听力课堂TED音频栏目主要包括TED演讲的音频MP3及中英双语文稿，供各位英语爱好者学习使用。本文主要内容为演讲MP3+双语文稿:如何更好地为深肤色人种做皮肤病诊断，希望你会喜欢！

【主讲人】Jenna C. Lester
皮肤科医生、加州大学旧金山分校有色人种皮肤病学项目的创始人。
该项目旨在解决非白人患者在医学研究和实践中被排斥和边缘化所带来的持续问题。
她致力于解决由于种族不平等造成的医疗差异，并努力填补教科书中关于非白人皮肤的教育空白。

【演讲主题】Why skin disease is often misdiagnosed in darker skin tones
皮肤是衡量健康状态的重要因素之一。然而很多医生在判断深肤色病人的健康问题上遇到困难，并导致有色人种患者的健康状况较差。演讲者分享了她如何在目前有限的医学培训范围，确保所有的医学生都能接受全面的疾病培训。

【中英文稿】
The skin is the human body's largest organ and one of the most powerful predictors of our health.
皮肤是人身体上面积最大的器官，并且是人类最强大的健康晴雨表之一。

This is erythema migrans, a hallmark feature of Lyme disease, a tick-borne illness present in over 80 countries and estimated to affect 476,000 people in the United States each year. Dermatologists like me are doctors of the skin trained to diagnose and treat skin disease. And this is how we're trained to see erythema migrans, as a bullseye-shaped rash that ranges from red to pink. But this is not at all what it looks like in dark skin. As you can see here, there are hues of violet, of magenta, and even dark brown.
游走性红斑，莱姆病的标志性特征，一种出现在80多个国家的蜱传播疾病，并且预计每年会影响在美国的47万6000人。皮肤科专家，也就是和我一样的管理皮肤的医生，训练有素的诊断和治疗皮肤疾病。这是我们被训练如何看待游走性红斑的，就像是牛眼形状的粉色到红色的皮疹。但在深色的皮肤上，完全不是一个样子。就像你能看到的一样，它是很多种深浅不一的紫罗兰色，洋红色，甚至是深棕色。

If we were to rely only on dermatology textbooks to teach us how to identify skin disease, we would frequently misdiagnose it in patients of color. And this is a huge problem because Lyme disease needs to be treated. Left untreated, Lyme disease has significant health ramifications including arthritis and even nerve damage. And what's more, as we've seen an increase in the incidence of Lyme disease, a phenomenon attributed in part to climate change, as we continue to see and experience the effects of climate change, we may see more people infected with Lyme disease, making it even more important that we're able to accurately diagnose it.
如果我们只依赖皮肤科的教科书来教我们如何识别皮肤疾病，我们会经常对有色人种患者诊断失误。因为莱姆病需要被治疗，这便成了一个大问题。如果不去治疗，莱姆病将对身体健康产生巨大影响，包括关节炎，甚至是神经损伤。另外，我们可以看到莱姆病传播增长地非常快，这个现象部分归因于气候变化，因为我们持续目睹和经历气候变化所造成的影响，我们可能会看到更多人感染莱姆病，让我们能够准确诊断它变得更加重要。

Now, this story of erythema migrans is emblematic of a larger issue. In the United States, 47 percent of graduating dermatology residents report feeling uncomfortable diagnosing skin disease in patients with dark skin. 47 percent. I just want that to sink in for a second. This is a staggering statistic, and this means that the people who have just undergone their most intensive training to become doctors of the skin don't feel comfortable diagnosing and treating all patients. And even so, they graduate from residency, and they're eligible to become board-certified dermatologists, qualified to care for all people.
现在，游走性红斑的故事其实是一个更大问题的象征性缩影。在美国47%即将毕业的皮肤科住院医师称当他们为深肤色患者诊断皮肤疾病时感觉不自在。47%，我想让我们为此沉思一下。这是一个令人震惊的数据，这意味着那些才刚刚受了大量培训，最终成为皮肤科医生的人们在诊断和治疗病人时，并不完全适应。即使这样，他们通过住院医师实习期，有资格成为通过认证的皮肤科执业医师，被准许去治疗所有人。

Now, I wonder, could this be why we still see and experience health care disparities in all aspects of medicine, including dermatology? I believe there's a connection between the fact that almost half of dermatology residents feel uncomfortable diagnosing and treating certain patients and the poorer health outcomes of those same patients.
现在我很想知道，这是不是我们为什么仍在医学领域各个方面看到、经历到卫生保健差异的原因，其中包括皮肤科？我相信与下列事实有关：近一半的皮肤科住院医师对诊断和治疗特定群体的病人感到不自在，而且这一群体的病人通常健康预后较差。

