ABOUT THE SPEAKER
Paul Ewald - Evolutionary biologist
After years of studying illness from the germs' point of view, microbiologist Paul Ewald believes that Big Pharma is wrong about some very big issues. What's right? The leader in evolutionary medicine posits radical new approaches.

Why you should listen

Paul Ewald has a problem with modern medicine: It ignores the fact that many diseases of unknown origin can be linked to slow-growing infections caused by viruses, bacteria and other microorganisms.

Ewald -- whose theory stems from both a formal education in biological sciences, ecology, and evolution, and a personal bout with diarrhea in the 1970s -- aims to change this thinking. To that end, he has written popular news articles, academic papers, and two books (Evolution of Infectious Disease and Plague Time) that explain and expand his idea. Ewald is regarded as the leading expert in the emerging field of evolutionary medicine. He directs the evolutionary medicine program in the Biology department at the University of Louisville, Kentucky, and lectures worldwide.

Among other honors, Ewald was the first recipient of the Smithsonian Institution's George E. Burch Fellowship in Theoretic Medicine and Affiliated Sciences, which was established to foster pioneering work in health sciences.

More profile about the speaker
Paul Ewald | Speaker | TED.com
TED2007

Paul Ewald: Can we domesticate germs?

保罗.埃瓦尔德问,我们能驯化病菌么?

Filmed:
583,626 views

进化生物学家保罗.埃瓦尔德把我们带入下水道来讨论病菌。为什么病菌种的多数是有害的?我们如何才能把有害的病菌变为无害的?为了寻找答案,他考察了一个令人作呕而又有吸引力的实例:痢疾。
- Evolutionary biologist
After years of studying illness from the germs' point of view, microbiologist Paul Ewald believes that Big Pharma is wrong about some very big issues. What's right? The leader in evolutionary medicine posits radical new approaches. Full bio

Double-click the English transcript below to play the video.

