Ramanan Laxminarayan: The coming crisis in antibiotics

105,385 views ใƒป 2014-11-10

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์•„๋ž˜ ์˜๋ฌธ์ž๋ง‰์„ ๋”๋ธ”ํด๋ฆญํ•˜์‹œ๋ฉด ์˜์ƒ์ด ์žฌ์ƒ๋ฉ๋‹ˆ๋‹ค.

๋ฒˆ์—ญ: Chanhee Lee ๊ฒ€ํ† : Jeong-Lan Kinser
00:12
The first patient to ever be treated with an antibiotic
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์ตœ์ดˆ๋กœ ํ•ญ์ƒ์ œ ์น˜๋ฃŒ๋ฅผ ๋ฐ›์€ ์‚ฌ๋žŒ์€ ์˜ฅ์Šคํผ๋“œ์˜ ํ•œ ๊ฒฝ์ฐฐ์ด์—ˆ์Šต๋‹ˆ๋‹ค.
00:16
was a policeman in Oxford.
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00:17
On his day off from work,
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์–ด๋Š ํœด์ผ, ๊ทธ๋Š” ์ •์›์—์„œ ์ผํ•˜๋‹ค๊ฐ€ ์žฅ๋ฏธ ๊ฐ€์‹œ์— ๊ธํ˜”์ฃ .
00:19
he was scratched by a rose thorn while working in the garden.
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00:23
That small scratch became infected.
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๊ทธ๋Ÿฐ๋ฐ ๊ทธ ์ž‘์€ ๊ธํžŒ ์ƒ์ฒ˜๋Š” ๊ฐ์—ผ๋˜์—ˆ์–ด์š”..
00:26
Over the next few days, his head was swollen
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๊ทธ ํ›„ ๋ฉฐ์น ์— ๊ฑธ์ณ ๊ทธ์˜ ๋จธ๋ฆฌ๋Š” ๋ถ€ํ’€์–ด ์˜ฌ๋ž๊ณ  ์ข…๊ธฐ๊ฐ€ ๋‚ฌ์Šต๋‹ˆ๋‹ค.
00:29
with abscesses,
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00:30
and in fact his eye was so infected
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๊ทธ์˜ ๋ˆˆ์€ ๊ฐ์—ผ์ด ๋„ˆ๋ฌด ์‹ฌํ•ด์„œ ์˜์‚ฌ๋“ค์ด ์ œ๊ฑฐํ•ด์•ผ ํ–ˆ์ฃ .
00:33
that they had to take it out,
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00:35
and by February of 1941,
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๊ทธ๋ฆฌ๊ณ  1941๋…„ 2์›”์ด ๋์„ ๋ฌด๋ ต ์ด ๋ถˆ์Œํ•œ ๋‚จ์ž๋Š” ๊ฑฐ์˜ ์ฃฝ์„ ์ƒํƒœ์˜€์ฃ .
00:38
this poor man was on the verge of dying.
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00:40
He was at Radcliffe Infirmary in Oxford,
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๊ทธ๋Š” ์˜ฅ์Šคํผ๋“œ์˜ ๋ž˜๋“œํด๋ฆฌํ”„ ๋ณ‘์›์—์„œ ์น˜๋ฃŒ๋ฐ›์•˜๊ณ , ์šด์ด ์ข‹๊ฒŒ๋„
00:43
and fortunately for him,
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00:45
a small team of doctors
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ํ•˜์›Œ๋“œ ํ”Œ๋Ÿฌ๋ฆฌ ๋ฐ•์‚ฌ๊ฐ€ ์ด๋„๋Š” ์˜์‚ฌ๋“ค๋กœ ์ด๋ฃจ์–ด์ง„ ์†Œ๊ทœ๋ชจ์˜ ํŒ€์ด
00:47
led by a Dr. Howard Florey
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00:48
had managed to synthesize
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์•„์ฃผ ์ ์€ ์–‘์˜ ํŽ˜๋‹ˆ์‹ค๋ฆฐ์„ ํ•ฉ์„ฑํ•˜๋Š” ๋ฐ ์„ฑ๊ณตํ–ˆ์Šต๋‹ˆ๋‹ค.
00:50
a very small amount of penicillin,
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00:53
a drug that had been discovered
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๊ทธ๊ฒƒ์€ ์•Œ๋ ‰์‚ฐ๋” ํ”Œ๋ ˆ๋ฐ์ด ์•ฝ๋ฌผ์„ ๋ฐœ๊ฒฌํ•˜๊ธฐ 12๋…„ ์ „์ด์—ˆ์–ด์š”.
00:55
12 years before by Alexander Fleming
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00:58
but had never actually been used to treat a human,
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ํ•˜์ง€๋งŒ, ๋‹น์‹œ ์ด ์•ฝ์€ ์ž„์ƒ ์‹œํ—˜๋„ ๊ฑฐ์น˜์ง€ ์•Š์•˜์—ˆ๊ณ ,
01:01
and indeed no one even knew if the drug would work,
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์ด ์•ฝ์ด ์‹ค์ œ๋กœ ํšจ๊ณผ๊ฐ€ ์žˆ์„์ง€๋„ ๋ˆ„๊ตฌ๋„ ํ™•์‹ ํ•˜์ง€ ๋ชปํ–ˆ๊ณ ,
01:04
if it was full of impurities that would kill the patient,
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๋ถˆ์ˆœ๋ฌผ์ด ๋งŽ์œผ๋ฉด, ํ™˜์ž๊ฐ€ ์ฃฝ์„ ์ˆ˜๋„ ์žˆ์—ˆ์Šต๋‹ˆ๋‹ค.
01:07
but Florey and his team figured
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๊ทธ๋ž˜์„œ ํ”Œ๋Ÿฌ๋ฆฌ ๋ฐ•์‚ฌ์™€ ๊ทธ์˜ ํŒ€์›๋“ค์€ ๋งŒ์•ฝ ์ด ์•ฝ์„ ๊ผญ ์‚ฌ์šฉํ•ด๋ด์•ผ ํ•œ๋‹ค๋ฉด,
01:09
if they had to use it, they might as well use it
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01:11
on someone who was going to die anyway.
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์–ด์ฐจํ”ผ ์ฃฝ๊ฒŒ ๋  ์‚ฌ๋žŒ์—๊ฒŒ ์‹œํ—˜ํ•ด์•ผ๊ฒ ๋‹ค๊ณ  ์ƒ๊ฐํ–ˆ๊ณ ,
01:14
So they gave Albert Alexander,
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๊ทธ ์˜ฅ์Šคํผ๋“œ์˜ ๊ฒฝ์ฐฐ๊ด€์ธ ์•จ๋ฒ„ํŠธ ์•Œ๋ ‰์‚ฐ๋”์—๊ฒŒ ์•ฝ์„ ํˆฌ์—ฌํ–ˆ์Šต๋‹ˆ๋‹ค.
01:17
this Oxford policeman, the drug,
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01:20
and within 24 hours,
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๊ทธ๋ฆฌ๊ณ  24์‹œ๊ฐ„๋„ ์•ˆ ๋ผ์„œ ๊ทธ๋Š” ํšŒ๋ณต๋˜๊ธฐ ์‹œ์ž‘ํ–ˆ์Šต๋‹ˆ๋‹ค.
01:23
he started getting better.
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01:25
His fever went down, his appetite came back.
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์—ด์ด ๋‚ด๋ ธ๊ณ , ์‹์š•๋„ ๋Œ์•„์™”์ฃ . ์ดํŠฟ๋‚ ์—๋Š” ํšŒ๋ณต์„ธ๊ฐ€ ๋”์šฑ ๋‘๋“œ๋Ÿฌ์กŒ์–ด์š”.
01:29
Second day, he was doing much better.
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01:31
They were starting to run out of penicillin,
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ํ•˜์ง€๋งŒ ํŽ˜๋‹ˆ์‹ค๋ฆฐ์ด ๋ฐ”๋‹ฅ๋‚˜๊ธฐ ์‹œ์ž‘ํ•ด์„œ ์˜์‚ฌ๋“ค์€ ๊ทธ์˜ ์†Œ๋ณ€์„ ๋ฐ›์•„๋‹ค๊ฐ€
01:33
so what they would do was run with his urine
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01:35
across the road to re-synthesize the penicillin from his urine
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๊ฑฐ๊ธฐ์„œ ํŽ˜๋‹ˆ์‹ค๋ฆฐ์„ ์žฌํ•ฉ์„ฑํ•ด์„œ ๋‹ค์‹œ ๊ทธ์—๊ฒŒ ํˆฌ์—ฌํ•ด์•ผ ํ–ˆ์Šต๋‹ˆ๋‹ค.
01:38
and give it back to him,
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01:40
and that worked.
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๋‹คํ–‰ํžˆ ํšจ๊ณผ๊ฐ€ ์žˆ์—ˆ์–ด์š”.
01:42
Day four, well on the way to recovery.
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๋‚˜ํ˜์งธ ๋˜๋˜ ๋‚ ์—๋Š” ์™„์พŒ๊ฐ€ ๋ฉ€์ง€ ์•Š์•„ ๋ณด์˜€์Šต๋‹ˆ๋‹ค. ๊ธฐ์ ์ด์—ˆ์ฃ .
01:44
This was a miracle.
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01:46
Day five, they ran out of penicillin,
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ํ•˜์ง€๋งŒ ๋‹ท์ƒˆ์งธ ํŽ˜๋‹ˆ์‹ค๋ฆฐ์ด ๋ฐ”๋‹ฅ๋‚ฌ๊ณ  ์•ˆํƒ€๊น๊ฒŒ๋„ ๊ทธ๋Š” ์ฃฝ๊ณ  ๋ง์•˜์Šต๋‹ˆ๋‹ค.
01:50
and the poor man died.
