The past, present and future of nicotine addiction | Mitch Zeller

翻译人员: psjmz mz 校对人员: Wanting Zhong

I'm going to tell you a story.

让我给你们讲一个故事。

I'm going to tell you a story

这个故事讲的是

about how the deadliest consumer product imaginable

你能想象的最致命的消费品

came to be.

是如何出现的。

It's the cigarette.

我指的是香烟。

The cigarette is the only consumer product

香烟是独一无二的消费品，

that, when used as intended,

当按照预期使用时，

will kill half of all long-term users prematurely, later in life.

它会让半数长期使用者在 日后的生活中过早死亡。

But this is also a story

但这个故事也是关于

about the work that we're doing at the Food and Drug Administration,

我们在美国食品和药物 管理局（FDA）的工作，

and specifically, the work that we're doing

具体来说，就是我们正进行的

to create the cigarette of the future,

制造未来香烟的工作，

that is no longer capable of creating or sustaining addiction.

使其无法再造成或维持上瘾。

A lot of people think that the tobacco problem or the smoking problem

很多人认为烟草问题 或者吸烟问题

has been solved in the United States

在美国已经解决了，

because of the great progress that's been made

因为过去四五十年间

over the last 40, 50 years,

我们在（烟草的）消费和使用率方面

when it comes to both consumption and prevalence.

都取得了巨大进步。

And it's true;

确实如此；

smoking rates are at historic lows.

吸烟率处于历史低位。

It's true for both adults and for kids.

对于成年人和儿童都是如此。

And it's true that those who continue to smoke

另外那些继续吸烟的人

are smoking far fewer cigarettes per day

每天吸的香烟数量

than at any time in history.

确实比历史任何时候都少。

But what if I told you that tobacco use,

但如果我告诉你们烟草使用，

primarily because of firsthand and secondhand exposure

主要是暴露在香烟烟雾中

吸入的一手烟和二手烟，

to the smoke in cigarettes,

仍然是这个国家完全可预防 的疾病和死亡的主要原因时，

remains the leading cause of completely preventable disease and death

in this country?

你会怎么想？

Well, that's true.

是的，这是真的。

And what if I told you that it's actually killing more people

如果再我告诉你，其实它杀害的人

than we thought to be the case ever before?

比我们想象的要多呢？

That's true, too.

这也是真的。

Smoking kills more people each year than alcohol, AIDS, car accidents,

每年死于吸烟的人数 比酒精、艾滋、车祸、

illegal drugs, murders and suicides combined.

非法毒品、谋杀和自杀 加在一起还多。

Year in and year out.

年复一年。

In 2014,

2014 年，

亚当斯博士 【注：美国现任卫生局局长】

Dr. Adams's predecessor released

the 50th anniversary Surgeon General's report

的前任发表了美国卫生总署 关于吸烟与健康的

on smoking and health.

五十周年报告。

And that report upped the annual death toll from smoking,

这份报告还增加了每年 因吸烟而死亡的人数，

because the list of smoking-related illnesses

因为与吸烟有关的疾病

got bigger.

越来越多。

And so it is now conservatively estimated

依据目前的保守估计，

that smoking kills 480,000 Americans every year.

美国每年因吸烟致死 的人数为 48 万。

These are completely preventable deaths.

这些全是可预防的死亡。

How do we wrap our heads around a statistic like this?

我们该如何理解这样的数据呢？

So much of what we've heard at this conference

我们在这次会议上听到很多

is about individual experiences and personal experiences.

个体经历和个人经验。

How do we deal with this at a population level,

我们如何在人口水平上 处理这个问题，

when there are 480,000 moms,

当每年有 48 万母亲、

dads, sisters, brothers, aunts and uncles

父亲、姐妹、兄弟、阿姨和叔叔

dying unnecessary deaths every year from tobacco?

不必要地死于烟草？

And then what happens when you think about this trajectory

当你思考未来的趋势时

for the future?

