TEDMED 2014
Ramanan Laxminarayan: The coming crisis in antibiotics
拉曼安·拉斯麥雅瑞安: 抗生素危機來襲
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抗生素可以挽救生命，但是我們過度使用，而且經常使用在沒有生命危險的情況下，比如說治療流感，甚至為了養殖低價雞肉。研究員拉曼安·拉斯麥雅瑞安說，如果繼續濫用，抗生素不會再有藥效，因為細菌會變得越來越有抗藥性。他呼籲所有人（比如說病人和醫生）把抗生素和它的藥效想像成一個有限的資源。每當我們使用之前也要再三考慮。這是對全球用藥趨勢，能對所有人造成怎樣的影響的嚴肅省思。
Ramanan Laxminarayan - Drug-resistance economist
At the Center for Disease Dynamics, Economics & Policy, economist Ramanan Laxminarayan looks at big-picture issues of global health. Full bio
At the Center for Disease Dynamics, Economics & Policy, economist Ramanan Laxminarayan looks at big-picture issues of global health. Full bio
Double-click the English transcript below to play the video.
00:12
The first patient to ever be
treated with an antibiotic
treated with an antibiotic
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第一位接受抗生素治療的患者
00:16
was a policeman in Oxford.
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是一位牛津的警察。
00:17
On his day off from work,
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有一天，他休假在家，
00:19
he was scratched by a rose thorn
while working in the garden.
while working in the garden.
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整理自家花園時被玫瑰的刺劃傷。
00:23
That small scratch became infected.
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那個小的傷口被感染了。
00:26
Over the next few days,
his head was swollen
his head was swollen
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在接下來的幾天裡，他的頭因為膿瘡
00:29
with abscesses,
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而腫了起來，
00:30
and in fact his eye was so infected
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事實上他的眼睛受到嚴重感染，
00:33
that they had to take it out,
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醫生只好將它摘除，
00:35
and by February of 1941,
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到了 1941 年二月，
00:38
this poor man was on the verge of dying.
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這個可憐的警察
已經徘徊在生死邊緣。
已經徘徊在生死邊緣。
00:40
He was at Radcliffe Infirmary in Oxford,
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他在牛津的拉德克利夫醫院接受治療，
00:43
and fortunately for him,
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幸運的是，
由霍華德·佛洛里醫生
00:45
a small team of doctors
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00:47
led by a Dr. Howard Florey
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領導的一個醫療小團隊
00:48
had managed to synthesize
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成功地合成了
00:50
a very small amount of penicillin,
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微量的青黴素，
00:53
a drug that had been discovered
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在 12 年前，由亞歷山大·佛萊明
00:55
12 years before by Alexander Fleming
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所發現的一種藥物，
00:58
but had never actually been
used to treat a human,
used to treat a human,
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但是從來沒有在人體上使用過，
01:01
and indeed no one even
knew if the drug would work,
knew if the drug would work,
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事實上，甚至沒人知道
這個藥是否有效，
這個藥是否有效，
01:04
if it was full of impurities
that would kill the patient,
that would kill the patient,
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如果這藥物不純淨的話會不會致死，
01:07
but Florey and his team figured
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但是佛洛里和他的團隊覺得
01:09
if they had to use it,
they might as well use it
they might as well use it
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如果他們一定要試用這個藥，
01:11
on someone who was going to die anyway.
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不妨用在無藥可救的患者身上。
01:14
So they gave Albert Alexander,
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於是他們將藥用在亞柏·亞歷山大
01:17
this Oxford policeman, the drug,
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那位牛津警察的身上。
01:20
and within 24 hours,
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在 24 小時之內，
01:23
he started getting better.
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他的狀況開始好轉。
01:25
His fever went down,
his appetite came back.
his appetite came back.
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他的燒退了，胃口也恢復了。
01:29
Second day, he was doing much better.
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第二天，他康復得更好。
01:31
They were starting to
run out of penicillin,
run out of penicillin,
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不過青黴素就快用完，
01:33
so what they would do
was run with his urine
was run with his urine
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所以醫生們採集他的尿液
01:35
across the road to re-synthesize
the penicillin from his urine
the penicillin from his urine
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從尿液裡重新合成青黴素，
01:38
and give it back to him,
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再用來治療他，
01:40
and that worked.
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這個方法也可行。
01:42
Day four, well on the way to recovery.
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第四天，他仍在慢慢康復。
01:44
This was a miracle.
