TEDxCanberra
Thomas Pogge: Medicine for the 99 percent
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Can we incentivize companies to produce much-needed drugs? Thomas Pogge proposes a $6 billion plan to revolutionize the way medications are developed and sold.
(Filmed at TEDxCanberra.)
Thomas Pogge - Philosopher
Philosopher Thomas Pogge wants to ensure medications get to those who need it most. He has published on a wide range of subjects such as global justice and human rights. Full bio
Philosopher Thomas Pogge wants to ensure medications get to those who need it most. He has published on a wide range of subjects such as global justice and human rights. Full bio
Double-click the English transcript below to play the video.
00:09
I hope you're all healthy,
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我希望你们都身体健康，
00:11
and I hope we will all remain healthy
for the indefinite future.
for the indefinite future.
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我希望我们未来也都会很健康。
00:15
But that hope is a little bit unrealistic,
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但是这个愿望有一些不现实，
00:18
and so I've got a second back-up hope.
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所以我有个退一步的愿望。
00:20
The second back-up hope is that,
insofar as we have health problems,
insofar as we have health problems,
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退一步的愿望是，
只要我们有健康问题，
只要我们有健康问题，
00:24
we will have good medicines
to take care of them.
to take care of them.
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就会有好的药物来解决。
00:28
Medicines are very cheap to produce
and they're very effective --
and they're very effective --
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药物成本很低，并且很有效——
00:32
much more pleasant, actually,
than the alternatives:
than the alternatives:
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实际上也比其他选择
更容易让人接受：
更容易让人接受：
00:35
hospitalization, operations,
emergency rooms, the morgue ...
emergency rooms, the morgue ...
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像住院，手术，急救室，太平间…
00:40
None of these are good things.
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以上这些都不是好事情。
00:41
So we should be very grateful
that we have pharmacologists around,
that we have pharmacologists around,
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所以我们应该感谢药剂师的存在，
00:45
people who research these things
and develop new medicines.
and develop new medicines.
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那些研究和设计新药品的人员。
00:49
And we should be grateful
that we have a pharmaceutical industry
that we have a pharmaceutical industry
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我们还应该感谢支持药剂师们工作
00:52
that supports their activities.
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的制药工业。
00:55
But there is a problem,
and you can tell from the fact
and you can tell from the fact
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但是有个问题，
你们也许发现了
你们也许发现了
00:58
that the pharmaceutical
industry isn't well-loved.
industry isn't well-loved.
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制药业并不受欢迎的事实。
事实上，论受欢迎程度，
它与烟草业和武器生产行业
它与烟草业和武器生产行业
01:01
In fact, in terms of popularity, they rank
just about with the tobacco companies
just about with the tobacco companies
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01:06
and the arms manufacturers.
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不相上下。
01:08
So that's the problem
I want to talk with you about today.
I want to talk with you about today.
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所以这就是我今天想
与你们谈论的问题。
与你们谈论的问题。
01:13
How would you organize
the pharmaceutical industry?
the pharmaceutical industry?
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你会如何组织制药业？
01:16
If we did it all over again,
how would you do it?
how would you do it?
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如果所有都重来，
你会怎样做？
你会怎样做？
01:18
I think we would think
of three main principles.
of three main principles.
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我认为我们应该考虑
三个主要原则。
三个主要原则。
01:22
The first one is:
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第一个是：
01:23
we want patients to have access
to all the important medicines.
to all the important medicines.
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我们想要病人能够获得
所有重要的药物。
所有重要的药物。
01:27
Remember, these things
are very cheap to produce.
are very cheap to produce.
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请记住，药物的生产费用十分便宜。
01:30
So everybody in the world
should have access
should have access
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所以世界上的每一个人都应该
01:33
to all the important medicines.
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能获取到所有重要药物。
01:36
Secondly, we want innovative activities,
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第二点，我们要让研发活动，
01:39
the research and development
that pharmaceutical companies do,
that pharmaceutical companies do,
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制药公司的所有研究与开发工作，
01:42
to track the diseases that are
the most important, the most damaging.
the most important, the most damaging.
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去追踪最重要，
最具有破坏性的疾病。
最具有破坏性的疾病。
01:46
We want them to aim
for the greatest health impact.
for the greatest health impact.
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我们想让他们着眼于
最大范围的健康影响。
最大范围的健康影响。
01:50
And thirdly, we want
the whole system to be efficient.
the whole system to be efficient.
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还有第三点，我们想要
整个系统有效运转。
整个系统有效运转。
01:53
We want as little of the money
that goes into the system to go to waste,
that goes into the system to go to waste,
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我们不希望进入
这个系统的资金被浪费，
这个系统的资金被浪费，
01:58
to go for overhead,
for red tape, and so on and so forth.
for red tape, and so on and so forth.
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被过度使用，用于官僚主义
和其他不恰当的领域。
和其他不恰当的领域。
02:02
Very simple three points.
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非常简单的三点。
02:05
Now what about the existing system?
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那现存的系统呢？
02:07
I think it does poorly
on all these three counts.
on all these three counts.
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我认为它在这三点上
做得非常糟糕。
做得非常糟糕。
02:11
First, universal access: forget about it.
