ABOUT THE SPEAKER
Ramanan Laxminarayan - Drug-resistance economist
At 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."
More profile about the speaker
Ramanan Laxminarayan | Speaker | TED.com
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

Filmed:
1,062,693 views

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。
- Drug-resistance economist
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患者 to ever be
treated治療 with an antibiotic抗生素
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第一位接受抗生素治療的患者
00:16
was a policeman警察 in Oxford牛津.
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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劃傷 by a rose玫瑰 thorn
while working加工 in the garden花園.
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整理自家花園時被玫瑰的刺劃傷。
00:23
That small scratch became成為 infected感染.
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那個小的傷口被感染了。
00:26
Over the next下一個 few少數 days,
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膿腫,
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而腫了起來,
00:30
and in fact事實 his eye was so infected感染
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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二月 of 1941,
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到了 1941 年二月,
00:38
this poor較差的 man was on the verge邊緣 of dying垂死.
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這個可憐的警察
已經徘徊在生死邊緣。
00:40
He was at Radcliffe拉德克利夫 Infirmary醫務室 in Oxford牛津,
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他在牛津的拉德克利夫醫院接受治療,
00:43
and fortunately幸好 for him,
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幸運的是,
由霍華德·佛洛里醫生
00:45
a small team球隊 of doctors醫生
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00:47
led by a Dr博士. Howard霍華德 Florey弗洛裡
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領導的一個醫療小團隊
00:48
had managed管理 to synthesize合成
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成功地合成了
00:50
a very small amount of penicillin青黴素,
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微量的青黴素,
00:53
a drug藥物 that had been discovered發現
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在 12 年前,由亞歷山大·佛萊明
00:55
12 years年份 before by Alexander亞歷山大 Fleming弗萊明
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所發現的一種藥物,
00:58
but had never actually其實 been
used to treat對待 a human人的,
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但是從來沒有在人體上使用過,
01:01
and indeed確實 no one even
knew知道 if the drug藥物 would work,
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事實上,甚至沒人知道
這個藥是否有效,
01:04
if it was full充分 of impurities雜質
that would kill the patient患者,
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如果這藥物不純淨的話會不會致死,
01:07
but Florey弗洛裡 and his team球隊 figured想通
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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威力 as well use it
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如果他們一定要試用這個藥,
01:11
on someone有人 who was going to die anyway無論如何.
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不妨用在無藥可救的患者身上。
01:14
So they gave Albert阿爾伯特 Alexander亞歷山大,
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於是他們將藥用在亞柏·亞歷山大
01:17
this Oxford牛津 policeman警察, the drug藥物,
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那位牛津警察的身上。
01:20
and within 24 hours小時,
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在 24 小時之內,
01:23
he started開始 getting得到 better.
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他的狀況開始好轉。
01:25
His fever發熱 went down,
his appetite食慾 came來了 back.
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他的燒退了,胃口也恢復了。
01:29
Second第二 day, he was doing much better.
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第二天,他康復得更好。
01:31
They were starting開始 to
run out of penicillin青黴素,
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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尿
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所以醫生們採集他的尿液
01:35
across橫過 the road to re-synthesize重新合成
the penicillin青黴素 from his urine尿
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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工作.
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這個方法也可行。
01:42
Day four, well on the way to recovery復甦.
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第四天,他仍在慢慢康復。
01:44
This was a miracle奇蹟.
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在當時這是一個奇蹟。
01:46
Day five, they ran out of penicillin青黴素,
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第五天,青黴素用完了,
01:50
and the poor較差的 man died死亡.
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那位可憐的警察就這樣去世了。
01:52
So that story故事 didn't end結束 that well,
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這個故事的結局不太好,
01:55
but fortunately幸好 for
millions百萬 of other people,
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不過,在他之後,有百萬人受益,
01:59
like this child兒童 who was treated治療
again in the early 1940s,
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就像是 40 年代初期,
02:02
who was again dying垂死 of a sepsis膿血症,
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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恢復 thanks謝謝 to this
wonder奇蹟 drug藥物, penicillin青黴素.
