TEDMED 2014
Ramanan Laxminarayan: The coming crisis in antibiotics
Ramanan Laxminarayan: 迫在眉睫的抗生素危机
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抗生素药物可以挽救生命。但是我们使用的过多了——而且常常不是用来治病救人，而单纯只是治疗感冒，甚至为了降低养鸡的成本。研究人员Ramanan Laxminarayan认为，这样做的结果就是抗生素无法作用于所有人，其针对的细菌变得越来越耐药了。他呼吁我们所有人（比如病人和医生）仔细思考一下抗生素这种有限的资源以及它们当前的治疗效果，在使用之前需要三思。这个演讲冷静的分析了全球医疗趋势是否能够取得显著的成效。
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疗的患者
00:16
was a policeman in Oxford.
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是一位来自牛津的警察。
00:17
On his day off from work,
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有一天他下班后，
00:19
he was scratched by a rose thorn
while working in the garden.
while working in the garden.
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在花园劳作时被一朵玫瑰上的刺划伤了。
00:23
That small scratch became infected.
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这个小伤口被感染了。
00:26
Over the next few days,
his head was swollen
his head was swollen
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在接下来的几天里，他的脸开始浮胀
00:29
with abscesses,
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并出现了脓肿，
00:30
and in fact his eye was so infected
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事实上他的眼球也被感染了，
00:33
that they had to take it out,
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不得不摘除。
00:35
and by February of 1941,
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到了1941年的2月，
00:38
this poor man was on the verge of dying.
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这个可怜的人已经奄奄一息了。
00:40
He was at Radcliffe Infirmary in Oxford,
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他在牛津市的Radcliffe Infirmary
医院接受治疗，
医院接受治疗，
00:43
and fortunately for him,
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幸运的是，
00:45
a small team of doctors
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由霍华德·弗洛里医生
（译注：澳洲药理学家）
（译注：澳洲药理学家）
00:47
led by a Dr. Howard Florey
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带头的一个医疗小组
00:48
had managed to synthesize
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成功的合成了
00:50
a very small amount of penicillin,
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少量的盘尼西林，
00:53
a drug that had been discovered
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一种被亚历山大·弗莱明
（译注：苏格兰药学家）
（译注：苏格兰药学家）
00:55
12 years before by Alexander Fleming
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在12年前发现的药物，
00:58
but had never actually been
used to treat a human,
used to treat a human,
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但它从来没有被用来给人治病，
01:01
and indeed no one even
knew if the drug would work,
knew if the drug would work,
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事实上甚至没有人知道
这种药是否有效，
这种药是否有效，
01:04
if it was full of impurities
that would kill the patient,
that would kill the patient,
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如果这种药不纯净是否会致死，
01:07
but Florey and his team figured
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但是弗洛里和他的团队觉得
01:09
if they had to use it,
they might as well use it
they might as well use it
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如果他们需要使用这种药，不妨干脆在
01:11
on someone who was going to die anyway.
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已无药可救的患者身上试试看。
01:14
So they gave Albert Alexander,
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于是他们把这种药用在了
01:17
this Oxford policeman, the drug,
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Albert Alexander这名
牛津警察的身上，
牛津警察的身上，
01:20
and within 24 hours,
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还不到24小时，
01:23
he started getting better.
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他的病情就开始逐渐好转。
01:25
His fever went down,
his appetite came back.
his appetite came back.
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他的烧退了，食欲也恢复了。
01:29
Second day, he was doing much better.
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第二天，他恢复的更快了。
01:31
They were starting to
run out of penicillin,
run out of penicillin,
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不过盘尼西林快用完了，
01:33
so what they would do
was run with his urine
was run with his urine
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于是医生们提取了他的尿液
01:35
across the road to re-synthesize
the penicillin from his urine
the penicillin from his urine
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来重新合成盘尼西林，
01:38
and give it back to him,
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再回过头来治疗他，
01:40
and that worked.
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这种做法见效了。
01:42
Day four, well on the way to recovery.
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第四天，他仍在慢慢好转。
01:44
This was a miracle.
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这是个奇迹。
01:46
Day five, they ran out of penicillin,
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第五天，盘尼西林又用完了，
01:50
and the poor man died.