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在當時這是一個奇蹟。
01:46
Day five, they ran out of penicillin,
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第五天，青黴素用完了，
01:50
and the poor man died.
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那位可憐的警察就這樣去世了。
01:52
So that story didn't end that well,
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這個故事的結局不太好，
01:55
but fortunately for
millions of other people,
millions of other people,
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不過，在他之後，有百萬人受益，
01:59
like this child who was treated
again in the early 1940s,
again in the early 1940s,
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就像是 40 年代初期，
02:02
who was again dying of a sepsis,
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在敗血症下垂死掙扎的這個孩子，
02:05
and within just six days, you can see,
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你們可以看到，在六天之內，
02:08
recovered thanks to this
wonder drug, penicillin.
wonder drug, penicillin.
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因為神奇的青黴素，這孩子痊癒了。
02:12
Millions have lived,
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上百萬的人因它活了下來，
02:14
and global health has been transformed.
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全人類的健康發生了轉變。
02:17
Now, antibiotics have been used
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現在，抗生素用來
02:20
for patients like this,
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治療這類病人，
02:23
but they've also been
used rather frivolously
used rather frivolously
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但是它們也被輕易用在
02:25
in some instances,
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別的情況下，
02:27
for treating someone
with just a cold or the flu,
with just a cold or the flu,
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比如說用來治療感冒和流感，
02:29
which they might not have
responded to an antibiotic,
responded to an antibiotic,
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抗生素的治療效果不會很明顯。
它們也被大量地使用在
非醫療場合裡，
非醫療場合裡，
02:32
and they've also been
used in large quantities
used in large quantities
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02:36
sub-therapeutically, which
means in small concentrations,
means in small concentrations,
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用低濃度的抗生素，
02:39
to make chicken and hogs grow faster.
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讓雞和豬長得更快一些。
02:42
Just to save a few pennies
on the price of meat,
on the price of meat,
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只是為了省一些的買肉的錢，
02:46
we've spent a lot of
antibiotics on animals,
antibiotics on animals,
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我們在動物身上用很多的抗生素，
02:49
not for treatment, not for sick animals,
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不是為了醫治生病的動物，
02:51
but primarily for growth promotion.
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主要是為了加速生長，
02:54
Now, what did that lead us to?
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這會導致什麼結果呢？
02:57
Basically, the massive use of antibiotics
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在全球
大量地使用抗生素，
03:00
around the world
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03:01
has imposed such large
selection pressure on bacteria
selection pressure on bacteria
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促進了細菌適者生存的自然選擇，
03:05
that resistance is now a problem,
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現在細菌的抗藥性成了問題，
03:08
because we've now selected for just
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因為只有抗藥性強的細菌
03:10
the resistant bacteria.
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才能生存到現在。
03:11
And I'm sure you've all read
about this in the newspapers,
about this in the newspapers,
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我敢肯定你們都在報紙上
看過類似報導，
看過類似報導，
03:14
you've seen this in every magazine
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你們瀏覽的每一本雜誌
03:16
that you come across,
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都有看過類似文章，
但是我想讓你們明白
03:18
but I really want you to appreciate
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03:20
the significance of this problem.
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這個問題的重要性。
03:22
This is serious.
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這是一個很嚴重的問題。
03:23
The next slide I'm about to show you is
of carbapenem resistance in acinetobacter.
of carbapenem resistance in acinetobacter.
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下一張幻燈片展示的是
不動桿菌對碳青黴烯的抗藥性，
不動桿菌對碳青黴烯的抗藥性，
03:28
Acinetobacter is a nasty hospital bug,
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不動桿菌是一種經常
存在於醫院的細菌，
存在於醫院的細菌，
03:31
and carbapenem is pretty much
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碳青黴烯是
03:32
the strongest class of antibiotics
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一種最強的抗生素
03:34
that we can throw at this bug.
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用來對抗這種細菌。
03:36
And you can see in 1999
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你們可以看到，在 1999 年
03:39
this is the pattern of resistance,
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這是抗藥性分布圖，
03:42
mostly under about 10 percent
across the United States.
across the United States.
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在美國通常是在 10% 以下。
03:45
Now watch what happens
when we play the video.
when we play the video.
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接下來隨著時間推移會發生什麼。
03:58
So I don't know where you live,
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我不知道各位是住在哪裡
04:00
but wherever it is, it certainly is a lot worse now
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不管你住在哪裡，現在的情況
04:03
than it was in 1999,
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都比 1999 年要差，
04:05
and that is the problem of antibiotic resistance.