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因為神奇的青黴素,這孩子痊癒了。
02:12
Millions百萬 have lived生活,
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上百萬的人因它活了下來,
02:14
and global全球 health健康 has been transformed改造.
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全人類的健康發生了轉變。
02:17
Now, antibiotics抗生素 have been used
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現在,抗生素用來
02:20
for patients耐心 like this,
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治療這類病人,
02:23
but they've他們已經 also been
used rather frivolously輕率
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但是它們也被輕易用在
02:25
in some instances實例,
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別的情況下,
02:27
for treating治療 someone有人
with just a cold or the flu流感,
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比如說用來治療感冒和流感,
02:29
which哪一個 they might威力 not have
responded回應 to an antibiotic抗生素,
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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,
02:32
and they've他們已經 also been
used in large quantities數量
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02:36
sub-therapeutically亞治療, which哪一個
means手段 in small concentrations濃度,
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用低濃度的抗生素,
02:39
to make chicken and hogs grow增長 faster更快.
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讓雞和豬長得更快一些。
02:42
Just to save保存 a few少數 pennies便士
on the price價錢 of meat,
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只是為了省一些的買肉的錢,
02:46
we've我們已經 spent花費 a lot of
antibiotics抗生素 on animals動物,
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我們在動物身上用很多的抗生素,
02:49
not for treatment治療, not for sick生病 animals動物,
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不是為了醫治生病的動物,
02:51
but primarily主要 for growth發展 promotion提升.
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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基本上, the massive大規模的 use of antibiotics抗生素
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在全球
大量地使用抗生素,
03:00
around the world世界
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03:01
has imposed徵收 such這樣 large
selection選擇 pressure壓力 on bacteria
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促進了細菌適者生存的自然選擇,
03:05
that resistance抵抗性 is now a problem問題,
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現在細菌的抗藥性成了問題,
03:08
because we've我們已經 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報紙,
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我敢肯定你們都在報紙上
看過類似報導,
03:14
you've seen看到 this in every一切 magazine雜誌
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你們瀏覽的每一本雜誌
03:16
that you come across橫過,
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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欣賞
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03:20
the significance意義 of this problem問題.
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這個問題的重要性。
03:22
This is serious嚴重.
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這是一個很嚴重的問題。
03:23
The next下一個 slide滑動 I'm about to show顯示 you is
of carbapenem碳青黴烯類 resistance抵抗性 in acinetobacter鮑曼不動.
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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,
03:28
Acinetobacter鮑曼不動 is a nasty討厭 hospital醫院 bug竊聽器,
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不動桿菌是一種經常
存在於醫院的細菌,
03:31
and carbapenem碳青黴烯類 is pretty漂亮 much
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碳青黴烯是
03:32
the strongest最強 class of antibiotics抗生素
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一種最強的抗生素
03:34
that we can throw at this bug竊聽器.
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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模式 of resistance抵抗性,
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這是抗藥性分布圖,
03:42
mostly大多 under about 10 percent百分
across橫過 the United聯合的 States狀態.
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在美國通常是在 10% 以下。
03:45
Now watch what happens發生
when we play the video視頻.
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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生活,
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我不知道各位是住在哪裡
04:00
but wherever哪裡 it is, it certainly當然 is a lot worse更差 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問題 of antibiotic抗生素 resistance抵抗性.
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問題所在就是對抗生素的抗藥性。
04:09
It's a global全球 issue問題
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這是一個全球性的問題
04:11
affecting影響 both rich豐富 and poor較差的 countries國家,
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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威力 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問題?
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這只是一個醫學問題吧?
04:18
If we taught doctors醫生 how not
to use antibiotics抗生素 as much,
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如果我們讓醫生少用抗生素,
04:20
if we taught patients耐心 how
not to demand需求 antibiotics抗生素,
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讓病人不要求使用抗生素,
04:23
perhaps也許 this really wouldn't不會 be an issue問題,
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不就化解難題了嘛,
04:25
and maybe the pharmaceutical製藥 companies公司
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也許醫藥公司
04:27
should be working加工 harder更難 to develop發展
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應該更努力研發
04:28
more antibiotics抗生素.