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01:52
So that story didn't end that well,
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์ด ์‚ฌ๋žŒ์˜ ์ด์•ผ๊ธฐ๋Š” ์•ˆ ์ข‹๊ฒŒ ๋๋‚ฌ์ง€๋งŒ ์šด์ข‹๊ฒŒ๋„, ๋‹ค๋ฅธ ์ˆ˜ ๋ฐฑ๋งŒ๋ช…์˜ ์‚ฌ๋žŒ๋“ค์€,
01:55
but fortunately for millions of other people,
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01:59
like this child who was treated again in the early 1940s,
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์—ฌ๊ธฐ 1940๋…„๋Œ€ ์ดˆ๋ฐ˜์— ์น˜๋ฃŒ๋ฅผ ๋ฐ›์€ ์ด ์•„์ด์ฒ˜๋Ÿผ,
02:02
who was again dying of a sepsis,
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ํŒจํ˜ˆ์ฆ์œผ๋กœ ์ฃฝ์–ด๊ฐ€๊ณ  ์žˆ์—ˆ์ง€๋งŒ,
02:05
and within just six days, you can see,
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ํŽ˜๋‹ˆ์‹ค๋ฆฐ์ด๋ผ๋Š” ๊ธฐ์ ์˜ ์•ฝ ๋•์— ๊ณ ์ž‘ 6์ผ ๋งŒ์— ํšŒ๋ณต๋˜์—ˆ์Šต๋‹ˆ๋‹ค.
02:08
recovered thanks to this wonder drug, penicillin.
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02:12
Millions have lived,
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์ˆ˜๋ฐฑ๋งŒ ๋ช…์ด ๋ชฉ์ˆจ์„ ๊ฑด์กŒ๊ณ  ์ „์„ธ๊ณ„์˜ ์˜๋ฃŒ๋Š” ํ˜์‹ ๋˜์—ˆ์Šต๋‹ˆ๋‹ค.
02:14
and global health has been transformed.
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02:17
Now, antibiotics have been used
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ํ•œํŽธ, ํ•ญ์ƒ์ œ์˜ ํˆฌ์—ฌ๋Š” ์ด๋Ÿฐ ํ™˜์ž๋“ค์—๊ฒŒ๋„ ์ด๋ฃจ์–ด์กŒ์ง€๋งŒ ๋‚จ์šฉ๋˜๊ธฐ๋„ ํ–ˆ์ฃ .
02:20
for patients like this,
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02:23
but they've also been used rather frivolously
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02:25
in some instances,
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์˜ˆ๋ฅผ ๋“ค์–ด, ํ•ญ์ƒ์ œ์˜ ๋ฐ˜์‘๋„ ํ™•์‹คํžˆ ๋ชจ๋ฅด๋ฉด์„œ ๊ฒจ์šฐ ๊ฐ๊ธฐ๋‚˜ ๋…๊ฐ์— ์‚ฌ์šฉ๋˜๊ฑฐ๋‚˜
02:27
for treating someone with just a cold or the flu,
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02:29
which they might not have responded to an antibiotic,
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02:32
and they've also been used in large quantities
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๋Œ€๋Ÿ‰์œผ๋กœ ์น˜๋ฃŒ์ œ๊ฐ€ ์•„๋‹Œ ๊ฒƒ์œผ๋กœ, ์•„์ฃผ ์ ์€ ๋†์ถ•๋Ÿ‰์„
02:36
sub-therapeutically, which means in small concentrations,
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02:39
to make chicken and hogs grow faster.
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๋‹ญ์ด๋‚˜ ๋ผ์ง€์—๊ฒŒ ์ฃผ์–ด ๋นจ๋ฆฌ ์ž๋ผ๊ฒŒ ํ•œ ๊ฒƒ์ž…๋‹ˆ๋‹ค.
02:42
Just to save a few pennies on the price of meat,
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๊ณ ๊ธฐ ๊ฐ€๊ฒฉ์„ ๋ช‡ ํ‘ผ ์•„๋ผ๊ฒ ๋‹ค๊ณ  ๋™๋ฌผ๋“ค์—๊ฒŒ ํ•ญ์ƒ์ œ๋ฅผ ๋‚จ์šฉํ•œ ๊ฑฐ์ฃ .
02:46
we've spent a lot of antibiotics on animals,
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02:49
not for treatment, not for sick animals,
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์•„ํ”ˆ ๋™๋ฌผ๋“ค์„ ์น˜๋ฃŒํ•˜๋ ค๋Š” ๊ฒŒ ์•„๋‹ˆ๋ผ, ๊ทธ์ € ์„ฑ์žฅ ์ด‰์ง„์šฉ์œผ๋กœ ๋ง์ž…๋‹ˆ๋‹ค.
02:51
but primarily for growth promotion.
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02:54
Now, what did that lead us to?
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์ž, ๊ทธ๋ž˜์„œ ์ œ๊ฐ€ ๊ทธ๊ฑธ ์–ธ๊ธ‰ํ•˜๋Š” ์ด์œ ๋Š” ๋ญ˜๊นŒ์š”?
02:57
Basically, the massive use of antibiotics
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๊ฐ„๋‹จํžˆ ๋งํ•ด, ์ „ ์„ธ๊ณ„์ ์œผ๋กœ ์ด๋ฃจ์–ด ์ง€๋Š” ํ•ญ์ƒ์ œ ์˜ค๋‚จ์šฉ์€
03:00
around the world
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03:01
has imposed such large selection pressure on bacteria
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๋ฐ•ํ…Œ๋ฆฌ์•„์— ์—„์ฒญ๋‚œ ์„ ํƒ์••์œผ๋กœ ์ž‘์šฉํ•ด์„œ ์ด์ œ๋Š” ์ €ํ•ญ๋ ฅ์ด ๋ฌธ์ œ๊ฐ€ ์ƒ๊น๋‹ˆ๋‹ค.
03:05
that resistance is now a problem,
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03:08
because we've now selected for just
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์šฐ๋ฆฌ๋Š” ์ด์ œ ๋‚ด์„ฑ์žˆ๋Š” ๋ฐ•ํ…Œ๋ฆฌ์•„๋ฅผ ์„ ํƒํ–ˆ๊ธฐ ๋•Œ๋ฌธ์ž…๋‹ˆ๋‹ค.
03:10
the resistant bacteria.
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03:11
And I'm sure you've all read about this in the newspapers,
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๋ฌผ๋ก  ์—ฌ๋Ÿฌ๋ถ„ ๋ชจ๋‘ ์ด๋Ÿฐ ์ด์•ผ๊ธฐ๋ฅผ ์‹ ๋ฌธ์—์„œ๋„ ์ฝ์—ˆ์„ ๊ฒƒ์ด๊ณ ,
03:14
you've seen this in every magazine
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๋ณด๊ฒŒ ๋˜๋Š” ์˜จ๊ฐ– ์žก์ง€์—์„œ๋„ ์ด๋Ÿฐ ๋‚ด์šฉ์„ ์ ‘ํ•˜์…จ๊ฒ ์ฃ .
03:16
that you come across,
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03:18
but I really want you to appreciate
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ํ•˜์ง€๋งŒ ์—ฌ๋Ÿฌ๋ถ„ ๋ชจ๋‘ ์ด ๋ฌธ์ œ์˜ ์ค‘๋Œ€์„ฑ์— ๋Œ€ํ•ด ๊ณ ์‹ฌํ•ด ์ฃผ์…จ์œผ๋ฉด ํ•ฉ๋‹ˆ๋‹ค.
03:20
the significance of this problem.
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03:22
This is serious.
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์ด๊ฑด ์‹ฌ๊ฐํ•œ ๋ฌธ์ œ์—์š”.
03:23
The next slide I'm about to show you is of carbapenem resistance in acinetobacter.
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๋‹ค์Œ ์Šฌ๋ผ์ด๋“œ๋Š” ์•„์‹œ๋„คํ† ๋ฐ•ํ„ฐ์˜ ์นด๋ฅด๋ฐ”ํŽ˜๋„ด์˜ ๋‚ด์„ฑ์— ๊ด€ํ•œ ๊ฒ๋‹ˆ๋‹ค.
03:28
Acinetobacter is a nasty hospital bug,
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์•„์‹œ๋„คํ† ๋ฐ•ํ„ฐ๋Š” ์•„์ฃผ ์ง€๋…ํ•œ ๋ณ‘์›๊ท ์ด๊ณ , ์นด๋ฅด๋ฐ”ํŽ˜๋„ด์€ ์‰ฝ๊ฒŒ ๋งํ•ด
03:31
and carbapenem is pretty much
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03:32
the strongest class of antibiotics
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์šฐ๋ฆฌ๊ฐ€ ์ด ๋ณ‘๊ท ์— ์‚ฌ์šฉํ•  ์ˆ˜ ์žˆ๋Š” ๊ฐ€์žฅ ๊ฐ•๋ ฅํ•œ ๋“ฑ๊ธ‰์˜ ํ•ญ์ƒ์ œ์ž…๋‹ˆ๋‹ค.
03:34
that we can throw at this bug.
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03:36
And you can see in 1999
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๋ณด์‹œ๋‹ค์‹œํ”ผ, 1999๋…„์˜ ๋‚ด์„ฑ๊ท ์˜ ๋ถ„ํฌ์ž…๋‹ˆ๋‹ค.
03:39
this is the pattern of resistance,
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03:42
mostly under about 10 percent across the United States.
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๋ฏธ๊ตญ์˜ ์ „์ง€์—ญ์—์„œ 10%๋„ ์•ˆ๋ฉ๋‹ˆ๋‹ค.
03:45
Now watch what happens when we play the video.
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์ด์ œ ์‹œ๊ฐ„์ด ์ง€๋‚จ์— ๋”ฐ๋ผ ์–ด๋–ป๊ฒŒ ๋ณ€ํ•˜๋Š”์ง€ ๋น„๋””์˜ค๋ฅผ ๋ณด์‹œ์ฃ .
03:58
So I don't know where you live,
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์—ฌ๋Ÿฌ๋ถ„์ด ์–ด๋”” ์‚ฌ์‹œ๋Š”์ง€๋Š” ๋ชจ๋ฅด๊ฒ ์ง€๋งŒ, ์–ด๋””๋“  ๊ฐ„์— ํ˜„์žฌ๋Š”
04:00
but wherever it is, it certainly is a lot worse now
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04:03
than it was in 1999,
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1999๋…„ ๋‹น์‹œ์™€ ๋น„๊ตํ•˜๋ฉด ํ›จ์”ฌ ์•…ํ™”๋์„ ๊ฒ๋‹ˆ๋‹ค.
