My mom, Jennie, took this picture.

OK，首先，先自我介紹一下。

That's my dad, Frank, in the middle.

這張照片是我母親珍妮拍的，

And on his left, my sisters:

在中間的是我爸，法蘭克。

Mary Catherine, Judith Ann, Theresa Marie.

在他左邊的是我姊姊：

John Patrick's sitting on his lap and Kevin Michael's on his right.

瑪莉凱瑟琳、僑蒂絲安、 泰瑞莎馬瑞。

And in the pale-blue windbreaker,

約翰派崔克坐在他腳上， 凱文麥克在他右邊。

Susan Diane. Me.

穿著淺藍色防風夾克的

I loved growing up in a big family.

就是在下我，蘇珊黛安娜。

And one of my favorite things was picking names.

我很開心可以在大家庭長大。

But by the time child number seven came along,

而我最喜歡的事就是命名。

we had nearly run out of middle names.

但到了第七個孩子出生時，

It was a long deliberation

我們家幾乎已經用光所有的名字，

before we finally settled on Jennifer Bridget.

我們考慮了很久，

Every parent in this audience

最後才把珍妮佛布里茲 的名字定下來。

knows the joy and excitement

在場的每位爸爸媽媽

of picking a new baby's name.

都很了解幫寶寶命名時的

And I was excited and thrilled

幸福與興奮。

to help my mom in that special ceremonial moment.

而我竟然可以在這種 喜慶的時刻幫助我媽

But it's not like that everywhere.

自然是興奮又激動的。

I travel a lot and I see a lot.

但世界上的其它地方 就不一定是如此了。

But it took me by surprise to learn

我時常旅行，見聞豐富。

in an area of Ethiopia,

但令我吃驚的是，

parents delay picking the names for their new babies

在伊索比亞的地方，

by a month or more.

父母不會馬上為孩子命名，

Why delay?

有時會拖延到一個月或更久之後。

Why not take advantage of this special ceremonial time?

為什麼要拖延？

Well, they delay because they're afraid.

為什麼不把握特別的一刻？

They're afraid their baby will die.

其實，他們拖延的原因是害怕。

And this loss might be a little more bearable without a name.

他們害怕寶寶會死亡。

A face without a name might help them feel

如果不幸過世，寶寶沒有名字 他們比較不會那麼難過。

just a little less attached.

不取名字能幫助他們

So here we are in one part of the world --

減少一點對新生兒的不捨。

a time of joy, excitement, dreaming of the future of that child --

世上有一部分父母是

while in another world,

——沉浸在幸福裡， 夢想著寶寶的未來——

parents are filled with dread,

而另一個世界的父母......

not daring to dream of a future for their child

卻是擔心受怕，

beyond a few precious weeks.

不敢在那寶貴的幾個星期裡，

How can that be?

夢想著他們小孩的未來。

How can it be that 2.6 million babies

怎麼會這樣？

die around the world

為什麼世界上有

before they're even one month old?

260 萬個小寶寶

2.6 million.

會在出生頭一個月去世？

That's the population of Vancouver.

260萬！

And the shocking thing is:

這可是溫哥華的總人口啊！

Why?

令人震驚的是：

In too many cases, we simply don't know.

為什麼？

Now, I remember recently seeing an updated pie chart.

很多時候，我們真的束手無策。

And the pie chart was labeled,

我記得最近看到一張 最新的圓形圖表，

"Causes of death in children under five worldwide."

圖表的主題是，

And there was a pretty big section of that pie chart, about 40 percent --

《全世界低於五歲小孩的死亡原因》

40 percent was labeled "neonatal."

圖表上有很大部分，大約40%，

Now, "neonatal" is not a cause of death.

有 40% 的原因是「初生」，

Neonatal is simply an adjective,

「初生」不是一種死因

an adjective that means that the child is less than one month old.

「初生」只是一個形容詞，

For me, "neonatal" said: "We have no idea."

是用來形容 剛出生不到一個月的新生兒。

Now, I'm a scientist. I'm a doctor.

對我而言，這像是對著新生兒們說： 「我們無能為力」。

I want to fix things.

我是一位科學家，我是醫生。

But you can't fix what you can't define.

我想要做點事改善這個狀況。

So our first step in restoring the dreams of those parents

但你無法改善你不理解的事。

is to answer the question:

所以，要重建那些父母親的夢想，

Why are babies dying?

