A few years ago, I broke into my own house. I had just driven home,it was around midnight in the dead of Montreal winter, I had been visiting my friend, Jeff, across town, and the thermometer on the front porch read minus 40 degrees -- and don't bother asking ifthat's Celsius or Fahrenheit, min us 40 is where the two scales meet-- it was very cold. And as I stood on the front porch fumbling inmy pockets, I found I didn't have my keys. In fact, I could see them through the window, lying on the dining room table where I hadleft them. So I quickly ran around and tried all the other doorsand windows, and they were locked tight. I thought about calling alocksmith -- at least I had my cellphone, but at midnight, it could take a while for a locksmith to show up, and it was cold. I couldn't go back to my friend Jeff's house for the night because Ihad an early flight to Europe the next morning, and I needed to getmy passport and my suitcase.
幾年前，我闖入了自己的家。 我開車回到家， 在蒙特婁的寒冬， 大約午夜時分， 我開車從城鎮一邊到另一邊， 去看望我的朋友Jeff,門廊上的溫度計顯示零下40度—— 不需要知道是攝氏度還是華氏度, 到了零下40度， 兩個溫度顯示都一樣—— 天氣非常冷。當我站在門廊，摸索著我的口袋， 發現找不到鑰匙。 實際上，我透過窗戶能看到我的鑰匙， 我把它們留在了餐桌上。 我趕緊圍著房子轉，找能進去的門和窗戶， 而它們都被鎖緊了。 我想到打電話給鎖匠， 至少我還有手機， 但在午夜， 鎖匠要過來可能需要一段時間，並且天氣真的很冷。 當晚我又不能回朋友Jeff的家， 因為第二天我要坐早班機到歐洲， 必須要進屋裡拿護照和行李。
So, desperate and freezing cold, I found a large rock and I brokethrough the basement window, cleared out the shards of glass, Icrawled through, I found a piece of cardboard and taped it up overthe opening, figuring that in the morning, on the way to theairport, I could call my contractor and ask him to fix it. This was going to be expensive, but probably no more expensive than amiddle-of-the-night locksmith, so I figured, under the circumstances, I was coming out even.
因此，在絕望和寒冷中， 我找到一塊大石頭， 打破了地下室的窗戶， 清理了玻璃碎片後， 我爬進屋裡， 找到了一塊硬紙板，用膠帶把它封貼在打破的窗戶上， 我想著早晨去機場的路上， 可以打電話給承包商， 請他來修理窗戶。 修理費會很昂貴， 但不會比在午夜時找鎖匠來開鎖更貴， 所以我覺得，在這種情況下 即使打破了窗戶，也還划得來。
Now, I'm a neuro scientist by training and I know a little bit about how the brain performs under stress. It releases cortisol thatraises your heart rate, it modulates adrenaline levels and itclouds your thinking. So the next morning, when I woke up on toolittle sleep, worrying about the hole in the window, and a mentalnote that I had to call my contractor, and the freezingtem peratures, and the meetings I had upcoming in Europe, and, you know, with all the cortisol in my brain, my thinking was cloudy,but I didn't know it was cloudy because my thinking was cloudy.
我是一個職業的神經科學家， 我大概知道在壓力下 大腦是如何工作的。 大腦會釋放皮質醇引起你的心率加速， 它調節你的腎上腺素水平並阻礙你的思維能力。 第二天早晨， 我醒來的時候嚴重睡眠不足， 還在擔心窗戶上打破的洞， 心裡想著必須打電話給承包商，還有，天氣非常寒冷， 在歐洲有個會要開， 還有，因為我大腦釋放的皮質醇， 我的思維變得混沌， 但我沒覺察到它很混沌，因為我的思維很混沌。
And it wasn't until I got to the airport check-in counter, that Irealized I didn't have my passport.
直到我在登機手續辦理櫃檯時， 才意識到我忘了帶護照。
So 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 had given away my seat to someone else, so I got stuck in the back ofthe plane, next to the bathrooms, in a seat that wouldn't recline,on an eight-hour flight. Well, I had a lot of time to think during those eight hours and no sleep.