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更多的抗生素。
04:30
Now, it turns out that there's something
fundamental基本的 about antibiotics抗生素
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但是抗生素在本質上
04:33
which哪一個 makes品牌 it different不同 from other drugs毒品,
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與其他藥物有不同的地方,
04:35
which哪一個 is that if I misuse濫用 antibiotics抗生素
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意味著,如果我誤用抗生素
04:37
or I use antibiotics抗生素,
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或使用抗生素,
04:39
not only am I affected受影響 but
others其他 are affected受影響 as well,
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不僅我會受到影響,
其他人也會受到影響,
04:43
in the same相同 way as if I
choose選擇 to drive駕駛 to work
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同理,有如我開車去上班
04:45
or take a plane平面 to go somewhere某處,
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或者坐飛機去別的地方,
04:48
that the costs成本 I impose強加 on others其他
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我造成的污染也會影響到別人
04:50
through通過 global全球 climate氣候 change更改 go everywhere到處,
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因此造成氣候變化
其影響無所不在,
04:52
and I don't necessarily一定 take
these costs成本 into consideration考慮.
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我卻不會考慮到我帶來的影響。
04:55
This is what economists經濟學家 might威力
call a problem問題 of the commons公地,
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這就是經濟學裡所謂的公共問題,
04:58
and the problem問題 of the commons公地 is exactly究竟
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公共問題恰好就是
05:00
what we face面對 in the case案件
of antibiotics抗生素 as well:
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抗生素所面對的問題:
05:02
that we don't consider考慮
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我們都不會考慮-
05:04
and we, including包含 individuals個人, patients耐心,
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包括個人、病患、
05:07
hospitals醫院, entire整個 health健康 systems系統
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醫院、整個醫療體系-
05:11
do not consider考慮 the costs成本
that they impose強加 on others其他
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沒有仔細思考濫用抗生素
05:13
by the way antibiotics抗生素 are actually其實 used.
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會給別人帶來什麼影響。
05:15
Now, that's a problem問題 that's similar類似
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這與我們所熟知的
05:17
to another另一個 area that we all know about,
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另一個領域的問題很類似,
05:19
which哪一個 is of fuel汽油 use and energy能源,
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那就是燃油的使用和能源問題,
05:21
and of course課程 energy能源 use
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當然,能源的使用問題
05:23
both depletes耗盡 energy能源 as well as
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不僅消耗了大量資源
05:26
leads引線 to local本地 pollution污染
and climate氣候 change更改.
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也造成了當地環境污染和氣候變化。
05:29
And typically一般, in the case案件 of energy能源,
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特別是能源的使用,
05:31
there are two ways方法 in which哪一個
you can deal合同 with the problem問題.
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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,
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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類似 to making製造 better use
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同樣的,我們可以更好的方式使用
05:39
of existing現有 antibiotics抗生素,
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現存的抗生素,
05:41
and we can do this in a number of ways方法
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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第二,
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我們稍後再討論這個問題,
05:45
but the other option選項 is the
"drill鑽頭, baby寶寶, drill鑽頭" option選項,
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另一個選擇就是繼續開採燃油,
05:48
which哪一個 in the case案件 of antibiotics抗生素
is to go find new antibiotics抗生素.
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在抗生素的角度來說
就是尋找新的抗生素。
05:53
Now, these are not separate分離.
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這不是分開的兩個選擇。
05:55
They're related有關, because if we invest投資 heavily嚴重
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它們是相關連的,
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減少 the incentives獎勵
for conservation保護 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相同 way that's going
to happen發生 for antibiotics抗生素.
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抗生素也會發生同樣的事情。
06:06
The reverse相反 is also going
to happen發生, which哪一個 is that
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相反的情況也會發生,
06:08
if we use our antibiotics抗生素 appropriately適當,
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如果我們適當使用抗生素,
06:10
we don't necessarily一定 have
to make the investments投資
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我們就不必投資
06:13
in new drug藥物 development發展.