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第一，普遍的获取权：不用说了。
02:14
The vast majority of human beings
do not have access to medicines,
do not have access to medicines,
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大部分人并没有药物的获取权，
02:18
at least while they're still under patent.
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至少在药物还在专利保护期时。
02:22
There are extremely high markups,
and that's the problem.
and that's the problem.
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这里有极高的加价，
这是问题所在。
这是问题所在。
02:25
The problem is that even though
these medicines are very cheap to produce,
these medicines are very cheap to produce,
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问题在于即便药物成本非常便宜，
02:29
they cost a great amount of money
during the time that they're under patent,
during the time that they're under patent,
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它们在专利保护期内却售价不菲，
02:34
and the reason for that is
that rich people can pay a lot of money.
that rich people can pay a lot of money.
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原因是那些有钱人可以付很多钱。
02:39
Pharmaceutical companies
have a temporary monopoly;
have a temporary monopoly;
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制药公司有暂时性的垄断；
02:41
they price for the rich,
they forget about the poor.
they forget about the poor.
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他们为富人定价，而忽略了穷人。
02:45
The second problem is innovation.
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第二个问题是创新。
02:48
Again, we don't focus on the diseases
that do the most damage,
that do the most damage,
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我们聚焦最具破坏性的疾病，
02:52
and that's often put
into the phrase "the 10/90 gap."
into the phrase "the 10/90 gap."
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而这经常被称为“10/90的差距”
02:57
Ten percent of all the money spent
on pharmaceutical research
on pharmaceutical research
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10% 的全部医药研究费用
03:01
is focusing on diseases
that account for ninety percent
that account for ninety percent
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花在占全球疾病负担90%
03:04
of the global burden of disease.
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的疾病上面。
03:06
And vice versa -- ninety percent
of the money is spent on diseases
of the money is spent on diseases
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反之——90% 的钱花在了
占全世界正在攻克的
10% 的疾病上面。
10% 的疾病上面。
03:10
that account for only ten percent
of the global burden of disease.
of the global burden of disease.
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03:13
So there's a huge mismatch between
where we spend the research money
where we spend the research money
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所以我们花在研发上的钱
跟存在的最大问题
跟存在的最大问题
03:18
and where the greatest problems are.
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极不匹配。
03:21
Now, both these problems --
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这两个问题——
03:23
the problem with innovation
and the problem with access --
and the problem with access --
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研发问题，以及可获取问题——
都和这件事有关：
03:25
have to do with this:
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03:28
the distribution of money in the world.
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世界财富的分配
03:30
It's extremely unequal.
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是极其不平等的。
03:31
The blue area here is the top quarter
of the human population.
of the human population.
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蓝色部分是最富有的人口。
03:36
They have more than ninety percent
of the global household income.
of the global household income.
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他们拥有超过 90% 的全球家庭收入。
03:40
The bottom half of humanity,
on the other hand,
on the other hand,
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底下部分的人口，另一方面，
03:42
has not even three percent
of global household income.
of global household income.
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家庭收入占比甚至不到 3%。
03:46
So if you're a pharmaceutical company
and you look for profit opportunities,
and you look for profit opportunities,
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所以如果你是制药公司，
在寻找赚钱机会，
在寻找赚钱机会，
03:50
you look at this sort of chart and say,
"Where's the money?
"Where's the money?
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就应该看看这个调查表，
然后问：“钱在哪里？
然后问：“钱在哪里？
03:53
What am I going to research?
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我该研究些什么？
03:55
Who am I going to provide with medicines?"
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我该为谁提供药品？”
03:58
And again, that is in the context
of there being only one way
of there being only one way
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同样的，在现有的背景下
04:02
in which pharmaceutical companies
make money under the present system,
make money under the present system,
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制药公司赚钱的唯一办法
04:06
that is, through patent-protected markups.
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就是通过专利保护加价。
04:08
That's how they make their money,
through markups.
through markups.
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这就是他们赚钱的方式。
04:10
And if you make money through markups,
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如果你通过加价去赚钱，
04:12
then obviously, you will go to where
the people have the most income.
the people have the most income.
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那么，很明显你会向
那些最富有的人群收费。
那些最富有的人群收费。
04:19
Now in terms of overall efficiency,
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在整体效率方面，
04:20
the system also does very, very poorly.
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这个系统的运作同样非常糟糕。
04:24
A lot of money goes
for lobbying politicians
for lobbying politicians
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很多钱被游说政客们收入囊中，
04:27
in order to extend patent periods --
to "evergreen," as it's called.
to "evergreen," as it's called.
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目的是延长专利有效期——
也被他们叫做“常青树”，
也被他们叫做“常青树”，
04:30
Data exclusivity and so on.
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还有数据垄断等等问题。
04:32
A lot of money goes for gaming,
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很多钱被花在竞争上，
04:34
where brand-name companies pay generic
companies to delay entry, for example.
companies to delay entry, for example.
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例如，品牌公司向仿制药公司付钱
以延迟他们进入市场的时间。
以延迟他们进入市场的时间。
04:40
A lot of money goes to take our patents
in all the different jurisdictions.
in all the different jurisdictions.
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很多钱花在了在不同
司法管辖区获得专利上，
司法管辖区获得专利上，
04:43
Money goes – even larger
amounts – for litigation.
amounts – for litigation.