04:05
and that is the problem of antibiotic resistance.
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์ด๊ฒŒ ๋ฐ”๋กœ ํ•ญ์ƒ์ œ ๋‚ด์„ฑ์ด ๊ฐ€์ง„ ๋ฌธ์ œ์ ์ž…๋‹ˆ๋‹ค.
04:09
It's a global issue
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๋ถ€๊ตญ๊ณผ ๋นˆ๊ตญ์„ ๊ฐ€๋ฆฌ์ง€ ์•Š๊ณ  ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์ „ ์„ธ๊ณ„์ ์ธ ๋ฌธ์ œ์ด์ฃ .
04:11
affecting both rich and poor countries,
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04:14
and at the heart of it, you might say, well,
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๋ฌธ์ œ์˜ ํ•ต์‹ฌ์€, ์—ฌ๋Ÿฌ๋ถ„์€ ๊ทธ์ € ์˜ํ•™์ ์ธ ๋ฌธ์ œ์— ๋ถˆ๊ณผํ•˜๋‹ค๊ณ  ํ•˜์‹ค์ง€ ๋ชจ๋ฅด์ฃ .
04:16
isn't this really just a medical issue?
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04:18
If we taught doctors how not to use antibiotics as much,
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์˜์‚ฌ๋“ค์—๊ฒŒ ํ•ญ์ƒ์ œ ์‚ฌ์šฉ์„ ์ค„์ด๋ผ๊ณ  ํ•˜๊ณ ,
04:20
if we taught patients how not to demand antibiotics,
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ํ™˜์ž๋“ค์—๊ฒŒ ํ•ญ์ƒ์ œ๋ฅผ ์š”๊ตฌํ•˜์ง€ ๋ง๋ผ๊ณ  ํ•˜๋ฉด ์‰ฝ๊ฒŒ ํ•ด๊ฒฐ๋  ๋ฌธ์ œ๋ผ๊ณ ์š”.
04:23
perhaps this really wouldn't be an issue,
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04:25
and maybe the pharmaceutical companies
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๋˜ ์ œ์•ฝ ํšŒ์‚ฌ๋“ค์ด ๋”์šฑ ์—ด์‹ฌํžˆ ๋…ธ๋ ฅํ•ด์„œ ์ƒˆ๋กœ์šด ํ•ญ์ƒ์ œ๋ฅผ ๊ฐœ๋ฐœํ•˜๋ฉด ๋œ๋‹ค๊ณ ์š”.
04:27
should be working harder to develop
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04:28
more antibiotics.
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04:30
Now, it turns out that there's something fundamental about antibiotics
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ํ•˜์ง€๋งŒ ํ•ญ์ƒ์ œ๋Š” ๊ทผ๋ณธ์ ์œผ๋กœ ๋‹ค๋ฅธ ์•ฝ๋“ค๊ณผ๋Š” ๋‹ค๋ฅธ ์ ์ด ์žˆ์Šต๋‹ˆ๋‹ค.
04:33
which makes it different from other drugs,
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04:35
which is that if I misuse antibiotics
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์ œ๊ฐ€ ํ•ญ์ƒ์ œ๋ฅผ ๋‚จ์šฉํ•˜๊ฑฐ๋‚˜, ์‹ฌ์ง€์–ด ์‚ฌ์šฉํ•˜๊ธฐ๋งŒ ํ•ด๋„
04:37
or I use antibiotics,
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04:39
not only am I affected but others are affected as well,
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์ €๋ฟ๋งŒ์ด ์•„๋‹ˆ๋ผ ๋ชจ๋‘๊ฐ€ ์˜ํ–ฅ์„ ๋ฐ›๋Š”๋‹ค๋Š” ๊ฒ๋‹ˆ๋‹ค.
04:43
in the same way as if I choose to drive to work
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์ œ๊ฐ€ ์ž๊ฐ€์šฉ์œผ๋กœ ์ถœ๊ทผํ•˜๊ฑฐ๋‚˜ ๋น„ํ–‰๊ธฐ๋กœ ์—ฌํ–‰ํ•˜๊ฒŒ ๋˜๋ฉด
04:45
or take a plane to go somewhere,
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04:48
that the costs I impose on others
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์ง€๊ตฌ ์˜จ๋‚œํ™”๋ฅผ ํ†ตํ•ด ๋ชจ๋‘์—๊ฒŒ ํ”ผํ•ด๋ฅผ ์ฃผ๊ฒŒ ๋˜๋Š” ๊ฒƒ๊ณผ ๋งˆ์ฐฌ๊ฐ€์ง€์ž…๋‹ˆ๋‹ค.
04:50
through global climate change go everywhere,
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04:52
and I don't necessarily take these costs into consideration.
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ํ•˜์ง€๋งŒ ์ €๋Š” ์ด๋Ÿฐ ํ”ผํ•ด๋ฅผ ์ง„์ง€ํ•˜๊ฒŒ ๊ณ ๋ คํ•˜์ง€ ์•Š๊ฒ ์ฃ .
04:55
This is what economists might call a problem of the commons,
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๊ฒฝ์ œํ•™์ž๋“ค์€ ์ด๋Ÿฐ ๊ฒƒ์„ ๊ณต์œ ์ง€์˜ ๋น„๊ทน์ด๋ผ๊ณ  ๋ถ€๋ฆ…๋‹ˆ๋‹ค.
04:58
and the problem of the commons is exactly
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๊ทธ๋ฆฌ๊ณ  ์ง€๊ธˆ ํ•ญ์ƒ์ œ ์‚ฌ์šฉ์—์„œ ๋‚˜ํƒ€๋‚˜๋Š” ํ˜„์ƒ๋„ ๊ณต์œ ์ง€์˜ ๋น„๊ทน์ด์ฃ .
05:00
what we face in the case of antibiotics as well:
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05:02
that we don't consider โ€”
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๊ฐœ์ธ, ํ™˜์ž, ๋ณ‘์›๊ณผ ์ „์ฒด ์˜๋ฃŒ ์ฒด๊ณ„๋ฅผ ํฌํ•จํ•œ
05:04
and we, including individuals, patients,
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05:07
hospitals, entire health systems โ€”
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05:11
do not consider the costs that they impose on others
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์šฐ๋ฆฌ ๋ชจ๋‘๊ฐ€ ํ•ญ์ƒ์ œ์˜ ์‚ฌ์šฉ์œผ๋กœ ์ธํ•œ ํ”ผํ•ด๋ฅผ ๊ณ ๋ คํ•˜์ง€ ์•Š๊ณ  ์žˆ์Šต๋‹ˆ๋‹ค.
05:13
by the way antibiotics are actually used.
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05:15
Now, that's a problem that's similar
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์ด์™€ ๋น„์Šทํ•œ ๋ฌธ์ œ ์–‘์ƒ์„ ๋ณด์ด๋Š” ์นœ์ˆ™ํ•œ ๋‹ค๋ฅธ ๋ถ„์•ผ๊ฐ€ ์žˆ์Šต๋‹ˆ๋‹ค.
05:17
to another area that we all know about,
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05:19
which is of fuel use and energy,
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๋ฐ”๋กœ ์—ฐ๋ฃŒ ์†Œ๋น„์™€ ์—๋„ˆ์ง€์ž…๋‹ˆ๋‹ค.
05:21
and of course energy use
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๋ฌผ๋กœ ์—๋„ˆ์ง€์˜ ์†Œ๋น„๋Š” ์—๋„ˆ์ง€๋ฅผ ๊ณ ๊ฐˆ์‹œํ‚ค๋Š” ๋™์‹œ์—
05:23
both depletes energy as well as
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05:26
leads to local pollution and climate change.
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์ผ๋Œ€๋ฅผ ์˜ค์—ผ์‹œํ‚ค๊ณ  ๊ธฐํ›„ ๋ณ€ํ™”๋ฅผ ์ผ์œผํ‚ต๋‹ˆ๋‹ค.
05:29
And typically, in the case of energy,
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์—๋„ˆ์ง€ ๋ฌธ์ œ์— ์žˆ์–ด์„œ๋Š” ๋ณดํ†ต ๋‘ ๊ฐ€์ง€ ๋ฐฉ๋ฒ•์œผ๋กœ ๋ฌธ์ œ๋ฅผ ํ•ด๊ฒฐํ•ฉ๋‹ˆ๋‹ค.
05:31
there are two ways in which you can deal with the problem.
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05:33
One is, we can make better use of the oil that we have,
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ํ•˜๋‚˜๋Š” ์šฐ๋ฆฌ๊ฐ€ ๊ฐ€์ง€๊ณ  ์žˆ๋Š” ์„์œ ๋ฅผ ์ข€ ๋” ํ˜„๋ช…ํ•˜๊ฒŒ ์“ฐ๋Š” ๊ฒƒ์ด๊ณ ,
05:37
and that's analogous to making better use
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์ด๊ฑด ์ง€๊ธˆ ์šฐ๋ฆฌ์—๊ฒŒ ์žˆ๋Š” ํ•ญ์ƒ์ œ๋ฅผ ๋” ์ง€ํ˜œ๋กญ๊ฒŒ ์“ฐ๋Š” ๊ฒƒ๊ณผ ์œ ์‚ฌํ•˜์ฃ .
05:39
of existing antibiotics,
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05:41
and we can do this in a number of ways
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์ž์„ธํ•œ ๋ฐฉ๋ฒ•์€ ์—ฌ๋Ÿฌ ๊ฐ€์ง€๊ฐ€ ์žˆ์ง€๋งŒ ๊ทธ๊ฑด ์ž ์‹œ ํ›„์— ์–˜๊ธฐํ•˜๊ธฐ๋กœ ํ•˜์ฃ .