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这个可怜的人就死了。
01:52
So that story didn't end that well,
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所以这个故事的结局不太好，
01:55
but fortunately for
millions of other people,
millions of other people,
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但是对其他几百万人来说却是个福音，
01:59
like this child who was treated
again in the early 1940s,
again in the early 1940s,
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比如这个在40年代同样接受
盘尼西林治疗的孩子，
盘尼西林治疗的孩子，
02:02
who was again dying of a sepsis,
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她差点死于败血症，
02:05
and within just six days, you can see,
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但经过了仅仅6天的治疗，你们可以看到，
02:08
recovered thanks to this
wonder drug, penicillin.
wonder drug, penicillin.
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在神奇的盘尼西林的治疗下
她已经康复。
她已经康复。
02:12
Millions have lived,
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几百万人因此活了下来，
02:14
and global health has been transformed.
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全球的健康状况也发生了转变。
02:17
Now, antibiotics have been used
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现在，抗生素已经被用在
02:20
for patients like this,
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这样的病人身上，
02:23
but they've also been
used rather frivolously
used rather frivolously
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但同时也应用于其他
02:25
in some instances,
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非常不合适的情况，
02:27
for treating someone
with just a cold or the flu,
with just a cold or the flu,
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比如仅仅用来治疗感冒或者流感，
02:29
which they might not have
responded to an antibiotic,
responded to an antibiotic,
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而这很可能没什么效果，
02:32
and they've also been
used in large quantities
used in large quantities
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抗生素也以非治疗的目的
被大量使用，
被大量使用，
02:36
sub-therapeutically, which
means in small concentrations,
means in small concentrations,
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也就是说用很低的浓度，
02:39
to make chicken and hogs grow faster.
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让鸡和猪长得更快。
02:42
Just to save a few pennies
on the price of meat,
on the price of meat,
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只为了买肉的时候省几分钱，
02:46
we've spent a lot of
antibiotics on animals,
antibiotics on animals,
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我们把大量的抗生素用在了动物身上，
02:49
not for treatment, not for sick animals,
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但不是为了治疗，
并没有用在生病的动物身上，
并没有用在生病的动物身上，
02:51
but primarily for growth promotion.
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而主要是促进生长。
02:54
Now, what did that lead us to?
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那么，长此以往会怎么样呢？
02:57
Basically, the massive use of antibiotics
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简单的说，世界范围内的
03:00
around the world
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抗生素滥用
03:01
has imposed such large
selection pressure on bacteria
selection pressure on bacteria
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已经导致其对很多细菌不起作用了，
03:05
that resistance is now a problem,
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抗药性已经成为了一个问题，
03:08
because we've now selected for just
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因为我们如今所针对的细菌
03:10
the resistant bacteria.
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恰恰都具备了抗药性。
03:11
And I'm sure you've all read
about this in the newspapers,
about this in the newspapers,
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我很确定你们都在报纸上
看到过这个信息，
看到过这个信息，
03:14
you've seen this in every magazine
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你们浏览的每本杂志
03:16
that you come across,
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也都提到了，
03:18
but I really want you to appreciate
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不过我真的希望你们能够认识到
03:20
the significance of this problem.
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这个问题的重要性。
03:22
This is serious.
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情况已经很严重了。
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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在下一张幻灯片我要提到
不动杆菌对碳青霉烯的抗药性。
不动杆菌对碳青霉烯的抗药性。
03:28
Acinetobacter is a nasty hospital bug,
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不动杆菌是一种极易附着在
医疗材料上的细菌，
医疗材料上的细菌，
03:31
and carbapenem is pretty much
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而碳青霉烯几乎是一种
03:32
the strongest class of antibiotics
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我们可用来对付这种细菌的
03:34
that we can throw at this bug.
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最强的抗生素。
03:36
And you can see in 1999
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你们可以看到在1999年，
03:39
this is the pattern of resistance,
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这种细菌抗药性在全美国的分布，
03:42
mostly under about 10 percent
across the United States.
across the United States.
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细菌抗药性只低于10%。
03:45
Now watch what happens
when we play the video.
when we play the video.