於是，我在冰天雪地中 用了40分鐘趕回家， 拿了護照後，又趕回機場， 剛好趕上了飛機， 但他們已把我的座位給了別人，我不得不坐在飛機最後一排， 緊挨著洗手間， 在八個小時的飛行中， 我的座椅都不能往後傾。 於是我就有了很多時間去思考，因為我在八小時中無法睡覺。
And I started wondering, are there things that I can do, systems 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 thinkingabout that, but my thoughts didn't crystallize until about a monthlater. I was having dinner with my colleague, Danny Kahneman, the Nobel Prize winner, and I somewhat embarrassedly told him abouthaving broken my window, and, you know, forgotten my passport, and Danny shared with me that he'd been practicing something called prospective hindsight.
我開始想，我能做些什麼， 有什麼切實可行的方法， 可以防止不好的事發生呢? 或者至少， 就算不好的事情真的會發生，也能把損失降到最小。 所以，我開始思考這個問題， 但我沒有想出來， 直到一個月後， 我和同事，也是諾貝爾獎獲得者 DannyKahneman去吃晚餐， 我有點尷尬地告訴他， 我打破窗戶爬進屋裡， 還有忘記拿護照的事， 而Danny和我分享了 他一直在練習的稱為」預測後見之明「的東西。
It's something that he had gotten from the psychologist Gary Klein,who had written about it a few years before, also called thepre-mortem. Now, you all know what the postmortem is. Whenever there's 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 to figure out all the things that could go wrong, and then you try to figure out what you can doto prevent those things from happening, or to minimize the damage.
這是他從心理學家Gary Klein 那裡學到的。 Gary 前幾年已經寫了這個理論， 也稱為"事前剖析"。你們都知道事後剖析是什麼意思。 每當有災難， 一個專家小組就會前去調查， 嘗試找出導致災難的原因，對吧 ?而Danny解釋，在事前剖析中， 你要預測， 嘗試想出可能出錯的所有事情， 然後你要嘗試可能的方法來 防止這些錯誤發生，或將損失降到最小。
So 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 of them are not so obvious. I'll start with the obvious ones.
所以，今天我想和你們談談關於 在事前剖析中， 我們能做的一些事情。 有些方式是顯而易見的， 而有些則不那麼明顯。我先談顯而易見的方式。
Around the home, designate a place for things that are easily lost.Now, this sounds like common sense, and it is, but there's a lot ofscience to back this up, based on the way our spatial memory works.There's a structure in the brain called 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 enemytribes live. The hippo campus is the part of the brain that in London taxicab drivers becomes enlarged. It's the part of the brain that allows squirrels to find their nuts. And if you're wondering,somebody actually did the experiment where they cut off the olfactory sense of the squirrels, and they could still find the irnuts. They weren't using smell, they were using the hippo campus,this exquisitely evolved mechanism in the brain for finding things.But it's really good for things that don't move around much, not so good for things that move around. So this is why we lose car keysand reading glasses and passports. So in the home, designate a spotfor your keys -- a hook by the door, maybe a decorative bowl. Foryour passport, a particular drawer. For your reading glasses, aparticular table. If you designate a spot and you're scrupulous about it, your things will always be there when you look for them.