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問題所在就是對抗生素的抗藥性。
04:09
It's a global issue
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這是一個全球性的問題
04:11
affecting both rich and poor countries,
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富有和貧窮國家都受到了影響，
04:14
and at the heart of it,
you might say, well,
you might say, well,
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歸根結底，你也許會說，
04:16
isn't this really just a medical issue?
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這只是一個醫學問題吧？
04:18
If we taught doctors how not
to use antibiotics as much,
to use antibiotics as much,
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如果我們讓醫生少用抗生素，
04:20
if we taught patients how
not to demand antibiotics,
not to demand antibiotics,
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讓病人不要求使用抗生素，
04:23
perhaps this really wouldn't be an issue,
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不就化解難題了嘛，
04:25
and maybe the pharmaceutical companies
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也許醫藥公司
04:27
should be working harder to develop
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應該更努力研發
04:28
more antibiotics.
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更多的抗生素。
04:30
Now, it turns out that there's something
fundamental about antibiotics
fundamental about antibiotics
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但是抗生素在本質上
04:33
which makes it different from other drugs,
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與其他藥物有不同的地方，
04:35
which is that if I misuse antibiotics
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意味著，如果我誤用抗生素
04:37
or I use antibiotics,
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或使用抗生素，
04:39
not only am I affected but
others are affected as well,
others are affected as well,
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不僅我會受到影響，
其他人也會受到影響，
其他人也會受到影響，
04:43
in the same way as if I
choose to drive to work
choose to drive to work
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同理，有如我開車去上班
04:45
or take a plane to go somewhere,
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或者坐飛機去別的地方，
04:48
that the costs I impose on others
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我造成的污染也會影響到別人
04:50
through global climate change go everywhere,
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因此造成氣候變化
其影響無所不在，
其影響無所不在，
04:52
and I don't necessarily take
these costs into consideration.
these costs into consideration.
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我卻不會考慮到我帶來的影響。
04:55
This is what economists might
call a problem of the commons,
call a problem of the commons,
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這就是經濟學裡所謂的公共問題，
04:58
and the problem of the commons is exactly
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公共問題恰好就是
05:00
what we face in the case
of antibiotics as well:
of antibiotics as well:
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抗生素所面對的問題：
05:02
that we don't consider —
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我們都不會考慮－
05:04
and we, including individuals, patients,
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包括個人、病患、
05:07
hospitals, entire health systems —
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醫院、整個醫療體系－
05:11
do not consider the costs
that they impose on others
that they impose on others
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沒有仔細思考濫用抗生素
05:13
by the way antibiotics are actually used.
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會給別人帶來什麼影響。
05:15
Now, that's a problem that's similar
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這與我們所熟知的
05:17
to another area that we all know about,
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另一個領域的問題很類似，
05:19
which is of fuel use and energy,
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那就是燃油的使用和能源問題，
05:21
and of course energy use
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當然，能源的使用問題
05:23
both depletes energy as well as
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不僅消耗了大量資源
05:26
leads to local pollution
and climate change.
and climate change.
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也造成了當地環境污染和氣候變化。
05:29
And typically, in the case of energy,
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特別是能源的使用，
05:31
there are two ways in which
you can deal with the problem.
you can deal with the problem.
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有兩個解決方案。
05:33
One is, we can make better
use of the oil that we have,
use of the oil that we have,
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一是更加有效率的使用現有的燃油，
05:37
and that's analogous to making better use
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同樣的，我們可以更好的方式使用
05:39
of existing antibiotics,
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現存的抗生素，
05:41
and we can do this in a number of ways
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我們可以通過很多途徑來實現它
05:42
that we'll talk about in a second,
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我們稍後再討論這個問題，
05:45
but the other option is the
"drill, baby, drill" option,
"drill, baby, drill" option,
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另一個選擇就是繼續開採燃油，
05:48
which in the case of antibiotics
is to go find new antibiotics.
is to go find new antibiotics.
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在抗生素的角度來說
就是尋找新的抗生素。
就是尋找新的抗生素。
05:53
Now, these are not separate.
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這不是分開的兩個選擇。
05:55
They're related, because if we invest heavily
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它們是相關連的，
如果我們大量地投資
如果我們大量地投資
05:58
in new oil wells,
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在開採新的油井，
06:00
we reduce the incentives
for conservation of oil
for conservation of oil
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我們對原油的節約意識也就降低了，
06:03
in the same way that's going
to happen for antibiotics.
to happen for antibiotics.