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现在我们看看视频里发生了哪些变化。
03:58
So I don't know where you live,
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我不知道你们都住在哪里，
04:00
but wherever it is, it certainly is a lot worse now
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不过无论在哪，情况都比1999年
04:03
than it was in 1999,
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糟糕得多，
04:05
and that is the problem of antibiotic resistance.
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这就是抗生素耐菌性问题。
04:09
It's a global issue
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这是个全球性的问题，
04:11
affecting both rich and poor countries,
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很多国家，不论穷富都受到了影响，
04:14
and at the heart of it,
you might say, well,
you might say, well,
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究其本质，你们可能会想，
04:16
isn't this really just a medical issue?
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这应该只是个医疗问题吧？
04:18
If we taught doctors how not
to use antibiotics as much,
to use antibiotics as much,
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如果我们告诉医生们
如何尽量少用抗生素，
如何尽量少用抗生素，
04:20
if we taught patients how
not to demand antibiotics,
not to demand antibiotics,
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如果我们告诉患者如何降低
对抗生素的依赖，
对抗生素的依赖，
04:23
perhaps this really wouldn't be an issue,
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这很有可能就不是个问题了，
04:25
and maybe the pharmaceutical companies
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可能制药公司
04:27
should be working harder to develop
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需要加大力度生产
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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现在事实已经证明了抗生素
具备一些基本性质
具备一些基本性质
04:33
which makes it different from other drugs,
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让它不同于其他药物，
04:35
which is that if I misuse antibiotics
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也就是说如果我误用了抗生素，
04:37
or I use antibiotics,
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或者我仅仅是使用了抗生素，
04:39
not only am I affected but
others are affected as well,
others are affected as well,
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不光是我自己，其他人也会受到影响，
04:43
in the same way as if I
choose to drive to work
choose to drive to work
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就好比我决定开车去上班，
04:45
or take a plane to go somewhere,
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或者飞去什么地方，
04:48
that the costs I impose on others
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我的出行造成的气候变化
04:50
through global climate change go everywhere,
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对其他人的影响无处不在，
04:52
and I don't necessarily take
these costs into consideration.
these costs into consideration.
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我并不会意识到由此产生的代价。
04:55
This is what economists might
call a problem of the commons,
call a problem of the commons,
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这就是经济学家们所谓的公地问题，
04:58
and the problem of the commons is exactly
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这种公地问题恰恰就是
05:00
what we face in the case
of antibiotics as well:
of antibiotics as well:
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我们在抗生素使用上需要面对的：
05:02
that we don't consider —
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我们并没有考虑到——
05:04
and we, including individuals, patients,
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这里的我们包括个人，患者，
05:07
hospitals, entire health systems —
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医院，整个卫生系统——
05:11
do not consider the costs
that they impose on others
that they impose on others
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没有认识到抗生素的实际使用方式
05:13
by the way antibiotics are actually used.
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对其他人造成的影响。
05:15
Now, that's a problem that's similar
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这个问题同另一个众所周知的
05:17
to another area that we all know about,
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领域非常相似，
05:19
which is of fuel use and energy,
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也就是燃料的使用以及能源，
05:21
and of course energy use
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当然，能源的使用
05:23
both depletes energy as well as
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不单大量的消耗了能源，同时也
05:26
leads to local pollution
and climate change.
and climate change.
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导致了地域性的空气污染和气候变化。
05:29
And typically, in the case of energy,
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具体点说，在能源这个问题上，
05:31
there are two ways in which
you can deal with the problem.
you can deal with the problem.
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有两种方法可以解决。
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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一个就是我们可以更好的
利用现有的原油，
利用现有的原油，
05:37
and that's analogous to making better use
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也就是说我们同样可以更好的利用
05:39
of existing antibiotics,
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现有的抗生素，
05:41
and we can do this in a number of ways
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可以通过很多种方法，
05:42
that we'll talk about in a second,
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不胜枚举，
05:45
but the other option is the
"drill, baby, drill" option,
"drill, baby, drill" option,
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不过另一个选择就是所谓的
“不断开采”方式，
“不断开采”方式，
05:48
which in the case of antibiotics
is to go find new antibiotics.
is to go find new antibiotics.
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在抗生素的问题上就是
找到新的抗生素。
找到新的抗生素。
05:53
Now, these are not separate.
