鑽石舞台

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 ofprogress that we have.

這是一個經典的思維實驗，旨在欺騙你的大腦，讓你從長遠考慮，並從日常的新聞循環中脫離出來。就像這樣：如果說一份報紙一世紀只出版一次，那麼它的頭版大標題會是什麼呢？我們戰勝了納粹，還是成功登月，又或許是互聯網的建立？而我認為頭版會是一個關於數字的故事，或許是我們想要取得進步最基本的方式。

Life expectancy at birth.The length of time that the average person can expect to live in a given place at a given time.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.

那就是出生時的預期壽命。我們所能預測的每一個人在給定的時間和地點的壽命長短。一百年以前，據我們所知，全球人均壽命大約在35歲上下。而今，人均壽命則超過了70歲，因此在一個世紀裡，我們全球人均壽命翻了近一倍。為了讓大家看看如果是從地理角度去觀察是什麼樣的，看一看這張圖片，這些地圖。

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.

這是一個很優秀的組織——數據看世界——提供的數據。這是1950年時的世界，而藍色區域是指那些人均壽命超過70歲的國家。你可以看到北歐只有5個國家位於藍色區域，僅此而已。而那些紅色的區域則是人均壽命低於45歲的國家。而這些國家的數量大約占全球國家總量的三分之一。讓我們快進到近代。

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.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.

在2015年——圖中藍色區域指的是人均壽命超過70歲的國家。看看所有地區的情況，而這些紅色部分則是人均壽命低於45歲的地區。這張地圖上沒有紅色的區域。那是因為沒有任何國家的人均壽命是低於45歲的。事實上，地圖上很少有國家的人均壽命是低於60歲的，這是一項非凡的成就。有時候，你會聽見一些人說到預期壽命以及我們現在所取得的這些進步，只是統計假象罷了。

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.

我們在降低嬰兒死亡率方面做得更好了，但實際上，其餘人的預期壽命並沒有和以往有太多的不同。在過去一百年裡，嬰兒的死亡率確實大幅下降。但事情遠比這要更加精彩、振奮。如果你看了早期的信息圖，由維多利亞時代偉大的統計學家——威廉·法爾所繪製——它嘗試向我們展示了19世紀40年代早期的倫敦不同年齡組的死亡率。

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.

我從這張圖表上發現了一些非常了不起的東西。我是說這個傢伙他沒有電腦，沒有網，沒有辦公軟件，卻嘗試着去完成這一極其困難卻極其重要的挑戰。他打算去研究一個大城市出生與死亡的大致關係，並搞明白自己下一步要去做些什麼。這個圖表展示出兒童極高的死亡量，這很慘，但不僅僅是嬰兒，五歲和十歲左右的兒童也正以令人驚恐的的速度死去。

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.You are not dead.Right?So I want to stress here that this good news is not uncomplicated.

幾乎沒有人能夠活到85或90歲。超過半數的人口在45歲之前死亡。我們這間屋子裡有多少人的年齡是大於45歲的？對吧？想想看：在座一半的人將不會在這兒。我們樂觀點來說，我想沒有什麼比這更好的消息了吧。你們沒有死，對吧？我所要強調的是這個好消息並不簡單。

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.

百年以前，只有不到20億的人類生活在地球上。而現在快有80億了，並且數量在不斷增加。我們的人口正在失控似的增長，並不是因為出生率提高了，而是因為人類的死亡率下降，人類數量不斷累積增加。我們面臨着很多問題，比如說氣候變化，而人口數量增加也是這些問題的誘因。

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, climatechange is the unintended consequence of industrialization and increased longevity.

如果我們始終保持1920年的人類死亡率，那麼我們將永遠不會面臨像現在這麼嚴峻的氣候危機，因為人類數量少了，將不會有那麼多的人在大氣中排放大量的碳，這將帶來很大的改變。從某種奇怪的意義上來講，氣候變化是工業化以及人類壽命延長所帶來的意外結果。

So all this extra life is a mixed blessing, like any change this momentous.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?