00:18
What I'd like to do is just drag拖动 us all down into the gutter排水沟,
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我想做的仅仅是将大家拽下排水沟,
00:21
and actually其实 all the way down into the sewer下水道
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并且实际上,一路下到下水道里
00:23
because I want to talk about diarrhea腹泻.
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因为我想谈谈痢疾。
00:25
And in particular特定, I want to talk about
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而且特别是,我想谈谈
00:29
the design设计 of diarrhea腹泻.
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痢疾的设计。
00:31
And when evolutionary发展的 biologists生物学家 talk about design设计,
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当进化生物学家谈起设计的时候
00:33
they really mean design设计 by natural自然 selection选择.
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他们实际上表示的自然选择的设计。
00:37
And that brings带来 me to the title标题 of the talk,
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这就引出了我这次演讲的题目,
00:39
"Using运用 Evolution演化 to Design设计 Disease疾病 Organisms生物 Intelligently智能."
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“通过进化来巧妙地设计病菌”。
00:43
And I also have a little bit of a sort分类 of smartass聪明的驴子 subtitle字幕 to this.
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并且我也有一个稍显聪明一些的副标题。
00:47
But I'm not just doing this to be cute可爱.
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但我这么说不是为了引人注目。
00:49
I really think that this subtitle字幕 explains说明
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我确实认为这个副标题说明了
00:52
what somebody like me, who's谁是 sort分类 of a Darwin达尔文 wannabe崇拜者,
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像我这样的达尔文的崇拜者,
00:55
how they actually其实 look at one's那些 role角色 in
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他们事实上是如何看待一个人在
00:58
sort分类 of coming未来 into this field领域 of health健康 sciences科学 and medicine医学.
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健康科学和医学领域中的角色。
01:02
It's really not a very friendly友善 field领域 for evolutionary发展的 biologists生物学家.
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对进化生物学家们来说这真不是个友好的领域。
01:05
You actually其实 see a great potential潜在,
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你确实看到了巨大的潜力,
01:07
but you see a lot of people who are sort分类 of defending卫冕 their turf草皮,
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但你也会看到许多人固步自封,
01:10
and may可能 actually其实 be very resistant, when one tries尝试
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实际上这些人在他人试图
01:14
to introduce介绍 ideas思路.
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提出新观点时也许会非常的抗拒。
01:16
So, all of the talk today今天 is going to deal合同 with two general一般 questions问题.
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因此,今天所有的讨论都是为了解决两个普通的问题。
01:21
One is that, why are some disease疾病 organisms生物 more harmful有害?
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一个是,为什么一些病菌更有害,
01:24
And a very closely密切 related有关 question, which哪一个 is,
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而一个与之关系非常密切的问题是,
01:26
how can we take control控制 of this situation情况 once一旦 we understand理解
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一旦我们有了第一个问题的答案,
01:30
the answer回答 to the first question?
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我们如何才能控制这种情况?
01:31
How can we make the harmful有害 organisms生物 more mild温和?
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我们如何才能使这些有害病菌的危害变得更轻微些?
01:34
And I'm going to be talking, to begin开始 with, as I said,
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而我将要谈论的,正如我所说,首先从
01:36
about diarrheal腹泻 disease疾病 organisms生物.
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痢疾病菌开始。
01:38
And the focus焦点 when I'm talking about the diarrheal腹泻 organisms生物,
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并且,当我谈论痢疾病菌时,
01:41
as well as the focus焦点 when I'm talking about any organisms生物
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同样,当我谈论任何
01:44
that cause原因 acute急性 infectious传染病 disease疾病,
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导致急性传染病的病菌时,
01:46
is to think about the problem问题 from a germ's细菌的 point of view视图,
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重点是从细菌的角度来思考这类问题。
01:49
germ's-eyegerm's眼 view视图.
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细菌的视角。
01:51
And in particular特定, to think about a fundamental基本的 idea理念
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尤其是考虑一个基本的观点,
01:55
which哪一个 I think makes品牌 sense out of a tremendous巨大 amount of variation变异
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我认为在有害的病菌中出现
01:58
in the harmfulness危害性 of disease疾病 organisms生物.
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大量的变异是合理的。
02:01
And that idea理念 is that from the germ's-eyegerm's眼 point of view视图,
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这一观点是从细菌的角度来看的,
02:05
disease疾病 organisms生物 have to get from one host主办 to another另一个,
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病菌不得不从一个宿主迁移到另一个宿主,
02:08
and often经常 they have to rely依靠 on the well-being福利 of the host主办
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并且它们通常不得不依赖于健康的宿主
02:12
to move移动 them to another另一个 host主办.
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把它们迁移到另一个宿主上。
02:14
But not always.
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但并不总是这样。
02:16
Sometimes有时, you get disease疾病 organisms生物
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有时你染上的病菌
02:18
that don't rely依靠 on host主办 mobility流动性 at all for transmission传输.
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根本不依赖于宿主的移动性来传播。
02:20
And when you have that, then evolutionary发展的 theory理论 tells告诉 us
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而当你染上他们后,进化论告诉我们
02:23
that natural自然 selection选择 will favor偏爱 the more exploitative剥削,
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自然选择会倾向于更会取巧的,
02:27
more predator-like捕食者样 organisms生物.
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更有侵略性的细菌。
02:29
So, natural自然 selection选择 will favor偏爱 organisms生物
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所以,自然选择会倾向于
02:31
that are more likely容易 to cause原因 damage损伤.
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更能造成破坏的细菌。
02:33
If instead代替 transmission传输 to another另一个 host主办 requires要求 host主办 mobility流动性,
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如果传播至另一宿主依靠原宿主的移动性,
02:37
then we expect期望 that the winners获奖者 of the competition竞争
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那么我们可以预料竞争的胜利者
02:40
will be the milder温和 organisms生物.
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将是那些温和的细菌。
02:42
So, if the pathogen病原 doesn't need the host主办 to be healthy健康 and active活性,
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不过,如果病菌不需要宿主保持健康和活力
02:45
and actual实际 selection选择 favors好处 pathogens病原体
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而且实际上自然选择倾向于选择
02:48
that take advantage优点 of those hosts主机,
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从宿主获利的细菌,
02:50
the winners获奖者 in the competition竞争 are those that exploit利用 the hosts主机
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竞争的胜利者就是那些为了繁殖成功
02:52
for their own拥有 reproductive生殖 success成功.
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而剥削宿主的病菌。
02:54
But if the host主办 needs需求 to be mobile移动 in order订购 to transmit发送 the pathogen病原,
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但是,如果需要宿主移动来传播病菌,
02:59
then it's the benign良性 ones那些 that tend趋向 to be the winners获奖者.
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那么那些温和的病菌往往会成为胜利者。
03:01
So, I'm going to begin开始 by applying应用 this idea理念 to diarrheal腹泻 diseases疾病.
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所以,我将从把这些观点应用于痢疾病菌作为(我的演讲的)开始。