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如今这两个问题已经不能区别对待了。
05:55
They're related, because if we invest heavily
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它们是相互关联的，
因为如果我们大量的
因为如果我们大量的
05:58
in new oil wells,
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开采新的油田，
06:00
we reduce the incentives
for conservation of oil
for conservation of oil
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我们就削弱了保护原油资源的动力，
06:03
in the same way that's going
to happen for antibiotics.
to happen for antibiotics.
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对待抗生素也是如此。
06:06
The reverse is also going
to happen, which is that
to happen, which is that
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相反的情况也同样会发生，也就是
06:08
if we use our antibiotics appropriately,
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如果我们适当的使用抗生素，
06:10
we don't necessarily have
to make the investments
to make the investments
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在新药研发领域
06:13
in new drug development.
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也就不需要什么投资了。
06:15
And if you thought that these two were entirely,
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如果你觉得这两点在这两个选择中
06:18
fully balanced between these two options,
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可以完全平衡，
06:20
you might consider the fact that
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你们可能会想到事实上
06:22
this is really a game that we're playing.
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我们在玩一个游戏。
06:24
The game is really one of coevolution,
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这个游戏类似于共同进化，
06:27
and coevolution is, in
this particular picture,
this particular picture,
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而共同进化在这幅图片中就是
06:30
between cheetahs and gazelles.
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非洲猎豹和瞪羚的关系。
06:32
Cheetahs have evolved to run faster,
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非洲猎豹已经进化到能够跑得更快，
06:34
because if they didn't run faster,
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因为如果它们不跑的再快一些，
06:35
they wouldn't get any lunch.
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它们就吃不到午餐。
06:37
Gazelles have evolved to run faster because
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瞪羚也进化的跑得更快了，
06:40
if they don't run faster, they would be lunch.
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因为如果它们不跑快点，
就会被吃掉。
就会被吃掉。
06:43
Now, this is the game we're
playing against the bacteria,
playing against the bacteria,
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这就是我们要跟抗生素做的斗争，
06:46
except we're not the cheetahs,
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只不过我们不是非洲猎豹，
06:48
we're the gazelles,
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我们是瞪羚，
06:49
and the bacteria would,
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而细菌们在
06:52
just in the course of this little talk,
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演讲的这段时间里
06:54
would have had kids and grandkids
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1426
就已经繁殖了一代又一代，
06:55
and figured out how to be resistant
157
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2385
弄清了如何通过筛选，尝试和误差
06:58
just by selection and trial and error,
158
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2474
来变得更顽强，
07:00
trying it over and over again.
159
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1912
不断的进行尝试，变化。
07:02
Whereas how do we stay
ahead of the bacteria?
ahead of the bacteria?
160
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3772
那么我们要如何抢在细菌前面呢？
07:06
We have drug discovery processes,
161
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我们有药物研究过程，
07:08
screening molecules,
162
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1630
筛选分子，
07:10
we have clinical trials,
163
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我们有临床试验，
07:11
and then, when we think we have a drug,
164
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当我们认为研制出了一种新药，
07:14
then we have the FDA regulatory process.
165
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3745
还要通过食品药物管理局的监管流程。
07:17
And once we go through all of that,
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2178
一旦我们经历了这些过程，
07:20
then we try to stay one step ahead
167
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我们就会尝试更进一步
07:22
of the bacteria.
168
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2296
对付细菌。
07:24
Now, this is clearly not a
game that can be sustained,
game that can be sustained,
169
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2777
显然这并不是一个能够长期进行的游戏，
07:27
or one that we can win
170
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1137
或者仅仅通过革新
07:28
by simply innovating to stay ahead.
171
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1837
就能保持领先优势。
07:30
We've got to slow the pace of coevolution down,
172
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3305
我们需要减慢共同进化的脚步，
07:33
and there are ideas that we
can borrow from energy
can borrow from energy
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我们可以从能源领域借鉴一些想法，
07:37
that are helpful in thinking about
174
445300
1770
能够帮助我们思考
07:39
how we might want to do this in the case
175
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1537
我们应该如何
07:40
of antibiotics as well.