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抗生素也會發生同樣的事情。
06:06
The reverse is also going
to happen, which is that
to happen, which is that
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相反的情況也會發生，
06:08
if we use our antibiotics appropriately,
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如果我們適當使用抗生素，
06:10
we don't necessarily have
to make the investments
to make the investments
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我們就不必投資
06:13
in new drug development.
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開發新的抗生素。
06:15
And if you thought that these two were entirely,
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如果你認為這兩者
06:18
fully balanced between these two options,
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處在完美的平衡狀態，
06:20
you might consider the fact that
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那你應該知道
06:22
this is really a game that we're playing.
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其實這只是我們玩的一個遊戲。
06:24
The game is really one of coevolution,
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這個遊戲只是一種共同進化，
06:27
and coevolution is, in
this particular picture,
this particular picture,
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如圖所示，在獵豹和羚羊之間，
06:30
between cheetahs and gazelles.
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就存在著共同進化。
06:32
Cheetahs have evolved to run faster,
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獵豹進化讓自己跑得更快，
06:34
because if they didn't run faster,
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因為如果牠們跑得不快，
06:35
they wouldn't get any lunch.
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就吃不到午飯。
06:37
Gazelles have evolved to run faster because
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羚羊也進化跑得更快
06:40
if they don't run faster, they would be lunch.
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因為如果牠們跑不快，
就會被當作午餐，
就會被當作午餐，
06:43
Now, this is the game we're
playing against the bacteria,
playing against the bacteria,
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我們就在和細菌玩這個遊戲，
06:46
except we're not the cheetahs,
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但我們不是獵豹，
06:48
we're the gazelles,
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我們是羚羊，
06:49
and the bacteria would,
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而細菌，
06:52
just in the course of this little talk,
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就在我們說話的同時，
06:54
would have had kids and grandkids
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會一代一代地繁衍，
06:55
and figured out how to be resistant
157
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2385
它們會想辦法抵抗抗生素，
06:58
just by selection and trial and error,
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通過選擇和試誤，
07:00
trying it over and over again.
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一再地嘗試。
07:02
Whereas how do we stay
ahead of the bacteria?
ahead of the bacteria?
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3772
那我們要怎麼做
才能跑在細菌的前面呢？
才能跑在細菌的前面呢？
07:06
We have drug discovery processes,
161
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2054
我們有藥物研發過程，
07:08
screening molecules,
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1630
篩選分子，
07:10
we have clinical trials,
163
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我們有臨床試驗，
07:11
and then, when we think we have a drug,
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當我們認為我們研發出新的藥物時，
07:14
then we have the FDA regulatory process.
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我們還要通過食品藥物管理局的審查。
07:17
And once we go through all of that,
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一旦我們完成了這些程序，
07:20
then we try to stay one step ahead
167
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2265
我們又要再想辦法跑在
07:22
of the bacteria.
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2296
細菌的前面。
07:24
Now, this is clearly not a
game that can be sustained,
game that can be sustained,
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很明顯這不是一個
可以長期堅持的遊戲，
可以長期堅持的遊戲，
07:27
or one that we can win
170
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1137
或是只依靠發現新藥物
07:28
by simply innovating to stay ahead.
171
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1837
就能贏得勝利的遊戲。
07:30
We've got to slow the pace of coevolution down,
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3305
我們需要讓共同進化的腳步慢下來，
07:33
and there are ideas that we
can borrow from energy
can borrow from energy
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能源問題的解決方法
我們可以引為借鏡，
我們可以引為借鏡，
07:37
that are helpful in thinking about
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1770
我們可以嫁接
07:39
how we might want to do this in the case
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1537
解決能源問題的辦法
07:40
of antibiotics as well.
176
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1546
來解決抗生素的問題。
07:42
Now, if you think about how we deal with
177
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2240
如果你們想想我們是
07:44
energy pricing, for instance,
178
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1423
怎麼處理能源的價格，
07:45
we consider emissions taxes,
179
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1849
我們會考慮污染排放稅，
07:47
which means we're imposing
the costs of pollution
the costs of pollution
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2584
意味著我們讓使用能源的人
07:50
on people who actually use that energy.