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開發新的抗生素。
06:15
And if you thought that these two were entirely完全,
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如果你認為這兩者
06:18
fully充分 balanced均衡 between之間 these two options選項,
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處在完美的平衡狀態,
06:20
you might威力 consider考慮 the fact事實 that
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那你應該知道
06:22
this is really a game遊戲 that we're playing播放.
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其實這只是我們玩的一個遊戲。
06:24
The game遊戲 is really one of coevolution協同進化,
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這個遊戲只是一種共同進化,
06:27
and coevolution協同進化 is, in
this particular特定 picture圖片,
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如圖所示,在獵豹和羚羊之間,
06:30
between之間 cheetahs獵豹 and gazelles瞪羚.
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就存在著共同進化。
06:32
Cheetahs獵豹 have evolved進化 to run faster更快,
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獵豹進化讓自己跑得更快,
06:34
because if they didn't run faster更快,
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因為如果牠們跑得不快,
06:35
they wouldn't不會 get any lunch午餐.
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就吃不到午飯。
06:37
Gazelles羚羊 have evolved進化 to run faster更快 because
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羚羊也進化跑得更快
06:40
if they don't run faster更快, they would be lunch午餐.
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因為如果牠們跑不快,
就會被當作午餐,
06:43
Now, this is the game遊戲 we're
playing播放 against反對 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獵豹,
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但我們不是獵豹,
06:48
we're the gazelles瞪羚,
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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課程 of this little talk,
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就在我們說話的同時,
06:54
would have had kids孩子 and grandkids孫子
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會一代一代地繁衍,
06:55
and figured想通 out how to be resistant
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它們會想辦法抵抗抗生素,
06:58
just by selection選擇 and trial審訊 and error錯誤,
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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?
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那我們要怎麼做
才能跑在細菌的前面呢?
07:06
We have drug藥物 discovery發現 processes流程,
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我們有藥物研發過程,
07:08
screening篩查 molecules分子,
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篩選分子,
07:10
we have clinical臨床 trials試驗,
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我們有臨床試驗,
07:11
and then, when we think we have a drug藥物,
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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 FDAFDA regulatory監管 process處理.
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我們還要通過食品藥物管理局的審查。
07:17
And once一旦 we go through通過 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
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我們又要再想辦法跑在
07:22
of the bacteria.
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細菌的前面。
07:24
Now, this is clearly明確地 not a
game遊戲 that can be sustained持續,
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很明顯這不是一個
可以長期堅持的遊戲,
07:27
or one that we can win贏得
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或是只依靠發現新藥物
07:28
by simply只是 innovating創新 to stay ahead.
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就能贏得勝利的遊戲。
07:30
We've我們已經 got to slow the pace步伐 of coevolution協同進化 down,
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我們需要讓共同進化的腳步慢下來,
07:33
and there are ideas思路 that we
can borrow from energy能源
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能源問題的解決方法
我們可以引為借鏡,
07:37
that are helpful有幫助 in thinking思維 about
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我們可以嫁接
07:39
how we might威力 want to do this in the case案件
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解決能源問題的辦法
07:40
of antibiotics抗生素 as well.
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來解決抗生素的問題。
07:42
Now, if you think about how we deal合同 with
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如果你們想想我們是
07:44
energy能源 pricing價錢, for instance,
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怎麼處理能源的價格,
07:45
we consider考慮 emissions排放 taxes,
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我們會考慮污染排放稅,
07:47
which哪一個 means手段 we're imposing威風
the costs成本 of pollution污染
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意味著我們讓使用能源的人
07:50
on people who actually其實 use that energy能源.
181
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出錢來解決排放的污染。
07:53
We might威力 consider考慮 doing that for antibiotics抗生素 as well,
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我們可以在抗生素上做同樣的事,
07:56
and perhaps也許 that would make sure that antibiotics抗生素
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2711
也許可以讓抗生素
07:58
actually其實 get used appropriately適當.
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被適當的使用。
08:01
There are clean清潔 energy能源 subsidies補貼,
185
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2028
還有清潔能源補貼,
08:03
which哪一個 are to switch開關 to fuels燃料
which哪一個 don't pollute污染 as much
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鼓勵使用低污染的能源,
08:06
or perhaps也許 don't need fossil化石 fuels燃料.
