As a kid I always loved information that I could get from data and the stories that could be told with numbers. I remember, growing up, I'd be frustrated at how my own parents would lie to me using numbers. "Talithia, if I've told you once I've told you a thousand times." No dad, you've only told me 17 times and twice it wasn't my fault. (Laughter)
I think that is one of the reasons I got a Ph.D. in statistics. I always wanted to know, what are people trying to hide with numbers? As a statistician, I want people to show me the data so I can decide for myself. Donald and I were pregnant with our third child and we were at about 41 and a half weeks, what some of you may refer to as being overdue. Statisticians, we call that being within the 95 percent confidence interval. (Laughter) And at this point in the process we had to come in every couple of days to do a stress test on the baby, and this is just routine, it tests whether or not the baby is feeling any type of undue stress. And you are rarely, if ever, seen by your actual doctor, just whoever happens to be working at the hospital that day. So we go in for a stress test and after 20 minutes the doctor comes out and he says, "Your baby is under stress, we need to induce you." Now, as a statistician, what's my response? Show me the data! So then he proceeds to tell us the baby's heart rate trace went from 18 minutes, the baby's heart rate was in the normal zone and for two minutes it was in what appeared to be my heart rate zone and I said, "Is it possible that maybe this was my heart rate? I was moving around a little bit, it's hard to lay still on your back, 41 weeks pregnant for 20 minutes. Maybe it was shifting around." He said, "Well, we don't want to take any chances." I said okay. I said, "What if I was at 36 weeks with this same data? Would your decision be to induce?" "Well, no, I would wait until you were at least 38 weeks, but you are almost 42, there is no reason to leave that baby inside, let's get you a room." I said, "Well, why don't we just do it again? We can collect more data. I can try to be really still for 20 minutes. We can average the two and see what that means. (Laughter) And he goes, "Ma'am, I just don't want you to have a miscarriage." That makes three of us. And then he says, "Your chances of having a miscarriage double when you go past your due date. Let's get you a room." Wow. So now as a statistician, what's my response? Show me the data! Dude, you're talking chances, I do chances all day long, tell me all about chances. Let's talk chances. (Laughter) Let's talk chances.
So I say, "Okay, great. Do I go from a 30-percent chance to a 60-percent chance? Where are we here with this miscarriage thing? And he goes, "Not quite, but it doubles, and we really just want what's best for the baby." Undaunted, I try a different angle. I said, "Okay, out of 1,000 full-term pregnant women, how many of them are going to miscarry just before their due date? And then he looks at me and looks at Donald, and he goes, about one in 1,000. I said, "Okay, so of those 1,000 women, how many are going to miscarry just after their due date?"
Okay, so at this point the data is not convincing us that we need to be induced, and so then we proceed to have a conversation about how inductions lead to a higher rate of Cesarean sections, and if at all possible we'd like to avoid that. And then I said, "And I really don't think my due date is accurate." (Laughter) And so this really stunned him and he looked sort of puzzled and I said, "You may not know this, but pregnancy due dates are calculated assuming that you have a standard 28-day cycle, and my cycle ranges — sometimes it's 27, sometimes it's up to 38 — and I have been collecting the data to prove it. (Laughter) And so we ended up leaving the hospital that day without being induced. We actually had to sign a waiver to walk out of the hospital. And I'm not advocating that you not listen to your doctors, because even with our first child, we were induced at 38 weeks; cervical fluid was low. I'm not anti-medical intervention. But why were confident to leave that day? Well, we had data that told a different story. We had been collecting data for six years. I had this temperature data, and it told a different story. In fact, we could probably pretty accurately estimate conception. Yeah, that's a story you want to tell at your kid's wedding reception. (Laughter) I remember like it was yesterday. My temperature was a sizzling 97.8 degrees as I stared into your father's eyes. (Laughter) Oh, yeah. Twenty-two more years, we're telling that story. But we were confident to leave because we had been collecting data. Now, what does that data look like? Here's a standard chart of a woman's waking body temperature during the course of a cycle. So from the beginning of the menstrual cycle till the beginning of the next. You'll see that the temperature is not random. Clearly there is a low pattern at the beginning of her cycle and then you see this jump and then a higher set of temperatures at the end of her cycle. So what's happening here? What is that data telling you? Well, ladies, at the beginning of our cycle, the hormone estrogen is dominant and that estrogen causes a suppression of your body temperature. And at ovulation, your body releases an egg and progesterone takes over, pro-gestation. And so your body heats up in anticipation of housing this new little fertilized egg. So why this temperature jump? Well, think about when a bird sits on her eggs. Why is she sitting on them? She wants to keep them warm, protect them and keep them warm. Ladies, this is exactly what our bodies do every month, they heat up in anticipation of keeping a new little life warm. And if nothing happens, if you are not pregnant, then estrogen takes back over and that cycle starts all over again. But if you do get pregnant, sometimes you actually see another shift in your temperatures and it stays elevated for those whole nine