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甚至有更大金额的资金被用于诉讼。
04:46
They're litigating endlessly --
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公司间无休止的诉讼——
04:48
brand-name company
against brand-name company,
against brand-name company,
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品牌公司对品牌公司，
04:50
brand-name company
against generic company ...
against generic company ...
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品牌公司对仿制药公司…
04:52
Enormous amounts go there.
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巨大的资金被浪费在了这里。
04:54
People say pharmaceutical companies
make a lot of profit.
make a lot of profit.
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人们都说制药公司利润颇丰。
04:57
Well, yes and no; they do, but a lot of it
goes to these wasteful activities.
goes to these wasteful activities.
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这话对，也不对：他们确实有钱，
但是大部分都花费在了无用的事情上。
但是大部分都花费在了无用的事情上。
05:02
Deadweight losses -- I won't
even tell you what they are,
even tell you what they are,
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无谓损失——我就不细说了，
05:04
because it's too complicated.
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这个概念太复杂，
但也有毫无疑义的市场营销。
05:06
But there's also wasteful marketing.
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05:08
A lot of the money
that pharmaceutical companies make
that pharmaceutical companies make
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制药公司的很多盈利
05:12
goes into advertising campaigns,
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被用于广告投放，
05:13
trying to win favor with doctors,
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试图获得医生青睐，
05:15
trying to persuade patients
to try this medicine.
to try this medicine.
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试图说服患者使用他们的药物。
05:18
And these marketing battles,
of course, are a pure waste,
of course, are a pure waste,
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当然，这些市场营销大战
纯属浪费资源，
纯属浪费资源，
因为当一个公司花钱
让患者使用他们的药物，
让患者使用他们的药物，
05:21
because what one company spends
to get patients over to their drug,
to get patients over to their drug,
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另外的公司也会花钱
把患者赢回来。
把患者赢回来。
05:24
another company spends to win them back.
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05:27
And then there is counterfeiting
in the developing countries.
in the developing countries.
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同时在发展中国家有许多假冒药品。
世界上很多药物，甚至占销售量的50%
05:30
A lot of the drugs there, often more than
fifty percent of what's sold,
fifty percent of what's sold,
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05:33
are counterfeit drugs, where people say,
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都是假冒的药品，那边的人说，
"因为这药太贵了，
我可以给你便宜的。”
我可以给你便宜的。”
05:35
"Because the drug is so expensive,
I can offer you a cheaper version."
I can offer you a cheaper version."
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05:39
But of course it's not the real thing,
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但当然它们是不一样的，
它要么是稀释的，
或者是完全没有用的。
或者是完全没有用的。
05:40
it's either diluted
or it's completely inert.
or it's completely inert.
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05:43
So on the whole, all the money
that is spent on pharmaceuticals --
that is spent on pharmaceuticals --
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所以总体来说，花费
在制药业的所有资金——
在制药业的所有资金——
05:47
and it's roughly a trillion dollars
now, per annum --
now, per annum --
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现在每年将近万亿美元——
05:50
much of that money
is absolutely going to waste,
is absolutely going to waste,
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大部分绝对被浪费掉了，
05:53
it's not going to where
it should be going,
it should be going,
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没有花费在正确的地方，
05:55
namely, to the development
of new medicines
of new medicines
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即开发新药品
05:58
and to the manufacturing
of ones that we already have.
of ones that we already have.
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以及生产我们已经
研发出的药品上。
研发出的药品上。
06:02
Now, many people think
that the solution to the problem
that the solution to the problem
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很多人认为这个问题的解法在于
06:04
is moral pressure
on pharmaceutical companies.
on pharmaceutical companies.
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向制药公司施加道德压力。
06:08
And, sure -- pharmaceutical companies
have moral obligations,
have moral obligations,
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是的——制药公司有道德义务，
06:12
just like we do.
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就像我们一样。
06:13
When we have to make a choice,
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当我们必须做决定时，
06:14
often between having a little extra money
and saving a human life,
and saving a human life,
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在拥有更多的钱
和拯救人类生命之间二选一，
和拯救人类生命之间二选一，
06:19
we often feel that we have a duty
to spend the money
to spend the money
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我们总是感到有责任
花费那些钱
花费那些钱
06:22
and save the life.
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去拯救生命。
06:23
And why should pharmaceutical
companies be any different?
companies be any different?
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为什么制药公司应该有所不同呢？
06:27
But really, it isn't realistic
to expect pharmaceutical companies
to expect pharmaceutical companies
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但是实话实说，期待制药公司
06:32
to act as well as you
or maybe I might act.
or maybe I might act.
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像你们一样行事，是不切实际的。
06:36
And the reason is threefold.
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原因有三。
06:38
One is that pharmaceutical companies
are bound to their shareholders.
are bound to their shareholders.
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第一，是制药公司必须听从他们的股东。
06:43
The executive of such a company
wouldn't last very long
wouldn't last very long
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如果公司高管花钱是出于好意，
06:46
if he gave a lot of money away,
or she, for good purposes,
or she, for good purposes,
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但因此造成了股东损失，
06:50
and thereby lost money
for the shareholders.
for the shareholders.
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这样的高管干不了多久，
06:54
They would be replaced.