176
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1546
应对抗生素。
07:42
Now, if you think about how we deal with
177
450153
2240
如果你们想想我们是如何应对
07:44
energy pricing, for instance,
178
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能源价格上涨，打个比方，
07:45
we consider emissions taxes,
179
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1849
我们考虑一下排放税，
07:47
which means we're imposing
the costs of pollution
the costs of pollution
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2584
也就是说我们在向使用了那些能源的
07:50
on people who actually use that energy.
181
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2831
人们征税。
07:53
We might consider doing that for antibiotics as well,
182
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我们会想要用同样的方式对待抗生素，
07:56
and perhaps that would make sure that antibiotics
183
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2711
这样可能会保证
07:58
actually get used appropriately.
184
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2401
抗生素能得到合理的使用。
08:01
There are clean energy subsidies,
185
469172
2028
洁净能源补贴
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
用在不会产生太多污染的燃料上，
08:06
or perhaps don't need fossil fuels.
187
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2845
或者可能完全不需要化石燃料。
08:09
Now, the analogy here is, perhaps we need
188
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2860
现在，相似的地方就是，可能我们需要
08:11
to move away from using antibiotics,
189
479960
2260
避免使用抗生素，
08:14
and if you think about it, what are
good substitutes for antibiotics?
good substitutes for antibiotics?
190
482220
3716
你们想一下，抗生素有哪些好的替代品？
08:17
Well, turns out that anything that reduces
191
485936
2164
任何可以减少对抗生素需求
08:20
the need for the antibiotic would really work,
192
488100
2243
的东西可能都行得通，
08:22
so that could include improving
hospital infection control
hospital infection control
193
490343
3142
也就是说可能包括提高医院的感染控制能力，
08:25
or vaccinating people,
194
493485
2895
或者给人们注射疫苗，
08:28
particularly against
the seasonal influenza.
the seasonal influenza.
195
496380
2297
尤其是针对季节性流感。
08:30
And the seasonal flu is probably
196
498677
2531
季节性流感可能
08:33
the biggest driver of antibiotic use,
197
501208
3004
是抗生素使用的最大诱因，
08:36
both in this country as well
as in many other countries,
as in many other countries,
198
504212
2919
不单是在我们国家，在其他国家也一样，
08:39
and that could really help.
199
507131
2020
这很有帮助。
08:41
A third option might include
something like tradeable permits.
something like tradeable permits.
200
509151
4103
第三种选择可能包括可交易许可之类的东西。
08:45
And these seem like faraway scenarios,
201
513254
4246
这些看起来像遥不可及的计划，
08:49
but if you consider the
fact that we might not
fact that we might not
202
517500
2427
但是如果你们思考一下这个事实，
我们可能
我们可能
08:51
have antibiotics for many
people who have infections,
people who have infections,
203
519927
3383
没有足够的抗生素让所有
受到感染的人都用上，
受到感染的人都用上，
08:55
we might consider the fact that we might
204
523310
2237
我们可能考虑到一个事实，
08:57
want to allocate who actually gets to use
205
525547
2311
可能想要把这些抗生素分配给
08:59
some of these antibiotics over others,
206
527858
2714
那些更需要的人，
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
而其中一些人需要考虑临床需要
09:05
but also on the basis of pricing.
208
533898
1935
以及价格。
09:07
And certainly consumer education works.
209
535833
1910
当然消费者教育起了作用。
09:09
Very often, people overuse antibiotics
210
537743
2601
多数时候，人们用了过量的抗生素，
09:12
or prescribe too much without necessarily
211
540344
2277
或者开了太多处方，而并没有意识到
09:14
knowing that they do so,
212
542621
1606
他们确实做的过头了，
09:16
and feedback mechanisms
213
544227
1431
而反馈机制
09:17
have been found to be useful,
214
545658
1902
也被证明很有用，
09:19
both on energy —
215
547560
1929
对能源来说也是一样——
09:21
When you tell someone that they're using
216
549489
1540
当你跟别人说他们在高峰时间段
09:23
a lot of energy during peak hour,
217
551029
1917
耗费了太多能源，
09:24
they tend to cut back,
218
552946
1470
他们会开始节约，
09:26
and the same sort of example has been performed
219
554416
1767
同样的例子在抗生素上
09:28
even in the case of antibiotics.
