Here's a classic thought experiment that's designed to trick your brain into thinking long-term and getting out of the daily news cycle. And it goes like this: if a newspaper came out once a century, what would the front page banner headline be? “We defeated the Nazis,” or “landed on the moon,” or "built the Internet"? I would argue that it would be the story of a single number, maybe the most elemental measure of progress that we have. Life expectancy at birth. The length of time that the average person can expect to live in a given place at a given time.
这是一个经典的思维实验, 旨在欺骗你的大脑,让你从长远考虑, 并从日常的新闻循环中脱离出来。 就像这样: 如果说一份报纸一世纪只出版一次, 那么它的头版大标题会是什么呢? “们战胜了纳粹”,还是“成功登月”, 又或许是“互联网建立”? 而我认为头版会是 一个关于数字的故事, 或许是我们想要取得进步 最基本的方式, 那就是出生时的预期寿命。 我们所能预测的 每一个人的生存寿命 在给定的时间和地点。
One hundred years ago, as best as we can measure, the average global life expectancy stood somewhere in the mid 30s. Today, it's just over 70. So in one century, we doubled global life expectancy. And to give a sense of what this looks like geographically, take a look at this image, these maps. This is data courtesy of the great organization, Our World in Data. This is the world in 1950. And in blue are the countries where life expectancy is more than 70. You can see it's just five countries in northern Europe. That's it. And in red, these are the countries where life expectancy is below 45. It's about a third of the planet. So fast-forward to more recent history. 2015 -- in blue the countries where life expectancy is above 70. Look at all that life. And in red, the countries where it's below 45. There's no red on the map because there are no countries where life expectancy is below 45. In fact, there are very few where it's below 60.
一百年以前,尽我们所能权衡, 全球人均寿命大约在 35 岁上下。 而今,人均寿命则超过了70岁, 因此在一个世纪里, 我们全球人均寿命翻了近一倍。 并为了给人一种 像是从地理角度去观察的感觉, 看一看这张图片,这些地图。 数据由一个很好的组织提供, 叫做“数据看世界(Our World in Data)”。 这是 1950 年时的世界, 而蓝色区域所指的是 那些人均寿命超过 70 岁的国家。 你可以看到只有北欧 5 个国家 位于蓝色区域,仅此而已。 而那些红色的区域则是 人均寿命低于 45 岁的国家。 而这些国家的数量大约 占全球国家总量的三分之一。 让我们快进到近代, 在2015年——图中蓝色区块指的是 人均寿命超过 70 岁的国家。 看看所有地区的情况, 而这些红色部分则是 人均寿命低于 45 岁的地区。 这张地图上没有红色的区域 那是因为没有任何国家的 人均寿命是低于 45 岁的。 事实上,地图上很少有国家的 人均寿命是低于 60 岁的,
This is an extraordinary achievement. And you'll sometimes hear people say that life expectancy and this kind of progress is actually just a statistical illusion. That we got better at reducing infant mortality, but the rest of our lives are actually not all that different. And it is true that infant mortality has been dramatically reduced over the last hundred years. But the story is much richer and more intense than that. If you take a look at this early infographic by the great Victorian statistician William Farr, which is attempting to show mortality rates by age group in London in the early 1840s. I find something incredibly heroic about this chart. I mean, here's a guy without computers, without the Internet, without Excel, trying to do something that is incredibly hard and incredibly important. He's trying to look at broad patterns in life and death in a great city, trying to make sense of what is going on. And what the chart reveals is that there is a tragic amount of death among children, not just infants, but five-year-olds and 10-year-olds are dying at an alarming rate. But almost nobody makes it to 85 or 90. And more than half of the population is dead by the age of 45. How many people in this room are older than 45? Right? And think about that: half of you would not be here. We talk about optimism. That is the most fundamental form of good news there is.