在家裡，指定一個地方， 放容易丟失的東西。 這聽起來就像是常識，也的確是， 但這符合我們空間記憶的工作原理，有很多科學依據支持這一點。 在我們大腦裡， 有一個叫海馬體的結構， 已經進化超過數萬年了， 它可以追蹤重要東西的位置——例如，水井的位置， 能夠發現魚的地方， 果樹的位置， 以及友好物種和敵對物種 分別居住在哪裡。 海馬體是大腦的一部分，倫敦計程車司機的 海馬體結構通常比常人要大。 松鼠能找到堅果， 也要歸功於它們大腦的海馬體。 你們可能對這點感到疑惑，但有人的確做了一個實驗。 他們切掉了松鼠的嗅覺器官， 松鼠仍然能找到它們的堅果。 它們不是用嗅覺， 而是用大腦的海馬體，這個進化完美的大腦機制 是用來找東西的。 但只是對找固定的東西比較有效， 找會移動的東西卻不是很管用。 這就是為什麼我們會常常找不到車鑰匙，老花鏡和護照。 所以，在家裡指定一個 地點存放你的鑰匙—— 門上的掛鈎，或是一個裝飾碗。 在一個特定的抽屜存放你的護照。你的老花鏡要放在特定的桌子上。 如果你指定了特定的地方， 並且一絲不苟地做這些事， 當你尋找它們時， 這些東西總是會在那裡。
What about travel? Take a cell phone picture of your credit cards,your driver's license, your passport, mail it to yourself so it'sin the cloud. If these things are lost or stolen, you canfacilitate replacement.
關於旅行呢? 用手機拍下你信用卡的照片， 還有你的駕照和護照， 把這些照片發到你的電子郵箱， 儲存在數據云端。 如果一旦丟失或被盜了，你可以很方便地用電子件代替它們。
Now these are some rather obvious things. Remember, when you'reunder stress, the brain releases cortisol. Cortisol is toxic, and it causes cloudy thinking. So part of the practice of the pre-mortem is to recognize that under stress you're not going to beat your best, and you should put systems in place.
這些是一些顯而易見的 事前剖析方法。 記住，當你有壓力時， 大腦會釋放皮質醇。 皮質醇是有毒的， 它會導致思維不清晰。所以，做事前剖析的練習， 是要認識到在壓力下， 你不是在最佳狀態， 你還應該把事情做到井然有序。
And there's perhaps no more stressful a situation than when you're confronted with a medical decision to make. And at some point, all of us are going 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.
不過也許沒有什麼 比你要做醫療決策 更緊張的情況了。 有時，我們都會經歷這種事情， 我們必須要做出一個很重要的決策，為我們自己或自己愛的人 做醫療決策。
And so I want to talk about that. And I'm going to talk about avery particular medical condition. But this stands as a proxy forall 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.
所以，我想談談這個話題。 我要說一個非常特殊的醫療情況。 但它代表了各種決策：醫療決策， 當然還有財政決策和社交決策——任何你必須做的決策， 可以讓你從理性的事實評估中受益。
So suppose you go to your doctor and the doctor says, "I just got your lab work back, your cholesterol's a little high." Now, you all know that high cholesterol is associated with an increased risk of cardiovascular disease, heart attack, stroke. And so you'rethinking having high cholesterol isn't the best thing, and so the doctor says, "You know, I'd like to give you a drug that will help you lower your cholesterol, a statin." And you've probably heard of statins, you know that they're among the most widely prescribed drugs in the world today, you probably even know people who take them. And so you're thinking, "Yeah! Give me the statin."
假設你去看醫生，而醫生說， 「我剛拿到你驗血結果， 你的膽固醇有點高。」 你們都知道，膽固醇高 會增加患心血管疾病，心臟病和中風的風險。 所以，你會想 高膽固醇不是一件好事， 那麼醫生會說：「我給你開點藥， 幫助你降低膽固醇， 他汀類藥就可以。」你可能已經聽說過他汀類藥物， 現如今是醫生開的 最多的處方藥之一。 你甚至可能認識服用這藥的人。於是你想，「好吧，給我他汀類藥。」
But there's a question you should ask at this point, a statistic you should ask for that most doctors don't like talking about, and pharmaceutical companies like talking about even less. It's for then umber needed to treat. Now, what is this, the NNT? It's the number of people that need to take a drug or under go a surgery or any medical procedure before one person is helped. And you're thinking,what kind of crazy statistic is that? The number should be one. Mydoctor wouldn't prescribe something to me if it's not going tohelp. But actually, medical practice doesn't work that way. And it's not the doctor's fault, if it's anybody's fault, it's the fault of scientists like me. We haven't figured out the under lying mechanisms well enough. But Glaxo SmithKline estimates that 90percent of the drugs work in only 30 to 50 percent of the people.So the number needed to treat for the most widely prescribedstatin, what do you suppose it is? How many people have 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 Bloomberg.com. I ran through the numbers myself. 300 people have to take the drug for a year before one heart attack, stroke or other adverse event is prevented.