187
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也許最後我們都不需要石油了。
08:09
Now, the analogy比喻 here is, perhaps也許 we need
188
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同樣的,或許我們必需
08:11
to move移動 away from using運用 antibiotics抗生素,
189
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遠離抗生素,
08:14
and if you think about it, what are
good substitutes代用品 for antibiotics抗生素?
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你仔細想想,什麼可以代替抗生素?
08:17
Well, turns out that anything that reduces減少
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一切可以減少抗生素使用的東西
08:20
the need for the antibiotic抗生素 would really work,
192
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都是可行的,
08:22
so that could include包括 improving提高
hospital醫院 infection感染 control控制
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包括提高醫院防治感染的能力,
08:25
or vaccinating接種疫苗 people,
194
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給人們打疫苗,
08:28
particularly尤其 against反對
the seasonal時令的 influenza流感.
195
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2297
特別是抵抗季節性流感的疫苗。
08:30
And the seasonal時令的 flu流感 is probably大概
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2531
季節性流感很可能
08:33
the biggest最大 driver司機 of antibiotic抗生素 use,
197
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3004
是抗生素使用最多的地方,
08:36
both in this country國家 as well
as in many許多 other countries國家,
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在我國和其他國家都是,
08:39
and that could really help.
199
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2020
注射疫苗可以提供極大的幫助。
08:41
A third第三 option選項 might威力 include包括
something like tradeable可交易 permits許可證.
200
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第三種選擇包括交易許可。
08:45
And these seem似乎 like faraway遠處 scenarios場景,
201
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這聽起來似乎和抗生素掛不上邊,
08:49
but if you consider考慮 the
fact事實 that we might威力 not
202
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但是如果我們沒有足量抗生素
08:51
have antibiotics抗生素 for many許多
people who have infections感染,
203
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3383
給被感染的人治療,
08:55
we might威力 consider考慮 the fact事實 that we might威力
204
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2237
我們也許可考慮
08:57
want to allocate分配 who actually其實 gets得到 to use
205
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2311
把抗生素分配
08:59
some of these antibiotics抗生素 over others其他,
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2714
給最需要的人,
09:02
and some of these might威力 have to
be on the basis基礎 of clinical臨床 need,
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3326
但我們需要考慮臨床需要,
09:05
but also on the basis基礎 of pricing價錢.
208
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1935
以及定價的基礎。
09:07
And certainly當然 consumer消費者 education教育 works作品.
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1910
當然教育消費者也可行。
09:09
Very often經常, people overuse過度使用 antibiotics抗生素
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2601
多數時候,大家濫用抗生素
09:12
or prescribe規定 too much without necessarily一定
211
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2277
或者醫生開了過量的抗生素,
09:14
knowing會心 that they do so,
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1606
卻不盡然明瞭自己已濫用或過量,
09:16
and feedback反饋 mechanisms機制
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1431
而反饋機制讓他們知道情況
09:17
have been found發現 to be useful有用,
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1902
也被證明有效,
09:19
both on energy能源
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1929
不僅在能源問題上-
09:21
When you tell someone有人 that they're using運用
216
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1540
當你告訴某人
09:23
a lot of energy能源 during peak hour小時,
217
551029
1917
他們在高峰期用了很多能源,
09:24
they tend趨向 to cut back,
218
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1470
他們一般都會變得節約一些,
09:26
and the same相同 sort分類 of example has been performed執行
219
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1767
同樣的例子
09:28
even in the case案件 of antibiotics抗生素.
220
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在抗生素上也有所體現。
09:29
A hospital醫院 in St. Louis路易 basically基本上 would put up
221
557993
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聖路易斯的一家醫院
09:31
on a chart圖表 the names of surgeons外科醫生
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4192
把外科醫生的名字做成一張表,
09:36
in the ordering排序 of how much antibiotics抗生素 they'd他們會 used
223
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2219
依上個月用了多少抗生素
09:38
in the previous以前 month,
224
566385
1944
來進行排名,
09:40
and this was purely純粹 an
informational信息 feedback反饋,
225
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2342
這全然是一個信息反饋,
09:42
there was no shaming羞辱,
226
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1183
這張表沒有對醫生指責,
09:43
but essentially實質上 that provided提供
some information信息 back
227
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2135
只是提供了一些資訊
這樣外科醫生可以反思
09:45
to surgeons外科醫生 that maybe they could rethink反思
228
573989
1954
09:47
how they were using運用 antibiotics抗生素.