会发生什么？

And just do the simple math:

只要做简单的计算：

from the time of the 50th anniversary Surgeon General's report five years ago,

从五年前卫生总署的 五十周年报道开始，

when this horrible statistic was raised,

那是这个可怕的统计数据 发表的时间，

just through mid-century --

只用了半个世纪——

that's more than 17 million avoidable deaths in the United States

美国就有超过 1700 万例可避免的

from tobacco use,

因烟草引起的死亡，

primarily because of cigarettes.

主要是由于香烟。

The Surgeon General concluded

卫生总署总结道，

that 5.6 million children alive in the United States in 2014

2014 年美国有 560 万儿童

will die prematurely later in life because of cigarettes.

日后将会因香烟过早死亡。

Five point six million children.

560 万儿童。

So this is an enormous public health problem for all of us

所以这对我们所有人都是 巨大的公共健康问题，

but especially for us as regulators

尤其对我们这些在 FDA

at the Food and Drug Administration and the Center for Tobacco Products.

和烟草制品中心的监管者而言。

What can we do about it?

我们对此能做些什么呢？

What can we do to reverse this trajectory of disease and death?

我们应如何扭转这种 疾病和死亡的趋势？

Well, we have an interesting guide to help unravel issues

我们有个有趣的指南 来帮助解决问题，

like: How did the cigarette as we know it come to be?

比如：我们所知道的 香烟是怎么来的？

What is the true nature of the tobacco and cigarette business?

烟草和卷烟业的真正性质是什么？

How did the industry behave

该行业在历史上不受监管

in the historically unregulated marketplace?

的市场中是如何运作的？

And our guide

我们的指南来自

is previously secret internal documents from the tobacco industry.

烟草行业曾经保持机密的内部文件。

Come with me

和那么请我一起

in a tobacco industry document time machine.

进入烟草业文件的时间机器。

Nineteen sixty-three

1963 年，

was 25 years before the Surgeon General was finally able to conclude

那是在卫生总署于

that the nicotine and cigarettes was addictive.

1998 年得出结论表明

That did not happen until the Surgeon General's report in 1998.

尼古丁和烟草会导致上瘾的 25 年前。

Nineteen sixty-three

1963 年，

was one year before the first-ever Surgeon General's report in 1964.

是 1964 年史上卫生总署 第一次发布报告的前一年。

I remember 1964.

我记得 1964 年。

I don't remember the Surgeon General's report,

我不记得卫生总署的报告了，

but I remember 1964.

但我记得 1964 年。

I was a kid growing up in Brooklyn, New York.

我是个在纽约布鲁克林长大的孩子。

This was at a time

那个时候

when almost one in two adults in the United States smoked.

几乎一半的美国成年人吸烟。

Both of my parents were heavy smokers at the time.

那时我父母都是重度烟民。

Tobacco use was so incredibly normalized

烟草使用极为正常

that -- and this wasn't North Carolina, Virginia or Kentucky,

——这里不是北卡罗莱纳， 不是弗吉尼亚，也不是肯塔基，

this was Brooklyn --

这是布鲁克林——

we made ashtrays for our parents in arts and crafts class.

我们甚至在工艺美术课上 为父母做烟灰缸。

(Laughter)

（笑声）

The ashtrays I made were pretty awful, but they were ashtrays.

我做的烟灰缸很难看，但倒是能用。

(Laughter)

（笑声）

So normalized that I remember seeing a bowl of loose cigarettes in the foyer

平常到我记得在我们家 和其他房子的门厅里

of our house and other houses

有一碗散装香烟

as a welcoming gesture when friends came over for a visit.

作为朋友来访时的招待品。

OK, we're back in 1963.

好了，我们回到 1963 年。

The top lawyer for Brown and Williamson,

当时美国的第三大烟草公司，

which was then the third-largest cigarette company in the United States,

布朗和威廉姆森的首席律师，

wrote the following:

写下了如下句子：

"Nicotine is addictive.

