时间:2019年10月18日 20:34:15

;I felt a funeral in my brain, and mourners to and fro“我的脑海中,进行着一场葬礼,悼念者络绎不绝kept ting, ting till I felt that sense was breaking through.不停的走着, 踩踏着,直到仪式的氛围渐浓And when they all were seated, a service, like a drum,当所有人入座,仪式开始,敲鼓的声音kept beating, beating, till I felt my mind was going numb.沉重有力,敲打着, 敲打着,直到我的意识变得麻木And then I heard them lift a box我听见他们抬起棺材and creak across my soul with those same boots of lead again,沉重的脚步,摇摇晃晃,我的灵魂吱呀作响then space began to toll, as if the heavens were a bell and being were an ear,四周丧钟响起,就像一个铃铛and I, and silence, some strange race wrecked, solitary, here.安静的我,如同异类,在此孤独,在此腐朽Just then, a plank in reason broke,失去依靠,理性开始崩塌and I fell down and down and hit a world at every plunge, and finished knowing then.;我从高处坠落跌入一个又一个世界,终于看清。We know depression through metaphors.我们能够在一些文学作品中看到抑郁的影子Emily Dickinson was able to convey it in language, Goya in an image.艾米莉·迪金森通过诗歌诠释它,戈雅通过绘画表达Half the purpose of art is to describe such iconic states.许多艺术作品产生的初衷就是为了表达这充满象征意义的状态As for me, I had always thought myself tough,就我自己来说,我一度认为自己非常坚强one of the people who could survive if Id been sent to a concentration camp.认为自己是那一类即使被送去集中营也可以存活下来的人In 1991, I had a series of losses.1991年,我经历了一连串的不幸My mother died, a relationship Id been in ended,母亲去世,爱情终结I moved back to the ed States from some years abroad,我也在几年的海外生活之后回到了美国and I got through all of those experiences intact.我在经历了这一切之后依旧安然无恙But in 1994, three years later,然而在1994年,也就是三年之后I found myself losing interest in almost everything.我突然发现自己对几乎所有的事情都失去了兴趣I didnt want to do any of the things甚至不愿意去做那些I had previously wanted to do, and I didnt know why.我曾经很想去做的事情,我不知道这是为什么The opposite of depression is not happiness, but vitality,抑郁的反面并非快乐,而是活力and it was vitality that seemed to seep away from me in that moment.而正是这样的活力似乎就在那段时间从我的身体中慢慢消失了Everything there was to do seemed like too much work.所有需要完成的事情都感觉那么麻烦I would come home and I would see the red light flashing on my answering machine,回到家的时候看着电话留言机上闪烁的红灯and instead of being thrilled to hear from my friends,我不但不会因为听到朋友们的声音感到兴奋I would think, ;What a lot of people that is to have to call back.;反而会想,怎么有这么多人等我回电话Or I would decide I should have lunch,有时该吃午饭了and then I would think, but Id have to get the food out and put it on a plate我却开始想,我还得把食物拿出来放到盘子里and cut it up and chew it and swallow it, and it felt to me like the Stations of the Cross.得切,得嚼,得咽,让我感觉就像耶稣受难一样And one of the things that often gets lost in discussions of depression人们在谈论抑郁时,时常忽略了一点is that you know its ridiculous.那就是你知道这一切都很荒谬You know its ridiculous while youre experiencing it.即使你正处在抑郁之中,你也知道这一切都很荒谬You know that most people manage to listen to their messages and eat lunch你知道多数人都可以让自己去听语音留言,去吃午餐and organize themselves to take a shower and go out the front door紧接着让自己冲个澡,然后出门and that its not a big deal, and yet you are nonetheless in its grip你知道这根本不是什么大不了的事情,然而你已经被它掌控and you are unable to figure out any way around it.并且无法找到任何解决的方式And so I began to feel myself doing less and thinking less and feeling less.于是我开始感到自己事情做得越来越少,思考得越来越少,感知得越来越少It was a kind of nullity.就好像整个人已经没什么价值了And then the anxiety set in.紧接着焦虑就来了201602/425262