03:05
Diarrheal腹泻 disease疾病 organisms生物 get transmitted发送 in basically基本上 three ways方法.
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痢疾病菌有三种基本的传播途径。
03:08
They can be transmitted发送 from person-to-person人对人 contact联系,
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它们能够通过人与人间的接触传播,
03:11
person-to-food-then-to-person人对食物然后到人 contact联系,
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当某人吃了被污染的食物时,
03:13
when somebody eats contaminated污染 food餐饮,
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会发生从人到食物再到人的传播。
03:15
or they can be transmitted发送 through通过 the water.
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或者它们能通过水进行传播。
03:17
And when they're transmitted发送 through通过 the water,
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当他们通过水传播时,
03:19
unlike不像 the first two modes模式 of transmission传输,
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不像前两种传播方式,
03:21
these pathogens病原体 don't rely依靠 on a healthy健康 host主办 for transmission传输.
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这些病菌并不依赖于健康的宿主进行传播。
03:25
A person can be sick生病 in bed and still infect感染 tens, even hundreds数以百计
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一个卧病在床的人仍能传染数以十计,甚至数以百计的
03:27
of other individuals个人.
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其他人。
03:29
To sort分类 of illustrate说明 that, this diagram emphasizes强调 that
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为了说明这些,这个图表表明,
03:32
if you've got a sick生病 person in bed,
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如果有一个卧床的病人,
03:34
somebody's某人的 going to be taking服用 out the contaminated污染 materials物料.
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总得有人来处理那些被污染的物品。
03:37
They're going to wash those contaminated污染 materials物料,
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他们将清洗这些被污染的物品,
03:38
and then the water may可能 move移动 into sources来源 of drinking water.
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然后用于清洗的水可能会流至饮用的水源。
03:42
People will come in to those places地方 where you've got
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人们将到这些水源处取用
03:45
contaminated污染 drinking water,
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这些被污染的饮用水,
03:46
bring带来 things back to the family家庭,
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带着他们回到家中,
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may可能 drink right at that point.
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他们也许在那儿就会喝一些水。
03:48
The whole整个 point is that a person who can't move移动
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重点是,一个不能移动的人
03:51
can still infect感染 many许多 other individuals个人.
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仍会传染其他许多人。
03:53
And so, the theory理论 tells告诉 us that
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因此,这理论告诉我们
03:56
when diarrheal腹泻 disease疾病 organisms生物 are transported by water,
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当痢疾病菌通过水进行传播时,
04:01
we expect期望 them to be more predator-like捕食者样, more harmful有害.
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我们认为它们会变得更有侵略性,更加有害。
04:03
And you can test测试 these ideas思路.
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你可以测试一下这些观点。
04:05
So, one way you can test测试 is just look at all diarrheal腹泻 bacteria,
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测试它的一个方法就是,仅仅等着看这些痢疾病菌
04:07
and see whether是否 or not the ones那些 that tend趋向 to be
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看看它们是不是更倾向于
04:09
more transmitted发送 by water, tend趋向 to be more harmful有害.
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通过水进行传播,更加的有害。
04:11
And the answer回答 is -- yep是的, they are.
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答案是 —— 是的,的确是的。
04:13
Now I put those names in there just for the bacteria buffs,
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现在我把这些名字放在这儿,仅仅为了细菌迷们,
04:16
but the main主要 point here is that --
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但是要点是--
04:19
(Laughter笑声)
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(笑声)
04:20
there's a lot of them here, I can tell --
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这儿有许多(细菌迷),我得说--
04:21
the main主要 point here is that those data数据 points
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要点是,这些数据点
04:25
all show显示 a very strong强大, positive association协会 between之间
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显示了在两件事之间有很强的正向联系:
04:27
the degree to which哪一个 a disease疾病 organism生物 is transmitted发送 by water,
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那就是这些病菌对水传播的依赖性,
04:31
and how harmful有害 they are,
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和它们(对人)的危害,
04:32
how much death死亡 they cause原因 per untreated未处理 infection感染.
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也就是在未治疗的情况下感染它们导致死亡的人数。
04:35
So this suggests提示 we're on the right track跟踪.
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因此这表明我们的思路是正确的。
04:37
But this, to me, suggests提示 that we really need
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但是,对我而言,这表明我们的确需要
04:42
to ask some additional额外 questions问题.
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问一些附加的问题。
04:43
Remember记得 the second第二 question that I raised上调 at the outset开始 was,
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回想一下我在开始提出的问题中的第二个问题,
04:46
how can we use this knowledge知识
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我们怎样才能利用这些知识
04:48
to make disease疾病 organisms生物 evolve发展 to be mild温和?
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来使得病菌进化的更加温和?
04:51
Now, this suggests提示 that if you could just block waterborne水性 transmission传输,
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现在这表明,如果你能阻止水媒传播,
04:53
you could cause原因 disease疾病 organisms生物 to shift转移 from
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那么就能使病菌从
04:56
the right-hand右手 side of that graph图形 to the left-hand左手 side of the graph图形.
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从这图表的右边转移到左边。
04:59
But it doesn't tell you how long.
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但是图中并没有表明这需要多久。
05:01
I mean, if this would require要求 thousands数千 of years年份,
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我是说,如果这需要数千年的话,
05:03
then it's worthless无用 in terms条款 of controlling控制 of these pathogens病原体.
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就控制这些病菌而言就没有意义了。
05:05
But if it could occur发生 in just a few少数 years年份,
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但如果这能在仅仅几年中就奏效
05:07
then it might威力 be a very important重要 way to control控制
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那么它也许就是一个非常重要的控制途径,
05:11
some of the nasty讨厌 problems问题 that we haven't没有 been able能够 to control控制.
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来控制那些我们没有控制住的严重的问题。
05:14
In other words, this suggests提示 that we could
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换句话说,这表明我们能够
05:16
domesticate these organisms生物.
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驯化这些病菌。
05:18
We could make them evolve发展 to be not so harmful有害 to us.
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我们能让它们进化的对我们不是那么有害。
05:21
And so, as I was thinking思维 about this, I focused重点 on this organism生物,
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而且,如我所回想起的我所关注的一种病菌,
05:24
which哪一个 is the El萨尔瓦多 Tor托尔 biotype生物型 of the organism生物 called Vibrio弧菌 cholerae霍乱弧菌.
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一种被称为霍乱弧菌的埃尔托生物型细菌。
05:28
And that is the species种类 of organism生物 that is responsible主管
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这种类型的细菌
05:32
for causing造成 cholera霍乱.
