We all go to doctors.
我们都会去看病就医。
And we do so with trust and blind faith that the test they are ordering and the medications they're prescribing are based upon evidence
我们还盲目的坚信他们所做的测试以及所开的处方药都是有医学根据的
evidence that's designed to help us.
为了能更好的帮助我们。
However, the reality is that that hasn't always been the case for everyone.
然而，现实状况是这些依据并非对每个人都适用。
What if I told you that the medical science discovered over the past century has been based on only half the population?
假如我告诉你医学研究的成果在过去的一个世纪以来仅仅只是基于一半的人口数据得来的呢？
I'm an emergency medicine doctor. I was trained to be prepared in a medical emergency.
我是一个急诊医生。接受的都是医疗急救方面的训练。
It's about saving lives. How cool is that?
也就是关于拯救生命。听起来很酷吧？
OK, there's a lot of runny noses and stubbed toes, but no matter who walks through the door to the ER,
好吧，当然也有很多涕水横流和撞伤脚趾的患者，但是不论是谁走进急诊室的大门，
we order the same tests, we prescribe the same medication, without ever thinking about the sex or gender of our patients.
我们都会做相同的测试，开相同的处方，从来不曾考虑过患者的性别。
Why would we? We were never taught that there were any differences between men and women.
我们为何不考虑呢？因为我们从未被教导过男女之间有何不同。
A recent Government Accountability study revealed that 80 percent of the drugs withdrawn from the market are due to side effects on women.
最近的一项政府责任研究显示，被从市场上撤回的药品中80%都是由于会对女性产生副作用。
So let's think about that for a minute.
让我们思考一下。
Why are we discovering side effects on women only after a drug has been released to the market?
为什么药物已经在市场上开始流通后我们才发觉其对女性有副作用呢？
Do you know that it takes years for a drug to go from an idea to being tested on cells in a laboratory,
你知道一种药物从一个想法开始，到在实验室里对细胞进行测试，
to animal studies, to then clinical trials on humans, finally to go through a regulatory approval process,
到动物研究，到临床人体试验，最后再经过监管审批程序，
to be available for your doctor to prescribe to you?
经由你的医生开处方给你，这一系列过程需要多少年吗？
Not to mention the millions and billions of dollars of funding it takes to go through that process.
更不用说还需要成百上千亿美金的投资款项去推动这一切。
So why are we discovering unacceptable side effects on half the population after that has gone through? What's happening?
那么为何在经历重重验证后，我们仍发现那些不可接受的副作用会出现在半数人口身上呢？究竟发生了什么？
Well, it turns out that those cells used in that laboratory, they're male cells,
事实证明，被实验室用于测试的细胞都是雄性细胞。
and the animals used in the animal studies were male animals, and the clinical trials have been performed almost exclusively on men.
动物研究时所用的也是雄性动物，而临床试验则几乎完全是针对男性的。
How is it that the male model became our framework for medical research?
为什么男性模型会成为医学研究的框架呢？
Let's look at an example that has been popularized in the media, and it has to do with the sleep aid Ambien.
让我们来看一个已被媒体广泛传播的示例吧，是关于一种助眠药物Ambien的。
Ambien was released on the market over 20 years ago, and since then, hundreds of millions of prescriptions have been written,
20多年前Ambien被投放到市场，迄今为止，医生们已经开出了数以百万计的处方，
primarily to women, because women suffer more sleep disorders than men.
主要是针对女性患者，因为女性遭受的睡眠障碍普遍比男性多。
But just this past year, the Food and Drug Administration recommended cutting the dose in half for women only,
然而仅仅在去年，美国食品及药物管理局（FDA）才建议针对女性消减一半的剂量，
because they just realized that women metabolize the drug at a slower rate than men,
因为他们刚意识到女性代谢药物的速度比男性慢得多，
causing them to wake up in the morning with more of the active drug in their system.
这意味着她们一早醒来后身体里所含的活性药物成分将会更多。
And then they're drowsy and they're getting behind the wheel of the car, and they're at risk for motor vehicle accidents.