months. That's why you see those pregnant women just sweating and hot, because their temperatures are high. Here's a chart that we had about three or four years ago. We were really very excited about this chart. You'll see the low temperature level and then a shift and for about five days, that's about the time it takes for the egg to travel down the fallopian tube and implant, and then you see those temperatures start to go up a little bit. And in fact, we had a second temperature shift, confirmed with a pregnancy test that were indeed pregnant with our first child, very exciting. Until a couple of days later I saw some spotting and then I noticed heavy blood flow, and we had in fact had an early stage miscarriage. Had I not been taking my temperature I really would have just thought my period was late that month, but we actually had data to show that we had miscarried this baby, and even though this data revealed a really unfortunate event in our lives, it was information that we could then take to our doctor. So if there was a fertility issue or some problem, I had data to show: Look, we got pregnant, our temperature shifted, we somehow lost this baby. What is it that we can do to help prevent this problem? And it's not just about temperatures and it's not just about fertility; we can use data about our bodies to tell us a lot of things.
For instance, did you know that taking your temperature can tell you a lot about the condition of your thyroid? So, your thyroid works a lot like the thermostat in your house. There is an optimal temperature that you want in your house; you set your thermostat. When it gets too cold in the house, your thermostat kicks in and says, "Hey, we need to blow some heat around." Or if it gets too hot, your thermostat registers, "Turn the A.C. on. Cool us off." That's exactly how your thyroid works in your body. Your thyroid tries to keep an optimal temperature for your body. If it gets too cold, your thyroid says, "Hey, we need to heat up." If it gets too hot, your thyroid cools you down. But what happens when your thyroid is not functioning well? When it doesn't function, then it shows up in your body temperatures, they tend to be lower than normal or very erratic. And so by collecting this data you can find out information about your thyroid.
Now, what is it, if you had a thyroid problem and you went to the doctor, your doctor would actually test the amount of thyroid stimulating hormone in your blood. Fine. But the problem with that test is it doesn't tell you how active the hormone is in your body. So you might have a lot of hormone present, but it might not be actively working to regulate your body temperature. So just by collecting your temperature every day, you get information about the condition of your thyroid. So, what if you don't want to take your temperature every day? I advocate that you do, but there are tons of other things you could take. You could take your blood pressure, you could take your weight — yeah, who's excited about taking their weight every day? (Laughter)
Early on in our marriage, Donald had a stuffy nose and he had been taking a slew of medications to try to relieve his stuffy nose, to no avail. And so, that night he comes and he wakes me up and he says, "Honey, I can't breath out of my nose." And I roll over and I look, and I said, "Well, can you breath out of your mouth?" (Laughter) And he goes, "Yes, but I can't breath out of my nose!" And so like any good wife, I rush him to the emergency room at 2 o'clock in the morning. And the whole time I'm driving and I'm thinking, you can't die on me now. We just got married, people will think I killed you! (Laughter) And so, we get to the emergency room, and the nurse sees us, and he can't breath out of his nose, and so she brings us to the back and the doctor says, "What seems to be the problem?" and he goes, "I can't breath out of my nose." And he said, "You can't breath out of your nose? No, but he can breath out of his mouth. (Laughter) He takes a step back and he looks at both of us and he says "Sir, I think I know the problem. You're having a heart attack. I'm going to order an EKG and a CAT scan for you immediately." And we are thinking, no, no, no. It's not a heart attack. He can breathe, just out of his mouth. No, no, no, no, no. And so we go back and forth with this doctor because we think this is the incorrect diagnosis, and he's like, "No really, it'll be fine, just calm down." And I'm thinking, how do you calm down? But I don't think he's having a heart attack. And so fortunately for us, this doctor was at the end of the shift. So this new doctor comes in, he sees us clearly distraught, with a husband who can't breath out of his nose. (Laughter) And he starts asking us questions. He says, "Well, do you two exercise?" We ride our bikes, we go to the gym occasionally. (Laughter) We move around. And he says, "What were you doing just before you came here?" I'm thinking, I was sleeping, honestly. But okay, what was Donald doing just before? So Donald goes into this slew of medications he was taking. He lists, "I took this decongestant and then I took this nasal spray," and then all of a sudden a lightbulb goes off and he says, "Oh! You should never mix this decongestant with this nasal spray. Clogs you up every time. Here, take this one instead." He gives us a prescription. We're looking at each other, and I looked at the doctor, and I said, "Why is it that it seems like you were able to accurately diagnose his condition, but this previous doctor wanted to order an EKG and a CAT scan?" And he looks at us and says, "Well, when a 350-pound man walks in the emergency room and says he can't breath, you assume he's having a heart attack and you ask questions later." Now, emergency room doctors are trained to make decisions quickly, but not always accurately. And so had we had some information about our heart health to share with him, maybe we would have gotten a better diagnosis the first time.