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导致了霍乱。
05:34
And the reason原因 I thought this is a really great organism生物 to look at
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而我认为这种病菌是个好例子的原因,
05:36
is that we understand理解 why it's so harmful有害.
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是因为我们理解了为什么它如此有害。
05:39
It's harmful有害 because it produces产生 a toxin毒素,
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它有害的原因是它产生一种毒素,
05:42
and that toxin毒素 is released发布 when the organism生物
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并且,当这些病菌在肠道中时
05:44
gets得到 into our intestinal tract管道.
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会释放这些毒素。
05:45
It causes原因 fluid流体 to flow from the cells细胞 that line线 our intestine
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这导致了体液从肠细胞流至
05:49
into the lumen流明, the internal内部 chamber of our intestine,
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肠腔内--肠内部的空间,
05:52
and then that fluid流体 goes the only way it can, which哪一个 is out the other end结束.
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然后这些液体去了他们唯一能去的地方,排出体外。
05:55
And it flushes刷新 out thousands数千 of different不同 other competitors竞争对手
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这一过程冲走了数以千计的那些可能会使弧菌生存困难的
05:58
that would otherwise除此以外 make life difficult for the Vibrios弧菌.
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各种其他竞争者。
06:01
So what happens发生, if you've got an organism生物,
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所以,如果你感染了一个病菌,会发生什么
06:03
it produces产生 a lot of toxin毒素.
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它会产生许多毒素。
06:04
After a few少数 days of infection感染 you end结束 up having --
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感染后的几天的最终结果--
06:07
the fecal粪便 material材料 really isn't so disgusting讨厌 as we might威力 imagine想像.
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排泄物实际上并不像我们想象的那么恶心。
06:09
It's sort分类 of cloudy多云的 water.
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它是一种浑浊的液体。
06:11
And if you took a drop下降 of that water,
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如果你去一滴这样的液体
06:13
you might威力 find a million百万 diarrheal腹泻 organisms生物.
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你也许能找到一百万只痢疾病菌。
06:16
If the organism生物 produced生成 a lot of toxin毒素,
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如果病菌产生了很多毒素,
06:18
you might威力 find 10 million百万, or 100 million百万.
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你也许会找到一千万或是一亿只。
06:20
If it didn't produce生产 a lot of this toxin毒素,
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如果它们没有产生很多毒素
06:22
then you might威力 find a smaller number.
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那么你也许会找到较少数量的病菌。
06:24
So the task任务 is to try to figure数字 out
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所以,我们的任务是试着发现
06:28
how to determine确定 whether是否 or not you could get an organism生物 like this
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如何来确定我们是否能通过阻止水媒传播
06:32
to evolve发展 towards mildness温和 by blocking闭塞 waterborne水性 transmission传输,
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使得这样的病菌朝着更温和的方向进化。
06:35
thereby从而 allowing允许 the organism生物 only to be transmitted发送
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也就是只允许病菌通过
06:37
by person-to-person人对人 contact联系,
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人与人之间的接触传播,
06:40
or person-food-person人食人 contact联系 --
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或者人-食物-人的接触传播。
06:41
both of which哪一个 would really require要求 that people be
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这两种方式实际上都需要人们
06:43
mobile移动 and fairly相当 healthy健康 for transmission传输.
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能移动和有适当的健康来进行传播。
06:45
Now, I can think of some possible可能 experiments实验.
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现在,我可以考虑一些可能的实验。
06:48
One would be to take a lot of different不同 strains of this organism生物 --
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一个实验需要许多不同株这类病菌--
06:51
some that produce生产 a lot of toxins毒素, some that produce生产 a little --
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一些会产生许多毒素,一些产生很少毒素--
06:53
and take those strains and spew them out in different不同 countries国家.
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然后把这些株放至不同的国家。
06:58
Some countries国家 that might威力 have clean清洁 water supplies耗材,
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一些国家有清洁的水源供应,
07:01
so that you can't get waterborne水性 transmission传输:
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因此不能进行水媒传播,
07:02
you expect期望 the organism生物 to evolve发展 to mildness温和 there.
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在那儿,病菌可能会进化的更加温和。
07:05
Other countries国家, in which哪一个 you've got a lot of waterborne水性 transmission传输,
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在另一些国家会有很多水媒传播,
07:08
there you expect期望 these organisms生物 to evolve发展
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这些病菌会朝着
07:10
towards a high level水平 of harmfulness危害性, right?
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更有害的方向进化,对么?
07:14
There's a little ethical合乎道德的 problem问题 in this experiment实验.
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这个实验会有些道德问题。
07:16
I was hoping希望 to hear a few少数 gasps喘气 at least最小.
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我(原本)以为至少会听到一些人抽冷气。
07:19
That makes品牌 me worry担心 a little bit.
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(你们这么容易就接受了这个实验计划,)这倒让我有点担心。
07:21
(Laughter笑声)
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(笑声)
07:22
But anyhow无论如何, the laughter笑声 makes品牌 me feel a little bit better.
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但无论如何,笑声让我感觉更好了点。
07:25
And this ethical合乎道德的 problem's问题 a big problem问题.
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但是这个道德问题是个大问题。
07:28
Just to emphasize注重 this, this is what we're really talking about.
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只是为了强调,这是我们所谓的(道德问题)。
07:31
Here's这里的 a girl女孩 who's谁是 almost几乎 dead.
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这是个差点死去的女孩。
07:33
She got rehydration补液 therapy治疗, she perked重新振作 up,
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她进行了补水治疗,她重新活泼起来,
07:35
within a few少数 days she was looking like a completely全然 different不同 person.
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在几天内她看起来像完全另外一个人。
07:38
So, we don't want to run an experiment实验 like that.
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所以我们并不想进行这样的一个实验。
07:40
But interestingly有趣, just that thing happened发生 in 1991.
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但是有趣地是,这些事在1991年发生了。
07:44
In 1991, this cholera霍乱 organism生物 got into Lima利马, Peru秘鲁,
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1991年,在秘鲁的利马爆发了霍乱,
07:48
and within two months个月 it had spread传播 to the neighboring邻接 areas.
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在两个月内病毒就传播至邻国。
07:51
Now, I don't know how that happened发生,
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我现在都不知道这是如何发生的,
07:54
and I didn't have anything to do with it, I promise诺言 you.
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而且我也与此无关,我保证。
07:58
I don't think anybody任何人 knows知道,
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我不认为有人知道(这是怎么发生的),
08:00
but I'm not averse规避 to, once一旦 that's happened发生,
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但是我并不反对,一旦一切已经发生,
08:03
to see whether是否 or not the prediction预测 that we would make,
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看看我们做的预测,
08:05
that I did make before, actually其实 holds持有 up.