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很快会被换掉。
06:56
Also, pharmaceutical companies stand
in fierce competition with one another,
in fierce competition with one another,
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同时，制药公司之间
存在激烈竞争，
存在激烈竞争，
07:00
and if you do more, if you are nicer
than the other company,
than the other company,
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如果你付出更多，
如果你比别的公司善良，
如果你比别的公司善良，
07:04
sooner or later, you'll be
driven out of the market.
driven out of the market.
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迟早，你会被挤出市场，
根本无法存活。
07:06
You will not survive.
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07:07
The other company will gain market share.
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其他公司会借此
扩大他们的市场份额。
扩大他们的市场份额。
07:11
And finally, remember --
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最后，记住——
07:12
the entire industry
is dependent for its income
is dependent for its income
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整个工业的收入依赖于
07:15
on one thing and one thing only: markups.
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并且只依赖于一件事：加价。
07:18
And ultimately, you have
to be sustainable.
to be sustainable.
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你总得持续发展下去。
07:22
If you spend a lot of money
on helping poor people
on helping poor people
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如果你花费很多钱帮助穷人
07:25
and you don't get paid for it,
and you lose this money;
and you lose this money;
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并且得不到回报，
那么你就损失了这些钱；
那么你就损失了这些钱；
07:27
you cannot continue
with your innovative activities.
with your innovative activities.
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你就无法继续进行创新活动。
07:32
So for these reasons,
it's just unrealistic
it's just unrealistic
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基于以上这些原因，
这就是为什么
这就是为什么
07:34
to expect that pharmaceutical companies
will solve the problem
will solve the problem
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期待公司基于道德去解决这个问题
07:38
on moral grounds.
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并不现实。
07:39
Who, then, should solve the problem?
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那么，谁能来解决这个问题？
07:41
I suggest it has to be us.
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我建议，让我们来做。
07:43
We, citizens and politicians,
have to do better
have to do better
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我们，公民和政治家们，
07:47
in terms of regulating
the pharmaceutical industry,
the pharmaceutical industry,
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在监管制药工业方面
可以做得更好，
可以做得更好，
07:50
focusing them,
giving them the right incentives,
giving them the right incentives,
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聚焦他们，给予他们正确的激励，
07:53
focusing them on the problems
that really matter.
that really matter.
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使他们聚焦在那些
真正重要的问题上，
真正重要的问题上，
07:57
The potential gains here are enormous.
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其中潜在的收益是巨大的。
08:00
About one third of all deaths
each day, each year,
each day, each year,
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每天，每年大约有 1/3 的死亡
08:05
are due to the diseases of poverty
in the developing world.
in the developing world.
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是由于发展中国家的
贫困导致的。
贫困导致的。
08:08
Fifty thousand people every day
die prematurely from these diseases.
die prematurely from these diseases.
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每天有五万人死于这些疾病。
08:15
And that's not even counting
all the diseases
all the diseases
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这还不包括我们
08:17
that we know only too well
in the rich countries:
in the rich countries:
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在富裕国家所熟知的所有这些疾病：
08:20
cancer, heart disease and so on.
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癌症，心脏病等等。
08:22
Again, poor people die often much earlier,
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而且，穷人的寿命也比较短，
08:24
because they don't have good medical care,
including good medicines.
including good medicines.
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因为他们没有良好
医护条件，包括医药。
医护条件，包括医药。
08:29
And even in rich countries, many patients
are not getting the best medicine.
are not getting the best medicine.
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甚至在富裕的国家，很多病人
也没能得到最好的药物。
也没能得到最好的药物。
08:34
That's sometimes due to the fact
that insurance companies won't cover it,
that insurance companies won't cover it,
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这有时候是因为
保险公司不包含相关费用，
保险公司不包含相关费用，
因为它的价钱高得离谱。
08:37
because the price
is so absolutely ridiculous.
is so absolutely ridiculous.
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08:40
And it's also due, sometimes,
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这也是因为，有时候，
08:41
to the fact that doctors
and patients are falsely influenced
and patients are falsely influenced
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医生和患者实际上
被制药公司的广告误导了。
08:45
by advertising campaigns
of pharmaceutical companies.
of pharmaceutical companies.
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08:50
So what can we do?
How can we change the system?
How can we change the system?
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那么，我们能做些什么？
我们怎样改变这个系统？
我们怎样改变这个系统？
08:53
I want to show you a way
in which we can better incentivize
in which we can better incentivize
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我想向大家展示一个
可以更好地
可以更好地
08:56
pharmaceutical innovation and
the provision [of] medicines
the provision [of] medicines
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激励医药公司创新
以及对富人穷人一视同仁
以及对富人穷人一视同仁
09:00
to poor people and rich alike.
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的供药系统。
09:02
And that is the Health Impact Fund.
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这就是健康影响基金。
09:04
The Health Impact Fund is basically
opening up the second track
opening up the second track
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健康影响基金开通了第二条通道，
09:08
with which pharmaceutical innovators
can be rewarded for their activities.
can be rewarded for their activities.
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使得制药创新者的活动
可以得到奖励。
可以得到奖励。
09:13
They have a choice.