I want you to consider the following chart, of systolic blood pressure measurements from October 2010 to July 2012. You'll see that these measurements start in the prehypertension/hypertension zone, but over about the course of a year and a half they move into the normal zone. This is about the heart rate of a healthy 16-year-old. What story is this data telling you? Obviously it's the data from someone who's made a drastic transformation, and fortunately for us, that person happens to be here today. So that 350-pound guy that walked into the emergency room with me is now an even sexier and healthier 225-pound guy, and that's his blood pressure trace. So over the course of that year and a half Donald's eating changed and our exercise regimen changed, and his heart rate responded, his blood pressure responded to that change that he made in his body.
So what's the take-home message that I want you to leave with today? By taking ownership of your data just like we've done, just by taking this daily measurements about yourself, you become the expert on your body. You become the authority. It's not hard to do. You don't have to have a Ph.D. in statistics to be an expert in yourself. You don't have to have a medical degree to be your body's expert. Medical doctors, they're experts on the population, but you are the expert on yourself. And so when two of you come together, when two experts come together, the two of you are able to make a better decision than just your doctor alone. Now that you understand the power of information that you can get through personal data collection, I'd like you all to stand and raise your right hand. (Laughter) Yes, get it up. I challenge you to take ownership of your data. And today, I hereby confer upon you a TEDx associate's degree in elementary statistics with a concentration in time-dependent data analysis with all the rights and privileges appertaining thereto. And so the next time you are in your doctor's office, as newly inducted statisticians, what should always be your response? Audience: Show me the data! Talithia Williams: I can't hear you! Audience: Show me the data! TW: One more time! Audience: Show me the data! TW: Show me the data. Thank you. (Applause)
