
14:50
and we need to learn學習 from them.
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如果我們這樣做了,
14:52
If we do,
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我認為我們可以,
並且我們必須做到的,
14:54
and I think we can,
and I absolutely絕對 think we have to,
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我們可以確保所有的患者
都能得到更好的體驗。
14:57
we can guarantee保證 all of our patients耐心
will have a much better experience經驗.
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3400
15:01
Thank you.
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謝謝大家。
15:02
(Applause掌聲)
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(掌聲)
Translated by joya xue
Reviewed by Ting-Chih Liang

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ABOUT THE SPEAKER
David Casarett - Physician
David Casarett asks: What if mainstream health care operated more like a medical marijuana dispensary?

Why you should listen

In his third book, Stoned: A Doctor's Case for Medical Marijuana, palliative care physician David Casarett takes a first-person investigative journalist's approach to making sense of marijuana's therapeutic potential and adverse effects. He shares what he's learned about this chronically misunderstood drug -- including the control it gives patients over their health and the educational atmosphere of dispensaries -- and outlines what we still need to do to explore its potential health benefits.

Casarett is a professor of medicine at the Duke University School of Medicine and chief of palliative care for the Duke Health System. He is the author of more than 100 journal articles, numerous magazine articles, and Shocked, another nonfiction book about the science of resuscitation. Casarett's first novel in the Ethical Chiang Mai Detective Agency series, Murder at the House of Rooster Happiness, was published in September 2016. The next installment, The Missing Guests of the Magic Grove Hotel, will be published in the fall of 2017.

More profile about the speaker
David Casarett | Speaker | TED.com