220
556183
1810
也有所体现。
09:29
A hospital in St. Louis basically would put up
221
557993
1981
圣路易斯的一家医院简单的
09:31
on a chart the names of surgeons
222
559974
4192
把外科医生的名字依据
09:36
in the ordering of how much antibiotics they'd used
223
564166
2219
上个月用了多少抗生素
09:38
in the previous month,
224
566385
1944
列了个表，
09:40
and this was purely an
informational feedback,
informational feedback,
225
568329
2342
这就是个直接的信息反馈，
09:42
there was no shaming,
226
570671
1183
没什么可丢人的，
09:43
but essentially that provided
some information back
some information back
227
571854
2135
不过重要的是这样做反馈给了
09:45
to surgeons that maybe they could rethink
228
573989
1954
外科大夫一些信息，
可能他们能够重新考虑
可能他们能够重新考虑
09:47
how they were using antibiotics.
229
575943
2229
如何使用抗生素。
09:50
Now, there's a lot that can be done
230
578172
2014
如今，在供给这方面
09:52
on the supply side as well.
231
580186
2149
也有不少可以采取的行动。
09:54
If you look at the price of penicillin,
232
582335
1777
如果你们看看盘尼西林的价格，
09:56
the cost per day is about 10 cents.
233
584112
1651
每一天的花费是10美分。
09:57
It's a fairly cheap drug.
234
585763
1758
这已经很便宜了。
09:59
If you take drugs that have
been introduced since then —
been introduced since then —
235
587521
2137
如果你们吃同一时期上市的药——
10:01
linezolid or daptomycin —
236
589658
2644
利奈唑胺或者达托霉素——
10:04
those are significantly more expensive,
237
592302
1878
它们都要贵得多，
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
所以对于一个习惯了每天花费
10美分在抗生素上的
10美分在抗生素上的
10:11
the idea of paying 180 dollars per day
239
599633
2530
市场来说，每天花180美元
10:14
seems like a lot.
240
602163
1567
看起来太多了。
10:15
But what is that really telling us?
241
603730
1987
那么这究竟告诉了我们什么呢？
10:17
That price is telling us
242
605717
1965
这个价格告诉了我们
10:19
that we should no longer
243
607682
1898
我们在可预见的未来
10:21
take cheap, effective
antibiotics as a given
antibiotics as a given
244
609580
4117
不应该继续使用
10:25
into the foreseeable future,
245
613697
1767
廉价有效的抗生素了，
10:27
and that price is a signal to us
246
615464
2530
这个价格对我们来说也是个信号，
10:29
that perhaps we need to be paying
247
617994
1609
可能我们需要对节俭保护
10:31
much more attention to conservation.
248
619603
2553
给予重视。
10:34
That price is also a signal
249
622156
2704
这个价格也给出了另外一个信号，
10:36
that maybe we need to start
looking at other technologies,
looking at other technologies,
250
624860
2875
可能我们需要开始转向其他技术，
10:39
in the same way that
gasoline prices are a signal
gasoline prices are a signal
251
627735
2652
就好像汽油价格是一种信号，
10:42
and an impetus, to, say,
252
630387
2590
可以说其
10:44
the development of electric cars.
253
632977
1868
刺激了电动车的发展。
10:46
Prices are important signals
254
634845
1777
价格是很重要的信号，
10:48
and we need to pay attention,
255
636622
1586
我们要重视起来，
10:50
but we also need to consider the fact that
256
638208
2452
但我们也要考虑到一个事实，
10:52
although these high prices
seem unusual for antibiotics,
seem unusual for antibiotics,
257
640660
4252
虽然这些高价对抗生素来说
看起来不太寻常，
看起来不太寻常，
10:56
they're nothing compared to the price per day
258
644912
2239
跟一些抗癌药的日常价格
10:59
of some cancer drugs,
259
647151
1384
相比抗生素的花销算不了什么，
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
抗癌药可以让患者的生命
多维持几个月或者一年，
多维持几个月或者一年，
11:03
whereas antibiotics would potentially
261
651905
1770
而抗生素很可能
11:05
save a patient's life forever.