I speak to patients of color all the time who express an awareness of the fact that their dermatologist is unfamiliar with diagnosing skin disease in their skin tone or uncomfortable teaching them how to care for their hair or scalp. And I wonder, what does this awareness that your doctor is uncomfortable with you due to the physician-patient relationship; to trust in the medical establishment; or to the likelihood that someone returns for additional care?
我和有色人种的病人一直在沟通，他们会感受到这一现实情况：他们的皮肤科专家对于诊断他们肤色的皮肤疾病并不是很熟悉，或是对教他们如何护理头发和头皮觉得别扭。而且我纳闷是什么使你觉察到医生和你之间别扭呢？是源自于医师和病患的关系，源自于对医疗机构的信任，还是源自于可能得要回诊接受额外的治疗呢？

A problem in dermatology is that we're not taught how skin disease appears in all skin tones. As a medical student, my classmates and I quickly realized that we only saw dark skin when we were learning about syphilis. And this observation is supported by research that I published in the British Journal of Dermatology in 2019 that shows an overrepresentation of dark skin in chapters focused on sexually transmitted infections, even while those same skin tones are underrepresented elsewhere in the same textbook.
皮肤科存在的一个问题是我们并没被教皮肤疾病在各种肤色中显现的样子。我和我的医学生同学们很快就意识到我们只有在学习梅毒的时候看到过深色皮肤。我于2019年发表在《英国皮肤病学杂志》上的研究支持这一观察结果，发表的论文表明在性传播感染的章节中黑皮肤的比例过高，然而这些相同的肤色在同一本教科书中的其他地方出现得太少。

What does this do to impressionable learners? Does it make them think that someone with dark skin is more likely to have a sexually transmitted infection?
这给学习的人留下了什么样的印象呢？他们会不会觉得有着深色皮肤的人更可能通过性传播感染疾病？

Now, I know some of you may be thinking, I know an algorithm that can solve this or machine learning to the rescue. And I'm here to gently disagree. And that's because the data from which these algorithms learn are the same photos that overrepresent dark skin in certain skin conditions, even while underrepresenting them in others. In other words, these algorithms will be as biased as we are unless we make significant change. I started the Skin of Color program at the University of California, San Francisco, where I work with medical students and residents in an effort to begin to help them unlearn some of these harmful patterns that make it easier to see some things, like dark skin with syphilis, and harder to see others, like dark skin with erythema migrans. I teach everything from how to identify inflammation in dark skin to how to talk to a Black woman about her hair care practices. And one important fact that I always make sure to mention is that it's neither good nor common for Black women to wash their hair every day. And any treatment regimen focused on taking care of the hair and scalp should reflect this important understanding.
现在，我知道你们当中肯定有人在想我知道有个算法可以解决这件事或者机器学习可以对此进行补救。在这里我提出一些异议。这是因为那些算法学习的数据都是在特定情况下，相同类型的被过度滥用的深色皮肤的照片，同时在别的地方又被引用的过少。换句话说，这些算法会和我们一样充满偏见，除非我们做出巨大的改变。我在旧金山的加州大学开始多彩肤色的项目，与和我共同工作的医学生和住院医师齐心合力的去除这些有害的图案学习，这样把看到一些事情变得更容易，像是有梅毒的深肤色，以及那些很难被看到的其他图片，像是存在游走性红斑的深肤色。我教授从如何在深肤色上识别发炎，到与黑人女性去谈论如何做头发护理。一个重要的事实，我每次都确保自己提及到：对黑人女性每天洗头发，即不好也不常见。任何一种注重保护头发和头皮的治疗规划，都应反映出对此的重要性的理解。

My work at the Skin of Color program, as well as the work of similar programs across the country, demonstrate the importance of creating a dedicated educational environment for residents and medical students to learn the full spectrum of skin disease as they appear in all patients, regardless of skin tone. This is an important first step on a long road towards eliminating health care disparities in dermatology. But let's commit to taking this journey together.
我在色彩肤色项目中的工作，和国内其他类似项目的工作，都展示出了为住院医师和医学生 创造专注的学术环境的重要性。使他们能够学习到皮肤疾病的方方面面，因为不管肤色如何， 这些疾病可能会出现在所有病人身上。这是消除皮肤健康保健差异这条长路中至关重要的第一步。但是来让我们共同开启这段旅程。

Thank you.
谢谢。