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他们有了选择。
09:14
They can either go with the old system,
with patent-protected markups,
with patent-protected markups,
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他们可以继续在旧系统下运作，
专利保护加价，
专利保护加价，
09:18
or they can go with the new system,
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或者也可以参与新的系统，
09:21
being rewarded on the basis
of the health impact
of the health impact
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根据他们开发的药物
09:24
of the medicines that they develop.
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对健康的影响给予奖励。
09:26
And with each particular medicine,
they have their choice.
they have their choice.
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对于每种特定的药品，
他们有他们的选择。
他们有他们的选择。
09:29
So they can be partly on one track,
partly on the other,
partly on the other,
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所以他们可以部分地在一条轨道上，
部分在另外一条，
部分在另外一条，
09:32
with different products.
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提供不同的产品。
09:34
Now, how would
the Health Impact Fund work?
the Health Impact Fund work?
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健康影响基金是怎样运行的？
09:38
There would be a fixed
reward pool every year.
reward pool every year.
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每年都有固定的奖金池。
09:40
We start with maybe six billion dollars,
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2000
最开始可能是 6 亿美元，
09:42
but that can eventually be revved up.
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但最后可以是加速的。
09:44
Remember that the total money
that the world spends on pharmaceuticals
that the world spends on pharmaceuticals
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要记得全世界花在医药上的钱
09:47
is a trillion.
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是兆亿规模，
09:48
So it's a thousand billion;
six billion is a drop in the bucket.
six billion is a drop in the bucket.
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也就是 10 亿的 1000 倍，
6 亿 就如沧海一粟。
6 亿 就如沧海一粟。
09:52
It's relatively small,
but it would work with six billion,
but it would work with six billion,
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它相对来说很小，
但能起到显著的作用，
但能起到显著的作用，
09:54
and we'd get a lot of bang for the buck
if we introduced the Health Impact Fund
if we introduced the Health Impact Fund
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如果我们推出 60 亿美元
的健康影响基金，
的健康影响基金，
09:58
with just six billion dollars.
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就会得到很大的回报。
10:00
If you have a product
and you want to register it
and you want to register it
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如果你有一个产品，
你想在健康影响基金
你想在健康影响基金
10:04
with the Health Impact Fund,
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去注册它，
10:06
you will be rewarded
for a period of 10 years.
for a period of 10 years.
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你将会得到 10 年的资助。
10:09
During these 10 years, you get a share
of these annual reward pools.
of these annual reward pools.
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在这 10 年间，你可以
获得这些年度奖励的份额。
获得这些年度奖励的份额。
10:15
That share would be proportional to
your share of the health impact achieved
your share of the health impact achieved
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该份额将与所有这些
注册产品对健康
注册产品对健康
10:20
by all these registered products.
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的影响份额成比例。
10:23
So if your product accounts
for eight percent of the health impact
for eight percent of the health impact
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所以如果你的产品对健康的影响
10:27
of all the registered products,
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占所有注册产品的 8%，
10:29
you get eight percent
of the reward money that year.
of the reward money that year.
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你那年就会得到 8% 的赏金。
10:33
That repeats for 10 years,
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这会重复 10 年，
10:35
and at the end of the 10 years,
your product goes generic,
your product goes generic,
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在 10 年后，你的产品会变得通用，
10:38
so you basically lose
any further income from it.
any further income from it.
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到时候你基本上就失去了
再用它赚钱的机会。
再用它赚钱的机会。
10:44
Each year, the health impact
from your product would be evaluated,
from your product would be evaluated,
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每年，你的产品的健康
影响将会被评估，
影响将会被评估，
10:48
and you would be paid on that basis.
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你会在这个基础上得到报酬。
10:51
Now, if you take that reward
from the Health Impact Fund,
from the Health Impact Fund,
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如果你拿了健康影响
基金的奖励，
基金的奖励，
10:54
you can't claim the other reward,
you can't mark up the price.
you can't mark up the price.
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2954
你不能再要求其他奖励，
也不能提高价格，
也不能提高价格，
10:57
You have to sell at cost.
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1486
只能以成本价出售你的产品。
10:59
What does that mean?
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那是什么意思？
11:01
Well, it doesn't mean
that the pharmaceutical company tells us
that the pharmaceutical company tells us
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并不是说制药公司就公布了他们的
11:04
what their cost is;
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成本价格；
11:05
but rather, our preferred way
of determining what the real cost is
of determining what the real cost is
210
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4197
反之，我们首选的确定
实际成本的方法是
实际成本的方法是
11:10
of making a medicine, of manufacturing it,
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重复制药过程，
11:12
is to ask the registrant to put
the production of the medicine
the production of the medicine
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是要求注册人把药品生产过程
11:16
out for tender, let generic companies
compete for the production,
compete for the production,
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5194
对公众招标，让仿制药
公司竞争生产，
公司竞争生产，
11:21
and then the innovator would buy
the product from the cheapest supplier
the product from the cheapest supplier
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然后创新者从最便宜的
供应商那里购买产品，
供应商那里购买产品，
11:25
and would sell it at that same
lowest possible price to patients.
lowest possible price to patients.
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5377
再以尽可能低的价格卖给病人。
11:31
So the innovator would make no money
at all on selling the product,
at all on selling the product,
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所以创新者在销售产品上
根本赚不到钱，
根本赚不到钱，
11:36
but would make all its money
from the health impact rewards.
from the health impact rewards.