因此，就像這樣重大的改變一樣，世界上所有其他的生命都是毀譽參半的。但我想要強調的並不僅僅是我們所做到的，我認為更加有趣的是我們是怎樣做到的。過去那些年裡，這個問題也困擾了我很久，這是我一直在進行的調查，我試着去找出究竟是什麼推動了這一結果，帶來了這樣重大的改變。真正推動這種改變的究竟是什麼呢？

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...Yes, right?Thank you.I did invent vaccines.So I appreciate that.I mean, for smallpox to polio, influenza, TB and measles, and covid.

我想我們應該說，既然事情都已經發生了，我們就應該指出這一點，大家都知道，這其中一種推動力就是疫苗。對吧？我們人多了一倍——我說的沒錯吧？謝謝。我發明了疫苗，所以我很感激。

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.

我是說從天花到小兒麻痹症，流感，結核病和麻疹，還有新冠病毒。假如我們就像慶祝登月成功那樣來慶祝天花這種疾病的消失，那麼我們就不會再去猶豫到底要不要注射疫苗。但我也認為，只關注科學的進步和有形的物體是錯誤的，比如說疫苗、抗生素或者X光片。我將通過下面的例子來解釋，我覺得看看這個故事還是挺有用：人類是如何克服19世紀最可怕的那些威脅的。

Milk.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.

牛奶。當今，我們把牛奶當作一種健康與活力的象徵，可實際上，在19世紀中葉，牛奶曾為人們視作一種健康威脅，尤其是對孩子。我們那時候沒有機械冷藏技術，所以那時候牛奶時常存在變質的問題。喝了牛奶以後，人們還會得肺結核。後來人們從城市的奶牛身上發現了這種疾病，那裡的人們沒有條件給奶牛提供草食。

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.

就只好用威士忌酒廠的泔水餵他們——而不是餵草，真是個高明的主意——這也導致了奶牛產出了藍色的奶水，這種牛奶叫做泔水奶，是不能用來飲用的。在1850年，有超過半數的紐約兒童死亡，他們中很多都是因為喝了這種受到污染的奶才死去的。我知道你們在想些什麼。你們在想：我知道我們是怎樣解決這個問題的。我們依靠科學解決了這個問題。

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 limitsof science.Because Louis Pasteur came up with his technique for sterilizing milk in 1865.

我們憑藉化學解決了這個問題。是這樣的嗎？人們採用了一種很有名的方法去解決。這種方法印在了全國每一個雜貨店的每一盒牛奶上，對吧？沒錯，那就是巴斯德氏殺菌法。實際上，巴斯德氏殺菌法是科學局限性的一個研究案例。因為路易·巴斯德在1865年發明了給牛奶消毒的方法。

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.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.

但直到1915年，也就是整整50年後，巴氏殺菌牛奶才真正成為美國雜貨店貨架上的標準牛奶。因為科學和化學本身並不足以促成有意義的改變。你還需要去勸說別人。你必須說服人們喝巴氏消毒牛奶。你必須說服乳制工廠去生產巴氏消毒牛奶。你需要在這其中扮演不同的角色。

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 pasteurizationcause.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.

這需要揭發醜聞的記者。這需要勇於改革的立法者。那時候有一群反對巴氏殺菌的激進分子。而有一個人絕對不與這些人為伍，他是百貨商店巨頭內森·施特勞斯，對巴氏消毒法情有獨鍾。他資助了紐約市所有的牛奶倉庫，在那裡巴氏殺菌牛奶以成本價出售給低收入居民，這樣他們就會習慣上喝牛奶。

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.And there's another prime mover thatwe don't talk about enough, which seems a little bit unlikely in the context of disruptive innovation.And that is large bureaucratic institutions.

從某角度上來講，我認為巴斯德是在化學層面上解決了這些問題。而施特勞斯和他們同伴則在社會層面上去處理問題。你需要在兩面都做出改變。另外一個因素則是我們在這方面討論的還不夠，在顛覆性的創新背景下，我們似乎不太可能進行充分的討論研究。官僚機構限制了我們的研究。

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.