181
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2831
出錢來解決排放的污染。
07:53
We might consider doing that for antibiotics as well,
182
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我們可以在抗生素上做同樣的事，
07:56
and perhaps that would make sure that antibiotics
183
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2711
也許可以讓抗生素
07:58
actually get used appropriately.
184
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2401
被適當的使用。
08:01
There are clean energy subsidies,
185
469172
2028
還有清潔能源補貼，
08:03
which are to switch to fuels
which don't pollute as much
which don't pollute as much
186
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3055
鼓勵使用低污染的能源，
08:06
or perhaps don't need fossil fuels.
187
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2845
也許最後我們都不需要石油了。
08:09
Now, the analogy here is, perhaps we need
188
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2860
同樣的，或許我們必需
08:11
to move away from using antibiotics,
189
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2260
遠離抗生素，
08:14
and if you think about it, what are
good substitutes for antibiotics?
good substitutes for antibiotics?
190
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3716
你仔細想想，什麼可以代替抗生素？
08:17
Well, turns out that anything that reduces
191
485936
2164
一切可以減少抗生素使用的東西
08:20
the need for the antibiotic would really work,
192
488100
2243
都是可行的，
08:22
so that could include improving
hospital infection control
hospital infection control
193
490343
3142
包括提高醫院防治感染的能力，
08:25
or vaccinating people,
194
493485
2895
給人們打疫苗，
08:28
particularly against
the seasonal influenza.
the seasonal influenza.
195
496380
2297
特別是抵抗季節性流感的疫苗。
08:30
And the seasonal flu is probably
196
498677
2531
季節性流感很可能
08:33
the biggest driver of antibiotic use,
197
501208
3004
是抗生素使用最多的地方，
08:36
both in this country as well
as in many other countries,
as in many other countries,
198
504212
2919
在我國和其他國家都是，
08:39
and that could really help.
199
507131
2020
注射疫苗可以提供極大的幫助。
08:41
A third option might include
something like tradeable permits.
something like tradeable permits.
200
509151
4103
第三種選擇包括交易許可。
08:45
And these seem like faraway scenarios,
201
513254
4246
這聽起來似乎和抗生素掛不上邊，
08:49
but if you consider the
fact that we might not
fact that we might not
202
517500
2427
但是如果我們沒有足量抗生素
08:51
have antibiotics for many
people who have infections,
people who have infections,
203
519927
3383
給被感染的人治療，
08:55
we might consider the fact that we might
204
523310
2237
我們也許可考慮
08:57
want to allocate who actually gets to use
205
525547
2311
把抗生素分配
08:59
some of these antibiotics over others,
206
527858
2714
給最需要的人，
09:02
and some of these might have to
be on the basis of clinical need,
be on the basis of clinical need,
207
530572
3326
但我們需要考慮臨床需要，
09:05
but also on the basis of pricing.
208
533898
1935
以及定價的基礎。
09:07
And certainly consumer education works.
209
535833
1910
當然教育消費者也可行。
09:09
Very often, people overuse antibiotics
210
537743
2601
多數時候，大家濫用抗生素
09:12
or prescribe too much without necessarily
211
540344
2277
或者醫生開了過量的抗生素，
09:14
knowing that they do so,
212
542621
1606
卻不盡然明瞭自己已濫用或過量，
09:16
and feedback mechanisms
213
544227
1431
而反饋機制讓他們知道情況
09:17
have been found to be useful,
214
545658
1902
也被證明有效，
09:19
both on energy —
215
547560
1929
不僅在能源問題上－
09:21
When you tell someone that they're using
216
549489
1540
當你告訴某人
09:23
a lot of energy during peak hour,
217
551029
1917
他們在高峰期用了很多能源，
09:24
they tend to cut back,
218
552946
1470
他們一般都會變得節約一些，
09:26
and the same sort of example has been performed
219
554416
1767
同樣的例子
09:28
even in the case of antibiotics.
220
556183
1810
在抗生素上也有所體現。
09:29
A hospital in St. Louis basically would put up
221
557993
1981
聖路易斯的一家醫院
09:31
on a chart the names of surgeons
222
559974
4192
把外科醫生的名字做成一張表，
09:36
in the ordering of how much antibiotics they'd used
223
564166
2219
依上個月用了多少抗生素
09:38
in the previous month,
224
566385
1944
來進行排名，
09:40
and this was purely an
informational feedback,
informational feedback,
225
568329
2342
這全然是一個信息反饋，
09:42
there was no shaming,
226
570671
1183
這張表沒有對醫生指責，
09:43
but essentially that provided
some information back
some information back
227
571854
2135
只是提供了一些資訊
這樣外科醫生可以反思
09:45
to surgeons that maybe they could rethink
228
573989
1954
09:47
how they were using antibiotics.