这是一项非凡的成就。 有时候,你会听见一些人说到 预期寿命以及我们现在 所取得的这些进步, 只是统计假象罢了。 我们在降低婴儿死亡率方面做得更好了, 但实际上,其余人的预期寿命 并没有和以往有太多的不同。 在过去一百年里, 婴儿的死亡率确实大幅下降。 但事情远比这要更加精彩、振奋。 如果你看了早期的信息图, 由维多利亚时代伟大的统计学家—— 威廉·法尔(William Farr)所绘制—— 它试图显示不同年龄组的死亡率 在 19 世纪 40 年代早期的伦敦。 我从这张图表上 发现了一些非常了不起的东西。 我是说这个家伙他没有电脑, 没有网,没有办公软件, 却尝试着去完成这一极其困难 却极其重要的挑战。 他打算去研究一个大城市 出生与死亡的大致关系, 并搞明白自己下一步要去做些什么。 这个图表所展现的是 儿童的死亡数量是极其多的, 这让我们感到悲伤, 而不仅仅是婴儿, 五岁和十岁左右的儿童 也正以令人惊恐的的速度死去。 可没有人几乎没有人 能够活到 85 或 90 岁。 超过半数的人口在 45 岁之前死亡。 我们这间屋子里 有多少人的年龄是大于 45 岁的? 对吧?想想看: 在座一半的人将不会在这儿。 我们演讲的主题是“乐观”, 我想没有什么比这更好的消息了吧。
(Laughter)
(笑声)
You are not dead. Right?
你们没有死,对吧?
(Laughter)
(笑声)
So I want to stress here that this good news is not uncomplicated. 100 years ago, there were less than two billion people on earth. Today there's almost eight billion and counting. And we have that runaway population growth not because people started having more babies, but rather because people stopped dying and the generations stacked up. And we have problems like climate change because of these underlying trends as well. If we had kept mortality rates where they were in 1920, we wouldn't have anywhere near the magnitude of the climate crisis we're facing now because there simply wouldn't have been enough people on the planet to emit enough carbon into the atmosphere to make a meaningful difference. In a weird sense, climate change is the unintended consequence of industrialization and increased longevity. So all this extra life is a mixed blessing, like any change this momentous.
我所要强调的是 这个好消息并不简单。 百年以前,只有不到 20 亿的人类 生活在地球上。 而现在快有 80 亿了, 并且数量在不断增加。 我们的人口正在失控似的增长, 并不是因为出生率提高了, 而是因为人类的死亡率下降, 人类数量不断累积增加。 我们面临着很多问题, 比如说气候变化, 而人口数量增加也是这些问题的诱因。 如果我们始终保持 1920 年的人类死亡率, 那么我们将永远不会 面临像现在这么严峻的气候危机, 因为人类数量少了, 将不会有那么多的人 在大气中排放大量的碳, 这将带来很大的改变。 从某种奇怪的意义上来讲,气候变化 是工业化以及人类寿命延长 所带来的意外结果。 因此,世界上所有其他的生命 都是毁誉参半的, 就像任何重大的改变一样。
But I want to stress not just that we did it, but I think the more interesting question is how we did it. That's what's been obsessing me over the last years, that's the investigation I've been on, trying to figure out what are the prime movers when we see change this momentous. What is really driving that change? And I think we should say, given everything that's happening in the world, we should point out that, you know, one of those prime movers, which we should shout from the rooftops, is vaccines. Right? We doubled --
但我想要强调的 并不仅仅是我们的所作所为, 我认为更加有趣的是 我们是怎样做到的。 过去那些年里,这个问题 也困扰了我很久, 这是我一直在进行的调查, 我试着去找出导致 这一结果的推动力究竟是什么, 这种推动力带来了极其重大的改变。 真正推动这种改变的究竟是什么呢? 我想我们应该说, 既然事情都已经发生了, 我们就应该指出这一点, 大家都知道,这其中一种推动力 就是疫苗。 对吧?我们人多了一倍——
(Applause)
(掌声)
Yes, right? Thank you. I did invent vaccines, so I appreciate that.
我说的没错吧? 谢谢。 我发明了疫苗,所以我很感激。
(Laughter)
(笑声)
I mean, for smallpox to polio, influenza, TB and measles, and covid. I mean, if we celebrated the eradication of smallpox the way we celebrate the moon landing, we would have a lot less vaccine hesitancy in the world right now. But I also think it's a mistake to focus exclusively on the march of science and the kind of tangible objects, like vaccines and antibiotics or X-rays. And to explain what I mean by that, I think it's useful to look at the story of how we conquered one of the most terrifying threats of the 19th century. Milk.