我們第一步就是要回答這個問題：

So today, I want to talk about a new approach,

為什麼寶寶會死亡？

an approach that I feel

所以，今天，我想要來談談 一個新的方法，

will not only help us know why babies are dying,

一個我覺得不只可以幫助我們了解

but is beginning to completely transform

為什麼寶寶會死亡，

the whole field of global health.

也讓我們可以開始動手 徹底改革全球醫療系統。

It's called "Precision Public Health."

這個方法叫做「精準公共醫療」。

For me, precision medicine comes from a very special place.

我對「精準醫學」的知識 來自一個特別的地方。

I trained as a cancer doctor, an oncologist.

我是一位癌症及腫瘤醫師。

I got into it because I wanted to help people feel better.

我會進入這一個領域的原因， 是因為我想要讓病人更舒服。

But too often my treatments made them feel worse.

但很多時候，我的治療方式 只會讓他們更痛苦。

I still remember young women being driven to my clinic

我仍記得那些年輕女孩們 被她們的媽媽載來我診所的那一幕，

by their moms --

這些成年人，被她們的媽媽們 載來我的診療室尋求幫助。

adults, who had to be helped into my exam room by their mothers.

我的治療方式讓她們變得很虛弱。

They were so weak

但在當時對抗癌症 這場戰役的前線，

from the treatment I had given them.

我們可用的工具極少。

But at the time, in those front lines in the war on cancer,

而我們擁有的工具，

we had few tools.

無法區別出需要消滅的癌症細胞

And the tools we did have couldn't differentiate

及想要保留的健康細胞。

between the cancer cells that we wanted to hit hard

大家都相當了解這些治療方式 產生的副作用——

and those healthy cells that we wanted to preserve.

掉髮、感到噁心、

And so the side effects that you're all very familiar with --

免疫系統不良， 於是常常別感染的威脅

hair loss, being sick to your stomach,

無時無刻潛伏在我們的身邊。

having a suppressed immune system, so infection was a constant threat --

所以我轉到生物科技領域找方法，

were always surrounding us.

我全心投入到一個 治療乳癌病患的新方法，

And then I moved to the biotechnology industry.

這個方法比較能有效地分辨出

And I got to work on a new approach for breast cancer patients

不健康的細胞或癌細胞。

that could do a better job of telling the healthy cells

這是一種叫「賀癌平」的藥。

from the unhealthy or cancer cells.

賀癌平可以讓我們精準地

It's a drug called Herceptin.

標靶到當時最恐怖的 HER2 乳癌細胞，

And what Herceptin allowed us to do

它能精準地攻擊癌症細胞，

is to precisely target HER2-positive breast cancer,

且對正常細胞的傷害降到最低。

at the time, the scariest form of breast cancer.

相當重大的突破，

And that precision let us hit hard the cancer cells,

感覺相當神奇，

while sparing and being more gentle on the normal cells.

因此今日，

A huge breakthrough.

我們可以利用這些工具——

It felt like a miracle,

大資料、消費監控、基因定序......等等

so much so that today,

來對抗各類疾病。

we're harnessing all those tools --

它可以讓我們用精準的療程

big data, consumer monitoring, gene sequencing and more --

及時對個人做治療。

to tackle a broad variety of diseases.

「精準醫學」變革了癌症治療的方式。

That's allowing us to target individuals

每件事都改變了，

with the right remedies at the right time.

而我希望每件事能再次改變。

Precision medicine revolutionized cancer therapy.

所以，我一直在問我自己：

Everything changed.

為什麼我們把

And I want everything to change again.

這種較聰明的、較精準的 對抗疾病的方式，

So I've been asking myself:

限制在富人階層？

Why should we limit

千萬別誤會我的意思——

this smarter, more precise, better way to tackle diseases

我不是在談，把類似「賀癌平」 這種貴重的藥，

to the rich world?

帶到開發中國家去，

Now, don't misunderstand me --

雖然我是這麼希望。

I'm not talking about bringing expensive medicines like Herceptin

我說的是，

to the developing world,

把這種精準的個人醫療方式，

although I'd actually kind of like that.

轉移去解決公共醫療問題。

What I am talking about

我知道，你們可能在想， 「這女的瘋了，

is moving from this precise targeting for individuals

不能這樣搞，這樣太大膽了！」

to tackle public health problems

但事情是這樣的：

in populations.