然后她们就昏昏欲睡地坐进驾驶座，面临着高概率的机动车事故。
And I can't help but think, as an emergency physician, how many of my patients that I've cared for over the years
作为一名急诊医生，我不禁想到，那么多年来我看过的病人中，
were involved in a motor vehicle accident that possibly could have been prevented
有多少人经历的机动车事故是可以避免的，
if this type of analysis was performed and acted upon 20 years ago when this drug was first released.
如果这种分析能在20年前进行并实施，尤其在药品流通到市场上之前。
How many other things need to be analyzed by gender? What else are we missing?
还有多少其他事情是需要做性别分析的？我们还遗漏了什么？
World War II changed a lot of things, and one of them was this need to protect people from becoming victims of medical research without informed consent.
第二次世界大战改变了许多事情，其中一件就是保护所有人避免成为医学研究的无辜受害者。
So some much-needed guidelines or rules were set into place,
许多政策和规则需要立即制定出来，
and part of that was this desire to protect women of childbearing age from entering into any medical research studies.
其中一部分就旨在保护育龄女性不受参与医学研究的威胁。
There was fear: what if something happened to the fetus during the study?
因为存在这样的担心：如果胎儿在研究中受到伤害怎么办？
Who would be responsible? And so the scientists at this time actually thought this was a blessing in disguise,
谁会为此负责呢？所以当时的科学家们还认为这是因祸得福，
because let's face it -- men's bodies are pretty homogeneous.
因为事实上--男性的体征是非常平稳的。
They don't have the constantly fluctuating levels of hormones that could disrupt clean data they could get if they had only men.
他们不会有长期荷尔蒙紊乱的情况去扰乱整齐的数据，所以他们只把男性作为研究对象。
It was easier. It was cheaper. Not to mention, at this time, there was a general assumption that men and women were alike in every way,
这样更简单，也更廉价。更何况，在那个时候人们普遍认为男性和女性的生理特征几乎一模一样，
apart from their reproductive organs and sex hormones.
除了生殖器官和性激素之外。
So it was decided: medical research was performed on men, and the results were later applied to women.
于是就有了这样一个决定：所有医学研究测试都针对男性，之后的研究结果再应用于女性身上。
What did this do to the notion of women's health?
这对女性健康的概念有什么影响呢？
Women's health became synonymous with reproduction: breasts, ovaries, uterus, pregnancy.
女性的健康被与生殖相等同：乳房，卵巢，子宫，怀孕。
It's this term we now refer to as "bikini medicine."
这些词都统称为“比基尼药学”。这
And this stayed this way until about the 1980s, when this concept was challenged by the medical community
种现象一直持续到上世纪八十年代，直到医学界以及公共卫生负责人对此提出异议，
and by the public health policymakers when they realized that by excluding women from all medical research studies we actually did them a disservice,
当他们发现在所有医学研究中排除女性反而是欲速则不达，
in that apart from reproductive issues, virtually nothing was known about the unique needs of the female patient.
因为除了生殖问题之外，我们对女性病人的独特需求一无所知。
Since that time, an overwhelming amount of evidence has come to light that shows us just how different men and women are in every way.
从那时起，大量证据不断涌现，指明了男女之间在各方面都存在差异。
You know, we have this saying in medicine: children are not just little adults.
我们在医学中有这么一句话：不能把小孩儿当作成人的微缩版。
And we say that to remind ourselves that children actually have a different physiology than normal adults.
我们这么说是为了提醒自己儿童的生理状况其实和成人不同。
And it's because of this that the medical specialty of pediatrics came to light.
而就是因为这个，医学界中才有儿科。

And we now conduct research on children in order to improve their lives.
现在我们有儿童医学研究来改善他们的生活。
And I know the same thing can be said about women. Women are not just men with boobs and tubes.
我知道，女性也面临同样的情况。女性不只是有女性生殖器官的男性。
But they have their own anatomy and physiology that deserves to be studied with the same intensity.
她们有自己独特的生理结构，也需要受到同样的重视。
Let's take the cardiovascular system, for example.
我们拿心血管系统来举例。
This area in medicine has done the most to try to figure out why it seems men and women have completely different heart attacks.
这个医学领域做出了许多努力试图找到为什么男性和女性心脏病发作的症状不同。
Heart disease is the number one killer for both men and women,
心脏病在两性中都是最常见的死因，
but more women die within the first year of having a heart attack than men.
