Maryn McKenna: What do we do when antibiotics don’t work any more?

翻译人员: Gabriella Hu 校对人员: Xiaoya Song

This is my great uncle,

这是我的曾伯父，

my father's father's younger brother.

我的父亲的父亲的弟弟

His name was Joe McKenna.

他叫乔·麦肯纳

He was a young husband and a semi-pro basketball player

他是一位年轻的丈夫 和一位半职业篮球运动员，

and a fireman in New York City.

还是一位纽约市消防员

Family history says he loved being a fireman,

家族史中说他非常喜爱当一名消防员，

and so in 1938, on one of his days off,

在1938年，放假的一天，

he elected to hang out at the firehouse.

他选择去消防站

To make himself useful that day, he started polishing all the brass,

他想帮忙，于是就开始擦拭所有的黄铜，

the railings on the fire truck, the fittings on the walls,

消防车上的栏杆，墙上的配件，

and one of the fire hose nozzles,

其中的一个消防水管的喷嘴，

a giant, heavy piece of metal,

一块巨大，沉重的金属，

toppled off a shelf and hit him.

从架子上掉了下来，并砸中了他

A few days later, his shoulder started to hurt.

几天之后，他的肩膀开始疼痛

Two days after that, he spiked a fever.

再过了两天，他突发高烧。

The fever climbed and climbed.

高烧不退，并且不断攀升

His wife was taking care of him,

他的妻子一直在照顾他，

but nothing she did made a difference, and when they got the local doctor in,

但是她所做的一切都没有用， 当他们请来医生时，

nothing he did mattered either.

也对他无能为力

They flagged down a cab and took him to the hospital.

他们拦下了一辆出租车， 把他带到医院

The nurses there recognized right away that he had an infection,

那里的护士马上看出他得了感染，

what at the time they would have called "blood poisoning,"

当时候的人把它叫败血症，

and though they probably didn't say it,

尽管他们没有说什么，

they would have known right away

他们肯定马上就知道

that there was nothing they could do.

他们已经无力医治了

There was nothing they could do because the things we use now

他们什么办法都没有 是因为我们现在拥有的

to cure infections didn't exist yet.

治疗感染的药品在那时还没有存在

The first test of penicillin, the first antibiotic,

第一个青霉素，抗生素的测试，

was three years in the future.

三年之后才发生

People who got infections either recovered, if they were lucky,

当时一旦得了感染， 能够康复算是幸运的，

or they died.

要不然就没命了

My great uncle was not lucky.

我的曾伯父没有那么幸运

He was in the hospital for a week, shaking with chills,

他在医院待了一个星期，一直打寒颤，

dehydrated and delirious,

脱水，并且神志不清，

sinking into a coma as his organs failed.

他的器官衰退，进入了昏迷状态

His condition grew so desperate

他的状况十分危急，

that the people from his firehouse lined up to give him transfusions

消防站的人排队给他输血，

hoping to dilute the infection surging through his blood.

希望能稀释他血液中的感染

Nothing worked. He died.

一切都没有用，他最终不幸去世了

He was 30 years old.

他年仅30岁

If you look back through history,

如果回顾历史，

most people died the way my great uncle died.

有许多人离世的情况同我曾伯父类似

Most people didn't die of cancer or heart disease,

许多人并不是因为癌症或心脏病去世，

the lifestyle diseases that afflict us in the West today.

不是现在折磨我们的生活习惯病

They didn't die of those diseases because they didn't live long enough

他们没有患上那些疾病是因为他们活不到

to develop them.

得那些疾病的年龄

They died of injuries --

他们是因身体受伤而死 --

being gored by an ox,

被牛角顶伤，

shot on a battlefield,

在战场上中弹，

crushed in one of the new factories of the Industrial Revolution --

在工业革命的新工厂中粉身碎骨 --

and most of the time from infection,

很多时候，是因为得了感染，

which finished what those injuries began.

因伤势造成的感染

All of that changed when antibiotics arrived.

当抗生素到来时，一切都变了

Suddenly, infections that had been a death sentence

曾经意味着死亡的感染突然

became something you recovered from in days.

