ted 演讲文档格式.docx

1、t know it was cloudy because my thinking was cloudy.02:12（Laughter）14And it wasnt until I got to the airport check-in counter, that I realized I didnt have my passport.1921So I raced home in the snow and ice, 40 minutes, got my passport, raced back to the airport, I made it just in time, but they ha

2、d given away my seat to someone else, so I got stuck in the back of the plane, next to the bathrooms, in a seat that wouldnt recline, on an eight-hour flight. Well, I had a lot of time to think during those eight hours and no sleep.4243And I started wondering, are there things that I can do, systems

3、 that I can put into place, that will prevent bad things from happening? Or at least if bad things happen, will minimize the likelihood of it being a total catastrophe. So I started thinking about that, but my thoughts didnt crystallize until about a month later. I was having dinner with my colleagu

4、e, Danny Kahneman, the Nobel Prize winner, and I somewhat embarrassedly told him about having broken my window, and, you know, forgotten my passport, and Danny shared with me that hed been practicing something called prospective hindsight.03:18Its something that he had gotten from the psychologist G

5、ary Klein, who had written about it a few years before, also called the pre-mortem. Now, you all know what the postmortem is. Whenever theres a disaster, a team of experts come in and they try to figure out what went wrong, right? Well, in the pre-mortem, Danny explained, you look ahead and you try

6、to figure out all the things that could go wrong, and then you try to figure out what you can do to prevent those things from happening, or to minimize the damage.47So what I want to talk to you about today are some of the things we can do in the form of a pre-mortem. Some of them are obvious, some

7、of them are not so obvious. Ill start with the obvious ones.58Around the home, designate a place for things that are easily lost. Now, this sounds like common sense, and it is, but theres a lot of science to back this up, based on the way our spatial memory works. Theres a structure in the brain cal

8、led the hippocampus, that evolved over tens of thousands of years, to keep track of the locations of important things - where the well is, where fish can be found, that stand of fruit trees, where the friendly and enemy tribes live. The hippocampus is the part of the brain that in London taxicab dri

9、vers becomes enlarged. Its the part of the brain that allows squirrels to find their nuts. And if youre wondering, somebody actually did the experiment where they cut off the olfactory sense of the squirrels, and they could still find their nuts. They werent using smell, they were using the hippocam

10、pus, this exquisitely evolved mechanism in the brain for finding things. But its really good for things that dont move around much, not so good for things that move around. So this is why we lose car keys and reading glasses and passports. So in the home, designate a spot for your keys - a hook by t

11、he door, maybe a decorative bowl. For your passport, a particular drawer. For your reading glasses, a particular table. If you designate a spot and youre scrupulous about it, your things will always be there when you look for them.05:23What about travel? Take a cell phone picture of your credit card

12、s, your drivers license, your passport, mail it to yourself so its in the cloud. If these things are lost or stolen, you can facilitate replacement.36Now these are some rather obvious things. Remember, when youre under stress, the brain releases cortisol. Cortisol is toxic, and it causes cloudy thin

13、king. So part of the practice of the pre-mortem is to recognize that under stress youre not going to be at your best, and you should put systems in place.54And theres perhaps no more stressful a situation than when youre confronted with a medical decision to make. And at some point, all of us are go

14、ing to be in that position, where we have to make a very important decision about the future of our medical care or that of a loved one, to help them with a decision.06:11And so I want to talk about that. And Im going to talk about a very particular medical condition. But this stands as a proxy for

15、all kinds of medical decision-making, and indeed for financial decision-making, and social decision-making - any kind of decision you have to make that would benefit from a rational assessment of the facts.30So suppose you go to your doctor and the doctor says, I just got your lab work back, your ch

16、olesterols a little high. Now, you all know that high cholesterol is associated with an increased risk of cardiovascular disease, heart attack, stroke. And so youre thinking having high cholesterol isnt the best thing, and so the doctor says, You know, Id like to give you a drug that will help you l

17、ower your cholesterol, a statin. And youve probably heard of statins, you know that theyre among the most widely prescribed drugs in the world today, you probably even know people who take them. And so youre thinking, Yeah! Give me the statin.07:06But theres a question you should ask at this point,

18、a statistic you should ask for that most doctors dont like talking about, and pharmaceutical companies like talking about even less. Its for the number needed to treat. Now, what is this, the NNT? Its the number of people that need to take a drug or undergo a surgery or any medical procedure before

19、one person is helped. And youre thinking, what kind of crazy statistic is that? The number should be one. My doctor wouldnt prescribe something to me if its not going to help. But actually, medical practice doesnt work that way. And its not the doctors fault, if its anybodys fault, its the fault of

20、scientists like me. We havent figured out the underlying mechanisms well enough. But GlaxoSmithKline estimates that 90 percent of the drugs work in only 30 to 50 percent of the people. So the number needed to treat for the most widely prescribed statin, what do you suppose it is? How many people hav

21、e to take it before one person is helped? 300. This is according to research by research practitioners Jerome Groopman and Pamela Hartzband, independently confirmed by B. I ran through the numbers myself. 300 people have to take the drug for a year before one heart attack, stroke or other adverse ev

22、ent is prevented.08:Now youre probably thinking, Well, OK, one in 300 chance of lowering my cholesterol. Why not, doc? Give me the prescription anyway. But you should ask at this point for another statistic, and that is, Tell me about the side effects. Right? So for this particular drug, the side ef

23、fects occur in five percent of the patients. And they include terrible things - debilitating muscle and joint pain, gastrointestinal distress - but now youFive percent, not very likely its going to happen to me, Ill still take the drug. But wait a minute. Remember under stress youre not thinking cle

24、arly. So think about how youre going to work through this ahead of time, so you dont have to manufacture the chain of reasoning on the spot. 300 people take the drug, right? One persons helped, five percent of those 300 have side effects, thats 15 people. Youre 15 times more likely to be harmed by t

25、he drug than you are to be helped by the drug.09:15m not saying whether you should take the statin or not. Im just saying you should have this conversation with your doctor. Medical ethics requires it, its part of the principle of informed consent. You have the right to have access to this kind of information to begin the conversation about whether you want to take the risks or not.32Now you might be thinking Ive pulled this number out of the air for shock value, but in fact its rather typical, this number needed to treat. For the most widely performed surgery