They will share the information on how to improve.他们会交流如何改善治疗效果的经验。So it is, by measuring and creating transparency,正是通过医疗效果量化和透明化,you get a cycle of continuous improvement,我们进入了一个不断改善的正循环,which is what this slide shows.正如这张幻灯片所示。Now, you may say this is a nice idea,现在,你可能觉得这是个不错的主意,but this isnt only an idea.不过这已经不仅仅是个主意了,This is happening in reality.它正在发生。Were creating a global community,我们正在打造一个全球共同体,and a large global community,一个很大的全球共同体,where well be able to measure and compare来量化和对比what we achieve.我们的成效。Together with two academic institutions, G Michael Porter at Harvard Business School,与两个学术院校,哈佛商学院的Michael Porter,and the Karolinska Institute in Sweden,以及瑞典的Karolinka学院,G has formed something we call ICHOM.合作成立了ICHOM。You may think thats a sneeze,你们可能会觉得这听起来but its not a sneeze, its an acronym.像打喷嚏,其实这是个缩写。It stands for the International Consortium for Health Outcome Measurement.它的意思是健康结果测评的国际联盟。Were bringing together leading physicians我们把顶尖的医生和病人and patients to discuss, disease by disease,集合起来,针对每一种疾病what is really quality,讨论是什么决定了医疗质量,what should we measure,我们应该如何衡量,and to make those standards global.最后形成全球统一标准。Theyve worked -- four working groups have worked在过去一年里,我们有四个小组在工作,during the past year:他们的项目是:cataracts, back pain,白内障,背部疼痛,coronary artery disease, which is, for instance, heart attack,冠状动脉疾病,比如心脏病,and prostate cancer.和前列腺癌。The four groups will publish their data这四个小组会在今年十一月in November of this year.发表研究数据。Thats the first time well be comparing这将是我们第一次apples to apples, not only within a country,在国家之间对比(疾病医疗的效果),but between countries.而不是仅限于单一国家内。Next year, were planning to do eight diseases,明年我们计划研究8种疾病,the year after, 16.后年,增加到16种。In three years time, we plan to have covered我们计划用三年时间40 percent of the disease burden.完成对40%的疾病的分析。201509/400138

And it seems to me that the first question我的看法是,is entirely a biology question,第一个问题完全是生物学的问题,and its extremely hard to answer.这是非常难回答。One has to be very speculative,一个人必须非常投机,and many of my colleagues would say that we should not do this speculation,和我的许多同事会说,我们不应该做这种推测,that we should simply keep our counsel until we know more.我们应该简单地保持沉默,直到我们了解更多。I say thats nonsense.我觉得这是一派胡言。I say we absolutely are irresponsible if we stay silent on this.保持沉默,绝对是不负责任的。We need to give our best guess as to the time frame,我们需要给我们最好的猜测有时间框架,in order to give people a sense of proportion以便使人们有个概念,so that they can assess their priorities.使他们能够评估他们的优先事项。So, I say that we have a 50/50 chance所以,我说,从我们应用强健老鼠再生的科技of reaching this RHR milestone,的十五年内,我们有百分之五十的机会robust human rejuvenation, within 15 years from the point实现强健人类再生科技that we get to robust mouse rejuvenation.这个重要的里程碑。15 years from the robust mouse.强健老鼠再生的科技应用的十五年内,The publics perception will probably be somewhat better than that.人们的看法可能会变好。The public tends to underestimate how difficult scientific things are.因为人们往往低估的科学进步的困难性。So theyll probably think its five years away.因此,他们很可能会认为只需五年。Theyll be wrong, but that actually wont matter too much.他们可能是错误的,但实际上这不太重要。And finally, of course, I think its fair to say最后,当然,我认为公众对于老龄化that a large part of the reason why the public is so ambivalent about aging now的看法这么的矛盾的主要原因,is the global trance I spoke about earlier, the coping strategy.是我刚才谈到的全球恍惚的应对策略。