变成了几天就能恢复的病

It seemed like a miracle,

它就像奇迹

and ever since, we have been living inside the golden epoch of the miracle drugs.

从此以后， 我们就一直生活在特效药的黄金时代中

And now, we are coming to an end of it.

现在，它即将结束了

My great uncle died in the last days of the pre-antibiotic era.

我的曾伯父在前抗生素时代 最后的日子中去世的

We stand today on the threshold of the post-antibiotic era,

我们现在已经能看到后抗生素时代的到来

in the earliest days of a time when simple infections

感染会像从前一样致命，

such as the one Joe had will kill people once again.

杀死乔（曾伯父）的致命感染会卷土重来

In fact, they already are.

其实， 这些感染已经夺取了很多人的性命了

People are dying of infections again because of a phenomenon

人们再次死于感染因为有一种现象

called antibiotic resistance.

叫做抗生素抗药性

Briefly, it works like this.

简单的来说，它的原理是这样的

Bacteria compete against each other for resources, for food,

细菌为了资源和食物相互竞争，

by manufacturing lethal compounds that they direct against each other.

有的细菌会针对性地制造 致命的化合物攻击对方

Other bacteria, to protect themselves,

其它的细菌则用化合物保护自己，

evolve defenses against that chemical attack.

发展防御系统对抗这些化学攻击

When we first made antibiotics,

我们最初发明抗生素时，

we took those compounds into the lab and made our own versions of them,

我们在实验室中创造了 我们自己版本的化合物

and bacteria responded to our attack the way they always had.

细菌像往常一样对我们的攻击作出了响应

Here is what happened next:

接下来是这样的：

Penicillin was distributed in 1943,

青霉素是在1943年发布的，

and widespread penicillin resistance arrived by 1945.

而广泛的青霉素耐药性在1945年就到来了

Vancomycin arrived in 1972,

万古霉素出现在1972年，

vancomycin resistance in 1988.

万古霉素耐药性就在1988年

Imipenem in 1985,

亚胺培南于1985年，

and resistance to in 1998.

抗药性在1998年又出现了

Daptomycin, one of the most recent drugs, in 2003,

2003年的达托霉素是最新的药物之一，

and resistance to it just a year later in 2004.

抗药性在2004年就紧跟而至

For 70 years, we played a game of leapfrog --

在这70年中， 我们像是在做一个蛙跳的游戏 --

our drug and their resistance,

一种药物，一种抗药性，

and then another drug, and then resistance again --

接下来又一种药物，又一个抗药性 --

and now the game is ending.

现在这个游戏结束了

Bacteria develop resistance so quickly that pharmaceutical companies

细菌的抵抗力极快， 以至于制药公司

have decided making antibiotics is not in their best interest,

认为生产抗生素不是他们的最佳利益，

so there are infections moving across the world

所以现在各种感染风靡全球，

for which, out of the more than 100 antibiotics

市场上可购买到的100多种

available on the market,

抗生素中，

two drugs might work with side effects,

可能只有两种药物会管用， 并带有副作用

or one drug,

或者一个药，

or none.

甚至没有

This is what that looks like.

看上去就是这个样子的

In 2000, the Centers for Disease Control and Prevention, the CDC,

在2000年， 疾病控制与预防中心（CDC），

identified a single case

鉴定有一例患者

in a hospital in North Carolina

在一家位于北卡罗来纳的医院里

of an infection resistant to all but two drugs.

除了两种药外，对其它药物都有抗药性

Today, that infection, known as KPC,

现在，这种感染被称为KPC，

has spread to every state but three,

除了3个州外，已经传播到了美国各地，

and to South America, Europe

还有南美，欧洲

and the Middle East.

和中东地区

In 2008, doctors in Sweden

在2008年，瑞典医生

diagnosed a man from India with a different infection

确诊一名来自印度的男子患有的感染

resistant to all but one drug that time.

只对一种药没有抗药性

The gene that creates that resistance,

创造这种抗药性的基因

known as NDM, has now spread from India into China, Asia, Africa,

叫做NDM，现在已经从印度传播到 中国，亚洲，非洲，

Europe and Canada, and the United States.