05:42
that we'll talk about in a second,
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05:45
but the other option is the "drill, baby, drill" option,
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๋‘ ๋ฒˆ์งธ ๋ฐฉ๋ฒ•์€ ๊ทธ๋ƒฅ ์‹  ๋‚˜๊ฒŒ ํŒŒ๋Œ€๋Š” ๊ฒ๋‹ˆ๋‹ค.
05:48
which in the case of antibiotics is to go find new antibiotics.
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ํ•ญ์ƒ์ œ ๋ฌธ์ œ์—์„œ๋Š”์ƒˆ ํ•ญ์ƒ์ œ๋ฅผ ์ฐพ์•„ ๋‚˜์„œ๋Š” ๋ฐฉ๋ฒ•์— ํ•ด๋‹นํ•˜๊ฒ ๋„ค์š”.
05:53
Now, these are not separate.
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์ด ๋‘ ๋ฐฉ๋ฒ•์€ ๋ณ„๊ฐœ๊ฐ€ ์•„๋‹™๋‹ˆ๋‹ค.
05:55
They're related, because if we invest heavily
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์ž ์ด๊ฒƒ๋“ค์€ ์—ฐ๊ด€๋˜์–ด ์žˆ์Šต๋‹ˆ๋‹ค.
์šฐ๋ฆฌ๊ฐ€ ์ƒˆ๋กœ์šด ์œ ์ •์— ํˆฌ์ž๋ฅผ ์ง‘์ค‘ํ•˜๋ฉด ์„์œ  ๋ณด์กด์— ์“ฐ์ผ ๋ˆ์ด ์ค„์–ด๋“œ๋‹ˆ๊นŒ์š”.
05:58
in new oil wells,
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06:00
we reduce the incentives for conservation of oil
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06:03
in the same way that's going to happen for antibiotics.
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์ด๊ฑด ํ•ญ์ƒ์ œ์˜ ๊ฒฝ์šฐ๋„ ๋งˆ์ฐฌ๊ฐ€์ง€์ž…๋‹ˆ๋‹ค.
06:06
The reverse is also going to happen, which is that
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๋ฐ˜๋Œ€์˜ ๊ฒฝ์šฐ๋„ ์ผ์–ด๋‚ ํ…๋ฐ, ์šฐ๋ฆฌ๊ฐ€ ํ•ญ์ƒ์ œ๋ฅผ ์ข€ ๋” ์ ์ ˆํ•˜๊ฒŒ ์‚ฌ์šฉํ•œ๋‹ค๋ฉด
06:08
if we use our antibiotics appropriately,
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06:10
we don't necessarily have to make the investments
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์ƒˆ๋กœ์šด ์•ฝ์„ ๊ฐœ๋ฐœํ•˜๋Š” ๋ฐ ํˆฌ์žํ•  ํ•„์š”๊ฐ€ ์—†์–ด์ง€๊ฒŒ ๋˜๋Š” ๊ฒƒ์ด์ฃ .
06:13
in new drug development.
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06:15
And if you thought that these two were entirely,
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์ด ๋‘ ๋ฐฉ๋ฒ•์ด ์„œ๋กœ ์™„๋ฒฝํ•˜๊ฒŒ ๊ท ํ˜•์„ ์ด๋ฃจ๊ณ  ์žˆ๋‹ค๊ณ  ์ƒ๊ฐํ•˜์‹ ๋‹ค๋ฉด,
06:18
fully balanced between these two options,
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06:20
you might consider the fact that
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์ด๊ฑด ์šฐ๋ฆฌ๊ฐ€ ํ•˜๋Š” ์ผ์ข…์˜ ๊ฒŒ์ž„์ด๋ผ๋Š” ์ ์„ ๊ณ ๋ คํ•˜์…”์•ผ ํ•ฉ๋‹ˆ๋‹ค.
06:22
this is really a game that we're playing.
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06:24
The game is really one of coevolution,
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๊ณต์ง„ํ™”๋ผ๋Š” ์ด๋ฆ„์˜ ๊ฒŒ์ž„์ž…๋‹ˆ๋‹ค.
06:27
and coevolution is, in this particular picture,
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๊ณต์ง„ํ™”๋Š”, ์ด ์‚ฌ์ง„์„ ์˜ˆ๋กœ ๋“ค๋ฉด, ์น˜ํƒ€์™€ ๊ฐ€์ ค ์‚ฌ์ด์—์„œ ๋‚˜ํƒ€๋‚ฉ๋‹ˆ๋‹ค.
06:30
between cheetahs and gazelles.
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06:32
Cheetahs have evolved to run faster,
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์น˜ํƒ€๋Š” ๋นจ๋ฆฌ ๋‹ฌ๋ฆด ์ˆ˜ ์žˆ๊ฒŒ ์ง„ํ™”ํ–ˆ์ฃ . ๋นจ๋ฆฌ ๋ชป๋‹ฌ๋ฆฌ๋ฉด ๋ผ๋‹ˆ๋ฅผ ๊ฑฐ๋ฅผ ํ…Œ๋‹ˆ๊นŒ์š”.
06:34
because if they didn't run faster,
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06:35
they wouldn't get any lunch.
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06:37
Gazelles have evolved to run faster because
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๊ฐ€์ ค๋„ ๋นจ๋ฆฌ ๋‹ฌ๋ฆด ์ˆ˜ ์žˆ๊ฒŒ ์ง„ํ™”ํ–ˆ๋Š”๋ฐ, ๋ชป๋‹ฌ๋ฆฌ๋ฉด ๋จน์ด๊ฑฐ๋ฆฌ๊ฐ€ ๋˜๊ธฐ ๋•Œ๋ฌธ์ž…๋‹ˆ๋‹ค.
06:40
if they don't run faster, they would be lunch.
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06:43
Now, this is the game we're playing against the bacteria,
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์ด๊ฒƒ์€ ์šฐ๋ฆฌ๊ฐ€ ๋ฐ•ํ…Œ๋ฆฌ์•„์— ๋Œ€ํ•ญํ•ด์„œ ๋ฒŒ์ด๋Š” ๊ฒŒ์ž„์ž…๋‹ˆ๋‹ค.
06:46
except we're not the cheetahs,
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ํ•˜์ง€๋งŒ ์—ฌ๊ธฐ์„œ ์šฐ๋ฆฌ๋Š” ์น˜ํƒ€๊ฐ€ ์•„๋‹ˆ๊ณ  ๊ฐ€์ ค์ด๋ผ๋Š” ์ ์ด ๋‹ค๋ฅด์ฃ .
06:48
we're the gazelles,
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06:49
and the bacteria would,
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๋˜, ๋ฐ•ํ…Œ๋ฆฌ์•„๋Š” ์˜ค๋Š˜ ์ œ๊ฐ€ ์ด ๊ฐ•์—ฐ์„ ํ•˜๋Š” ๋™์•ˆ ์ž์‹ ์†์ž๊นŒ์ง€ ๋ดค์„ ๊ฒ๋‹ˆ๋‹ค.
06:52
just in the course of this little talk,
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06:54
would have had kids and grandkids
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06:55
and figured out how to be resistant
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๊ทธ๋ ‡๊ฒŒ ์ž์—ฐ ์„ ํƒ๊ณผ ์‹œํ–‰์ฐฉ์˜ค๋กœ ๋‚ด์„ฑ์„ ๊ธฐ๋ฅด๋Š” ๊ฑฐ์ฃ .
06:58
just by selection and trial and error,
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07:00
trying it over and over again.
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๋ฐ˜๋ณตํ•ด์„œ ์—ฌ๋Ÿฌ ๋ฐฉ๋ฒ•์„ ์‹œ๋„ํ•ด ๋ณด๋ฉด์„œ ๋ง์ด์ฃ .
07:02
Whereas how do we stay ahead of the bacteria?
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๋ฐ˜๋ฉด ์šฐ๋ฆฌ๋Š” ์–ด๋–ป๊ฒŒ ๋ฐ•ํ…Œ๋ฆฌ์•„๋ณด๋‹ค ๋” ์ง„๋ณดํ•˜๋Š” ๊ฑธ๊นŒ์š”?
07:06
We have drug discovery processes,
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์šฐ๋ฆฌ๋Š” ์ƒˆ๋กœ์šด ์•ฝ์˜ ๋ฐœ๊ฒฌ ๊ณผ์ •์ด ์žˆ๊ณ , ๋ถ„์ž ๊ฒ€์‚ฌ๋ฅผ ํ•˜๊ณ ,
07:08
screening molecules,
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07:10
we have clinical trials,
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์ž„์ƒ ์‹œํ—˜์„ ๊ฑฐ์ณ์„œ, ์ƒˆ๋กœ์šด ํ›„๋ณด ์•ฝ์„ ๋งŒ๋“ค์–ด๋‚ด๋ฉด
07:11
and then, when we think we have a drug,
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07:14
then we have the FDA regulatory process.
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FDA ๊ทœ์ •์— ๋”ฐ๋ผ ์Šน์ธ๊ณผ์ •์„ ๋ฐ›์•„์•ผ ํ•ฉ๋‹ˆ๋‹ค.
07:17
And once we go through all of that,
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์ด ๋ชจ๋“  ๊ณผ์ •์„ ๊ฑฐ์ณ์•ผ ๋ฐ•ํ…Œ๋ฆฌ์•„๋กœ๋ถ€ํ„ฐ ๊ฒจ์šฐ ํ•œ๋ฐœ ์•ž์„ค๊นŒ ๋ง๊นŒ ํ•ฉ๋‹ˆ๋‹ค.
07:20
then we try to stay one step ahead
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07:22
of the bacteria.
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07:24
Now, this is clearly not a game that can be sustained,
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์ด๊ฑด ์ ˆ๋Œ€ ์ง€์† ๊ฐ€๋Šฅํ•œ ๊ฒŒ์ž„์ด ์•„๋‹™๋‹ˆ๋‹ค.
07:27
or one that we can win
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๋‹จ์ˆœํžˆ ํ˜์‹ ์„ ํ†ตํ•ด ์ด๊ธธ ์ˆ˜ ์žˆ๋Š” ๊ฒƒ๋„ ์•„๋‹ˆ๊ณ ์š”.