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我之前做的预测,是不是对的。
08:08
Did the organism生物 evolve发展 to mildness温和 in a place地点 like Chile智利,
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病菌会在像智利那样
08:11
which哪一个 has some of the most well protected保护 water supplies耗材
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有拉美保护得最好的水源供应的地方
08:14
in Latin拉丁 America美国?
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进化的更温和么?
08:15
And did it evolve发展 to be more harmful有害 in a place地点 like Ecuador厄瓜多尔,
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它会在那些水源保护的最差的地方,比如厄瓜多尔,
08:19
which哪一个 has some of the least最小 well protected保护?
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进化的更有害么?
08:21
And Peru's秘鲁 got something sort分类 of in between之间.
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而秘鲁的水源供应保护在这两种情况之间,处于中等保护程度。
08:23
And so, with funding资金 from the Bosack-KrugerBosack - 克鲁格 Foundation基础,
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因此,由波扎克-克鲁格基金会提供资金支持,
08:27
I got a lot of strains from these different不同 countries国家
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我从不同国家得到了许多菌株
08:30
and we measured测量 their toxin毒素 production生产 in the lab实验室.
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并且,我们在实验室中仔细测量了毒素的生产。
08:33
And we found发现 that in Chile智利 -- within two months个月 of the invasion侵入 of Peru秘鲁
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我们发现在智利--在病毒入侵秘鲁后的两个月内
08:37
you had strains entering进入 Chile智利 --
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就会在智利发现菌株。
08:39
and when you look at those strains,
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当留心观察这些菌株,
08:41
in the very far left-hand左手 side of this graph图形,
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在这幅图的很靠左侧的地方,
08:43
you see a lot of variation变异 in the toxin毒素 production生产.
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你会看到毒素生产中的许多变异。
08:46
Each dot corresponds对应 to an islet from a different不同 person --
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每个点对应着来自不同人的一个样本。
08:49
a lot of variation变异 on which哪一个 natural自然 selection选择 can act法案.
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自然选择会导致许多的变异。
08:51
But the interesting有趣 point is, if you look over the 1990s,
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但是有趣的地方时,如果你仔细看看90年代,
08:54
within a few少数 years年份 the organisms生物 evolved进化 to be more mild温和.
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仅仅几年病菌就进化的更温和。
08:58
They evolved进化 to produce生产 less toxin毒素.
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它们进化的会产生更少毒素。
09:00
And to just give you a sense of how important重要 this might威力 be,
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为了让你们对这有多重要有个感觉,
09:02
if we look in 1995, we find that there's only one case案件 of cholera霍乱,
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注意一下1995年起,在智利平均每两年
09:07
on average平均, reported报道 from Chile智利 every一切 two years年份.
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我们只发现一例霍乱。
09:09
So, it's controlled受控.
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这说明它被控制住了。
09:11
That's how much we have in America美国,
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这就是我们在美洲所了解到的。
09:13
cholera霍乱 that's acquired后天 endemically地方性,
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霍乱是地方性的。
09:15
and we don't think we've我们已经 got a problem问题 here.
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而我们不认为这儿有问题。
09:17
They didn't -- they solved解决了 the problem问题 in Chile智利.
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没有--在智利他们解决了这个问题。
09:19
But, before we get too confident信心, we'd星期三 better look at some of those other countries国家,
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但在我们变得过于自信之前,我们最好看看其他一些国家的情况。
09:22
and make sure that this organism生物 doesn't just always evolve发展 toward mildness温和.
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并确认这一病菌并不总是朝着更温和的方向进化。
09:25
Well, in Peru秘鲁 it didn't.
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好吧,在秘鲁它不是的。
09:27
And in Ecuador厄瓜多尔 -- remember记得, this is the place地点 where it has
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而且在厄瓜多尔--别忘了这是
09:30
the highest最高 potential潜在 waterborne水性 transmission传输 --
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最可能通过水媒进行传播的地方--
09:32
it looked看着 like it got more harmful有害.
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看起来,它变得更加有害了。
09:33
In every一切 case案件 there's a lot of variation变异,
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在每个病例中都有许多的变异,
09:35
but something about the environment环境 the people are living活的 in,
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但这与那儿的人们所居住的环境有关,
09:38
and I think the only realistic实际 explanation说明 is that it's
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而且我认为水媒传播程度
09:41
the degree of waterborne水性 transmission传输,
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是唯一正确的解释。
09:43
favored青睐 the harmful有害 strains in one place地点, and mild温和 strains in another另一个.
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在一个地方对有害的菌株有利,而另一个地方则对温和的菌株有利。
09:47
So, this is very encouraging鼓舞人心的,
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这非常让人振奋,
09:49
it suggests提示 that something that we might威力 want to do anyhow无论如何,
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这个结果表明我们应该,其实无论如何我们都应该,
09:51
if we had enough足够 money, could actually其实 give us a much bigger bang for the buck降压.
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如果我们有足够的资金,我们可以取得更大的进展,
09:54
It would make these organisms生物 evolve发展 to mildness温和,
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我们可以使得这些病菌进化的更温和,
09:56
so that even though虽然 people might威力 be getting得到 infected感染,
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以便人们即使感染了病毒,
09:58
they'd他们会 be infected感染 with mild温和 strains.
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他们也是被温和的菌株所感染。
10:00
It wouldn't不会 be causing造成 severe严重 disease疾病.
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这不会导致严重的疾病。
10:02
But there's another另一个 really interesting有趣 aspect方面 of this,
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但这有另一个真实而有趣的方面,
10:04
and this is that if you could control控制 the evolution演化 of virulence毒力,
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就是说如果你能控制致病力的进化,
10:07
evolution演化 of harmfulness危害性,
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危害性的进化,
10:09
then you should be able能够 to control控制 antibiotic抗生素 resistance抵抗性.
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然后你就有能力控制抗生素抗药性了。
10:11
And the idea理念 is very simple简单.
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这个想法很简单。
10:12
If you've got a harmful有害 organism生物,
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如果你有一个有害的病菌,
10:14
a high proportion比例 of the people are going to be symptomatic症状,
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高比例的人会出现症状,
10:16
a high proportion比例 of the people are going to be going to get antibiotics抗生素.
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高比例的人会有抗体。
10:18
You've got a lot of pressure压力 favoring有利于 antibiotic抗生素 resistance抵抗性,
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在对抗生素的抗药性的促进上有很大的压力。
10:21
so you get increased增加 virulence毒力 leading领导 to
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因此增强的毒性导致了
10:23
the evolution演化 of increased增加 antibiotic抗生素 resistance抵抗性.
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(病菌对)抗生素的抗药性增强的进化。
10:25
And once一旦 you get increased增加 antibiotic抗生素 resistance抵抗性,
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并且,一旦(病菌)对抗生素的抗药性增强,
10:28