欧洲和加拿大，还有美国

It would be natural to hope

我们真心希望

that these infections are extraordinary cases,

这些感染病例只是罕见情况，

but in fact,

但是其实，

in the United States and Europe,

在美国和欧洲，

50,000 people a year

每年都有50,000人

die of infections which no drugs can help.

死于无药可救的感染

A project chartered by the British government

一项由英国政府特许的项目

known as the Review on Antimicrobial Resistance

叫做抗生素抗药性评审

estimates that the worldwide toll right now is 700,000 deaths a year.

预计每年全球死亡人数有700,000

That is a lot of deaths,

这个数字巨大，

and yet, the chances are good that you don't feel at risk,

然而这个比例还是很小， 所以我们感觉不到风险，

that you imagine these people were hospital patients

你想象他们是医院里的病人

in intensive care units

在重症监护室

or nursing home residents near the ends of their lives,

或者住在疗养院中，接近生命的尽头，

people whose infections are remote from us,

感觉他们离我们很远，

in situations we can't identify with.

他们的状况我们还很陌生

What you didn't think about, none of us do,

你们想不到的是， 我们所有人都想不到的是

is that antibiotics support almost all of modern life.

抗生素支撑着几乎所有的现代生活

If we lost antibiotics,

如果我们失去了抗生素，

here's what else we'd lose:

我们还会失去所有这些东西：

First, any protection for people with weakened immune systems --

首先，所有免疫系统较弱的人 都失去了保护 --

cancer patients, AIDS patients,

癌症患者，艾滋病患者，

transplant recipients, premature babies.

器官移植接受者，早产婴儿

Next, any treatment that installs foreign objects in the body:

接下来，任何需要在人体中 安装异物的治疗：

stents for stroke, pumps for diabetes,

中风时使用的支架， 治疗糖尿病的胰岛素磊

dialysis, joint replacements.

透析，关节置换

How many athletic baby boomers need new hips and knees?

婴儿潮一代的运动员有多少需要髋关节， 膝关节置换？

A recent study estimates that without antibiotics,

一个近期的研究预计如果没有抗生素，

one out of ever six would die.

每六个人中就会有一人死亡

Next, we'd probably lose surgery.

接下来，我们可能会失去手术

Many operations are preceded

很多手术的进行

by prophylactic doses of antibiotics.

需要预防性剂量的抗生素

Without that protection,

如果没有这个措施，

we'd lose the ability to open the hidden spaces of the body.

我们就不可能对人体隐蔽的器官开刀

So no heart operations,

于是就不会有心脏手术，

no prostate biopsies,

没有前列腺活检，

no Cesarean sections.

没有剖腹产

We'd have to learn to fear infections that now seem minor.

我们会惧怕那些现在看似微小的感染

Strep throat used to cause heart failure.

咽喉炎以前会导致心脏衰竭

Skin infections led to amputations.

皮肤感染会发展成截肢

Giving birth killed, in the cleanest hospitals,

即使在最干净的医院， 孕产妇的死亡率

almost one woman out of every 100.

几乎达到百分之一

Pneumonia took three children out of every 10.

每10个孩子中， 肺炎会夺走3个孩子的生命

More than anything else,

更重要的是，

we'd lose the confident way we live our everyday lives.

我们失去了生活的信心

If you knew that any injury could kill you,

如果你知道任何伤口都有可能致命，

would you ride a motorcycle,

你还会不会去骑摩托车，

bomb down a ski slope,

从雪山上飞驰而下，

climb a ladder to hang your Christmas lights,

爬上梯子去挂你的圣诞彩灯，

let your kid slide into home plate?

让你的孩子滑进本垒吗？

After all, the first person to receive penicillin,

毕竟，第一名接受青霉素的病人，

a British policeman named Albert Alexander,

一名叫阿尔伯特·亚历山大英国警察，

who was so ravaged by infection that his scalp oozed pus

他的感染严重到他的头皮都渗出了脓液，

and doctors had to take out an eye,

一只眼睛也被医生摘除了，

was infected by doing something very simple.

他的感染的起因十分微不足道

He walked into his garden and scratched his face on a thorn.