如果這對你來說有點不好理解，我建議你去翻翻書，翻翻20世紀早期的任何藥品目錄。這上面寫的都是一長串的毒物名稱，一條接着一條：砷、汞、顛茄，更別提海洛因和可卡因了。很多醫學歷史學家認為，在20世紀40年代抗生素髮明之前，所有藥物對人類健康都是負面的。

That's what life was like.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.

生活就是這樣。在1937年，這家田納西州的製藥公司研發出了一種新興的咳嗽糖漿，可用來治療鏈球菌性喉炎，適用於兒童使用。當時，有一種新藥叫磺胺，這種藥正是抗生素的前身。可那時，磺胺都只能裝在大個的藥丸裡面，咽下這些藥丸對於孩子們來說非常困難。

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.

這家公司的一位化學家想出了一個絕妙的主意，將磺胺類藥物溶解在二甘醇中，然後加入一些覆盆子香料，這讓孩子們更加容易喝下口。這看似是一個絕佳的想法，然而二甘醇會產生對人體有害的毒素。它的毒性基本上和防凍劑差不多。所以幾周後，在美國，有很多的孩子因為喝了這種糟糕的調製藥劑相繼死亡。

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.

更讓我們感到詫異的是，鑑於那時候的法規，將二甘醇和藥物放在一起在當時是被允許的。食品及藥物管理局當時唯一關注的那就是你有沒有列出藥劑相應的成分標籤。所以如果你想把助凍劑和咳嗽糖漿放在一起，只要你在藥盒上註明就行。

That's what life was like.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.

那時的生活就是這樣。但正是因為這場悲劇，國家修改了相應的法律。食品及藥物管理局首次要求法爾諾德製藥公司證明他們的藥物對消費者無害。雖然似乎真相顯而易見，但還是要有人去找答案。在那個階段，人們真正需要的並不僅僅是這麼一款特效藥。我們需要新的體系。

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.

我們也需要新的醫療創新，像三期試驗，同時還需要進行隨機對照試驗，以及監察機構，例如食品及藥物管理局，這些機構能幫助我們將假藥和真藥區分開。在未來的幾十年裡，這種體系創新正變得愈發重要。因為現在在世界各地，有資金充足的科學家和嚴謹的實驗室正致力於解決這個日益嚴峻的難題。

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 thisis going to happen.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.

目前，人類生命的外邊界大約是在110歲到115歲。很難再超過這個數值。但一項嚴謹的研究表明，我們可以越過那條界限，並活得更久，甚至永遠活下去。我並不是說這將會發生。但已經提上日程了。

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.

問題是，如果我們真的做到了，這將會成為人類歷史上最重大的改變，對吧？首先，這將會極大程度上導致世界健康不平等。因為最初只有富人才能付得起這些治療的費用。

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.

這將會極大程度上加劇人口失控增長的問題。它將從根本上改變人們生活軌跡的定義。而當你問人們，我們是否應該研究如何永生，絕大多數的普通人都會說不。但問題是，整體上，我們並不具有一個能幫助我們應對如此巨大變化的決策機構。我們就像1930年的食品及藥物管理局，尋求製造出永生藥的辦法。

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 makethese innovations if we if we work at it.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,

我們只要確認標籤上的成分都正確就行。這就是我們在幹的事情。因此，我們所需要的創新是在監督層面上以及決策層面上的。如果我們致力於此，我認為我們可以實現創新。現在，我們都意識到，過度管制是存在問題的。我們必須得建立決策機構，這種決策機構會對危險和意外後果保持敏感，

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.

但也要真正接受各種可能性。但在我看來，我們不應該過於關注如何延長壽命，而應該着重縮小世界各國在健康產出方面所存在的差距。我是說，看看我們在過去一年半的時間裡經歷了些什麼。2020年，因為新冠疫情，美國白人平均預期壽命減少了1年，而非裔美國人則減少了三年的壽命。

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.

我們應該着重去縮小差距，縮小我們所說的壽命之間的差距。從根本上來講，我們所花費的時間是大量和充分的。我想大家都認同我的說法：這些問題是值得解決的。而且我們現在也有解決這些問題的工具。如果說人類健康第一次偉大的革命是延長人類平均壽命的話，那麼第二次革命則將是縮小壽命差距。

Thank you very much.

非常感謝。