the antibiotics抗生素 aren't knocking敲门 out the harmful有害 strains anymore.
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那么抗生素就不在能消灭有害的菌株了。
10:30
So, you've got a higher更高 level水平 of virulence毒力.
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因此,你得到了更高级别的毒性。
10:32
So, you get this vicious恶毒 cycle周期.
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这是个危险的循环。
10:34
The goal目标 is to turn this around.
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我们的目标是使这种情况得到扭转。
10:36
If you could cause原因 an evolutionary发展的 decrease减少 in virulence毒力
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如果你能通过清洁水源供应来促进
10:38
by cleaning清洁的 up the water supply供应,
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毒性进化的衰减。
10:40
you should be able能够 to get an evolutionary发展的 decrease减少
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那你就应该能使它们对抗生素的抗药性
10:42
in antibiotic抗生素 resistance抵抗性.
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的进化衰减。
10:44
So, we can go to the same相同 countries国家 and look and see.
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因此我们能去同样的国家,看一看。
10:46
Did Chile智利 avoid避免 the problem问题 of antibiotic抗生素 resistance抵抗性,
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智利避免了抗生素的抗药性的问题么?
10:49
whereas did Ecuador厄瓜多尔 actually其实 have the beginnings开始 of the problem问题?
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而厄瓜多尔实际上只是处于这一问题的初始阶段?
10:52
If we look in the beginning开始 of the 1990s,
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如果我们看看九十年代初,
10:54
we see, again, a lot of variation变异.
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我们会又一次看到许多的变异。
10:56
In this case案件, on the Y-axisY轴, we've我们已经 just got a measure测量 of antibiotic抗生素 sensitivity灵敏度 --
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在这种情况下,在Y轴上我们会得到一个对抗生素敏感性的衡量。
11:00
and I won't惯于 go into that.
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我不准备详谈这些。
11:02
But we've我们已经 got a lot of variation变异 in antibiotic抗生素 sensitivity灵敏度 in Chile智利,
250
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但在智利,我们发现了许多抗生素敏感性的变异。
11:05
Peru秘鲁 and Ecuador厄瓜多尔, and no trend趋势 across横过 the years年份.
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秘鲁和厄瓜多尔,没有跨越数年的趋势。
11:07
But if we look at the end结束 of the 1990s, just half a decade later后来,
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但如果我们看看90年代末,仅仅五年后,
11:11
we see that in Ecuador厄瓜多尔 they started开始 having a resistance抵抗性 problem问题.
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我们看到在厄瓜多尔,开始有抗药性的问题了。
11:14
Antibiotic抗生素 sensitivity灵敏度 was going down.
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抗生素的敏感性在下降。
11:16
And in Chile智利, you still had antibiotic抗生素 sensitivity灵敏度.
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而在智利仍有抗生素敏感性。
11:19
So, it looks容貌 like Chile智利 dodged回避 two bullets子弹.
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因此,看起来智利避免了两个问题。
11:21
They got the organism生物 to evolve发展 to mildness温和,
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他们使病菌进化的更温和,
11:23
and they got no development发展 of antibiotic抗生素 resistance抵抗性.
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而且他们没有让病菌的抗药性进一步恶化。
11:26
Now, these ideas思路 should apply应用 across横过 the board,
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现在这些观点应该被全面的应用。
11:29
as long as you can figure数字 out why some organisms生物 evolved进化 to virulence毒力.
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只要你能弄明白为什么一些病菌进化的更具毒性。
11:32
And I want to give you just one more example,
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我想仅仅再给出一个例子,
11:34
because we've我们已经 talked a little bit about malaria疟疾.
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因为我们已经谈论了一下痢疾。
11:36
And the example I want to deal合同 with is,
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而我想要给出的例子是,
11:38
or the idea理念 I want to deal合同 with, the question is,
264
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或者说我想提出的想法,问题是,
11:42
what can we do to try to get the malarial疟疾 organism生物 to evolve发展 to mildness温和?
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为了使痢疾病菌进化的更加温和,我们能做什么?
11:45
Now, malaria's疟疾的 transmitted发送 by a mosquito蚊子,
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现在,痢疾通过蚊子进行传播,
11:47
and normally一般 if you're infected感染 with malaria疟疾, and you're feeling感觉 sick生病,
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通常,如果你感染了痢疾,你会觉得不舒服,
11:51
it makes品牌 it even easier更轻松 for the mosquito蚊子 to bite you.
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这使得蚊子更容易叮你。
11:53
And you can show显示, just by looking at data数据 from literature文学,
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而且,仅仅通过查看文献中的数据,你就会发现
11:56
that vector-borne虫媒 diseases疾病 are more harmful有害
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通过虫媒传播的疾病比那些
11:58
than non-vector-borne非媒传 diseases疾病.
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通过非虫媒传播的疾病更加有害。
12:01
But I think there's a really fascinating迷人 example
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但我想有个真实的迷人的例子,
12:04
of what one can do experimentally实验 to try to actually其实 demonstrate演示 this.
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人们可以做实验来尝试实际的去论证这些。
12:08
In the case案件 of waterborne水性 transmission传输,
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就水媒传播而言,
12:10
we'd星期三 like to clean清洁 up the water supplies耗材,
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我们想通过清理水源供应,
12:12
see whether是否 or not we can get those organisms生物 to evolve发展 towards mildness温和.
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来看看是否能使得这些病菌朝着温和的方向进化。
12:15
In the case案件 of malaria疟疾, what we'd星期三 like to do is mosquito-proof防蚊 houses房屋.
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就痢疾而言,我们想做的是建造防蚊的房屋。
12:20
And the logic's逻辑的 a little more subtle微妙 here.
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这儿的逻辑有点更微妙了。
12:22
If you mosquito-proof防蚊 houses房屋,
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如果在防蚊的房屋里,
12:24
when people get sick生病, they're sitting坐在 in bed --
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当人们生病了,坐在床上时,
12:26
or in mosquito-proof防蚊 hospitals医院, they're sitting坐在 in a hospital醫院 bed --
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或者在防蚊的医院中,人们坐在医院的床上时,
12:28
and the mosquitoes蚊子 can't get to them.
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蚊子没法去叮咬他们。
12:30
So, if you're a harmful有害 variant变种
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因此如果你是一个有害的病菌,
12:32
in a place地点 where you've got mosquito-proof防蚊 housing住房, then you're a loser失败者.
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结果不得不待在一个防蚊的房子里,你就输了。
12:36
The only pathogens病原体 that get transmitted发送
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那些唯一能传播的病原体
12:39
are the ones那些 that are infecting感染 people that feel healthy健康 enough足够
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是通过那些感染了却觉得自己很健康的人进行传播的,
12:41
to walk步行 outside and get mosquito蚊子 bites咬伤.
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他们走到外面,被蚊子叮咬了。
12:44
So, if you were to mosquito蚊子 proof证明 houses房屋,
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那么,如果你在防蚊的房屋里,
12:46
you should be able能够 to get these organisms生物 to evolve发展 to mildness温和.
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你就能够使得这些病菌进化的更温和。
12:48
And there's a really wonderful精彩 experiment实验 that was doneDONE
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实际上我们已经作了一个非常棒的实验,
12:51
that suggests提示 that we really should go ahead and do this.
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这实验说明我们应该来使用防蚊的房屋和医院。
12:54
And that experiment实验 was doneDONE in Northern北方 Alabama阿拉巴马.