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4341
但会在健康影响奖励中
赚到所有的钱。
赚到所有的钱。
11:42
Now, how do we assess the impact
of the introduction of a medicine?
of the introduction of a medicine?
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接下来，我们如何评估
药物引入的影响？
药物引入的影响？
11:47
Well, we assess it relative
to the preceding state of the art.
to the preceding state of the art.
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我们用相对于先前的
技术水平来评估它。
技术水平来评估它。
11:51
So some people,
before the medicine came along,
before the medicine came along,
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所以，在这个药物出来前，
11:53
had no treatment at all.
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有些病无药可医。
11:55
Now for the first time, they have
treatment, because it's cheap;
treatment, because it's cheap;
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如今，他们第一次有了
治疗方法，因为它很便宜；
治疗方法，因为它很便宜；
11:58
people can afford it.
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人们负担得起。
11:59
So here, the impact is the difference
between being treated
between being treated
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所以在这里，影响是得到治疗
12:02
and not being treated.
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1327
和没法得到治疗的差别。
12:04
In other cases, the new product
is better than the old products,
is better than the old products,
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3670
其他情况中，新的产品
要比老的产品好，
要比老的产品好，
12:08
and so a person gets switched over
to a better product,
to a better product,
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所以人们会切换到更好的产品，
12:11
and we pay for the impact,
for the difference the new product makes.
for the difference the new product makes.
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我们为新产品带来的不同影响付费。
12:16
If you have a product
on the Health Impact Fund
on the Health Impact Fund
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2288
如果你有个产品在健康影响基金上，
12:19
and you simply switch somebody
from an existing product
from an existing product
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2690
并且你只是简单的让
某个人从现存的产品
某个人从现存的产品
12:21
to another product, to your product,
and it's no better,
and it's no better,
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转移到你的产品上，
并且效果并没有更好，
并且效果并没有更好，
12:24
you get no money.
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1156
你就拿不到钱。
12:25
That's in stark contrast
to the existing system,
to the existing system,
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这与现有的体制形成了鲜明对比，
12:28
where you get a lot of money
for switching somebody from one product
for switching somebody from one product
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3361
现有体制中，你花大量的钱
让患者从一个产品
让患者从一个产品
12:32
to an equal product that is your product.
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2762
转移到你的同等产品中。
12:35
The Health Impact Fund
does not pay for that.
does not pay for that.
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2686
健康影响基金并不会为此买单。
12:39
We quantify health impact in terms
of quality-adjusted life years.
of quality-adjusted life years.
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3636
我们用“质量调整生命年”
来量化健康影响。
来量化健康影响。
12:43
That method has been around
for about 20 years,
for about 20 years,
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2459
这个方法已经有 20 年历史了，
12:45
and it's very easy to explain.
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1528
它非常容易理解。
12:47
Just think of a human life
as a kind of plank.
as a kind of plank.
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2621
只需要把人的生命想像成一块木板，
12:49
It's eighty inches long, one inch high.
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2731
长 80 英寸，高 1 英寸。
12:52
And when you die prematurely
before you reach 80,
before you reach 80,
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2472
如果你在 80 岁前过早死亡，
12:55
well, the plank is a little shorter.
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767026
1936
这个木板就会就比较短。
12:56
And if you're sick during
the time that you live,
the time that you live,
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3102
如果你在活着的时候生病了，
13:00
the plank is a little bit thinner.
245
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1810
木板就会变得薄一点。
13:02
And what diseases can nibble away,
medicines can restore,
medicines can restore,
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774688
3700
疾病可以蚕食这个木板，
药物可以恢复它，
药物可以恢复它，
13:06
or medicines can avert
the taking away of these parts.
the taking away of these parts.
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4251
或者药物可以避免这部分的流失。
13:11
And they get paid for that.
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2314
这些药物的制造商就会因此得到报酬。
13:13
That's the method, basically.
249
785541
1672
就是这么个方法。
13:16
Now, we look – of course,
each year, we have to assess.
each year, we have to assess.
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3503
当然，每年我们都要去评估。
13:20
We have to spend
a considerable amount of money
a considerable amount of money
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2205
我们必须花大量的钱来
研究这些注册在健康影响基金
13:22
looking at how these various medicines
252
794564
1818
13:24
that are registered
with the Health Impact Fund
with the Health Impact Fund
253
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2203
的不同药物在不同国家
13:26
are doing in various countries.
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798633
1514
的表现。
13:28
And here, statistics is extremely helpful.
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2045
这时候，统计就变得特别重要。
13:30
You all know how exit polling works.
This is a similar method.
This is a similar method.
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802240
3706
你们都知道，出口民调是如何运作的，
这里用的也是类似的方法。
这里用的也是类似的方法。
13:33
You look for a statistically
significant sample,
significant sample,
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3535
我们要寻找一个具有
统计学意义的样本，
统计学意义的样本，
13:37
and then try to figure out
what the health impact of the medicine is
what the health impact of the medicine is
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3965
然后试图计算出药物在
13:41
in different locations,
in different demographic groups ...
in different demographic groups ...