在資源有限的情況下， 我們已經開始在做這件事，

Now, OK, I know probably you're thinking, "She's crazy.

而且已經有很大的成效了。

You can't do that. That's too ambitious."

我接下來談談成效如何，

But here's the thing:

我剛跟各位提到， 我是一位癌症醫師，

we're already doing this in a limited way,

但就如同在 80 年代 舊金山受訓的醫師們一樣，

and it's already starting to make a big difference.

我也是一位愛滋病治療醫師，

So here's what's happening.

那段時間，情況非常糟糕。

Now, I told you I trained as a cancer doctor.

感染愛滋病等同宣判死亡，

But like many, many doctors who trained in San Francisco in the '80s,

我所有的愛滋病人都死了。

I also trained as an AIDS doctor.

現在，情況好轉了，

It was a terrible time.

但愛滋病仍然是全球艱苦的挑戰。

AIDS was a death sentence.

全世界，目前約有1700萬 女人感染愛滋病。

All my patients died.

我們都曉得，當這些女人懷孕時，

Now, things are better,

她們會把病毒傳染給小孩。

but HIV/AIDS remains a terrible global challenge.

我們也清楚，因缺乏治療的方式，

Worldwide, about 17 million women are living with HIV.

一半的愛滋寶寶活不到 2 歲。

We know that when these women become pregnant,

但我們知道抗逆轉錄病毒療法可以保證

they can transfer the virus to their baby.

她們不會把病毒傳染給孩子。

We also know in the absence of therapy,

所以，我們要怎麼做？

half those babies will not survive until the age of two.

我們要找出一個 一體適用的方法，

But we know that antiretroviral therapy can virtually guarantee

意思就是要找到一個可以檢測並 治療全世界女人的方法。

that she will not transmit the virus to the baby.

這樣才能達到目標，

So what do we do?

但有點不實際。

Well, a one-size-fits-all approach, kind of like that blast of chemo,

所以，我們把目標轉到 愛滋病率最高的區域。

would mean we test and treat every pregnant woman in the world.

我們知道在撒哈拉南邊的 某些非洲國家有相當高的愛滋病感染率，

That would do the job.

我們可以在這裡檢測並 治療到最多的女人。

But it's just not practical.

這個針對性的公共醫療方式，

So instead, we target those areas where HIV rates are the highest.

在最近這五年，解決了將近一大半

We know in certain countries in sub-Saharan Africa

從母親身上傳染愛滋病到 孩童身上的公共醫療問題。

we can test and treat pregnant women where rates are highest.

（掌聲）

This precision approach to a public health problem

篩檢這些開發中國家懷孕的女人，

has cut by nearly half

充分展示了精準公共醫療

HIV transmission from mothers to baby

可以如何大規模改善現狀。

in the last five years.

所以，

(Applause)

我們要怎麼做？

Screening pregnant women in certain areas in the developing world

因為我們知道，我們做的到。

is a powerful example

我們知道要治療誰、

of how precision public health can change things on a big scale.

要治療甚麼病、

So ...

去哪治療、如何治療。

How do we do that?

對我而言，這些是 精準公共醫療的重要元素：

We can do that because we know.

（治療）誰、甚麼、去哪、如何。

We know who to target,

但讓我們回到 260 萬個 活不到一個月的寶寶身上。

what to target,

問題是這樣的：我們只是不了解。

where to target and how to target.

這聽起來好像不可思議。

And that, for me, are the important elements of precision public health:

但我們想到一個方法，

who, what, where and how.

就是直接找

But let's go back to the 2.6 million babies

有最高嬰兒死亡率國家的母親對話。

who die before they're one month old.

醫療人員會問 寶寶剛過世的母親一個問題，

Here's the problem: we just don't know.

「寶寶有嘔吐嗎？有發高燒嗎？」

It may seem unbelievable,

對話也許就在

but the way we figure out the causes of infant mortality

寶寶去世後的三個月。

in those countries with the highest infant mortality

現在，各位換位思考一下 那位母親的感受，

is a conversation with mom.

那會是一場多麼令人心碎 與備受折磨的對話啊...

A health worker asks a mom who has just lost her child,

更糟糕的是，這一點也沒有幫助，

"Was the baby vomiting? Did they have a fever?"