他走进他的花园，然后脸上被刺划伤了

That British project I mentioned which estimates that the worldwide toll

刚才我提到的英国项目预计现在每年的

right now is 700,000 deaths a year

全球死亡人数为700,000人

also predicts that if we can't get this under control by 2050,

他们也预测如果我们无法在2050年前 控制现在的情况，

not long, the worldwide toll will be 10 million deaths a year.

在不久的将来， 全球死亡人数会上升到一千万

How did we get to this point

我们是如何走到这一步的，

where what we have to look forward to

面对这些可怕的数字

is those terrifying numbers?

我们的未来将何去何从？

The difficult answer is, we did it to ourselves.

残酷的现实是， 这都是我们的所作所为

Resistance is an inevitable biological process,

抗药性是一个必然的生物过程，

but we bear the responsibility for accelerating it.

但是我们要为加快这一过程承担责任

We did this by squandering antibiotics

我们随心所欲地滥用抗生素的行为

with a heedlessness that now seems shocking.

现在看来十分触目惊心

Penicillin was sold over the counter until the 1950s.

青霉素在上世纪50年代之前是非处方药

In much of the developing world, most antibiotics still are.

在很多发展中国家，很多抗生素依旧是

In the United States, 50 percent

在美国，医院给出的

of the antibiotics given in hospitals are unnecessary.

50%的抗生素都是没有必要的

Forty-five percent of the prescriptions written in doctor's offices

医生办公室中开出的45%的药

are for conditions that antibiotics cannot help.

都是抗生素治不了的病

And that's just in healthcare.

这只是在医疗系统中的数据

On much of the planet, most meat animals get antibiotics every day of their lives,

在全球很多地方， 许多家畜每天都进食抗生素，

not to cure illnesses,

不是为了治疗疾病，

but to fatten them up and to protect them against

而是把它们催肥，为了在

the factory farm conditions they are raised in.

工厂化养殖的环境下保护它们

In the United States, possibly 80 percent

在美国，每年大约有80%的

of the antibiotics sold every year go to farm animals, not to humans,

抗生素是卖给农场动物的， 不是病人，

creating resistant bacteria that move off the farm

于是创造了抗药性细菌， 它们从农场流到了

in water, in dust,

水里，到灰尘中，

in the meat the animals become.

到这些动物最终变成的肉制品中

Aquaculture depends on antibiotics too,

水产养殖也依赖抗生素，

particularly in Asia,

尤其是在亚洲，

and fruit growing relies on antibiotics

水果种植也依靠抗生素，

to protect apples, pears, citrus, against disease.

让苹果，梨，柑橘远离病害，

And because bacteria can pass their DNA to each other

由于细菌能够互相传递DNA

like a traveler handing off a suitcase at an airport,

就像一个旅客在机场托运行李，

once we have encouraged that resistance into existence,

一旦我们促进这种耐药性，

there is no knowing where it will spread.

就无法控制它的传播

This was predictable.

这是可预测的

In fact, it was predicted

事实上，发现青霉素的科学家，

by Alexander Fleming, the man who discovered penicillin.

亚历山大·弗莱明早已预测到了

He was given the Nobel Prize in 1945 in recognition,

他在1945年获得诺贝尔奖表彰，

and in an interview shortly after, this is what he said:

在之后的一个采访中，他说：

"The thoughtless person playing with penicillin treatment

“滥用青霉素的无知的人

is morally responsible for the death of a man

将在道德上为他人的死负责，

who succumbs to infection

他的无知带来了耐药性的问题，

with a pencillin-resistant organism."

导致那些人为此丧命。“

He added, "I hope this evil can be averted."

他补充道：”我希望能够 避免这个厄运。“

Can we avert it?

我们能避免它吗？

There are companies working on novel antibiotics,

有些公司正在研发新型抗生素，

things the superbugs have never seen before.

一些超级细菌从未见过的东西

We need those new drugs badly,

我们十分迫切地需要这些药物，

and we need incentives:

我们也需要一些奖励：

discovery grants, extended patents,

研发补助，延长专利，

prizes, to lure other companies into making antibiotics again.

奖金等等， 去吸引其它公司再次制造去抗生素

But that probably won't be enough.

但是这还不够

Here's why: Evolution always wins.

这就是原因：大自然的进化总会赢

Bacteria birth a new generation every 20 minutes.