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这个实验室在北阿拉巴马进行的。
12:57
Just to give you a little perspective透视 on this,
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仅仅给你一个关于这一实验的小观点,
12:59
I've given特定 you a star at the intellectual知识分子 center中央 of the United联合的 States状态,
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我告诉你一个位于肯塔基的路易斯维尔的
13:03
which哪一个 is right there in Louisville路易斯维尔, Kentucky肯塔基.
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美国知识产权中心的明星。
13:07
And this really cool experiment实验 was doneDONE
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这个非常酷的实验是由田纳西流域管理局作的,
13:09
about 200 miles英里 south of there, in Northern北方 Alabama阿拉巴马,
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实验地点是从这个中心向南大约200英里的地方,
13:12
by the Tennessee田纳西 Valley Authority权威.
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就在北阿拉巴马。
13:13
They had dammed截流 up the Tennessee田纳西 River.
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他们阻塞了田纳西河。
13:16
They'd他们会 caused造成 the water to back up,
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他们把水蓄积起来,
13:18
they needed需要 electric电动, hydroelectric水电 power功率.
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他们需要电力,水电。
13:21
And when you get stagnant water, you get mosquitoes蚊子.
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而当有一片死水的时候,就会出现蚊子。
13:23
They found发现 in the late晚了 '30s -- 10 years年份 after they'd他们会 made制作 these dams水坝 --
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他们发现在最近30年代后期--在建造了这些大坝后的十年内--
13:27
that the people in Northern北方 Alabama阿拉巴马 were infected感染 with malaria疟疾,
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北阿拉巴马的人们感染了疟疾。
13:33
about a third第三 to half of them were infected感染 with malaria疟疾.
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大约三分之一到一半的人感染了疟疾。
13:36
This shows节目 you the positions位置 of some of these dams水坝.
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这里显示了这些水库的位置。
13:39
OK, so the Tennessee田纳西 Valley Authority权威 was in a little bit of a bind捆绑.
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那好,田纳西流域管理局受到一点点限制。
13:43
There wasn't DDTDDT, there wasn't chloroquineschloroquines: what do they do?
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在那儿不能用滴滴涕,不能用氯喹,那么人们该怎么办?
13:47
Well, they decided决定 to mosquito蚊子 proof证明 every一切 house in Northern北方 Alabama阿拉巴马.
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好吧,他们决定让北阿拉巴马的每所房屋都能够防蚊。
13:50
So they did. They divided分为 Northern北方 Alabama阿拉巴马 into 11 zones,
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他们这么做了。他们把北阿拉巴马分成了11个区域,
13:53
and within three years年份, about 100 dollars美元 per house,
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并且在三年内,每所房子花费大约100美元,
13:55
they mosquito蚊子 proofed醒发 every一切 house.
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他们对每所房子都进行了防蚊处理。
13:57
And these are the data数据.
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这儿是一些数据。
13:59
Every一切 row across横过 here represents代表 one of those 11 zones.
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每个横跨这里的一行表示11个区域的其中之一。
14:03
And the asterisks星号 represent代表 the time at which哪一个
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这些星号表示防蚊措施实施
14:05
the mosquito蚊子 proofing打样 was complete完成.
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完成的时间。
14:07
And so what you can see is that
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那么你可以看到,
14:09
just the mosquito-proofed蚊子醒发 housing住房, and nothing else其他,
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仅仅是进行了房屋的防蚊处理,没有做别的,
14:12
caused造成 the eradication根除 of malaria疟疾.
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就根除了疟疾。
14:14
And this was, incidentally顺便, published发表 in 1949,
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而且这在1949年,偶然地发表在
14:16
in the leading领导 textbook教科书 of malaria疟疾, called "Boyd's博伊德 MalariologyMalariology."
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关于疟疾最重要的名为"博伊德的痢疾学"的教科书中。
14:19
But almost几乎 no malaria疟疾 experts专家 even know it exists存在.
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但是几乎没有痢疾方面的专家知道它的存在。
14:22
This is important重要,
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这很重要,
14:24
because it tells告诉 us that if you have moderate中等 biting尖刻 densities密度,
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因为它告诉我们,如果在中等的叮咬密度下,
14:26
you can eradicate根除 malaria疟疾 by mosquito蚊子 proofing打样 houses房屋.
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你用防蚊的房屋就能消除疟疾。
14:28
Now, I would suggest建议 that you could do this in a lot of places地方.
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现在,我建议可以在许多地方这么做。
14:31
Like, you know, just as you get into the malaria疟疾 zone,
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比如,你知道,正如你进入疟疾区,
14:35
sub-Saharan撒哈拉以南 Africa非洲.
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非洲的撒哈拉以南。
14:37
But as you move移动 to really intense激烈 biting尖刻 rate areas, like Nigeria尼日利亚,
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但是如果你去有十分强烈的叮咬率的区域,比如尼日利亚,
14:40
you're certainly当然 not going to eradicate根除.
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你肯定不能根除它。
14:42
But that's when you should be favoring有利于 evolution演化 towards mildness温和.
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但是你可以帮助它们变得更加温和。
14:46
So to me, it's an experiment实验 that's waiting等候 to happen发生,
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因此对我而言,这是个等待发生的实验,
14:49
and if it confirms确认 the prediction预测, then
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而如果它确认了预测的结果,那么
14:51
we should have a very powerful强大 tool工具.
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我们就会有了一个非常强有利的工具。
14:53
In a way, much more powerful强大 than the kind of tools工具 we're looking at,
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在某种程度上,它是比我们现在用的工具有力得多。
14:56
because most of what's being存在 doneDONE today今天 is
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因为如今我们能做的就是
14:58
to rely依靠 on things like anti-malarial抗疟疾 drugs毒品.
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依赖于像抗疟疾药似的东西。
15:00
And we know that, although虽然 it's great to make those
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而我们知道,虽然这能让这些抗疟疾药
15:03
anti-malarial抗疟疾 drugs毒品 available可得到 at really low cost成本 and high frequency频率,
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以实在的低价和高频率供应。
15:08
we know that when you make them highly高度 available可得到
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我们知道,当你不断用药时,
15:11
you're going to get resistance抵抗性 to those drugs毒品.
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它们将对这些药产生抗药性。
15:13
And so it's a short-term短期 solution.
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所以这是个短期的解决方案。
15:15
This is a long-term长期 solution.
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这是个长期的解决方案。
15:17
What I'm suggesting提示 here is that we could get evolution演化
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我的建议是,我们能让进化
15:19
working加工 in the direction方向 we want it to go,
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朝着我们希望的方向进行。
15:21
rather than always having to battle战斗 evolution演化 as a problem问题
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而不总是与进化做斗争。
15:24
that stymies吓退 our efforts努力 to control控制 the pathogen病原,
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这是个问题因为它妨碍了我们对控制病原体做出的努力,
15:27
for example with anti-malarial抗疟疾 drugs毒品.
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例如抗疟疾药。
15:29
So, this table I've given特定 just to emphasize注重
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因此,我给出的这张表仅仅是为了强调,
15:32
that I've only talked about two examples例子.