因為，我們只知道 有發燒嘔吐的情況發生，

And that conversation may take place

但我們不知道為什麼。

as long as three months after the baby has died.

因為缺乏這方面的知識，

Now, put yourself in the shoes of that mom.

我們就無法阻止那位母親、家庭

It's a heartbreaking, excruciating conversation.

或在那個社區的其他家庭

And even worse -- it's not that helpful,

悲劇繼續發生。

because we might know there was a fever or vomiting,

但如果我們應用 精準公共醫療的治療方式呢？

but we don't know why.

舉個例子，

So in the absence of knowing that knowledge,

我們在非洲發現到某些特定區域，

we cannot prevent that mom, that family,

有母親傳染細菌給寶寶 而造成寶寶死亡的案例，

or other families in that community

而這細菌也就是 大家所孰悉的 B 型鏈球菌。

from suffering the same tragedy.

因缺乏治療，這些母親的 下一個寶寶死亡率

But what if we applied a precision public health approach?

會比正常高出七倍。

Let's say, for example,

一旦我們找出問題的核心， 我們就可以利用便宜又安全

we find out in certain areas of Africa

類似青黴素的藥物來避免死亡。

that babies are dying because of a bacterial infection

我們這樣做之後就能夠了解 致病的根本原因，

transferred from the mother to the baby,

這才是重點：

known as Group B streptococcus.

一旦我們了解了， 我們就能用正確的治療方式，

In the absence of treatment, mom has a seven times higher chance

對特定區域的人做精準且即時的治療， 來完成救人的目的。

that her next baby will die.

有了這個方法、這些介入的方式

Once we define the problem, we can prevent that death

及其它類似的方法，

with something as cheap and safe as penicillin.

我深信，

We can do that because then we'll know.

精準公共醫療方法

And that's the point:

可以幫助我們完成 「15 年目標」。

once we know, we can bring the right interventions

我們也可以把它解讀成

to the right population in the right places

每年可以拯救一百萬個寶寶。

to save lives.

每年一百萬個寶寶。

With this approach, and with these interventions

為什麼我們要停下來？

and others like them,

一個對公眾健康這麼有幫助的方法——

I have no doubt

想像一下，還有甚麼病 也可以用這種方式來解決？

that a precision public health approach

為什麼我們不可以更有效地 解決營養不良問題？

can help our world achieve our 15-year goal.

為什麼我們不能防止 女性的子宮頸癌？

And that would translate into a million babies' lives saved

為什麼不能根除瘧疾？

every single year.

（掌聲）

One million babies every single year.

是的，為這件事用力鼓掌吧！

And why would we stop there?

（掌聲）

A much more powerful approach to public health --

各位知道嗎，我們住在 兩個截然不同的世界裡，

imagine what might be possible.

一個世界充滿了科學家，

Why couldn't we more effectively tackle malnutrition?

而另一個世界卻 到處是公共醫療專家。

Why wouldn't we prevent cervical cancer in women?

精準公共醫療的承諾，

And why not eradicate malaria?

就是把這兩個世界結合在一起。

(Applause)

但各位要知道， 我們都住在這兩個世界裡：

Yes, clap for that!

富人與窮人的世界。

(Applause)

我對精準公共醫療 最興奮的地方，

So, you know, I live in two different worlds,

就是將這兩個世界連結一起。

one world populated by scientists,

在富人世界的每一天，

and another world populated by public health professionals.

這些完美的天分與工具， 在我們的掌控下，

The promise of precision public health

用前所未有的精準方式 治療富人的疾病。

is to bring these two worlds together.

當然，我們也要運用這些天分與工具

But you know, we all live in two worlds:

來阻止窮人世界寶寶的死亡。

the rich world and the poor world.

如果我們能做到，

And what I'm most excited about about precision public health

如此，每個爸爸媽媽都可以在 寶寶出生的那一刻，

is bridging these two worlds.

更有信心地幫寶寶命名，

Every day in the rich world,

大膽地夢想寶寶未來的十幾年，

we're bringing incredible talent and tools --

而不是只有幾天而已。

everything at our disposal --

謝謝各位！

to precisely target diseases in ways I never imagined

（掌聲）

would be possible.

Surely, we can tap into that kind of talent and tools

to stop babies dying in the poor world.

If we did,

then every parent would have the confidence

to name their child the moment that child is born,

daring to dream that that child's life will be measured in decades,

not days.

Thank you.

(Applause)