但這個時候，你必須問一個問題，一個許多醫生不願談論， 製藥公司更不喜歡談論到的 一個統計數字。 這個統計數字就是，治療所需人數。這是什麼意思呢， 治療所需人數(NNT)? 它是指多少人服用了某種藥， 或接收了手術或其他任何治療方式， 才會有1人收益。 你心說，這是哪門子統計數字? 這數字應該是1啊， 如果這藥對我沒有幫助， 那醫生就不會開給我。 但實際上， 醫療實踐不是這樣運行的。這不是醫生的錯， 如果是某些人的錯， 那就是像我一樣的科學家的錯。 我們還沒有想出足夠好的運作機制。 但據葛蘭素史克製藥公司(Glaxo Smith Kline)估計， 90%的藥品只對30%到50%的人有用。 所以，這種最廣泛的處方藥的 治療所需人數，你們猜是多少? 多少人要服用它 才會出現一個受益的人? 300。 這是根據研究工作者 Jerome Groopman 和 PamelaHartzband 做的研究得出的數據， 這項研究由Bloomberg.com 權威網站獨立證實過。 我自己想了一下這個數字。必須有300人服用此藥一年， 才能預防一起心臟病， 中風或其他疾病。
Now you're probably thinking,"Well,OK,onein 300 chance oflowering 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 effects occur in five percent of the patients. And they include terrible things -- debilitating muscle and joint pain, gastrointestinal distress -- but now you'rethinking, "Five percent, not very likely it's going to happen tome, I'll still take the drug." But wait a minute. Remember understress you're not thinking clearly. So think about how you're going to work through this ahead of time, so you don't have tomanu facture the chain of reasoning on the spot. 300 people take the drug, right? One person's helped, five percent of those 300 have side effects, that's 15 people. You're 15 times more likely to beharmed by the drug than you are to be helped by the drug.
現在你可能在想，「好吧，還有300分之1的機會 可以降低我的膽固醇。 為什麼不服用呢?醫生， 給我開這個藥。」 但是你應該問醫生，有關這藥的另一個統計數字， 那就是，」告訴我這藥的副作用。」 對吧? 那麼針對這種藥， 副作用會發生在5%的患者身上。這些副作用包括一些可怕的情況—— 肌無力，關節疼痛和腸胃不適 —— 但你可能覺得：「 才5%的比例， 不太可能發生在我身上，我還是會服用它。」 但是，請等等。 記住在壓力下，你可能 思維混亂，不能考慮清楚。 所以，要提前思考一下你該如何做，這樣你就不用事到臨頭時 再去進行一連串的推理了。 300人要服用這藥， 才會有一個人受益，對吧? 300人中5%的人會受藥物副作用的影響， 也就是15人。 你受藥物副作用傷害的可能性 是你受益於藥物的15倍。
Now, I'm not saying whether you should take the statin or not. I'm just saying you should have this conversation with your doctor.Medical ethics requires it, it's 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.
我並不是想表明 你該不該服用他汀類藥物。我只是說，你應該諮詢你的醫生。 醫德要求我們這樣做， 這是知情同意原則的一部分。你有權力要求知道這類信息， 有權和醫生談你是否 願意承擔這樣的風險。
Now you might be thinking I've pulled this number out of the airfor shock value, but in fact it's rather typical, this number needed to treat. For the most widely performed surgery on men overthe age of 50, removal of the prostate for cancer, the number needed to treat is 49. That's right, 49 surgeries are done forevery one person who's helped. And the side effects in that caseoccur in 50 percent of the patients. They include impotence,erectile dys function, urinary incontinence, rectal tearing, fecalin continence. And if you're lucky, and you're one of the 50 percent who has these, they'll only last for a year or two.