我想这是为什么我去念了统计学博士的原因之一 我总是想知道 人们在数字背后隐藏了什么秘密 作为统计学家 我总是要求人们给我看数据 然后我自己来做出判断 当我怀着我的第三个孩子的时候 我已经41周半了 在座有些人可能会觉得我已经超预产期了 在统计学上 我们说这还在95%置信区间 （笑声） 在这段时间 我们需要每隔两天 去做一次胎儿压力检查 这是例行公事 用来检测胎儿是否 感受到了过大的压力 通常你很少会碰到你自己的大夫 谁在那天值班就是谁看诊 所以在我们去做了压力测试 20分钟之后，医生出来跟我们说 “你的孩子压力过大，我们需要引产。” 现在，作为统计学家，你猜我会怎么说？ “给我看数据！” 于是他就告诉我 胎儿过去18分钟的心率数据是正常的 最后两分钟的心率看起来更像是 我自己的心率范围，于是我说 “有没有可能那是我的心率？ 我刚才下来走了走 让一个41周的孕妇 平躺20分钟不动是有点难的 可能胎儿也因此动了动。” 他说，“嗯，我们不想出任何差错。” 我说，“好。如果我现在是36周， 也是这个数据 你也会建议我引产吗？” “嗯，不会，我会等到你至少38周 不过你先已经快42周了 没有理由还让胎儿在里面 让我来帮你准备产房。” 我说，“那么， 让我们再做一次检查吧？ 我们可以拿到更多的数据 我可以尝试坚持平躺20分钟不动 我们可以把两次结果取平均值 再看看结果如何？“（笑声） 他听了之后说 “女士，我只是不希望你流产。” 我们当然都不希望如此 他继续说 “当你过了预产期还没有生产的时候， 你发生流产的可能性就提高了一倍。 我们开始吧。” 哇。这时，作为统计学家 我是什么反应呢？ 给我看数据！ 老兄，你跟我谈概率 我天天都跟概率打交道，要跟我谈概率 我们就来谈概率吧 （笑声） 我们来谈概率
好，到目前为止所有这些数据都没有说服我们 让我们接受引产 于是接下来我们又开始新一轮讨论 有关引产手术会增加 剖腹产的可能性， 而这个是我们希望能够避免的 然后我说 “其实我真的不知道我的预产期是否是准确的。” （笑声） 这句话真的惊到他了 他看起来非常的困惑 我接着说，“你可能不知道 但是预产期的计算是 基于28天的生理周期 而我的月经周期不规律 从27天到38天不等 而且我有自己的周期记录来证明这一点 （笑声） 所以，那天最后的结果是， 我们没有引产，回家了 事实上我们必须签一个免责声明 才能够从医院回家 我不是在怂恿你不去听你的医生的话 因为我们的第一个孩子 也是在第38周的时候引产的 因為子宮頸黏液偏低 我并不是那种反对医疗介入的人 但是为什么那天我会满怀自信的离开医院 那是因为我有数据，支持我的观点 我们已经收集了6年相关的数据 我收集了体温数据 这个数据透露出来不同的信息 事实上，我们有可能 非常精确的预测怀孕 或许你会愿意在你孩子的婚礼上 分享这个故事（笑声） 我还记得那天，就像昨天才发生一样 当我与你父亲深情对望的时候 我的体温飙到了97.8华氏度 （笑声） 是的。二十多年过去了 我们一直在说这个故事 那天我们之所以很自信的离开医院 因为我们一直在收集数据 这些数据看起来如何？ 这是一个女性 在一次完整的生理周期过程中 早晨体表温度的变化图 从每次月经周期的开始 到下一次月经周期的开始 你会看到这个温度曲线是有规律的 很明显的在生理周期的开始 温度是比较低的 然后你会看到温度突然上升 直到她生理周期的结束 为什么会这样？ 这些数据告诉你什么？ 女士们，在我们周期的开始 你体内主要是雌性激素起主导作用 这种激素会抑制你的体温 排卵期开始之后，你的身体产生一个卵子 这个时候孕酮开始起主导作用，准备怀孕 所以你的身体开始升温 为新的受精卵做好准备工作 为什么温度突然升高？ 想想鸟类妈妈孵蛋 为什么鸟妈妈要坐在蛋上呢？ 因为她希望保持蛋的温度 保护它们并让它们保持温暖 女士们，我们的身体每个月都在做同样的事情 它提高我们的体温 为接纳新生命做准备 如果什么事情都没有发生，没有怀孕 那么雌性激素的水平又会上来 这个循环又重新开始 而当你真的受孕了 那么你会看到另一种体温变化曲线 温度会一直保持在较高的水平直到分娩 这就是为什么有些孕妇 很容易出汗，觉得热 因为她们的体温就是变高了 这是我们三四年前记录的数据 我们看到这个曲线的时候真的很兴奋 你看到刚开始的时候体温是偏低的 然后开始变高，持续4到5天 这大概是一个卵细胞从输卵管 移动到子宫开始着床的时间 然后你看到温度的数值 又开始往上提高了一点点 事实上，当时我们看到了第二个温度的变化 通过早早孕测试 证实了我确实怀孕了 那是我们的第一个孩子 我们非常兴奋 但是在几天之后 我开始有点状出血 接着我注意到出血量大量增加 事实上我是怀孕初期流产 如果我没有一直保持记录这些数据 我非常有可能把这个事情理解为 我那次的月经延后而已 但是我们通过这些数据知道了 我实际上经历了一次流产 即使这些数据透露出来的故事 对于我们而言是不幸的 当我们去找医生的时候 这些信息依然非常有价值 所以当我们去咨询受孕有关的问题时 我有数据可以提供（给大夫）: 看，我之前怀孕了，我的体温变高了 但是不知为何流产了 我们怎么做可以避免此类事情发生？ 这种方法不仅仅适用于体温 也不仅仅适用于怀孕过程 我们可以根据我们身体的数据发现 很多很多的事情
