ted 演讲文档格式.docx

ted 演讲文档格式.docx

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tknowitwascloudybecausemythinkingwascloudy.

02:

12

（Laughter）

14

Anditwasn'

tuntilIgottotheairportcheck-incounter,thatIrealizedIdidn'

thavemypassport.

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SoIracedhomeinthesnowandice,40minutes,gotmypassport,racedbacktotheairport,Imadeitjustintime,buttheyhadgivenawaymyseattosomeoneelse,soIgotstuckinthebackoftheplane,nexttothebathrooms,inaseatthatwouldn'

trecline,onaneight-hourflight.Well,Ihadalotoftimetothinkduringthoseeighthoursandnosleep.

42

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AndIstartedwondering,aretherethingsthatIcando,systemsthatIcanputintoplace,thatwillpreventbadthingsfromhappening?

Oratleastifbadthingshappen,willminimizethelikelihoodofitbeingatotalcatastrophe.SoIstartedthinkingaboutthat,butmythoughtsdidn'

tcrystallizeuntilaboutamonthlater.Iwashavingdinnerwithmycolleague,DannyKahneman,theNobelPrizewinner,andIsomewhatembarrassedlytoldhimabouthavingbrokenmywindow,and,youknow,forgottenmypassport,andDannysharedwithmethathe'

dbeenpracticingsomethingcalledprospectivehindsight.

03:

18

It'

ssomethingthathehadgottenfromthepsychologistGaryKlein,whohadwrittenaboutitafewyearsbefore,alsocalledthepre-mortem.Now,youallknowwhatthepostmortemis.Wheneverthere'

sadisaster,ateamofexpertscomeinandtheytrytofigureoutwhatwentwrong,right?

Well,inthepre-mortem,Dannyexplained,youlookaheadandyoutrytofigureoutallthethingsthatcouldgowrong,andthenyoutrytofigureoutwhatyoucandotopreventthosethingsfromhappening,ortominimizethedamage.

47

SowhatIwanttotalktoyouabouttodayaresomeofthethingswecandointheformofapre-mortem.Someofthemareobvious,someofthemarenotsoobvious.I'

llstartwiththeobviousones.

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Aroundthehome,designateaplaceforthingsthatareeasilylost.Now,thissoundslikecommonsense,anditis,butthere'

salotofsciencetobackthisup,basedonthewayourspatialmemoryworks.There'

sastructureinthebraincalledthehippocampus,thatevolvedovertensofthousandsofyears,tokeeptrackofthelocationsofimportantthings--wherethewellis,wherefishcanbefound,thatstandoffruittrees,wherethefriendlyandenemytribeslive.ThehippocampusisthepartofthebrainthatinLondontaxicabdriversbecomesenlarged.It'

sthepartofthebrainthatallowssquirrelstofindtheirnuts.Andifyou'

rewondering,somebodyactuallydidtheexperimentwheretheycutofftheolfactorysenseofthesquirrels,andtheycouldstillfindtheirnuts.Theyweren'

tusingsmell,theywereusingthehippocampus,thisexquisitelyevolvedmechanisminthebrainforfindingthings.Butit'

sreallygoodforthingsthatdon'

tmovearoundmuch,notsogoodforthingsthatmovearound.Sothisiswhywelosecarkeysandreadingglassesandpassports.Sointhehome,designateaspotforyourkeys--ahookbythedoor,maybeadecorativebowl.Foryourpassport,aparticulardrawer.Foryourreadingglasses,aparticulartable.Ifyoudesignateaspotandyou'

rescrupulousaboutit,yourthingswillalwaysbetherewhenyoulookforthem.

05:

23

Whatabouttravel?

Takeacellphonepictureofyourcreditcards,yourdriver'

slicense,yourpassport,mailittoyourselfsoit'

sinthecloud.Ifthesethingsarelostorstolen,youcanfacilitatereplacement.

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Nowthesearesomeratherobviousthings.Remember,whenyou'

reunderstress,thebrainreleasescortisol.Cortisolistoxic,anditcausescloudythinking.Sopartofthepracticeofthepre-mortemistorecognizethatunderstressyou'

renotgoingtobeatyourbest,andyoushouldputsystemsinplace.

54

Andthere'

sperhapsnomorestressfulasituationthanwhenyou'

reconfrontedwithamedicaldecisiontomake.Andatsomepoint,allofusaregoingtobeinthatposition,wherewehavetomakeaveryimportantdecisionaboutthefutureofourmedicalcareorthatofalovedone,tohelpthemwithadecision.