229
575943
2229
自己有沒有適當使用抗生素。
如今，在供給這方面
09:50
Now, there's a lot that can be done
230
578172
2014
09:52
on the supply side as well.
231
580186
2149
也有需要改善的地方。
09:54
If you look at the price of penicillin,
232
582335
1777
如果你看看青黴素的價格，
09:56
the cost per day is about 10 cents.
233
584112
1651
一天的價格是 10 美分 （三元台幣）。
09:57
It's a fairly cheap drug.
234
585763
1758
這是非常便宜的藥。
09:59
If you take drugs that have
been introduced since then —
been introduced since then —
235
587521
2137
如果你使用之後發明的藥物－
10:01
linezolid or daptomycin —
236
589658
2644
利奈唑胺或者達託黴素－
10:04
those are significantly more expensive,
237
592302
1878
是要貴得多，
10:06
so to a world that has been used to
paying 10 cents a day for antibiotics,
paying 10 cents a day for antibiotics,
238
594180
5451
如果你可以每天花 10 美分
使用抗生素，
使用抗生素，
10:11
the idea of paying 180 dollars per day
239
599633
2530
那麼花 180 美元使用別的藥物
10:14
seems like a lot.
240
602163
1567
看起來就貴多了。
10:15
But what is that really telling us?
241
603730
1987
這個究竟告訴了我們什麼呢？
10:17
That price is telling us
242
605717
1965
價格告訴我們
10:19
that we should no longer
243
607682
1898
我們不應該
10:21
take cheap, effective
antibiotics as a given
antibiotics as a given
244
609580
4117
在可見的未來裡
將使用廉價有效的抗生素視為當然，
10:25
into the foreseeable future,
245
613697
1767
10:27
and that price is a signal to us
246
615464
2530
這個價格是一個信號
10:29
that perhaps we need to be paying
247
617994
1609
也許我們應該
10:31
much more attention to conservation.
248
619603
2553
重視節用抗生素。
10:34
That price is also a signal
249
622156
2704
這個價格也給出了另一個信號
10:36
that maybe we need to start
looking at other technologies,
looking at other technologies,
250
624860
2875
那就是我們應該開始轉向其他的技術，
10:39
in the same way that
gasoline prices are a signal
gasoline prices are a signal
251
627735
2652
就好像汽油價格是一個信號
10:42
and an impetus, to, say,
252
630387
2590
可以說它
10:44
the development of electric cars.
253
632977
1868
刺激了電動車的發展。
10:46
Prices are important signals
254
634845
1777
價格是很重要的信號
10:48
and we need to pay attention,
255
636622
1586
我們要更重視這個訊號，
10:50
but we also need to consider the fact that
256
638208
2452
但我們也要考慮到
10:52
although these high prices
seem unusual for antibiotics,
seem unusual for antibiotics,
257
640660
4252
雖然高價抗生素似乎不太常見，
10:56
they're nothing compared to the price per day
258
644912
2239
和某些癌症治療藥物比起來
10:59
of some cancer drugs,
259
647151
1384
這種高價基本上可以被忽視，
11:00
which might save a patient's life only
for a few months or perhaps a year,
for a few months or perhaps a year,
260
648535
3370
癌症藥物可能只能拖延幾個月
或者一年的時間，
或者一年的時間，
11:03
whereas antibiotics would potentially
261
651905
1770
而抗生素
可以徹底挽救一個病人的生命。
11:05
save a patient's life forever.
262
653675
1826
11:07
So this is going to involve
263
655501
1319
所以一個全新的模式變革
11:08
a whole new paradigm shift,
264
656820
1962
將會發生，
11:10
and it's also a scary shift because
265
658782
1856
這種變化也會很可怕
11:12
in many parts of this country,
266
660638
2329
因為在這個國家很多地方，
11:14
in many parts of the world,
267
662967
1744
在全球各個角落，
11:16
the idea of paying 200 dollars
268
664711
2069
每天花上 200 美元
11:18
for a day of antibiotic treatment
269
666780
2891
進行抗生素治療
11:21
is simply unimaginable.