我是说从天花到小儿麻痹症, 流感,结核病和麻疹,还有新冠病毒。 假如我们以庆祝登月成功的方式 来庆祝成功消灭天花这种疾病, 那么我们就不会再去犹豫 到底要不要注射疫苗。 但是我认为我们不应该 完全地专注于科学 过于在乎那些可触摸到的事物, 比如说疫苗、抗生素或者 X 光片。 我将通过下面的例子来解释, 我觉得看看这个故事还是挺有用的 讲的是人类如何克服 19 世纪最可怕的 那些威胁。 牛奶。
Now, we think of milk as this kind of emblem of health and vitality, but in fact, in the middle of the 19th century, milk was a serious health threat, particularly to children. We had no mechanical refrigeration and so there was a lot of spoilage problems. People could get tuberculosis from milk. They figured out this thing for urban cattle where they couldn't feed them grass so they would feed them slop from whiskey distilleries -- instead of grass, brilliant idea -- which produced this kind of blue-tinted milk that was very dangerous, called swill milk. In 1850, more than half of all the deaths recorded in New York City were young children, many of them killed by contaminated milk. And look, I know what you're thinking. You're thinking, "I know how we solved this problem. We solved it with science. We solved it with chemistry." Right? I mean, the solution is so famous. It's sitting there printed on every carton of milk in every grocery store in the country, right? Pasteurization. But actually, the story of pasteurization is a case study in the limits of science because Louis Pasteur came up with his technique for sterilizing milk in 1865, but we didn't actually have pasteurized milk as a standard on American grocery stores’ shelves until 1915, a full 50 years later. And that's because science and chemistry on its own wasn't enough to make a meaningful change. You also needed persuasion.
当今,我们把牛奶当作 一种健康与活力的象征, 可实际上,在 19 世纪中叶, 牛奶曾为人们视作一种健康威胁, 对于孩子的威胁尤为明显。 我们那时候没有机械冷藏技术, 所以那时候牛奶 时常存在变质的问题。 喝了牛奶以后,人们还会的肺结核。 人们后来从城市的奶牛身上 发现了这种疾病, 因为当时人们没有条件 给奶牛提供草食, 就只好用威士忌酒厂的泔水喂他们—— 而不是喂草,真是个高明的主意—— 这也导致了奶牛生产出了 蓝色的奶水, 这种牛奶叫做泔水奶, 是不能用来饮用的。 在 1850 年, 有超过半数的纽约儿童死亡, 他们中很多都是因为 喝了这种受到污染才死去的。 我知道你们在想些什么, 你们在想: “我知道我们是怎样解决这个问题的, 我们依靠科学解决了这个问题, 我们凭借化学解决了这个问题。” 是这样的吗?人们采用了 一种很有名的方法去解决。 这种方法印在了全国每一个杂货店 每一盒牛奶上,对吧? 没错,那就是“巴斯德氏杀菌法”。 实际上,“巴斯德氏杀菌法” 是科学局限性的一个研究案例, 因为路易·巴斯德(Louis Pasteur) 在 1865 年发明了 消毒牛奶的方法。 直到 1915 年, 巴氏法消毒牛奶 才被美国杂货商店定为上市标准, 这时已经整整过去了 50 年了。 因为科学和化学本身并不足以 促成有意义的改变。 你还需要去劝说别人。
You had to convince people to drink pasteurized milk, you had to convince the dairy industry to make pasteurized milk, and that took a whole other cast of characters. It took muckraking journalists. It took crusading lawmakers. There was a whole subculture of pasteurization activists back then. Maybe the most unlikely one was a department store magnate named Nathan Straus, who got obsessed with the pasteurization cause and he funded all these milk depots all around New York City where pasteurized milk was sold at cost to low-income residents so that they would develop a taste for it. So in a sense, the way to think about it is that Pasteur solved the problem on the level of chemistry, but Straus and his allies solved it on the level of society. And you need both fronts to effect change on that scale.