07:28
by simply innovating to stay ahead.
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07:30
We've got to slow the pace of coevolution down,
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์šฐ๋ฆฌ๋Š” ๊ณต์ง„ํ™”์˜ ์†๋„๋ฅผ ๋Šฆ์ถฐ์•ผ ํ•ฉ๋‹ˆ๋‹ค.
07:33
and there are ideas that we can borrow from energy
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๋˜ํ•œ ์—๋„ˆ์ง€์—์„œ ์•„์ด๋””์–ด๋ฅผ ๋นŒ๋ ค์˜ฌ ์ˆ˜๋„ ์žˆ์–ด์š”.
07:37
that are helpful in thinking about
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ํ•ญ์ƒ์ œ์˜ ๋ฌธ์ œ์— ๊ด€ํ•ด ์–ด๋–ป๊ฒŒ ๋Œ€์ฒ˜ํ•  ์ง€๋ฅผ ์ƒ๊ฐํ•˜๋Š” ๋ฐ ์œ ์šฉํ•˜๋„๋ก ๋ง์ด์ฃ .
07:39
how we might want to do this in the case
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07:40
of antibiotics as well.
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07:42
Now, if you think about how we deal with
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์ž, ์—๋„ˆ์ง€์˜ ๊ฐ€๊ฒฉ ๊ฒฐ์ • ์ •์ฑ…์„ ํ•œ๋ฒˆ ์‚ดํŽด๋ณด์ž๋ฉด,
07:44
energy pricing, for instance,
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07:45
we consider emissions taxes,
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์ผ๋‹จ ๊ณตํ•ด๋ฐฐ์ถœ์„ธ๋ฅผ ๊ณ ๋ คํ•ด ๋ด…๋‹ˆ๋‹ค.
07:47
which means we're imposing the costs of pollution
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์‹ค์ œ๋กœ ์—๋„ˆ์ง€๋ฅผ ์†Œ๋น„ํ•˜๋Š” ์‚ฌ๋žŒ๋“ค์—๊ฒŒ ๊ณตํ•ด ๋ฐœ์ƒ ๋น„์šฉ์„ ๋ถ€๋‹ด์‹œํ‚ค๋Š” ๊ฑฐ์ฃ .
07:50
on people who actually use that energy.
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07:53
We might consider doing that for antibiotics as well,
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ํ•ญ์ƒ์ œ์—๋„ ์ด๋Ÿฐ ๊ฑธ ์ ์šฉํ•˜๋Š” ๊ฒƒ์„ ์ƒ๊ฐํ•ด ๋ณด๊ฒŒ ๋˜๋Š”๋ฐ
07:56
and perhaps that would make sure that antibiotics
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๊ทธ๊ฒƒ์€ ํ•ญ์ƒ์ œ๊ฐ€ ์˜ฌ๋ฐ”๋ฅธ ๋ฐฉํ–ฅ์œผ๋กœ ์‚ฌ์šฉ๋  ์ˆ˜ ์žˆ๋„๋ก ํ•ด ์ค„ ๊ฒ๋‹ˆ๋‹ค.
07:58
actually get used appropriately.
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08:01
There are clean energy subsidies,
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์ฒญ์ •์—๋„ˆ์ง€ ๋ณด์กฐ๊ธˆ์€ ๊ณตํ•ด๋ฅผ ๋œ ๋ฐœ์ƒ์‹œํ‚ค๊ฑฐ๋‚˜
08:03
which are to switch to fuels which don't pollute as much
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08:06
or perhaps don't need fossil fuels.
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์•„์˜ˆ ๋ฐœ์ƒ์‹œํ‚ค์ง€ ์•Š๋Š” ์—ฐ๋ฃŒ๋ฅผ ์‚ฌ์šฉํ•˜๋„๋ก ์žฅ๋ คํ•˜๋Š” ๊ฑฐ์ฃ .
08:09
Now, the analogy here is, perhaps we need
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์ด์™€ ์œ ์‚ฌํ•œ ๋ฐฉ๋ฒ•์„ ์‚ฌ์šฉํ•˜๊ณ ์ž ํ•œ๋‹ค๋ฉด
08:11
to move away from using antibiotics,
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ํ•ญ์ƒ์ œ๋ฅผ ์‚ฌ์šฉํ•˜์ง€ ์•Š์„ ๋ฐฉ๋ฒ•์„ ์ฐพ์•„์•ผ ํ•  ๊ฒ๋‹ˆ๋‹ค.
08:14
and if you think about it, what are good substitutes for antibiotics?
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๊ทธ๋Ÿฌ๋ฉด ํ•ญ์ƒ์ œ์˜ ๋Œ€์•ˆ์—๋Š” ๋ฌด์—‡์ด ์žˆ์„๊นŒ์š”?
08:17
Well, turns out that anything that reduces
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ํ•ญ์ƒ์ œ์˜ ํ•„์š”์„ฑ์„ ์ค„์ด๋Š” ๊ฒƒ์ด๋ผ๋ฉด, ์–ด๋–ค ๊ฒƒ์ด๋“  ๊ฐ€๋Šฅํ•ฉ๋‹ˆ๋‹ค.
08:20
the need for the antibiotic would really work,
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08:22
so that could include improving hospital infection control
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๋ณ‘์› ๊ฐ์—ผ ๊ด€๋ฆฌ๋‚˜ ๋ฐฑ์‹  ์ ‘์ข…์„ ํฌํ•จํ•˜์—ฌ ํŠนํžˆ ๊ณ„์ ˆ์„ฑ ๋…๊ฐ ๋ฐฑ์‹ ์ด ๊ฐ€์žฅ ํฝ๋‹ˆ๋‹ค.
08:25
or vaccinating people,
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08:28
particularly against the seasonal influenza.
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08:30
And the seasonal flu is probably
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๊ณ„์ ˆ์„ฑ ๋…๊ฐ๋ฐฑ์‹ ์€ ๊ตญ๋‚ด์™ธ๋ฅผ ๋ง‰๋ก ํ•˜๊ณ  ํ•ญ์ƒ์ œ ์‚ฌ์šฉ์„ ๋ถ€์ถ”๊ธฐ๋Š” ํฐ ์š”์ธ์ด์ฃ .
08:33
the biggest driver of antibiotic use,
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08:36
both in this country as well as in many other countries,
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08:39
and that could really help.
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๊ทธ๋Ÿฌ๋‹ˆ ๋ฐฑ์‹ ์„ ๋งž์ง€ ์•Š์œผ๋ฉด ํฐ ๋„์›€์ด ๋˜๊ฒ ์ฃ .
08:41
A third option might include something like tradeable permits.
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์„ธ ๋ฒˆ์งธ ๋ฐฉ๋ฒ•์€ ํ—ˆ๊ฐ€์ฆ ๊ฑฐ๋ž˜์™€ ๊ฐ™์€ ๊ฒƒ์„ ๋„์ž…ํ•˜๋Š” ๊ฒƒ์ž…๋‹ˆ๋‹ค.
08:45
And these seem like faraway scenarios,
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์•„์ง์€ ๋จผ ๋ฏธ๋ž˜์˜ ์–˜๊ธฐ์ธ ๊ฒƒ์ฒ˜๋Ÿผ ์—ฌ๊ฒจ์ง€์ง€๋งŒ,
08:49
but if you consider the fact that we might not
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๊ฐ์—ผ์œผ๋กœ ํ•ญ์ƒ์ œ๊ฐ€ ํ•„์š”ํ•œ ๋ชจ๋‘์—๊ฒŒ ๊ทธ๊ฒƒ์„ ์ค„ ์—ฌ์œ ๊ฐ€ ์•ˆ ๋œ๋‹ค๋ฉด
08:51
have antibiotics for many people who have infections,
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08:55
we might consider the fact that we might
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๋‹ค๋ฅธ ์‚ฌ๋žŒ๋ณด๋‹ค ์šฐ์„  ํ•ญ์ƒ์ œ๋ฅผ ์ง€๊ธ‰ ๋ฐ›์„ ์‚ฌ๋žŒ๋“ค์„ ์„ ํƒํ•  ๊ธฐ์ค€์„ ๊ณ ๋ ค ํ•ด์•ผ๊ฒ ์ฃ .
08:57
want to allocate who actually gets to use
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08:59
some of these antibiotics over others,
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09:02
and some of these might have to be on the basis of clinical need,
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๊ทธ ๊ธฐ์ค€์€ ์ž„์ƒ์  ํ•„์š”๋„๊ฐ€ ๋  ์ˆ˜๋„ ์žˆ๊ฒ ์ง€๋งŒ,
09:05
but also on the basis of pricing.
208
545898
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๋น„์šฉ์— ๋”ฐ๋ฅธ ํ•„์š”๋„ ๋˜ํ•œ ๋  ์ˆ˜ ์žˆ๊ฒ ์ฃ .
09:07
And certainly consumer education works.
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์†Œ๋น„์ž ๊ต์œก์€ ํ™•์‹คํžˆ ํšจ๊ณผ๊ฐ€ ์žˆ์ฃ .
09:09
Very often, people overuse antibiotics
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์‚ฌ๋žŒ๋“ค์€ ํ”ํžˆ ๋ฌด์˜์‹์ค‘์— ํ•ญ์ƒ์ œ๋ฅผ ๊ณผ์šฉํ•˜๊ฑฐ๋‚˜ ๊ณผ๋„ํ•˜๊ฒŒ ์ฒ˜๋ฐฉํ•ฉ๋‹ˆ๋‹ค.