举个例子，你是否知道 通过你的温度能够推断 你的甲状腺功能的状态？ 你的甲状腺在你身体中的作用， 可以类比为一座房子的恒温器 你希望你的房子的温度 能够保持在一个理想的水平 你可以调节你的恒温器 如果你的房子温度太低了 你的恒温器就会开始工作 “嘿，我们需要加加热” 如果你的房子太热了，恒温器就会发出命令 “把空调打开，降低温度。” 你的甲状腺在你身体的作用正是如此 你的甲状腺尝试为你的身体 维持一个理想温度 你冷了，你的甲状腺会说 “嘿，我们需要升温。” 如果体温高了，它负责降温 但是如果甲状腺功能出了问题 会如何呢？ 当甲状腺出问题的时候 你的体温就会表现出来 体温会比正常体温低 或是其它更奇怪的表现 所以通过收集这些数据 你可以知道你的甲状腺的一些信息
我跟我丈夫刚结婚的时候，他有鼻塞 他当时吃很多药 想要缓解他的鼻塞，不过效果不好 有一天夜里 他把我推醒，跟我说 “老婆，我没法用鼻子呼吸。” 我翻身过去，看了看他，问 “那你能用嘴呼吸吗？” （笑声） 他说，（喘气声）“可以， 但是我不能用鼻子呼吸！” 作为一个好妻子 我带他冲到医院急救室 当时是半夜两点 我开车的时候一直在想 丈夫你千万不能死在路上啊 我们才结婚 别人会觉得是我杀了你的 （笑声） 最终我们到了急救中心 护士看了看 我丈夫还是不能用鼻子呼吸 所以护士带我们去见了医生 医生问，“什么问题？” 我丈夫说，“我不能用鼻子呼吸。” 医生问，“你不能用鼻子呼吸了？” 是，但是他可以用嘴呼吸。（笑声） 他退后观察了我们两个人 然后说，“先生，我大概知道了 你是心脏病发作 我这就为你准备心电图检测 和CT扫描。” 我们的反应是 不，不，不是心脏病。他能呼吸 只是得用嘴而已。不，不，不，不 然后我们就跟大夫反复讨论 因为我们认为这个诊断不正确 他的反应是， “没关系的，没事的，别激动。” 我的反应是，“怎么能冷静下来？” 但是我真的不认为是心脏病发作 非常幸运的是， 这个医生快下班了 另一个医生进来了 看到一个狂躁的我，和我那个 不能用鼻子呼吸的丈夫。（笑声） 新医生开始问我们问题 他问，“嗯，你俩来之前做了什么运动么？” 我们经常骑脚踏车， 偶尔去健身房 （笑声） 我们会走动走动 他问，“你们来之前， 在做什么？” 我在想，我在睡觉，真的 但是，我丈夫之前在干嘛？ 我丈夫开始报出自己正在吃的 各种药的名字 他说，“我吃了这个鼻子减充血剂 然后喷了这个喷鼻剂，” 然后突然之间新医生发现了答案 “哦！你不能这么干，这两个不能同时用 百分百鼻塞。来，给你开另外一种药。” 他给我们开了个处方 我跟丈夫面面相觑，然后我看着医生 说，“为什么看起来 你能够准确的诊断出来问题 但是之前那个医生却想要 做心电图和CT扫描？” 他看了我们一眼说 “是的，当一个350磅的胖子 跑到急救室说自己不能呼吸 你得假设他有心脏病发作 来不及先问诊了。” 急诊科大夫所受的训练是快速诊断 但他们的诊断不都是正确的 所以如果我们有一些自己心脏的数据 和医生分享 或许第一个医生就能够 给我们更好的诊断
我希望在座各位从今天的演讲 得到什么信息呢？ 通过像我们一样拥有你自己的身体数据 通过每天测量一下自己的身体 你能够成为你自己身体的专家 你能够成为权威 一点不难 你不需要去读个统计学博士 就可以做到 你不需要拿到医学博士资格 才能成为自己身体的专家 医生们的专业经验是针对大众群体的 你的经验是针对你个人的 所以当你跟医生聚在一起 两个专家聚在一起 两个人能够一起做出更好的诊断 比医生一个人诊断要好很多 现在如果你能够理解信息的重要性 能够从个人身体信息中获得的信息的重要性 我希望你们站起来 举起你的的右手 （笑声） 没错，举起来 我向你发出挑战： 去拥有你自己的数据 今天，我在此向在座各位 授予一个基础统计学的TEDx认证 关于时间序列相关的数据分析方面 你们现在有了相关的权利和能力 所以，当你们下一次去找你的医生 你们作为一个新入行的统计学家 你们一贯的反应应该是什么？ 听众：给我看数据 演讲者：我听不到 听众：给我看数据！ 演讲者：再大声一点 听众：给我看数据！ 演讲者：给我看数据 感谢大家 (掌声)
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