你必须说服人们喝巴氏消毒牛奶, 你必须说服乳制工厂 去生产巴氏消毒牛奶, 你需要在这其中扮演不同的角色。 这需要揭发丑闻的记者, 这需要勇于改革的立法者。 那时候有一群 反对巴氏杀菌的激进分子。 而有一家百货公司的巨头, 绝对不与这些人为伍的公司老板, 名叫做施特劳斯, 他对巴氏消毒法情有独钟, 并资助了纽约市这些 储存巴氏消毒牛奶的仓库。 这里的牛奶将会卖给 那些低收入的居民, 这样子他们也会养成喝牛奶的习惯。 从某角度上来讲,我认为 巴斯德是在化学层面上 解决了这些问题, 而施特劳斯和他们同伴 则在社会层面上去处理问题。 你需要在两面都做出改变。
And there's another prime mover that we don't talk about enough, which seems a little bit unlikely in the context of disruptive innovation, and that is large bureaucratic institutions. Now, if that seems contradictory to you, I suggest that you flip through the pages of any pharmaceutical drug catalog from the early 20th century. I mean, these things are just a laundry list of deadly poisons, one after another: arsenic, mercury, belladonna, not to mention all the heroin and cocaine. A lot of medical historians believe that all-in pharmaceutical drugs were a net negative in terms of human health until the invention of antibiotics in the 1940s. That's what life was like.
另外一个因素 则是我们在这方面讨论的还不够, 在颠覆性的创新背景下, 我们似乎不太可能进行充分的讨论研究, 官僚机构限制了我们的研究。 如果这对你来说有点矛盾和突兀, 我建议你去翻翻书, 翻翻 20 世纪早期的任何药品目录。 这上面写的都是一长串的毒物名称, 一条接着一条: 砷、汞、颠茄, 更别提海洛因和可卡因了。 很多研究医学历史的学者 都认为所有的药品 都对人的身体健康有负面的影响 直到 20 世纪 40 年代, 抗生素的发明才消除了这种影响。 生活就是这样。
And in 1937, there was this Tennessee pharma startup that hit upon this idea for a new cough syrup, a cure for strep throat actually, targeted at children. At the time, there was a new drug called sulfa drugs that were kind of a forerunner of antibiotics. But they were generally packaged in this bulky pill format, very difficult for kids to swallow. So a chemist at this startup came up with the brilliant idea of dissolving the sulfa drug in diethylene glycol and then adding some raspberry flavoring to make it more palatable for the kids. Seemed like a brilliant idea, except that diethylene glycol is toxic to human beings. It's basically antifreeze. And so almost immediately, weeks after, there were dozens of deaths around the United States from this terrible concoction, and the crazy thing is that putting diethylene glycol in your medicine was not a problem, given the existing regulations of the day. The only thing that the FDA was really interested in was whether you were actually listing the ingredients of your potion on the label. So if you wanted to put antifreeze in your cough syrup, go ahead, as long as you list ingredients on the label. That's what life was like.
在 1937 年,这家田纳西州的制药公司 研发出了一种新兴的咳嗽糖浆, 可用来治疗链球菌性喉炎, 适用于儿童使用。 当时,有一种新药叫磺胺, 这种药正是抗生素的前身。 可那时,磺胺都只能装在 大个的药丸里面, 咽下这些药丸对于孩子们来说非常困难。 因此一位化学家开始了新的尝试 他想到了一个绝妙的主意, 让磺胺溶解 在二甘醇里, 接着再加入树莓调味剂, 这让孩子们更加容易喝下口。 这看似一个绝佳的想法。 然而二甘醇会 产生对人体有害的毒素, 它的毒性基本上和防冻剂差不多。 所以几周后, 在美国,有很多的孩子 因为喝了这种糟糕的调制药剂 相继死亡, 更让我们感到诧异的是, 将二甘醇和药物放在一起 在当时是被允许的, 鉴于那时候的现行法规。 食品及药物管理局当时唯一关注的 那就是你有没有列出 药剂相应的成分标签。 所以如果你想把 助冻剂和咳嗽糖浆放在一起, 只要你在药盒上注明就行, 生活那时就是这样。
But because of this tragedy, laws were changed. And for the first time, the FDA mandated the pharma companies show that their drugs were not harmful to consumers, which seems kind of obvious, but somebody had to figure that out. And so what we needed at that point was not just kind of new miracle drugs. We needed new institutions. We needed new medi-innovations, like three phase trials and randomized controlled experiments, and regulatory bodies, like the FDA, to separate out the fake cures from the real thing. And that kind of institutional innovation is going to be increasingly important in the decades to come, because all around the world right now, there are well-funded scientists and serious labs that are working on tackling the problem of aging itself.