09:12
or prescribe too much without necessarily
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09:14
knowing that they do so,
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09:16
and feedback mechanisms
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๊ทธ๋ฆฌ๊ณ  ํ”ผ๋“œ๋ฐฑ์€ ์ด๋Ÿด ๋•Œ ์œ ์šฉํ•œ๋ฐ,
09:17
have been found to be useful,
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09:19
both on energy โ€”
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์—๋„ˆ์ง€์˜ ๊ฒฝ์šฐ์—๋„ ๊ทธ๋ ‡๊ณ , ๋ˆ„๊ตฐ๊ฐ€์—๊ฒŒ ๊ณผ๋‹ค์†Œ๋ชจ ์‹œ๊ฐ„๋Œ€์—
09:21
When you tell someone that they're using
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09:23
a lot of energy during peak hour,
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563029
1917
๋งŽ์€ ์—๋„ˆ์ง€๋ฅผ ์“ฐ๊ณ  ์žˆ๋‹ค๊ณ  ์–˜๊ธฐํ•ด์ฃผ๋ฉด ๋Œ€๋ถ€๋ถ„ ์†Œ๋น„๋ฅผ ์ค„์ž…๋‹ˆ๋‹ค.
09:24
they tend to cut back,
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09:26
and the same sort of example has been performed
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566416
1767
์ด์™€ ๋น„์Šทํ•œ ์‚ฌ๋ก€๊ฐ€ ํ•ญ์ƒ์ œ์˜ ๊ฒฝ์šฐ์—๋„ ์ ์šฉ๋œ ๋ฐ” ์žˆ์Šต๋‹ˆ๋‹ค.
09:28
even in the case of antibiotics.
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09:29
A hospital in St. Louis basically would put up
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1981
์„ธ์ธํŠธ๋ฃจ์ด์Šค์˜ ํ•œ ๋ณ‘์›์—์„œ ์ด์ „ ๋‹ฌ์˜ ํ•ญ์ƒ์ œ ์‚ฌ์šฉ๋Ÿ‰์„ ๊ธฐ์ค€์œผ๋กœ
09:31
on a chart the names of surgeons
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09:36
in the ordering of how much antibiotics they'd used
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์™ธ๊ณผ์˜๋“ค์˜ ์ˆœ์œ„๋ฅผ ๋งค๊ฒจ ๊ณต๊ฐœํ•œ ๊ฒƒ์ด์ฃ .
09:38
in the previous month,
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578385
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09:40
and this was purely an informational feedback,
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์ฐฝํ”ผ๋ฅผ ์ฃผ๋ ค๋Š” ๊ฒƒ๋„ ์•„๋‹ˆ๊ณ  ๋‹จ์ˆœํ•œ ์ •๋ณด ์ œ๊ณต์ผ ๋ฟ์ด์ง€๋งŒ, ๋ณธ์งˆ์ ์œผ๋กœ
09:42
there was no shaming,
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09:43
but essentially that provided some information back
227
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์™ธ๊ณผ์˜๋“ค์—๊ฒŒ ํ•ญ์ƒ์ œ์˜ ์‚ฌ์šฉ ์Šต๊ด€์„ ์žฌ๊ณ ํ•ด๋ณผ ๋งŒํ•œ ์ •๋ณด๋ฅผ ์ œ๊ณตํ•œ ์…ˆ์ž…๋‹ˆ๋‹ค.
09:45
to surgeons that maybe they could rethink
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1954
09:47
how they were using antibiotics.
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2229
09:50
Now, there's a lot that can be done
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2014
๊ณต๊ธ‰์˜ ์ธก๋ฉด์—์„œ๋„ ๋ณ€ํ™”์˜ ์—ฌ์ง€๋Š” ๋งŽ์Šต๋‹ˆ๋‹ค.
09:52
on the supply side as well.
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ํŽ˜๋‹ˆ์‹ค๋ฆฐ์˜ ๊ฐ€๊ฒฉ์„ ๋ณด์‹œ๋ฉด ํ•˜๋ฃจ์น˜์˜ ๊ฐ’์€ ์•ฝ 10์„ผํŠธ๋กœ ๊ฝค ์ €๋ ดํ•œ ์•ฝ์ด์ฃ .
09:54
If you look at the price of penicillin,
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09:56
the cost per day is about 10 cents.
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09:57
It's a fairly cheap drug.
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09:59
If you take drugs that have been introduced since then โ€”
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ํ•˜์ง€๋งŒ ๋ฆฌ๋„ค์กธ๋ฆฌ๋“œ๋‚˜ ๋Žํ† ๋งˆ์ด์‹  ๊ฐ™์€ ํŽ˜๋‹ˆ์‹ค๋ฆฐ ์ดํ›„๋กœ ๋„์ž…๋œ ์•ฝ๋“ค์„ ๋ณด๋ฉด
10:01
linezolid or daptomycin โ€”
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10:04
those are significantly more expensive,
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๊ฐ€๊ฒฉ์ด ์ƒ๋‹นํžˆ ๋” ๋น„์Œ‰๋‹ˆ๋‹ค.
10:06
so to a world that has been used to paying 10 cents a day for antibiotics,
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ํ•˜๋ฃจ ์น˜ ํ•ญ์ƒ์ œ ๊ฐ€๊ฒฉ์œผ๋กœ 10์„ผํŠธ๊ฐ€ ์ต์ˆ™ํ•œ ์„ธ์ƒ์—์„œ
10:11
the idea of paying 180 dollars per day
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ํ•˜๋ฃจ์— 180๋‹ฌ๋Ÿฌ๋ผ๋Š” ๊ธˆ์•ก์€ ๋งค์šฐ ๋น„์‹ธ๊ฒŒ ๋Š๊ปด์ง€์ฃ .
10:14
seems like a lot.
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10:15
But what is that really telling us?
241
615730
1987
์ด๊ฒƒ์ด ์˜๋ฏธํ•˜๋Š” ๋ฐ”๊ฐ€ ๋ญ˜๊นŒ์š”? ๊ทธ ๊ฐ€๊ฒฉํ‘œ๋Š”, ์šฐ๋ฆฌ๊ฐ€ ๋จธ์ง€์•Š์•„
10:17
That price is telling us
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1965
10:19
that we should no longer
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1898
10:21
take cheap, effective antibiotics as a given
244
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4117
์‹ธ๊ณ  ํšจ๊ณผ์ ์ธ ํ•ญ์ƒ์ œ๋ฅผ ๋‹น์—ฐ์‹œ ํ•˜๋ฉด ์•ˆ ๋˜๋Š” ๋•Œ๊ฐ€ ์˜ฌ ๊ฒƒ์ด๋ฉฐ,
10:25
into the foreseeable future,
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10:27
and that price is a signal to us
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๊ทธ ๊ฐ€๊ฒฉ์€ ์šฐ๋ฆฌ๊ฐ€ ๋ณด์กด์— ๋” ํฐ ๊ด€์‹ฌ์„ ๊ธฐ์šธ์—ฌ์•ผ ํ• ๊ฒƒ์„ ์•Œ๋ ค์ฃผ๋Š” ๊ฑฐ์ฃ .
10:29
that perhaps we need to be paying
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10:31
much more attention to conservation.
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10:34
That price is also a signal
249
634156
2704
๋˜ํ•œ ์šฐ๋ฆฌ๊ฐ€ ์ด์ œ ๋Œ€์•ˆ ๊ธฐ์ˆ ์„ ์ฐพ์•„ ๋‚˜์„œ์•ผ ํ•œ๋‹ค๋Š” ์‹ ํ˜ธ์ด๊ธฐ๋„ ํ•ฉ๋‹ˆ๋‹ค.
10:36
that maybe we need to start looking at other technologies,
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10:39
in the same way that gasoline prices are a signal
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๋งˆ์น˜ ํœ˜๋ฐœ์œ  ๊ฐ€๊ฒฉ์ด ์ „๊ธฐ ์ž๋™์ฐจ์˜ ๊ฐœ๋ฐœ์„ ์ด‰์ง„ํ•˜๋Š” ๊ฒƒ์ฒ˜๋Ÿผ ๋ง์ด์ฃ .
10:42
and an impetus, to, say,
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10:44
the development of electric cars.
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10:46
Prices are important signals
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๋น„๋ก ๊ฐ€๊ฒฉ์€ ์šฐ๋ฆฌ๊ฐ€ ์ฃผ๋ชฉํ•ด์•ผ ํ•  ์ค‘์š”ํ•œ ์‹ ํ˜ธ์ง€๋งŒ
10:48
and we need to pay attention,
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10:50
but we also need to consider the fact that
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ํ•ญ์ƒ์ œ ์น˜๊ณ ๋Š” ์ด๋ก€์ ์œผ๋กœ ๋Š๊ปด์ง€๋Š” ์ด ๋น„์‹ผ ๊ฐ€๊ฒฉ๋„
10:52
although these high prices seem unusual for antibiotics,
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10:56
they're nothing compared to the price per day
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์ผ๋ถ€ ํ•ญ์•”์ œ์˜ ํ•˜๋ฃจ ์น˜ ๊ฐ€๊ฒฉ๊ณผ๋Š” ๋น„๊ตํ•  ์ˆ˜ ์—†์ด ์‹ธ๋‹ค๋Š” ๊ฒ๋‹ˆ๋‹ค.
10:59
of some cancer drugs,
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11:00
which might save a patient's life only for a few months or perhaps a year,
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ํ•ญ์•”์ œ๋Š” ํ™˜์ž์˜ ์ฃฝ์Œ์„ ๋ช‡ ๋‹ฌ, ํ˜น์€ 1๋…„ ์ •๋„ ๋ฏธ๋ฃฐ ๋ฟ์ด์ง€๋งŒ
11:03
whereas antibiotics would potentially
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ํ•ญ์ƒ์ œ๋Š” ์ž ์žฌ์ ์œผ๋กœ ํ™˜์ž์˜ ์ƒ๋ช…์„ ์™„์ „ํžˆ ๊ตฌํ•  ์ˆ˜ ์žˆ์œผ๋‹ˆ๊นŒ์š”.
11:05
save a patient's life forever.
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11:07
So this is going to involve
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๊ฒฐ๊ตญ ์ด๊ฑด ์ธ์‹์˜ ์ „์ฒด์  ์ „ํ™˜์ด๊ณ  ๋ฌด์„œ์šด ๋ฐฉํ–ฅ์œผ๋กœ์˜ ์ „ํ™˜์ด๊ธฐ๋„ ํ•ฉ๋‹ˆ๋‹ค.