262
653675
1826
彻底挽救一个患者的生命。
11:07
So this is going to involve
263
655501
1319
所以这将会包括
11:08
a whole new paradigm shift,
264
656820
1962
一个全新的模式变革
11:10
and it's also a scary shift because
265
658782
1856
这种变化也很可怕，因为
11:12
in many parts of this country,
266
660638
2329
在这个国家的很多地方，
11:14
in many parts of the world,
267
662967
1744
在世界的各个角落，
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
来进行抗生素治疗
11:21
is simply unimaginable.
270
669671
2542
简直是不可想象。
11:24
So we need to think about that.
271
672213
1734
所以我们需要好好想一想。
11:25
Now, there are backstop options,
272
673947
1813
还有一些强化方案，
11:27
which is other alternative technologies
273
675760
2676
也就是人们正在努力研究的
11:30
that people are working on.
274
678436
1194
很多其他技术。
11:31
It includes bacteriophages, probiotics,
275
679630
2652
包括噬菌体，益生菌，
11:34
quorum sensing, synbiotics.
276
682282
4048
细菌群体行为调控机制，合生剂。
11:38
Now, all of these are useful avenues to pursue,
277
686330
3039
现如今这些都是可以探寻的有效途径，
11:41
and they will become even more lucrative
278
689369
2610
当新的抗生素的价格不断上涨时，
11:43
when the price of new
antibiotics starts going higher,
antibiotics starts going higher,
279
691979
3081
它们就会变得越来越盈利，
11:47
and we've seen that the
market does actually respond,
market does actually respond,
280
695060
2897
事实上市场已经开始有所回应了，
11:49
and the government is now considering
281
697957
2008
政府现在正在考虑
11:51
ways of subsidizing new
antibiotics and development.
antibiotics and development.
282
699965
3767
为新的抗生素及其研发提供补助。
11:55
But there are challenges here.
283
703732
1723
不过还有些挑战。
11:57
We don't want to just throw money at a problem.
284
705455
1575
我们可不想把钱都花在麻烦上面。
11:59
What we want to be able to do
285
707030
1519
我们想要做的是
12:00
is invest in new antibiotics
286
708549
2279
投资新的抗生素，
12:02
in ways that actually encourage
287
710828
2976
能够实际上鼓励
12:05
appropriate use and sales of those antibiotics,
288
713804
3020
这些抗生素的适度使用和销售，
12:08
and that really is the challenge here.
289
716824
2463
这就是真正的挑战。
12:11
Now, going back to these technologies,
290
719287
2329
那么现在回到这些技术上，
12:13
you all remember the line from that famous
291
721616
2363
你们肯定都记得《侏罗纪公园》里的
12:15
dinosaur film, "Nature will find a way."
292
723979
2226
台词，“大自然会自寻出路。”
12:18
So it's not as if these are
permanent solutions.
permanent solutions.
293
726205
3319
所以这看起来并不像个
一劳永逸的解决方案。
一劳永逸的解决方案。
12:21
We really have to remember that,
whatever the technology might be,
whatever the technology might be,
294
729524
4086
我们需要谨记，无论采用什么样的技术，
12:25
that nature will find some
way to work around it.
way to work around it.
295
733610
2876
大自然都会找到方法解决问题。
12:28
You might think, well,
this is just a problem
this is just a problem
296
736486
2071
你们可能会想，这只是个有关
12:30
just with antibiotics and with bacteria,
297
738557
2744
抗生素和细菌的问题，
12:33
but it turns out that we
have the exact same
have the exact same
298
741301
1946
不过事实证明我们在很多其他领域
12:35
identical problem in
many other fields as well,
many other fields as well,
299
743247
2734
都有相同的问题，
12:37
with multidrug-resistant tuberculosis,
300
745981
2952
比如对很多药物都有耐药性的肺结核，
12:40
which is a serious problem
in India and South Africa.
in India and South Africa.
301
748933
3562
这种病在印度和南非的状况不容乐观。
12:44
Thousands of patients are dying because
302
752495
1787
数以千计的患者都在面临死亡的威胁，
12:46
the second-line drugs are so expensive,
303
754282
1834
因为二线药物都很贵，
12:48
and in some instances, even those don't work
304
756116
2227
有的情况下，当你患有这种病时
12:50
and you have XDR TB.