229
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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 doneDONE
230
578172
2014
09:52
on the supply供應 side as well.
231
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2149
也有需要改善的地方。
09:54
If you look at the price價錢 of penicillin青黴素,
232
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1777
如果你看看青黴素的價格,
09:56
the cost成本 per day is about 10 cents.
233
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1651
一天的價格是 10 美分 (三元台幣)。
09:57
It's a fairly相當 cheap低廉 drug藥物.
234
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這是非常便宜的藥。
09:59
If you take drugs毒品 that have
been introduced介紹 since以來 then —
235
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2137
如果你使用之後發明的藥物-
10:01
linezolid利奈唑胺 or daptomycin達托黴素
236
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2644
利奈唑胺或者達託黴素-
10:04
those are significantly顯著 more expensive昂貴,
237
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1878
是要貴得多,
10:06
so to a world世界 that has been used to
paying付款 10 cents a day for antibiotics抗生素,
238
594180
5451
如果你可以每天花 10 美分
使用抗生素,
10:11
the idea理念 of paying付款 180 dollars美元 per day
239
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2530
那麼花 180 美元使用別的藥物
10:14
seems似乎 like a lot.
240
602163
1567
看起來就貴多了。
10:15
But what is that really telling告訴 us?
241
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1987
這個究竟告訴了我們什麼呢?
10:17
That price價錢 is telling告訴 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低廉, effective有效
antibiotics抗生素 as a given特定
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可預見的 future未來,
245
613697
1767
10:27
and that price價錢 is a signal信號 to us
246
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2530
這個價格是一個信號
10:29
that perhaps也許 we need to be paying付款
247
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1609
也許我們應該
10:31
much more attention注意 to conservation保護.
248
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重視節用抗生素。
10:34
That price價錢 is also a signal信號
249
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2704
這個價格也給出了另一個信號
10:36
that maybe we need to start開始
looking at other technologies技術,
250
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2875
那就是我們應該開始轉向其他的技術,
10:39
in the same相同 way that
gasoline汽油 prices價格 are a signal信號
251
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2652
就好像汽油價格是一個信號
10:42
and an impetus原動力, to, say,
252
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2590
可以說它
10:44
the development發展 of electric電動 cars汽車.
253
632977
1868
刺激了電動車的發展。
10:46
Prices價格 are important重要 signals信號
254
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1777
價格是很重要的信號
10:48
and we need to pay工資 attention注意,
255
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1586
我們要更重視這個訊號,
10:50
but we also need to consider考慮 the fact事實 that
256
638208
2452
但我們也要考慮到
10:52
although雖然 these high prices價格
seem似乎 unusual異常 for antibiotics抗生素,
257
640660
4252
雖然高價抗生素似乎不太常見,
10:56
they're nothing compared相比 to the price價錢 per day
258
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2239
和某些癌症治療藥物比起來
10:59
of some cancer癌症 drugs毒品,
259
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1384
這種高價基本上可以被忽視,
11:00
which哪一個 might威力 save保存 a patient's耐心 life only
for a few少數 months個月 or perhaps也許 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,
11:03
whereas antibiotics抗生素 would potentially可能
261
651905
1770
而抗生素
可以徹底挽救一個病人的生命。
11:05
save保存 a patient's耐心 life forever永遠.
262
653675
1826
11:07
So this is going to involve涉及
263
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1319
所以一個全新的模式變革
11:08
a whole整個 new paradigm範例 shift轉移,
264
656820
1962
將會發生,
11:10
and it's also a scary害怕 shift轉移 because
265
658782
1856
這種變化也會很可怕
11:12
in many許多 parts部分 of this country國家,
266
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2329
因為在這個國家很多地方,
11:14
in many許多 parts部分 of the world世界,
267
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1744
在全球各個角落,
11:16
the idea理念 of paying付款 200 dollars美元
268
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2069
每天花上 200 美元
11:18
for a day of antibiotic抗生素 treatment治療
269
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2891
進行抗生素治療
11:21
is simply只是 unimaginable不可思議.