但是在心脏病发作第一年内女性死亡率比男性要高。
Men will complain of crushing chest pain -- an elephant is sitting on their chest. And we call this typical. Women have chest pain, too.
发病时，男性常常抱怨有胸口剧痛--像一头大象坐在胸口一样。我们把这叫做典型心脏病。女性也会经历胸痛。
But more women than men will complain of "just not feeling right," "can't seem to get enough air in," "just so tired lately."
但是更多女性会抱怨“感觉不对劲，”“好像喘不过气来，”“感觉最近太累了。”
And for some reason we call this atypical, even though, as I mentioned, women do make up half the population.
我们通常把这个叫做非典型心脏病，尽管我刚才提到过，人口的一半是女性。
And so what is some of the evidence to help explain some of these differences?
那我们有什么证据来解释这些差异呢？
If we look at the anatomy, the blood vessels that surround the heart are smaller in women compared to men,
如果从解剖学的角度来看的话，女性环绕着心脏的血管要比男性的小一些，
and the way that those blood vessels develop disease is different in women compared to men.
这些血管发展疾病的方式在不同性别间也存在着差异。
And the test that we use to determine if someone is at risk for a heart attack,
而我们诊断病人心脏病发病率的测试
well, they were initially designed and tested and perfected in men, and so aren't as good at determining that in women.
原本是根据男性的生理特征来设计，检测和完善的，所以并不适用于女性。
And then if we think about the medications -- common medications that we use, like aspirin.
接下来再看看药品--常用的药品，比如阿司匹林。
We give aspirin to healthy men to help prevent them from having a heart attack,
我们让健康男性服用阿司匹林来预防心脏病，
but do you know that if you give aspirin to a healthy woman, it's actually harmful?
但是你知道如果给健康女性阿司匹林，其实是有害的吗？
What this is doing is merely telling us that we are scratching the surface. Emergency medicine is a fast-paced business.
这些都是在告诉我们我们对这方面的了解还十分有限。急诊药物是一个快节奏商业。
In how many life-saving areas of medicine, like cancer and stroke,
在多少旨在挽救生命的药学领域，比如癌症和中风，
are there important differences between men and women that we could be utilizing?
在男女之间存在重要的区别，让我们可以用来发展医学？
Or even, why is it that some people get those runny noses more than others,
甚至，为什么有些人比其他人更容易流鼻涕，
or why the pain medication that we give to those stubbed toes work in some and not in others?
或者那些碰伤脚趾的人使用的止痛药只在某些人身上管用？
The Institute of Medicine has said every cell has a sex. What does this mean? Sex is DNA.
医学研究所已经发现每个细胞都有自己的性别。这代表什么呢？生理性别就是DNA（脱氧核糖核酸）。
Gender is how someone presents themselves in society.
社会性别则取决于一个人在社会中的举动和表现。
And these two may not always match up, as we can see with our transgendered population.
这两者并不一定完全匹配，比如我们看到的变性人群体。
But it's important to realize that from the moment of conception, every cell in our bodies -- skin, hair, heart and lungs
但是我们必须要认识到，从受孕的那一刻起，我们身体里的每一个细胞--皮肤，头发，心脏，肺脏
contains our own unique DNA, and that DNA contains the chromosomes that determine whether we become male or female, man or woman.
都包含着我们独特的DNA，而这些DNA中就含有决定你的性别，是男性还是女性的染色体。
It used to be thought that those sex-determining chromosomes pictured here -- XY if you're male, XX if you're female
过去我们常认为照片中的性染色体--男性是XY，女性是XX
merely determined whether you would be born with ovaries or testes,
只会决定你会有卵巢还是睾丸，
and it was the sex hormones that those organs produced that were responsible for the differences we see in the opposite sex.
而这些器官产生的性激素是我们看到的异性区别的原因。
But we now know that that theory was wrong -- or it's at least a little incomplete.