305
758343
2070
它们甚至完全不起作用。
12:52
Viruses are becoming resistant.
306
760413
1811
病毒也在变得更耐药。
12:54
Agricultural pests. Malaria parasites.
307
762224
3166
农业害虫。疟原虫。
12:57
Right now, much of the world depends on
308
765390
1783
现在，世界上很多地方都依赖一种药，
12:59
one drug, artemisinin drugs,
309
767173
3697
青蒿素药物，
13:02
essentially to treat malaria.
310
770870
1956
尤其是用它来治疗疟疾。
13:04
Resistance to artemisinin has already emerged,
311
772826
2587
青蒿素耐菌性已经开始减弱了，
13:07
and if this were to become widespread,
312
775413
2354
如果这种情况愈演愈烈，
13:09
that puts at risk
313
777767
1348
单一药物的风险
13:11
the single drug that we have to
treat malaria around the world
treat malaria around the world
314
779115
2891
就会在全世界出现出现，
我们就需要采取目前看来安全有效的方式
我们就需要采取目前看来安全有效的方式
13:14
in a way that's currently
safe and efficacious.
safe and efficacious.
315
782006
3214
来治疗疟疾。
13:17
Mosquitos develop resistance.
316
785220
1798
蚊子也变得耐药了。
13:19
If you have kids, you probably
know about head lice,
know about head lice,
317
787018
2237
如果你有孩子，你可能知道头虱，
13:21
and if you're from New York City,
318
789255
1713
如果你从纽约市来，
13:22
I understand that the
specialty there is bedbugs.
specialty there is bedbugs.
319
790968
2733
我知道那里的臭虫问题很严重。
13:25
So those are also resistant.
320
793701
2255
这些东西都有耐药性。
13:27
And we have to bring an
example from across the pond.
example from across the pond.
321
795956
2879
我们需要借鉴一洋之隔的例子。
13:30
Turns out that rats are
also resistant to poisons.
also resistant to poisons.
322
798835
2355
事实证明老鼠对毒药也产生了耐性。
13:33
Now, what's common
to all of these things is
to all of these things is
323
801190
2701
那么所有这些事的共同点就是
13:35
the idea that we've had these technologies
324
803891
2706
我们用现有的技术
13:38
to control nature only for
the last 70, 80 or 100 years
the last 70, 80 or 100 years
325
806597
4621
控制大自然的力量仅仅有七八十，
或者一百年左右，
或者一百年左右，
13:43
and essentially in a blink,
326
811218
3028
而重点在于短时间内，
13:46
we have squandered our ability to control,
327
814246
2551
我们就浪费了真正能
掌控大自然的能力
掌控大自然的能力
13:48
because we have not recognized
328
816797
2491
因为我们还没有认识到
13:51
that natural selection and
evolution was going to find
evolution was going to find
329
819288
2812
自然选择和进化会找到
13:54
a way to get back,
330
822100
1174
恢复原状的途径，
13:55
and we need to completely rethink
331
823274
2049
我们需要彻底重新考虑
13:57
how we're going to use
332
825323
2343
应该如何
13:59
measures to control biological organisms,
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采取行动来控制生物体，
14:02
and rethink how we incentivize
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重新考虑我们要如何实质性的促进
14:06
the development, introduction,
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发展和新型药物的引入，
14:08
in the case of antibiotics prescription,
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比如抗生素药物处方，
14:11
and use of these valuable resources.
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以及如何使用这些珍贵的资源。
14:14
And we really now need to
start thinking about them
start thinking about them
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我们现在真的需要把它们
14:17
as natural resources.
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当成自然资源。
14:19
And so we stand at a crossroads.
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我们正站在一个岔路口。
14:21
An option is to go through that rethinking
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一种选择就是重新思考，
14:24
and carefully consider incentives
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谨慎的考虑相关的动机
14:26
to change how we do business.
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来改变我们的行事方式。
14:28
The alternative is
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另一种情况就是
14:31
a world in which even a blade of grass
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即便只是一片草叶子
14:34
is a potentially lethal weapon.
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都可能成为一个世界的致命武器。
14:36
Thank you.
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谢谢大家。
14:38
(Applause)
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（掌声）
Reviewed by Rocky LIANG
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