現在你可能會想我為了製造震撼的效果 憑空捏造了這個數字， 但實際上，這個治療所需人數 是相當具有代表性的。 對於50歲以上的男性，做的最多的手術是為治療 前列腺癌而切除前列腺， 治療所需人數是49。 是的，49個患者做了手術 才會出現一個受益的人。而這種情況手術的副作用 會發生在50%的患者身上。 這些副作用包括陽痿， 勃起功能障礙， 尿失禁，直腸撕裂， 大便失禁。如果你「有幸」成為了50% 受副作用影響的人中的一個， 這些副作用通常只會持續1-2年。
So the idea of the pre-mortem is to think ahead of time to the questions that you might be able to ask that will push the conversation forward. You don't want to have to manufacture all of this on the spot. And you also want to think about things like quality of life. Because you have a choice oftentimes, do you Iwant a shorter life that's pain-free, or a longer life that might have a great deal of pain towards the end? These are things to talk about and think about now, with your family and your loved ones.You might change your mind in the heat of the moment, but at least you're practiced with this kind of thinking.
所以，事前剖析是要提前想好你想問醫生的問題， 這樣會深入推進你和醫生的對話。 畢竟你不想事到臨頭 再來思考所有事情。而且你也需要考慮一下生活質量。 因為通常你是有選擇的， 你想要較短的沒有痛苦的人生， 或想要較長的最終 要承受巨大痛苦的人生呢?這些都是現在需要 談論和思考的問題， 和你的家人，愛人一起。 你可能會在事發時改變你的想法， 但至少你練習了這種思維方法。
Remember, our brain under stress releases cortisol, and one of the things that happens at that moment is a whole bunch on systems shutdown. There's an evolutionary reason for this. Face-to-face with apredator, you don't need your digestive system, or your libido, oryour immune system, because if you're body is expending metabolismon those things and you don't react quickly, you might become the lion's lunch, and then none of those things matter. Unfortunately,one of the things that goes out the window during those times ofstress is rational, logical thinking, as Danny Kahneman and his colleagues have shown. So we need to train ourselves to think ahead to these kinds of situations.
請記住，我們的大腦 在壓力下會釋放皮質醇，在那一刻發生的一件事是 你整個思維系統似乎停工了。 這裡有一個進化方面的原因。和一個捕食者面對面時， 你不需要你的消化系統， 性慾或者免疫系統的幫助。 因為如果你的身體忙著在 這些事情上進行新陳代謝，你就不能迅速作出反應， 那麼你可能會成為獅子的午餐， 然後那些事情也就不重要了， 不幸的是， 在緊張時，其中一件會出錯的事情是理性地，有邏輯地思考。 Danny Kahneman和他的同事 已經證明了這點。 所以，我們需要培養 自己超前思考的習慣，去面對這類事情。
I think the important point here is recognizing that all of us are flawed. We all are going to fail now and then. The idea is to think ahead to what those failures might be, to put systems in place that will help minimize the damage, or to prevent the bad things from happening in the first place.
這裡很重要的一點是，要認識 到我們所有人都不是完美的。我們都會不時地經歷失敗， 事前剖析就要超前思考 可能的失敗會是什麼，井然有序地做事有助於 把傷害減到最小， 或者在第一時間 防止糟糕的事情發生。
Getting back to that snowy night in Montreal, when I got back frommy trip, I had my contractor install a combination lock next to the door, with a key to the front door in it, an easy to remember combination. And I have to admit, I still have piles of mail that haven't been sorted, and piles of emails that I haven't gone through. So I'm not completely organized, but I see organization asa gradual process, and I'm getting there.Thank you very much.
說回到我在蒙特婁 那個冰天雪地的晚上，當我從歐洲返程回到家時， 我的承包商在門旁邊安裝了密碼鎖， 還有一把鑰匙以及一個簡單易記的密碼。 我不得不承認， 我還是有一堆沒有分類的信件， 以及一堆沒有處理的郵件。 所以，我還沒能完全做到井然有序，但我把井然有序做事 看成是一個漸進的過程， 也正在慢慢實現這個目標。 謝謝。