That will be history at this point,这将是历史性的一刻,because it will no longer be possible to believe that aging is inevitable in humans,因为公众将不再认为老化是人类不可避免的,since its been postponed so very effectively in mice.因为它已经非常有效地在小老鼠体内被推迟。So were likely to end up with a very strong change in peoples attitudes,因此,我们很可能会看到人们的观念有了巨大变化,and of course that has enormous implications.而这将会具有极大的影响。So in order to tell you now how were going to get these mice,为了现在要告诉你我们要如何得到这些老鼠,Im going to add a little bit to my description of aging.我要补充一点我对老化的描述。Im going to use this word ;damage;我会用“损害”这个词来表示to denote these intermediate things that are caused by metabolism所有由新陈代谢中阶段造成的东西,and that eventually cause pathology.而最终导致不可避免的死亡。Because the critical thing about this因为这个关键的是,is that even though the damage only eventually causes pathology,尽管这些损害只有在最终才会造成不可避免的死亡,the damage itself is caused ongoing-ly throughout life, starting before were born.它们是从我们出生之前就开始累积的东西,我们整个人生它们都不断累积。But it is not part of metabolism itself.但是这些损害不是新陈代谢的一部分,And this turns out to be useful.这一点对我们来说是有益的。Because we can re-draw our original diagram this way.因为这样我们可以重新绘制我们的原始图。We can say that, fundamentally, the difference between gerontology and geriatrics我们可以说,老年学和老年病学之间根本区别就是,is that gerontology tries to inhibit the rate老年学试图抑制新陈代谢,at which metabolism lays down this damage.这些“损害”累积的速度。And Im going to explain exactly what damage is我等一下会准确地解释我所谓in concrete biological terms in a moment.的“损害”在生物学里指的是什么。And geriatricians try to hold back the sands of time老年病学呢,就试图阻止by stopping the damage converting into pathology.这些“损害”所带来的的后果,And the reason its a losing battle比如说死亡。这是一个败仗,is because the damage is continuing to accumulate.因为损害只会继续积累。So theres a third approach, if we look at it this way.如果我们这样看的话,有第三种办法。We can call it the ;engineering approach,;我们可以把它叫做工程方法,and I claim that the engineering approach is within range.我声称工程方法是在人类的科技,技术范围之内。The engineering approach does not intervene in any processes.该工程方法不会干预任何过程。It does not intervene in this process or this one.它不会干预这个过程,也不干预这一个。And thats good because it means that its not a losing battle,这很好,因为这意味着这不是一个败仗,and its something that we are within range of being able to do,并且它是在我们现在的范围之内能够做到的事情,because it doesnt involve improving on evolution.因为它不涉及对人类进化改善。The engineering approach simply says,该工程方法只是表示,;Lets go and periodically repair all of these various types of damage --“我们定期修复所有的这些不同类型的损害 –not necessarily repair them completely, but repair them quite a lot,他们不一定完全修复,so that we keep the level of damage down below the threshold但修复的足以让我们继续避免that must exist, that causes it to be pathogenic.;一个会造成导致死亡或生病的程度。”We know that this threshold exists,我们知道这个门槛程度的存在,because we dont get age-related diseases until were in middle age,因为我们只有当我们在中年时才会得到与年龄有关的疾病,even though the damage has been accumulating since before we were born.即使损害已经从我们诞生时就开始累积了。Why do I say that were in range? Well, this is basically it.为什么我说,在人类近期的技术范围内呢?这基本上就是原因。The point about this slide is actually the bottom.这图片的重点在底部。If we try to say which bits of metabolism are important for aging,如果我们试图说新陈代谢的那个部分才是对老化过程有着重要的影响,we will be here all night, because basically all of metabolism那我们可能要在这里呆一整晚,is important for aging in one way or another.因为基本上新陈代谢的每个组件都对老化有影响。201508/392920

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