270
669671
2542
是難以想像的。
11:24
So we need to think about that.
271
672213
1734
所以我們需要好好的想一想。
11:25
Now, there are backstop options,
272
673947
1813
現在，還有一些備案，
11:27
which is other alternative technologies
273
675760
2676
人們在研發
其他可以代替的技術。
11:30
that people are working on.
274
678436
1194
11:31
It includes bacteriophages, probiotics,
275
679630
2652
包括噬菌體、益生菌，
11:34
quorum sensing, synbiotics.
276
682282
4048
細菌群聚感應、合益素。
11:38
Now, all of these are useful avenues to pursue,
277
686330
3039
如今這些都是可以探索的途徑，
11:41
and they will become even more lucrative
278
689369
2610
當新抗生素價格不斷上漲時
11:43
when the price of new
antibiotics starts going higher,
antibiotics starts going higher,
279
691979
3081
它們就會變得更有利可圖，
11:47
and we've seen that the
market does actually respond,
market does actually respond,
280
695060
2897
我們看到市場已經開始回應，
11:49
and the government is now considering
281
697957
2008
政府也在考慮
11:51
ways of subsidizing new
antibiotics and development.
antibiotics and development.
282
699965
3767
為新抗生素研發提供補貼。
11:55
But there are challenges here.
283
703732
1723
但我們正面臨挑戰。
11:57
We don't want to just throw money at a problem.
284
705455
1575
問題不能只光砸錢。
11:59
What we want to be able to do
285
707030
1519
我們想做的
12:00
is invest in new antibiotics
286
708549
2279
是投資研發新的抗生素
12:02
in ways that actually encourage
287
710828
2976
但要能實際鼓勵
12:05
appropriate use and sales of those antibiotics,
288
713804
3020
這些抗生素的銷售和適當使用，
12:08
and that really is the challenge here.
289
716824
2463
這才是真正的挑戰。
12:11
Now, going back to these technologies,
290
719287
2329
現在回到技術上，
你們肯定記得那部知名恐龍影片，
12:13
you all remember the line from that famous
291
721616
2363
侏儸紀公園裡面的一句台詞
「大自然會找到自己的出路。」
「大自然會找到自己的出路。」
12:15
dinosaur film, "Nature will find a way."
292
723979
2226
12:18
So it's not as if these are
permanent solutions.
permanent solutions.
293
726205
3319
所以這些都不是永久的解決辦法。
12:21
We really have to remember that,
whatever the technology might be,
whatever the technology might be,
294
729524
4086
我們需要記住，不管是什麼科技，
12:25
that nature will find some
way to work around it.
way to work around it.
295
733610
2876
大自然總會找到解決方法。
12:28
You might think, well,
this is just a problem
this is just a problem
296
736486
2071
你也許會想，這只是一個
12:30
just with antibiotics and with bacteria,
297
738557
2744
有關抗生素和細菌的問題，
12:33
but it turns out that we
have the exact same
have the exact same
298
741301
1946
但是我們在其他領域
12:35
identical problem in
many other fields as well,
many other fields as well,
299
743247
2734
也有相同的問題，
12:37
with multidrug-resistant tuberculosis,
300
745981
2952
有多重抗藥性肺結核，
12:40
which is a serious problem
in India and South Africa.
in India and South Africa.
301
748933
3562
在南非和印度都是一個大問題。
12:44
Thousands of patients are dying because
302
752495
1787
上千的病人面臨死亡的威脅
12:46
the second-line drugs are so expensive,
303
754282
1834
因為二線藥物太昂貴，
12:48
and in some instances, even those don't work
304
756116
2227
有的情況，二線藥物都沒有作用，
12:50
and you have XDR TB.
305
758343
2070
因為你得了廣泛抗藥性肺結核。
12:52
Viruses are becoming resistant.
306
760413
1811
病毒也變得具抗藥性。
12:54
Agricultural pests. Malaria parasites.
307
762224
3166
農業害蟲、 瘧原蟲。
12:57
Right now, much of the world depends on
308
765390
1783
現在，世界上很多地方
都依賴一種藥物
都依賴一種藥物
12:59
one drug, artemisinin drugs,
309
767173
3697
青蒿素藥物，
13:02
essentially to treat malaria.