11:08
a whole new paradigm shift,
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11:10
and it's also a scary shift because
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11:12
in many parts of this country,
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์ด ๋‚˜๋ผ์˜ ๋งŽ์€ ์ง€์—ญ์—์„œ๋„ ๊ทธ๋ ‡๊ณ , ์„ธ๊ณ„์˜ ์—ฌ๋Ÿฌ ์ง€์—ญ์—์„œ๋„
11:14
in many parts of the world,
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11:16
the idea of paying 200 dollars
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ํ•ญ์ƒ์ œ ์น˜๋ฃŒ๋ฅผ ์œ„ํ•ด ํ•˜๋ฃจ 200๋‹ฌ๋Ÿฌ๋ฅผ ๋‚ธ๋‹ค๋Š” ๊ฒƒ์€ ์ƒ์ƒ์กฐ์ฐจ ํ•  ์ˆ˜ ์—†๊ฑฐ๋“ ์š”.
11:18
for a day of antibiotic treatment
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11:21
is simply unimaginable.
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11:24
So we need to think about that.
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์šฐ๋ฆฌ๊ฐ€ ๊ณ ๋ฏผํ•ด์•ผํ•  ๋ฌธ์ œ์ด์ฃ .
11:25
Now, there are backstop options,
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ํ•ญ์ƒ์ œ๊ฐ€ ๋ฌด๋ ฅํ™”๋  ๊ฒฝ์šฐ ๋Œ€์•ˆ์œผ๋กœ ์‚ฌ์šฉํ• ๋งŒํ•œ ๊ธฐ์ˆ ๋“ค๋„ ์—ฐ๊ตฌ๋˜๊ณ  ์žˆ๋Š”๋ฐ,
11:27
which is other alternative technologies
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11:30
that people are working on.
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11:31
It includes bacteriophages, probiotics,
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๋ฐ•ํ…Œ๋ฆฌ์˜คํŒŒ์ง€, ์ƒ๊ท ์ œ,์ •์กฑ์ˆ˜ ๊ฐ์ง€, ์‹ ๋ฐ”์ด์˜คํ‹ฑ ๋“ฑ์„ ํฌํ•จํ•ฉ๋‹ˆ๋‹ค.
11:34
quorum sensing, synbiotics.
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11:38
Now, all of these are useful avenues to pursue,
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์ด ๋ชจ๋‘๊ฐ€ ์—ฐ๊ตฌํ•ด๋ณผ ๊ฐ€์น˜๊ฐ€ ์žˆ๋Š” ๋ถ„์•ผ๋“ค์ด๊ณ ,
11:41
and they will become even more lucrative
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์ƒˆ๋กœ์šด ํ•ญ์ƒ์ œ๋“ค์˜ ๊ฐ€๊ฒฉ์ด ๋น„์‹ธ์งˆ์ˆ˜๋ก ๋”์šฑ ์‹œ์žฅ ์ด์œค ๊ฐ€์น˜๋Š” ๋†’์•„์งˆ ๊ฒƒ์ž…๋‹ˆ๋‹ค.
11:43
when the price of new antibiotics starts going higher,
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11:47
and we've seen that the market does actually respond,
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๊ทธ๋ฆฌ๊ณ  ์‚ฌ์‹ค ์‹œ์žฅ์€ ๋ฐ˜์‘์„ ๋ณด์ด๊ณ  ์žˆ๊ณ ,
11:49
and the government is now considering
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์ •๋ถ€๋Š” ์ƒˆ๋กœ์šด ํ•ญ์ƒ์ œ ๊ฐœ๋ฐœ์— ๋ณด์กฐ๊ธˆ์„ ์ง€๊ธ‰ํ•˜๋Š” ๋ฐฉ์•ˆ์„ ๋ชจ์ƒ‰ํ•˜๊ณ  ์žˆ์Šต๋‹ˆ๋‹ค.
11:51
ways of subsidizing new antibiotics and development.
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11:55
But there are challenges here.
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ํ•˜์ง€๋งŒ ์‰ฝ์ง€๋Š” ์•Š๊ฒ ์ฃ . ๋ฌธ์ œ๋ฅผ ๊ทธ๋ƒฅ ๋ˆ์œผ๋กœ ํ•ด๊ฒฐํ•˜๋ ค๊ณ  ํ•ด์„œ๋Š” ์•ˆ ๋ฉ๋‹ˆ๋‹ค.
11:57
We don't want to just throw money at a problem.
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11:59
What we want to be able to do
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๋Œ€์‹ , ํ•ญ์ƒ์ œ์˜ ์˜ฌ๋ฐ”๋ฅธ ์‚ฌ์šฉ ํŒ๋งค๊ฐ€ ์žฅ๋ ค๋˜๋Š” ์‹์œผ๋กœ ํˆฌ์ž๋ฅผ ์ง„ํ–‰ํ•ด์•ผ์ฃ .
12:00
is invest in new antibiotics
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12:02
in ways that actually encourage
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12:05
appropriate use and sales of those antibiotics,
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12:08
and that really is the challenge here.
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์—ฌ๊ธฐ์„œ๋Š” ๊ทธ๊ฒƒ์ด ๋‚œ์ œ์ž…๋‹ˆ๋‹ค.
12:11
Now, going back to these technologies,
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๋‹ค์‹œ ๊ธฐ์ˆ ์˜ ๋ฌธ์ œ๋กœ ๋Œ์•„๊ฐ€์„œ, ์—ฌ๋Ÿฌ๋ถ„ ๋ชจ๋‘ ๊ทธ ์œ ๋ช…ํ•œ ๊ณต๋ฃก ์˜ํ™”์˜ ๋Œ€์‚ฌ,
12:13
you all remember the line from that famous
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12:15
dinosaur film, "Nature will find a way."
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"์ž์—ฐ์€ ๋ฐฉ๋ฒ•์„ ์ฐพ์•„๋‚ผ ๊ฒƒ์ด๋‹ค." ๋ฅผ ์•„์‹ค ๊ฒ๋‹ˆ๋‹ค.
12:18
So it's not as if these are permanent solutions.
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๊ฒฐ๊ตญ, ์ด๊ฒƒ๋“ค๋„ ์˜๊ตฌ์ ์ธ ํ•ด๊ฒฐ์ฑ…์€ ์•„๋‹™๋‹ˆ๋‹ค.
12:21
We really have to remember that, whatever the technology might be,
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์šฐ๋ฆฌ๋Š” ๊ธฐ์–ตํ•ด์•ผ ํ•ฉ๋‹ˆ๋‹ค. ์–ด๋–ค ๊ธฐ์ˆ ์ด๋“ ์ง€
12:25
that nature will find some way to work around it.
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์ž์—ฐ์€ ์ด๊ฒƒ์— ๋Œ€ํ•ด ํ•ด๊ฒฐํ•  ๋ฐฉ๋ฒ•์„ ์ฐพ์„๊ฒƒ์ด๋ผ๋Š” ๊ฒƒ์ž…๋‹ˆ๋‹ค.
12:28
You might think, well, this is just a problem
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์—ฌ๋Ÿฌ๋ถ„์€ ์ด๊ฒƒ์ด ํ•ญ์ƒ์ œ์™€ ๋ฐ•ํ…Œ๋ฆฌ์•„์— ๊ตญํ•œ๋œ ๋ฌธ์ œ๋ผ๊ณ  ์ƒ๊ฐํ•˜์‹ค์ง€ ๋ชจ๋ฅด๊ฒ ์ง€๋งŒ,
12:30
just with antibiotics and with bacteria,
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12:33
but it turns out that we have the exact same
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์šฐ๋ฆฌ๋Š” ์ด๊ฒƒ๊ณผ ๋˜‘๊ฐ™์€ ๋ฌธ์ œ๋ฅผ ๋‹ค๋ฅธ ์—ฌ๋Ÿฌ ๋ถ„์•ผ์—์„œ๋„ ์ง๋ฉดํ•˜๊ณ  ์žˆ์Šต๋‹ˆ๋‹ค.
12:35
identical problem in many other fields as well,
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12:37
with multidrug-resistant tuberculosis,
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๋‹ค์ฒด๋‚ด์„ฑ ๊ฒฐํ•ต์ด ํ•œ ์˜ˆ์ž…๋‹ˆ๋‹ค.
12:40
which is a serious problem in India and South Africa.
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ํ˜„์žฌ ์ด๊ฒƒ์€ ์ธ๋„์™€ ๋‚จ์•„ํ”„๋ฆฌ์นด์—์„œ ์‹ฌ๊ฐํ•œ ๋ฌธ์ œ์ž…๋‹ˆ๋‹ค.
12:44
Thousands of patients are dying because
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2์ฐจ ๊ณ„์—ด ์•ฝ์ œ๊ฐ€ ๋„ˆ๋ฌด ๋น„์‹ธ ์ˆ˜์ฒœ ๋ช…์ด ์‚ฌ๋งํ•˜๊ณ  ์žˆ์œผ๋ฉฐ,
12:46
the second-line drugs are so expensive,
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12:48
and in some instances, even those don't work
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๊ด‘๋ฒ”์œ„ ์•ฝ์ œ๋‚ด์„ฑ ๊ฒฐํ•ต์ธ ๊ฒฝ์šฐ์—”, ์‹ฌ์ง€์–ด ๊ทธ๋งˆ์ €๋„ ๋“ฃ์ง€ ์•Š๊ธฐ๋„ ํ•˜์ฃ .
12:50
and you have XDR TB.
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12:52
Viruses are becoming resistant.
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๋ฐ”์ด๋Ÿฌ์Šค๋„ ๋‚ด์„ฑ์ด ์ƒ๊ธฐ๊ณ  ์žˆ์Šต๋‹ˆ๋‹ค. ๋†ํ•ด์ถฉ์ด๋‚˜ ๋ง๋ผ๋ฆฌ์•„ ๊ธฐ์ƒ์ถฉ๋„์š”.
12:54
Agricultural pests. Malaria parasites.