259
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3043
不同位置，不同人口群体中的
健康影响…
健康影响…
13:44
And, of course, you look very carefully
at the actual world --
at the actual world --
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3024
当然，你也要仔细审视现实世界——
13:47
this is in contrast to how medicines
are today rewarded.
are today rewarded.
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4570
这与今天的药物激励方式
形成了鲜明对比。
形成了鲜明对比。
13:52
Sometimes, there is a reward
based on performance,
based on performance,
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824227
2676
有时候，我们会根据表现给予奖励，
13:54
but it's the performance in clinical
trials, in the laboratory, if you like,
trials, in the laboratory, if you like,
263
826927
4534
但这个表现是基于
临床实验，在实验室中，
临床实验，在实验室中，
13:59
and not the performance in the real world.
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2992
而非真实世界的表现。
14:02
The Health Impact Fund
would look at real-world impact.
would look at real-world impact.
265
834501
4013
健康影响基金将会观察
真实世界的影响。
真实世界的影响。
14:06
It would look not just
at the quality of a drug,
at the quality of a drug,
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3182
它不仅关注药物的质量，
14:09
but also at how widely it is distributed,
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也关注药物被分发的广泛程度，
14:13
whether the innovator manages
to target those patients
to target those patients
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创新者是否能够将目标对准
14:16
who can benefit the most,
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那些最能受益的患者，
14:18
and also, how well the drug
is used in the field.
is used in the field.
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以及这些药物在实际中的使用情况。
14:22
So innovators would have much
stronger incentives than they do now
stronger incentives than they do now
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这样一来，创新者就会
比现在有更强的动力，
比现在有更强的动力，
14:26
to make sure that every patient
who takes the drug
who takes the drug
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去确保每个使用这个药物的病人
14:29
knows exactly how to take it
to optimal effect.
to optimal effect.
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确实知道如何使其达到最佳效果。
14:32
Today, most packaged inserts are not even
translated into local languages,
translated into local languages,
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今天，大多数包装说明书
甚至没翻译成当地语言，
甚至没翻译成当地语言，
14:37
and so it's not surprising that patients
don't make the best use of the product.
don't make the best use of the product.
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所以病人没能充分利用
这种产品就不足为奇了。
这种产品就不足为奇了。
14:43
Now, how would the financing work?
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875555
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那么，融资将如何运作？
14:46
Basically, the Health Impact Fund,
as I said, could start
as I said, could start
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如我刚才所说，
健康影响基金设立之初
可以 60 亿美元开始。
可以 60 亿美元开始。
14:49
with something like six billion dollars.
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881357
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这不是小钱，但跟如今世界上
14:51
It's not nothing, but it's also
not a lot of money,
not a lot of money,
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2393
已在制药上花的钱相比，
也不是什么大数目。
也不是什么大数目。
14:53
compared to what the world is already
spending on pharmaceuticals.
spending on pharmaceuticals.
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所以最好的方法是把这当成
14:56
So the best way to think of it
is as a new way of paying
is as a new way of paying
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2822
14:59
for what we are already paying for,
namely, new medicines.
namely, new medicines.
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我们已经在新药上付钱的一种新方式。
15:02
You pay with one hand
through the tax system,
through the tax system,
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你一只手通过税收系统纳税，
15:05
but you get something back
with the other hand,
with the other hand,
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用另一只手拿回一些东西来，
15:08
because you also get
these medicines for cheap.
these medicines for cheap.
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因为你也以便宜的成本
获得了这些药品。
获得了这些药品。
15:10
This is not just for poor people --
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这不仅只为穷人——
每个人都将以非常低的成本价
获得这些健康影响基金
获得这些健康影响基金
15:12
everybody will have these Health Impact
Fund registered medicines at cost,
Fund registered medicines at cost,
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5087
15:17
at a very low price.
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注册的药品。
15:20
One very important hurdle here,
politically, is that we have to make sure
politically, is that we have to make sure
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一个非常重要的障碍是，
政治上，我们必须确保
政治上，我们必须确保
15:25
that we have long-term
visibility for innovators,
visibility for innovators,
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对创新者具有长期的可见性，
15:29
that innovators know
that the money is actually there,
that the money is actually there,
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2712
确保创新者知道钱确实存在，
15:31
and so we need governments
to fund the Health Impact Fund,
to fund the Health Impact Fund,
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923758
4161
因此，我们需要政府为
健康影响基金提供资金，
健康影响基金提供资金，
15:35
because only governments can make
predictable commitments
predictable commitments
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因为只有政府才能对长期
15:38
for a long period of time.
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930997
2070
做出可预测的承诺。
15:41
Because the Health Impact Fund
registration is voluntary,
registration is voluntary,
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4794
因为健康影响基金的
注册是自愿的，
注册是自愿的，
15:46
you basically have
a self-adjusting reward rate.
a self-adjusting reward rate.
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3539
有一个自我调整的奖励率。
15:50
As the rate rises too high,
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3137
随着利率比率太高，
15:54
innovators will come in
and drive the rate down.
and drive the rate down.
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2822
创新者将会进入市场，
推动比率下降。
推动比率下降。
15:56
Conversely, if the rate falls too low,
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相反，如果比率降得太低，
15:59
innovators would be reluctant
to register, and the rate will recover.
to register, and the rate will recover.