270
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2542
是難以想像的。
11:24
So we need to think about that.
271
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1734
所以我們需要好好的想一想。
11:25
Now, there are backstop逆止 options選項,
272
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1813
現在,還有一些備案,
11:27
which哪一個 is other alternative替代 technologies技術
273
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2676
人們在研發
其他可以代替的技術。
11:30
that people are working加工 on.
274
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1194
11:31
It includes包括 bacteriophages噬菌體, probiotics益生菌,
275
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2652
包括噬菌體、益生菌,
11:34
quorum法定人數 sensing傳感, synbiotics合生元.
276
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4048
細菌群聚感應、合益素。
11:38
Now, all of these are useful有用 avenues渠道 to pursue追求,
277
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3039
如今這些都是可以探索的途徑,
11:41
and they will become成為 even more lucrative有利可圖
278
689369
2610
當新抗生素價格不斷上漲時
11:43
when the price價錢 of new
antibiotics抗生素 starts啟動 going higher更高,
279
691979
3081
它們就會變得更有利可圖,
11:47
and we've我們已經 seen看到 that the
market市場 does actually其實 respond響應,
280
695060
2897
我們看到市場已經開始回應,
11:49
and the government政府 is now considering考慮
281
697957
2008
政府也在考慮
11:51
ways方法 of subsidizing補貼 new
antibiotics抗生素 and development發展.
282
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3767
為新抗生素研發提供補貼。
11:55
But there are challenges挑戰 here.
283
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1723
但我們正面臨挑戰。
11:57
We don't want to just throw money at a problem問題.
284
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1575
問題不能只光砸錢。
11:59
What we want to be able能夠 to do
285
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1519
我們想做的
12:00
is invest投資 in new antibiotics抗生素
286
708549
2279
是投資研發新的抗生素
12:02
in ways方法 that actually其實 encourage鼓勵
287
710828
2976
但要能實際鼓勵
12:05
appropriate適當 use and sales銷售 of those antibiotics抗生素,
288
713804
3020
這些抗生素的銷售和適當使用,
12:08
and that really is the challenge挑戰 here.
289
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2463
這才是真正的挑戰。
12:11
Now, going back to these technologies技術,
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記得 the line from that famous著名
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。」
12:15
dinosaur恐龍 film電影, "Nature性質 will find a way."
292
723979
2226
12:18
So it's not as if these are
permanent常駐 solutions解決方案.
293
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3319
所以這些都不是永久的解決辦法。
12:21
We really have to remember記得 that,
whatever隨你 the technology技術 might威力 be,
294
729524
4086
我們需要記住,不管是什麼科技,
12:25
that nature性質 will find some
way to work around it.
295
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大自然總會找到解決方法。
12:28
You might威力 think, well,
this is just a problem問題
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你也許會想,這只是一個
12:30
just with antibiotics抗生素 and with bacteria,
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有關抗生素和細菌的問題,
12:33
but it turns out that we
have the exact精確 same相同
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但是我們在其他領域
12:35
identical相同 problem問題 in
many許多 other fields領域 as well,
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也有相同的問題,
12:37
with multidrug-resistant耐多藥 tuberculosis結核,
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有多重抗藥性肺結核,
12:40
which哪一個 is a serious嚴重 problem問題
in India印度 and South Africa非洲.
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在南非和印度都是一個大問題。
12:44
Thousands成千上萬 of patients耐心 are dying垂死 because
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上千的病人面臨死亡的威脅
12:46
the second-line第二行 drugs毒品 are so expensive昂貴,
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因為二線藥物太昂貴,
12:48
and in some instances實例, even those don't work
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有的情況,二線藥物都沒有作用,
12:50
and you have XDRXDR TBTB.