310
770870
1956
它用於治療瘧疾。
13:04
Resistance to artemisinin has already emerged,
311
772826
2587
對青蒿素的抗藥性已經開始顯現，
13:07
and if this were to become widespread,
312
775413
2354
如果這種情況蔓延，
13:09
that puts at risk
313
777767
1348
會使這種目前我們在全球治療瘧疾
13:11
the single drug that we have to
treat malaria around the world
treat malaria around the world
314
779115
2891
安全又有效的單一療法藥物
13:14
in a way that's currently
safe and efficacious.
safe and efficacious.
315
782006
3214
產生風險。
13:17
Mosquitos develop resistance.
316
785220
1798
蚊子也產生了耐藥性。
13:19
If you have kids, you probably
know about head lice,
know about head lice,
317
787018
2237
如果你有小孩，你應該會知道頭蝨，
13:21
and if you're from New York City,
318
789255
1713
如果你是紐約人，
13:22
I understand that the
specialty there is bedbugs.
specialty there is bedbugs.
319
790968
2733
我聽說那裡的特產是臭蟲。
13:25
So those are also resistant.
320
793701
2255
這些也有了抗藥性。
13:27
And we have to bring an
example from across the pond.
example from across the pond.
321
795956
2879
我們還得舉個一洋之隔的
英國的例子。
英國的例子。
13:30
Turns out that rats are
also resistant to poisons.
also resistant to poisons.
322
798835
2355
那裡的老鼠也變得抗毒藥了。
13:33
Now, what's common
to all of these things is
to all of these things is
323
801190
2701
這些事的共同點就是
13:35
the idea that we've had these technologies
324
803891
2706
我們有了這些技術
13:38
to control nature only for
the last 70, 80 or 100 years
the last 70, 80 or 100 years
325
806597
4621
讓我們戰勝了自然 70、80
或者 100 年，
或者 100 年，
13:43
and essentially in a blink,
326
811218
3028
轉眼之間，
13:46
we have squandered our ability to control,
327
814246
2551
我們就失去了控制力，
13:48
because we have not recognized
328
816797
2491
因為我們還沒有意識到
13:51
that natural selection and
evolution was going to find
evolution was going to find
329
819288
2812
自然選擇和進化
總會找到一個出路，
13:54
a way to get back,
330
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1174
13:55
and we need to completely rethink
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我們需要全盤反思
13:57
how we're going to use
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我們究竟要用什麼
13:59
measures to control biological organisms,
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去控制生物體，
14:02
and rethink how we incentivize
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我們需要反思
我們如何促進藥物的發展及引進，
14:06
the development, introduction,
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14:08
in the case of antibiotics prescription,
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比如在抗生素的處方上，
14:11
and use of these valuable resources.
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及如何利用這些寶貴的資源。
14:14
And we really now need to
start thinking about them
start thinking about them
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我們需要把它們
14:17
as natural resources.
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當作自然資源。
14:19
And so we stand at a crossroads.
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我們站在一個十字路口上。
14:21
An option is to go through that rethinking
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一個選擇就是反思自己
14:24
and carefully consider incentives
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謹慎地考慮所有的動機
14:26
to change how we do business.
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怎麼改變我們做事的方法。
14:28
The alternative is
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要不然我們就會淪落在
14:31
a world in which even a blade of grass
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即便一片草葉子
14:34
is a potentially lethal weapon.
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也是致命武器的世界裡。
14:36
Thank you.
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謝謝。
14:38
(Applause)
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（掌聲）
ABOUT THE SPEAKER
Ramanan Laxminarayan - Drug-resistance economistAt the Center for Disease Dynamics, Economics & Policy, economist Ramanan Laxminarayan looks at big-picture issues of global health.
Why you should listen
Economist Ramanan Laxminarayan works to improve understanding of drug resistance as a problem of managing a shared global resource. As Director and Senior Fellow at the Center for Disease Dynamics, Economics & Policy (CDDEP), he is interested in cross-disciplinary, pragmatic solutions to reduce drug resistance. He has advised the World Health Organization and World Bank on evaluating malaria treatment policy, vaccination strategies, the economic burden of tuberculosis, and control of non-communicable diseases. He was a key architect of the Affordable Medicines Facility for malaria, a novel financing mechanism to improve access and delay resistance to antimalarial drugs. In 2012, he created the Immunization Technical Support Unit in India, which has been credited with improving the immunization program in the country. He teaches at Princeton.
As he says: "It has been a long time since people died of untreatable bacterial infections, and the prospect of returning to that world is worrying."Ramanan Laxminarayan | Speaker | TED.com