细菌每20分钟就能生成新的一代

It takes pharmaceutical chemistry 10 years to derive a new drug.

药物化学家需要花10年 才能制成一种新的药

Every time we use an antibiotic,

每次我们使用一种新的抗生素时，

we give the bacteria billions of chances

我们就给了细菌数亿次机会

to crack the codes

去破解我们建造的

of the defenses we've constructed.

防御系统的密码

There has never yet been a drug

迄今为止，任何药物都不能够

they could not defeat.

打败它们

This is asymmetric warfare,

这是一场不公平的战争，

but we can change the outcome.

但是我们能够改变它的结果

We could build systems to harvest data to tell us automatically and specifically

我们能够创造一个系统去收集数据， 并且自动、具体地

how antibiotics are being used.

告诉我们抗生素是如何被使用的

We could build gatekeeping into drug order systems

我们可以在药物订购系统中放置守门人，

so that every prescription gets a second look.

再次检查每一个处方

We could require agriculture to give up antibiotic use.

我们可以要求在农业中不再使用抗生素

We could build surveillance systems

我们可以构建监控系统

to tell us where resistance is emerging next.

及时告知我们哪里出现了抗药性

Those are the tech solutions.

这些是科技解决方案

They probably aren't enough either,

这些还不够，

unless we help.

我们都要出一份力

Antibiotic resistance is a habit.

抗生素耐药性是一种习惯

We all know how hard it is to change a habit.

我们都知道改掉一种习惯是很难的

But as a society, we've done that in the past.

但是作为社会中的一员， 我们曾经做到过

People used to toss litter into the streets,

人们曾经在马路上随便扔垃圾，

used to not wear seatbelts,

曾经不系安全带，

used to smoke inside public buildings.

曾经在公共场所抽烟

We don't do those things anymore.

我们不再这么做了

We don't trash the environment

我们不破坏环境，

or court devastating accidents

不引发巨大事故，

or expose others to the possibility of cancer,

不再使别人得到患有癌症的风险，

because we decided those things were expensive,

因为我们懂得那些事情代价太高，

destructive, not in our best interest.

具有毁灭性，对我们没有一点益处

We changed social norms.

我们改变了社会规范

We could change social norms around antibiotic use too.

我们也可以改变抗生素使用的规范

I know that the scale of antibiotic resistance

我知道抗生素耐药性的规模

seems overwhelming,

看似巨大，

but if you've ever bought a fluorescent lightbulb

但是如果你对气候变化感到忧虑，

because you were concerned about climate change,

于是去购买荧光灯泡，

or read the label on a box of crackers

或者考虑到棕榈油毁林，

because you think about the deforestation from palm oil,

就每次阅读一盒饼干上的标签

you already know what it feels like

你应该已经知道

to take a tiny step to address an overwhelming problem.

用生活中的一点一滴去改变一个大问题 是什么样的感觉

We could take those kinds of steps for antibiotic use too.

我们也可以用这样的方式 去改变抗生素的使用

We could forgo giving an antibiotic if we're not sure it's the right one.

如果不确定我们是否正确使用抗生素， 那就放弃它

We could stop insisting on a prescription for our kid's ear infection

我们可以 不要执意为孩子的耳部感染开处方，

before we're sure what caused it.

而是先查明起因

We could ask every restaurant,

我们可以询问每一家餐厅，

every supermarket,

每一家超市

where their meat comes from.

它们的肉制品是从哪里来的

We could promise each other

我们可以做承诺

never again to buy chicken or shrimp or fruit

不再购买长期使用抗生素养殖的

raised with routine antibiotic use,

鸡，虾或水果，

and if we did those things,

若果我们能做到这些，

we could slow down the arrival of the post-antibiotic world.

我们可以减缓后抗生素时代的到来

But we have to do it soon.

但是我们要马上开始行动

Penicillin began the antibiotic era in 1943.

青霉素在1943年开启了抗生素时代

In just 70 years, we walked ourselves up to the edge of disaster.

仅仅70年后，我们已经走在灾难的边缘

We won't get 70 years

我们没有70年的时间

to find our way back out again.

去找到我们的出路

Thank you very much.

谢谢大家！

(Applause)

（掌声）