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951518
3740
创新者将不愿注册，
而这一比率将会回升。
而这一比率将会回升。
16:03
So the rate will always be
at a reasonable level.
at a reasonable level.
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3378
所以比率将永远处于合理水平。
16:07
The Health Impact Fund
is beneficial for all parties.
is beneficial for all parties.
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959819
3344
健康影响基金对所有各方都有利。
16:11
It benefits innovators
by giving them a new market,
by giving them a new market,
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它有利于创新者，
为他们提供了新的市场，
为他们提供了新的市场，
16:15
and most importantly, by overcoming
their public relations problems
their public relations problems
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更重要的是，也能
克服一开始我们提到的
克服一开始我们提到的
16:19
that we started with.
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1316
公共关系问题。
16:21
It benefits patients,
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973198
1551
它有利于病人，
16:22
because patients are much more likely
to get the right medicine,
to get the right medicine,
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974773
3372
因为病人更有可能
获得正确的药品，
获得正确的药品，
16:26
and also for these
medicines to be developed,
medicines to be developed,
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2962
以及这些我们最需要
16:29
the medicines that we most need.
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981155
1799
的药品的研发。
16:31
And it also benefits governments
or taxpayers, if you like,
or taxpayers, if you like,
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3409
这也有利于政府，或者说纳税人，
16:35
because it creates a permanent source
of pharmaceutical innovation
of pharmaceutical innovation
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987091
3465
因为它为制药创新
创造的这个永久源泉
创造的这个永久源泉
16:38
that will be here for all future times.
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将会持续存在。
16:40
It's a kind of machine that always
directs pharmaceutical innovation
directs pharmaceutical innovation
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3558
这是一种总是能够把
医药创新引导到
医药创新引导到
16:44
to where we have the greatest problems,
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996526
2124
最大问题的机器，
16:46
maybe for diseases
that don't even exist yet.
that don't even exist yet.
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2691
也许对于现在还
不存在疾病也是如此。
不存在疾病也是如此。
16:49
The Health Impact Fund
will always channel innovation
will always channel innovation
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健康影响基金将总是引导创新
16:52
in the direction where it's most needed.
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朝着最需要的地方去。
16:55
Now, we have a little bit of help already.
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1007321
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现在，我们已经
得到了一点帮助。
得到了一点帮助。
16:57
You can see here the number of people
who have agreed to help us,
who have agreed to help us,
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1009587
3784
你可以在这里看到已经
有不少人同意帮助我们，
有不少人同意帮助我们，
17:01
but we want your help as well.
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2210
但我们也想要获得你们的帮助。
17:03
We want you to join us,
maybe to talk with your government
maybe to talk with your government
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我们想要你们加入我们，
也许跟你们的政府谈谈，
也许跟你们的政府谈谈，
17:08
to help us with publicity,
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1020099
1676
帮助我们宣传，
17:09
to help us with your ideas in perfecting
the Health Impact Fund scheme.
the Health Impact Fund scheme.
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1021799
4479
以您的意见协助我们完善
健康影响基金计划。
健康影响基金计划。
17:14
And what we most urgently need
for the moment
for the moment
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1026787
2704
我们此刻最急需的是
17:17
is to start a pilot.
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开始试点。
17:20
The pilot would introduce one medicine
into one jurisdiction
into one jurisdiction
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试点将把一种健康影响
基金模式下的药物
基金模式下的药物
17:24
on the Health Impact Fund model.
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1036218
2547
引入一个司法管辖区。
17:26
The innovator would get paid according
to the cost of the medicine for the sales,
to the cost of the medicine for the sales,
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1038789
5205
创新者将根据销售药品的
成本获得报酬，
成本获得报酬，
17:32
and would then get additional money
on the basis of the health impact.
on the basis of the health impact.
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1044018
4046
然后根据对健康的影响
获得额外的资金。
获得额外的资金。
17:37
Here, we need funding for the rewards,
funding for the assessment,
funding for the assessment,
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1049286
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这里，我们需要奖励资金，评估资金，
17:42
and in particular, we need
political support
political support
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并且尤其需要政治支持，
17:45
to get politicians to support
a pilot of that sort.
a pilot of that sort.
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1057389
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来让政客们支持这类试点项目。
17:51
If you have any further questions,
don't hesitate to write us
don't hesitate to write us
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4164
如果你有任何其他问题，请随时
17:56
and contact us at this address.
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1803
通过这个网址联系我们。
17:57
Thank you very much.
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谢谢你们。
（鼓掌）
17:59
(Applause)
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ABOUT THE SPEAKER
Thomas Pogge - PhilosopherPhilosopher Thomas Pogge wants to ensure medications get to those who need it most. He has published on a wide range of subjects such as global justice and human rights.
Why you should listen
Originally from Germany, Thomas Pogge received a PhD in philosophy from Harvard in 1983. Since then, he has taught philosophy, political science, and ethics at universities around the world. His 2002 book, World Poverty and Human Rights, offers proposals on how to achieve global economic equality. In 2008, he co-authored The Health Impact Fund, which lays out the plan to make life-saving medicines accessible for everyone. He is currently Leitner Professor of Philosophy and International Affairs at Yale.
Thomas Pogge | Speaker | TED.com