06:

11

AndsoIwanttotalkaboutthat.AndI'

mgoingtotalkaboutaveryparticularmedicalcondition.Butthisstandsasaproxyforallkindsofmedicaldecision-making,andindeedforfinancialdecision-making,andsocialdecision-making--anykindofdecisionyouhavetomakethatwouldbenefitfromarationalassessmentofthefacts.

30

Sosupposeyougotoyourdoctorandthedoctorsays,"

Ijustgotyourlabworkback,yourcholesterol'

salittlehigh."

Now,youallknowthathighcholesterolisassociatedwithanincreasedriskofcardiovasculardisease,heartattack,stroke.Andsoyou'

rethinkinghavinghighcholesterolisn'

tthebestthing,andsothedoctorsays,"

Youknow,I'

dliketogiveyouadrugthatwillhelpyouloweryourcholesterol,astatin."

Andyou'

veprobablyheardofstatins,youknowthatthey'

reamongthemostwidelyprescribeddrugsintheworldtoday,youprobablyevenknowpeoplewhotakethem.Andsoyou'

rethinking,"

Yeah!

Givemethestatin."

07:

06

Butthere'

saquestionyoushouldaskatthispoint,astatisticyoushouldaskforthatmostdoctorsdon'

tliketalkingabout,andpharmaceuticalcompaniesliketalkingaboutevenless.It'

sforthenumberneededtotreat.Now,whatisthis,theNNT?

It'

sthenumberofpeoplethatneedtotakeadrugorundergoasurgeryoranymedicalprocedurebeforeonepersonishelped.Andyou'

rethinking,whatkindofcrazystatisticisthat?

Thenumbershouldbeone.Mydoctorwouldn'

tprescribesomethingtomeifit'

snotgoingtohelp.Butactually,medicalpracticedoesn'

tworkthatway.Andit'

snotthedoctor'

sfault,ifit'

sanybody'

sfault,it'

sthefaultofscientistslikeme.Wehaven'

tfiguredouttheunderlyingmechanismswellenough.ButGlaxoSmithKlineestimatesthat90percentofthedrugsworkinonly30to50percentofthepeople.Sothenumberneededtotreatforthemostwidelyprescribedstatin,whatdoyousupposeitis?

Howmanypeoplehavetotakeitbeforeonepersonishelped?

300.ThisisaccordingtoresearchbyresearchpractitionersJeromeGroopmanandPamelaHartzband,independentlyconfirmedbyB.Iranthroughthenumbersmyself.300peoplehavetotakethedrugforayearbeforeoneheartattack,strokeorotheradverseeventisprevented.

08:

Nowyou'

reprobablythinking,"

Well,OK,onein300chanceofloweringmycholesterol.Whynot,doc?

Givemetheprescriptionanyway."

Butyoushouldaskatthispointforanotherstatistic,andthatis,"

Tellmeaboutthesideeffects."

Right?

Soforthisparticulardrug,thesideeffectsoccurinfivepercentofthepatients.Andtheyincludeterriblethings--debilitatingmuscleandjointpain,gastrointestinaldistress--butnowyou'

Fivepercent,notverylikelyit'

sgoingtohappentome,I'

llstilltakethedrug."

Butwaitaminute.Rememberunderstressyou'

renotthinkingclearly.Sothinkabouthowyou'

regoingtoworkthroughthisaheadoftime,soyoudon'

thavetomanufacturethechainofreasoningonthespot.300peopletakethedrug,right?

Oneperson'

shelped,fivepercentofthose300havesideeffects,that'

s15people.You'

re15timesmorelikelytobeharmedbythedrugthanyouaretobehelpedbythedrug.

09:

15

mnotsayingwhetheryoushouldtakethestatinornot.I'

mjustsayingyoushouldhavethisconversationwithyourdoctor.Medicalethicsrequiresit,it'

spartoftheprincipleofinformedconsent.Youhavetherighttohaveaccesstothiskindofinformationtobegintheconversationaboutwhetheryouwanttotaketherisksornot.

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NowyoumightbethinkingI'

vepulledthisnumberoutoftheairforshockvalue,butinfactit'

srathertypical,thisnumberneededtotreat.Forthemostwidelyperformedsurgery