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因為你得了廣泛抗藥性肺結核。
12:52
Viruses病毒 are becoming變得 resistant.
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病毒也變得具抗藥性。
12:54
Agricultural農業的 pests害蟲. Malaria瘧疾 parasites寄生蟲.
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農業害蟲、 瘧原蟲。
12:57
Right now, much of the world世界 depends依靠 on
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現在,世界上很多地方
都依賴一種藥物
12:59
one drug藥物, artemisinin青蒿素 drugs毒品,
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青蒿素藥物,
13:02
essentially實質上 to treat對待 malaria瘧疾.
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它用於治療瘧疾。
13:04
Resistance抵抗性 to artemisinin青蒿素 has already已經 emerged出現,
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2587
對青蒿素的抗藥性已經開始顯現,
13:07
and if this were to become成為 widespread廣泛,
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如果這種情況蔓延,
13:09
that puts看跌期權 at risk風險
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會使這種目前我們在全球治療瘧疾
13:11
the single drug藥物 that we have to
treat對待 malaria瘧疾 around the world世界
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安全又有效的單一療法藥物
13:14
in a way that's currently目前
safe安全 and efficacious有效的.
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產生風險。
13:17
Mosquitos蚊子 develop發展 resistance抵抗性.
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蚊子也產生了耐藥性。
13:19
If you have kids孩子, you probably大概
know about head lice蝨子,
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2237
如果你有小孩,你應該會知道頭蝨,
13:21
and if you're from New York紐約 City,
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1713
如果你是紐約人,
13:22
I understand理解 that the
specialty專業 there is bedbugs臭蟲.
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我聽說那裡的特產是臭蟲。
13:25
So those are also resistant.
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這些也有了抗藥性。
13:27
And we have to bring帶來 an
example from across橫過 the pond池塘.
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我們還得舉個一洋之隔的
英國的例子。
13:30
Turns out that rats大鼠 are
also resistant to poisons毒藥.
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那裡的老鼠也變得抗毒藥了。
13:33
Now, what's common共同
to all of these things is
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這些事的共同點就是
13:35
the idea理念 that we've我們已經 had these technologies技術
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我們有了這些技術
13:38
to control控制 nature性質 only for
the last 70, 80 or 100 years年份
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讓我們戰勝了自然 70、80
或者 100 年,
13:43
and essentially實質上 in a blink,
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轉眼之間,
13:46
we have squandered揮霍 our ability能力 to control控制,
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我們就失去了控制力,
13:48
because we have not recognized認可
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因為我們還沒有意識到
13:51
that natural自然 selection選擇 and
evolution演化 was going to find
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自然選擇和進化
總會找到一個出路,
13:54
a way to get back,
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13:55
and we need to completely全然 rethink反思
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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措施 to control控制 biological生物 organisms生物,
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去控制生物體,
14:02
and rethink反思 how we incentivize激勵
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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發展, introduction介紹,
335
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2226
14:08
in the case案件 of antibiotics抗生素 prescription處方,
336
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比如在抗生素的處方上,
14:11
and use of these valuable有價值 resources資源.
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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開始 thinking思維 about them
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我們需要把它們
14:17
as natural自然 resources資源.
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1958
當作自然資源。
14:19
And so we stand at a crossroads十字路口.
340
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我們站在一個十字路口上。
14:21
An option選項 is to go through通過 that rethinking重新思考
341
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一個選擇就是反思自己
14:24
and carefully小心 consider考慮 incentives獎勵
342
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謹慎地考慮所有的動機
14:26
to change更改 how we do business商業.
343
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怎麼改變我們做事的方法。
14:28
The alternative替代 is
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要不然我們就會淪落在
14:31
a world世界 in which哪一個 even a blade of grass
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即便一片草葉子
14:34
is a potentially可能 lethal致命 weapon武器.
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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掌聲)
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(掌聲)
Translated by Yamei Huang
Reviewed by Regina Chu

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ABOUT THE SPEAKER
Ramanan Laxminarayan - Drug-resistance economist
At 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."
More profile about the speaker
Ramanan Laxminarayan | Speaker | TED.com