但是我们现在知道这个理论是错误的--至少是不全面的。
And thankfully, scientists like Dr.Page from the Whitehead Institute, who works on the Y chromosome, and Doctor Yang from UCLA,
幸好有像来自怀特海德研究所的Page博士一样的科学家，一直在进行Y染色体的研究，还有加州大学洛杉矶分校的杨博士，
they have found evidence that tells us that those sex-determining chromosomes that are in every cell in our bodies continue to remain active for our entire lives
他们已经找到证据指明我们身体中每个细胞中的性染色体在我们的一生中一直处于活跃状态，
and could be what's responsible for the differences we see in the dosing of drugs,
而且可能和我们观察到的男女用药剂量上的差别有关，
or why there are differences between men and women in the susceptibility and severity of diseases.
还有男性和女性对疾病的易感性和病情严重程度存在区别的原因。
This new knowledge is the game-changer, and it's up to those scientists that continue to find that evidence,
这个新发现会彻底改变我们的认知，当前科学家有责任继续寻找和研究这些证据，
but it's up to the clinicians to start translating this data at the bedside, today. Right now.
但是临床医生有责任去分析这些数据，并运用于临床上。现在就要采取行动。
And to help do this, I'm a co-founder of a national organization called Sex and Gender Women's Health Collaborative,
为了推动这项工作，我与人合作创立了一个全国性组织，叫做“性别研究女性健康协会”，
and we collect all of this data so that it's available for teaching and for patient care.
我们收集了所有的这些相关数据，用于教学和患者护理。
And we're working to bring together the medical educators to the table. That's a big job.
我们试图汇集医学教育家来一起合作。这是一项巨大的任务。
It's changing the way medical training has been done since its inception.
从一开始，这就在改变医疗培训的方式。
But I believe in them. I know they're going to see the value of incorporating the gender lens into the current curriculum.
但是我相信他们能够做到。我知道他们会认识到性别研究的重要性，并把它纳入课程中。
It's about training the future health care providers correctly.
这直接联系到对未来医疗人员的正确培训。
And regionally, I'm a co-creator of a division within the Department of Emergency Medicine here at Brown University,
在本地，我是布朗大学急诊医药学科一个部门的联合创始人，
called Sex and Gender in Emergency Medicine, and we conduct the research to determine the differences between men and women in emergent conditions,
部门的名字是“急诊医疗中的性别研究”，我们正在对男性和女性在紧急状况中不同的反应进行研究，
like heart disease and stroke and sepsis and substance abuse, but we also believe that education is paramount.
比如心脏病，中风，脓血症和药物滥用，但是我们始终相信教育是最重要的。
We've created a 360-degree model of education. We have programs for the doctors, for the nurses, for the students and for the patients.
我们创造了一个全方位的教育模式。我们有针对医生，护士，学生和病人的课程方案。
Because this cannot just be left up to the health care leaders.
因为我们不能把问题都留给医疗管理者。
We all have a role in making a difference. But I must warn you: this is not easy.
我们每一个人都有责任去改变现状。但是我必须事先提醒你们：这并不简单。
In fact, it's hard. It's essentially changing the way we think about medicine and health and research.
事实上十分艰难。这在实质上改变了我们看待药物，健康，还有研究的方式。
It's changing our relationship to the health care system.
这也改变了我们和医疗系统之间的关系。
But there's no going back. We now know just enough to know that we weren't doing it right.
但是我们已经无路可退了。我们现在所了解的已经足够证明我们之前的做法是错误的。
Martin Luther King, Jr. has said, "Change does not roll in on the wheels of inevitability, but comes through continuous struggle."
马丁·路德·金曾说过，“改变不会自动到来，唯有经过不断抗争。”
And the first step towards change is awareness. This is not just about improving medical care for women.
而我们要做的第一步就是提高意识。这不仅仅关系到女性的医疗保健。
This is about personalized, individualized health care for everyone.
这是关于每一个人的个性化，个体化的医疗。
This awareness has the power to transform medical care for men and women.
这种意识有能力完全改变两性的医疗。
And from now on, I want you to ask your doctors whether the treatments you are receiving are specific to your sex and gender.
从现在开始，我想让你们问问自己的医生，你们接受的治疗是否针对你的性别。
They may not know the answer -- yet. But the conversation has begun, and together we can all learn.
他们或许不知道答案--但马上就会知道了。改变已经发生了，我们可以一起学习和进步。
Remember, for me and my colleagues in this field, your sex and gender matter. Thank you.
请记住，对我和我的同事而言，你的性别很重要。谢谢！