但正是因为这场悲剧, 国家修改了相应的法律。 食品及药物管理局首次要求 法尔诺德制药公司证明 他们的药物对消费者无害, 虽然似乎真相显而易见, 但还是要有人去找答案。 在那个阶段,人们真正需要的 并不仅仅是这么一款特效药, 我们需要新的体系, 我们也需要新的医疗创新, 像三期试验, 同时还需要进行随机对照试验, 以及监察机构, 例如食品及药物管理局, 这些机构能帮助我们 将假药和真药区分开, 这种体系创新正变得愈发重要。 在未来的几十年里, 因为在世界的各个角落, 都会有一些受资助的科学家在实验室里 注重于攻克这个日益严峻的难题。
I mean, currently the outer boundary of human life is somewhere around 110 and 115. It's very hard to live past that. But there is serious research out there that suggests that we can just blow past that boundary and live for decades longer, maybe even indefinitely. I'm not saying this is going to happen, but it is on the table. And the thing about it is, if we did do that, it would be the most momentous change in the history of our species, right? Initially, it would intensely -- increase the health inequalities in the world because people could -- only rich people could afford these treatments originally. It would greatly exacerbate our runaway population growth problem and it would fundamentally alter the definition of the arc of a human life. And when you ask people, do you think we should mess around with immortality, ordinary people, most of them say no. But the problem is we don't have collectively a decision-making body that can help us wrestle with changes this immense. We're like the FDA back in 1930, like, go ahead and make your immortality pill. Just make sure the ingredients are right on the label. That's where we are. So the kinds of innovations we need are going to be on the level of oversight and decision making, and I think we can make these innovations if we if we work at it.
目前,人们生活的外部边界 在 110 和 115 之间的某处。 这要是在过去,人们是很难活下去的。 但一项严谨的研究表明, 我是可以越过那条界限的 并活得更久,甚至永远活下去。 我并不是说这将会发生, 但已经提上日程了。 问题是,如果我们真的做到了, 这将会成为人类历史上 最重大的改变,对吧? 首先,这将会极大程度上—— 导致世界健康不平等, 因为最初只有富人 才能付得起这些治疗的费用。 这将会极大程度上加剧 人口失控增长的问题, 它将从根本上改变 人们生活轨迹的定义。 而当你问人们, 问他们是否追求永生, 绝大多数的普通人都会说不。 但问题是,我们整体上并不具有 一个能帮助我们应对 如此巨大变化的决策机构。 我们就像 1930 年的食品及药物管理局, 寻求制造出永生药的办法。 我们只要确认 标签上的成分都正确就行, 这就是我们在干的事情。 因此,我们所需要的创新 是在监督层面上 以及决策层面上的。 如果我们致力于此, 我认为我们可以实现创新。
Now, we all realize that regulatory overreach is a problem. So we're going to have to design decision-making bodies that are both sensitive to the dangers and the unintended consequences, but also genuinely open to the possibilities. But to my mind, we should be focusing less on extending life indefinitely and more on reducing the gaps that remain in health outcomes here and around the world. I mean, just look at what we've lived through in the past year and a half. On average, white Americans lost one year of expected life in 2020, thanks largely to covid. African Americans lost three years. And we should be focusing on reducing the gap between what we call health span and lifespan. The amount of time that we spend that is fundamentally healthy and full capacity. I think we all agree that these are problems that are worth solving and we have the tools at our disposal right now to solve them. If the first great revolution in human health was extending the overall average human life, the second should be about closing the gaps.
现在,我们都意识到、 过度管制是存在问题的。 我们必须得建立决策机构, 这种决策机构会对 危险和意外后果保持敏感, 但也要真正接受各种可能性。 但在我看来, 我们不应该过于关注如何延长寿命, 而应该着重缩小世界各国 在健康产出方面 所存在的差距。 我是说,看看我们在过去 一年半的时间里经历了些什么。 在 2020 年,白人的平均预期寿命 相较于前年减少了一年, 很大程度上都归咎于新冠疫情, 而美国黑人则减少了三年的寿命。 我们应该着重去缩小差距, 缩小我们所说的寿命之间的差距。 我们所花费的时间 从根本上来将, 正是健康、充分的产能。 我想大家都认同我的说法:这些问题 是值得解决的, 而且我们现在也有 解决这些问题的工具。 如果说人类健康第一次伟大的革命 是延长人类平均寿命的话, 那么第二次革命则将是 缩小寿命差距。
Thank you very much.
非常感谢。
(Applause)
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