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我只是谈了两个例子。
15:35
But as I said earlier, this kind of logic逻辑 applies适用 across横过 the board
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但如我之前所说,这类的逻辑应用贯穿整个
15:38
for infectious传染病 diseases疾病, and it ought应该 to.
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传染病领域,应该这样。
15:40
Because when we're dealing交易 with infectious传染病 diseases疾病, we're dealing交易 with living活的 systems系统.
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由于当我们应对传染病时,我们是在应对生命系统。
15:44
We're dealing交易 with living活的 systems系统;
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我们在应对生命系统,
15:46
we're dealing交易 with systems系统 that evolve发展.
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我们在应对一个可以进化的系统。
15:48
And so if you do something with those systems系统,
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而如果你对这样的系统做了些什么,
15:50
they're going to evolve发展 one way or another另一个.
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它们将朝着这个或那个方向进化。
15:52
And all I'm saying is that we need to figure数字 out how they'll他们会 evolve发展,
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而所有我要说的是,我们需要弄明白它们如何进化,
15:55
so that -- we need to adjust调整 our interventions干预措施
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以便于我们调整我们的干预措施,
15:57
to get the most bang for the intervention介入 buck降压,
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来获得最大收益的干预措施,
16:00
so that we can get these organisms生物 to evolve发展 in the direction方向 we want them to go.
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以便于我们能使这些病菌朝着我们期望的方向进化。
16:03
So, I don't really have time to talk about those things,
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所以,我真的没有时间来讨论这些事,
16:05
but I did want to put them up there,
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但我确实想要把它们放在这儿。
16:07
just to give you a sense that there really are solutions解决方案
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仅仅为了给你们一个感觉,我们确实有办法
16:10
to controlling控制 the evolution演化 of harmfulness危害性
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来控制
16:13
of some of the nasty讨厌 pathogens病原体 that we're confronted面对 with.
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一些我们所面对的有害的病菌的进化。
16:19
And this links链接 up with a lot of the other ideas思路 that have been talked about.
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并且,这把许多之前讨论过的观点联系了起来。
16:23
So, for example, earlier today今天 there was discussion讨论 of,
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那么,例如,今天早些时候的讨论,
16:28
how do you really lower降低 sexual有性 transmission传输 of HIVHIV?
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如何真正降低艾滋病毒的性传播?
16:34
What this emphasizes强调 is that we need to figure数字 out how it will work.
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需要强调的是我们需要清楚它是如何造成危害的。
16:37
Will it maybe get lowered降低 if we alter改变 the economy经济 of the area?
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如果我们改变了这一区域的经济状况,它可能会降低么?
16:40
It may可能 get lowered降低 if we intervene干预 in ways方法 that
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它可能会降低,如果我们的干预措施
16:42
encourage鼓励 people to stay more faithful可信 to partners伙伴, and so on.
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鼓励人们对他们的伴侣更忠诚,等等。
16:46
But the key thing is to figure数字 out how to lower降低 it,
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但关键是明白如何降低它。
16:48
because if we lower降低 it, we'll get an evolutionary发展的 change更改 in the virus病毒.
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因为如果我们降低它的话,我们将改变病毒的进化。
16:51
And the data数据 really do support支持 this:
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并且有数据的确实支持的,
16:53
that you actually其实 do get the virus病毒 evolving进化 towards mildness温和.
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如果你确实是让病毒朝着更加温和的方向进化。
16:56
And that will just add to the effectiveness效用 of our control控制 efforts努力.
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并且这将增加我们的控制投入的效率。
17:01
So the other thing I really like about this,
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因此,另一个我确实喜欢的部分是,
17:03
besides除了 the fact事实 that it brings带来 a whole整个 new dimension尺寸
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除了它会为疾病控制研究带来
17:05
into the study研究 of control控制 of disease疾病,
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一个全新的领域之外,
17:09
is that often经常 the kinds of interventions干预措施 that you want,
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通常各种你想要的干预措施,
17:12
that it indicates指示 should be doneDONE,
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这些应该做的干预措施,
17:14
are the kinds of interventions干预措施 that people want anyhow无论如何.
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就是人们无论如何都想要的那些干预措施。
17:16
But people just haven't没有 been able能够 to justify辩解 the cost成本.
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但人们只是不能判断出所需付出的代价。
17:19
So, this is the kind of thing I'm talking about.
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因此,我所谈论的这类事情,
17:22
If we know that we're going to get extra额外 bang for the buck降压 from providing提供 clean清洁 water,
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如果我们知道我们将会从提供清洁的水源中获得额外的好处,
17:25
then I think that we can say,
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那么我想,我们会说,
17:27
let's push the effort功夫 into that aspect方面 of the control控制,
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让我们努力推进这方面的控制,
17:31
so that we can actually其实 solve解决 the problem问题,
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以便我们能真正的解决这个问题,
17:34
even though虽然, if you just look at the frequency频率 of infection感染,
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即使这样,如果你仅仅是看看这些感染的频率,
17:37
you would suggest建议 that you can't solve解决 the problem问题 well enough足够
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你可能会觉得这个问题无法仅仅通过清理水源供应
17:41
just by cleaning清洁的 up water supply供应.
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就可以很好的解决。
17:43
Anyhow无论如何, I'll end结束 that there, and thank you very much.
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总之,我的演讲到此结束,非常感谢。
17:45
(Applause掌声)
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(掌声)
Translated by Felix Chen
Reviewed by Alison Xiaoqiao Xie

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ABOUT THE SPEAKER
Paul Ewald - Evolutionary biologist
After years of studying illness from the germs' point of view, microbiologist Paul Ewald believes that Big Pharma is wrong about some very big issues. What's right? The leader in evolutionary medicine posits radical new approaches.

Why you should listen

Paul Ewald has a problem with modern medicine: It ignores the fact that many diseases of unknown origin can be linked to slow-growing infections caused by viruses, bacteria and other microorganisms.

Ewald -- whose theory stems from both a formal education in biological sciences, ecology, and evolution, and a personal bout with diarrhea in the 1970s -- aims to change this thinking. To that end, he has written popular news articles, academic papers, and two books (Evolution of Infectious Disease and Plague Time) that explain and expand his idea. Ewald is regarded as the leading expert in the emerging field of evolutionary medicine. He directs the evolutionary medicine program in the Biology department at the University of Louisville, Kentucky, and lectures worldwide.

Among other honors, Ewald was the first recipient of the Smithsonian Institution's George E. Burch Fellowship in Theoretic Medicine and Affiliated Sciences, which was established to foster pioneering work in health sciences.

More profile about the speaker
Paul Ewald | Speaker | TED.com