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12:57
Right now, much of the world depends on
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ํ˜„์žฌ ์„ธ๊ณ„์˜ ๋Œ€๋ถ€๋ถ„ ์ง€์—ญ์—์„œ ๋ง๋ผ๋ฆฌ์•„ ์น˜๋ฃŒ์ œ์ธ ์•„๋ฅดํ…Œ๋ฏธ์‹œ๋‹Œ ์•ฝ์—๋งŒ ์˜์กดํ•˜์ฃ .
12:59
one drug, artemisinin drugs,
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13:02
essentially to treat malaria.
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13:04
Resistance to artemisinin has already emerged,
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ํ•˜์ง€๋งŒ ์•„๋ฅดํ…Œ๋ฏธ์‹œ๋‹Œ์•ฝ์— ๋‚ด์„ฑ์ด ๋‚˜ํƒ€๋‚˜๊ณ  ์žˆ๊ณ , ์ด๊ฒŒ ํ™•์‚ฐ๋œ๋‹ค๋ฉด
13:07
and if this were to become widespread,
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ํ˜„์žฌ๋Š” ์•ˆ์ „ํ•˜๊ณ  ํšจ๊ณผ์ ์ด๊ณ  ์œ ์ผํ•œ ๋ง๋ผ๋ฆฌ์•„ ์น˜๋ฃŒ์ œ๋ฅผ ์žƒ๊ฒŒ ๋ ์ง€๋„ ๋ชจ๋ฅด์ฃ .
13:09
that puts at risk
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13:11
the single drug that we have to treat malaria around the world
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13:14
in a way that's currently safe and efficacious.
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13:17
Mosquitos develop resistance.
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๋ชจ๊ธฐ๋„ ๋‚ด์„ฑ์ด ์ƒ๊ธฐ๊ณ  ์žˆ์ฃ . ์•„์ด๊ฐ€ ์žˆ์œผ์‹œ๋‹ค๋ฉด ๋จธ๋ฆฟ๋‹ˆ์— ๋Œ€ํ•ด ์•„์‹ค ๊ฒƒ์ด๊ณ ,
13:19
If you have kids, you probably know about head lice,
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13:21
and if you're from New York City,
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๋‰ด์š•์—์„œ ์˜ค์…จ๋‹ค๋ฉด ๊ทธ๊ณณ์€ ์ง€๋…ํ•œ ๋นˆ๋Œ€๊ฐ€ ์œ ๋ช…ํ•˜๋‹ค๊ณ  ์•Œ๊ณ  ์žˆ์Šต๋‹ˆ๋‹ค.
13:22
I understand that the specialty there is bedbugs.
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13:25
So those are also resistant.
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์ด๊ฒƒ๋“ค๋„ ๋‚ด์„ฑ์ด ์ƒ๊ธฐ๊ณ  ์žˆ์–ด์š”.
13:27
And we have to bring an example from across the pond.
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๋˜, ๋Œ€์„œ์–‘ ๋„ˆ๋จธ ์˜๊ตญ์˜ ์˜ˆ๋ฅผ ๋ณด๋ฉด, ์ฅ๋“ค๋„ ๋…์— ๋‚ด์„ฑ์ด ์ƒ๊ฒผ๋‹ค๊ณ  ํ•ฉ๋‹ˆ๋‹ค.
13:30
Turns out that rats are also resistant to poisons.
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13:33
Now, what's common to all of these things is
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์—ฌ๊ธฐ์„œ ๊ณตํ†ต์ ์œผ๋กœ ๋ณผ ์ˆ˜ ์žˆ๋Š” ๊ฒƒ์€ ์šฐ๋ฆฌ๊ฐ€ ๊ธฐ์ˆ ์„ ๊ฐ€์ง€๊ณ ์„œ
13:35
the idea that we've had these technologies
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13:38
to control nature only for the last 70, 80 or 100 years
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๋‹จ 70, 80, 100๋…„๊ฐ„ ์ž์—ฐ๋™์•ˆ๋งŒ ์ง€๋ฐฐํ•˜๋‹ค๊ฐ€ ๋ˆˆ ๊นœ์งํ•  ์‚ฌ์ด์—
13:43
and essentially in a blink,
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13:46
we have squandered our ability to control,
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์šฐ๋ฆฌ์˜ ํ†ต์ œ๋ ฅ์„ ๋‚ญ๋น„ํ–ˆ๋‹ค๋Š” ๊ฐœ๋…์ธ๋ฐ,
13:48
because we have not recognized
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๊ทธ๊ฒƒ์€ ์šฐ๋ฆฌ๊ฐ€ ์ž์—ฐ์˜ ์ž์—ฐ ์„ ํƒ๊ณผ ์ง„ํ™”๋ฅผ ํ†ตํ•œ
13:51
that natural selection and evolution was going to find
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๋Œ€ํ•ญ๋ฐฉ๋ฒ•์„ ์ฐพ์„ ๊ฒƒ์„ ๊ฐ„๊ณผํ–ˆ๊ฑฐ๋“ ์š”.
13:54
a way to get back,
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13:55
and we need to completely rethink
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์šฐ๋ฆฌ๋Š” ์ƒ๋ฌผํ•™์  ์œ ๊ธฐ์ฒด๋ฅผ ํ†ต์ œํ•  ์ˆ˜๋‹จ์„ ์‚ฌ์šฉํ•˜๋Š” ๋ฐฉ์‹์„ ์žฌ์ •๋ฆฝ ํ•ด์•ผ ํ•ฉ๋‹ˆ๋‹ค.
13:57
how we're going to use
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13:59
measures to control biological organisms,
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14:02
and rethink how we incentivize
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๋˜, ์ด ๊ท€์ค‘ํ•œ ์ˆ˜๋‹จ๋“ค์˜ ๊ฐœ๋ฐœ๊ณผ ๋„์ž…, ํ•ญ์ƒ์ œ์˜ ๊ฒฝ์šฐ๋Š” ์ฒ˜๋ฐฉ์ด๊ฒ ์ฃ .
14:06
the development, introduction,
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14:08
in the case of antibiotics prescription,
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14:11
and use of these valuable resources.
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๋˜, ์‚ฌ์šฉ๋ฒ•์„ ์žฅ๋ คํ•˜๋Š” ๋ฐฉ์‹๋„ ์žฌ์ •๋ฆฝ ํ•  ํ•„์š”๊ฐ€ ์žˆ์Šต๋‹ˆ๋‹ค.
14:14
And we really now need to start thinking about them
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์ด์ œ๋Š” ์ •๋ง๋กœ ์ด๋Ÿฐ ์ˆ˜๋‹จ๋“ค์„ ์ฒœ์—ฐ์ž์›์œผ๋กœ ๋ด์•ผ ํ•ฉ๋‹ˆ๋‹ค.
14:17
as natural resources.
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14:19
And so we stand at a crossroads.
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์ง€๊ธˆ ์šฐ๋ฆฌ๋Š” ์„ ํƒ์˜ ๊ฐˆ๋ฆผ๊ธธ์— ์„œ ์žˆ์Šต๋‹ˆ๋‹ค.
14:21
An option is to go through that rethinking
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ํ•œ ๊ฐ€์ง€ ๋ฐฉ๋ฒ•์€ ์ด ์žฌ์ •๋ฆฝ์˜ ๊ณผ์ •์„ ๊ฑฐ์น˜๊ณ 
14:24
and carefully consider incentives
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์žฅ๋ ค์ฑ…๋“ค์„ ์‹ ์ค‘ํžˆ ์ ์šฉํ•˜์—ฌ ์‚ฌ์—…ํ•˜๋Š” ๋ฐฉ์‹์„ ๋ฐ”๊พธ๋Š” ๊ฒƒ์ด์ฃ .
14:26
to change how we do business.
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14:28
The alternative is
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๊ทธ๊ฒŒ ์•„๋‹ˆ๋ผ๋ฉด ํ’€์žŽ์— ๋ฒ ์ธ ์ƒ์ฒ˜์กฐ์ฐจ ์น˜๋ช…์ƒ์ด ๋˜๋Š” ์„ธ์ƒ์ด ๋  ๊ฒƒ์ž…๋‹ˆ๋‹ค.
14:31
a world in which even a blade of grass
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14:34
is a potentially lethal weapon.
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14:36
Thank you.
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๊ฐ์‚ฌํ•ฉ๋‹ˆ๋‹ค.
14:38
(Applause)
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(๋ฐ•์ˆ˜)
์ด ์›น์‚ฌ์ดํŠธ ์ •๋ณด

์ด ์‚ฌ์ดํŠธ๋Š” ์˜์–ด ํ•™์Šต์— ์œ ์šฉํ•œ YouTube ๋™์˜์ƒ์„ ์†Œ๊ฐœํ•ฉ๋‹ˆ๋‹ค. ์ „ ์„ธ๊ณ„ ์ตœ๊ณ ์˜ ์„ ์ƒ๋‹˜๋“ค์ด ๊ฐ€๋ฅด์น˜๋Š” ์˜์–ด ์ˆ˜์—…์„ ๋ณด๊ฒŒ ๋  ๊ฒƒ์ž…๋‹ˆ๋‹ค. ๊ฐ ๋™์˜์ƒ ํŽ˜์ด์ง€์— ํ‘œ์‹œ๋˜๋Š” ์˜์–ด ์ž๋ง‰์„ ๋”๋ธ” ํด๋ฆญํ•˜๋ฉด ๊ทธ๊ณณ์—์„œ ๋™์˜์ƒ์ด ์žฌ์ƒ๋ฉ๋‹ˆ๋‹ค. ๋น„๋””์˜ค ์žฌ์ƒ์— ๋งž์ถฐ ์ž๋ง‰์ด ์Šคํฌ๋กค๋ฉ๋‹ˆ๋‹ค. ์˜๊ฒฌ์ด๋‚˜ ์š”์ฒญ์ด ์žˆ๋Š” ๊ฒฝ์šฐ ์ด ๋ฌธ์˜ ์–‘์‹์„ ์‚ฌ์šฉํ•˜์—ฌ ๋ฌธ์˜ํ•˜์‹ญ์‹œ์˜ค.

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