“尼古丁会上瘾。

We are, then, in the business of selling nicotine -- an addictive drug."

我们的业务是出售尼古丁， 一种会让人上瘾的毒品。”

It's a remarkable statement,

这个声明很不可思议，

as much for what it doesn't say as for what it does say.

不仅在于它说出的话， 还在于它没说的内容。

He didn't say they were in the cigarette business.

他没说他们是做香烟生意。

He didn't say they were in the tobacco business.

他没说他们在烟草行业。

He said they were in the business of selling nicotine.

他说他们是销售尼古丁的行业。

Philip Morris in 1972:

1972 年，菲利普·莫里斯公司说： 【注：烟草公司】

"The cigarette isn't a product,

“香烟不是一种产品，

it's a package.

它是个包装。

The product is nicotine.

产品是尼古丁。

The pack is a storage container for a day's supply of nicotine.

烟盒是储存一天所需 尼古丁的容器。

The cigarette, a dispenser for a dose unit of nicotine."

香烟是一剂量单位 尼古丁的分配器。”

We'll come back to this dose unit notion later.

我们稍后会回到剂量单位的概念。

And R.J. Reynolds in 1972:

还有 1972 年的雷诺兹烟草公司：

"In a sense, the tobacco industry may be thought of as being a specialized,

“在某种意义上，烟草行业 可以说是制药行业中

highly ritualized and stylized segment of the pharmaceutical industry.

一个专业化、高度仪式化 和风格化的部门。

Tobacco products uniquely contain and deliver nicotine,

香烟制品独一无二地 包含并投送尼古丁，

a potent drug with a variety of physiological effects."

一种具有多种生理效应的强效药物。”

At the time, and for many decades, publicly,

当时，并且几十年来，

the industry completely denied addiction

这个行业公开地 完全否认上瘾，

and completely denied causality.

完全否认背后的因果关系。

But they knew the true nature of their business.

但他们知道他们生意的真正本质。

And from time to time,

时不时地，

there have been health scares made public about cigarettes,

有关于香烟的健康恐慌 被公诸于众，

going back many decades.

早在几十年前就是如此。

How did the industry respond?

这个行业是如何回应的？

And how did they respond

它们在这个历史上

in this historically unregulated marketplace?

不受监管的市场中是如何反应的？

Going back to the 1930s,

回到 1930 年代，

it was with advertising that heavily featured imagery of doctors

他们在广告中 让医生和其他医护人员

and other health care professionals

传达安抚信息的画面

sending messages of reassurance.

占据了显著位置。

This is an ad for Lucky Strikes,

这是美国好彩公司的一则广告，

the popular cigarette of the time in the '30s:

它是 30 年代流行的香烟产品：

[20,679 physicians say "Luckies are less irritating."

【20679 名医生说：“好彩刺激性更低。”

Your throat protection against irritation, against cough.]

保护喉咙免受刺激，防止咳嗽。】

(Laughter)

（笑声）

We laugh,

我们笑了，

but this was the kind of advertising

但这就是那类广告

that was there to send a health message of reassurance.

用来传递让人放心的健康信息。

Fast-forward to 1950s, '60s and '70s.

快进到 1950 年代， 60 年代和 70 年代。

And here, again, in the absence of regulation,

同样缺乏监管，

what we're going to see is modifications to the product

我们看到了商家通过修改产品

and product design

和产品设计

to respond to the health concerns of the day.

来响应当时的健康顾虑。

This is the Kent Micronite filter.

这是肯特微型过滤器。

And here, the innovation, if you will, was the filtered cigarette.

这里所谓的创新是过滤香烟。

[Full smoking pleasure ...

【吸烟的全部乐趣……

plus proof of the greatest health protection ever.]

再加上有史以来最有效的 健康保护措施。】

What the smoker of this product didn't know,

这个产品的烟民不知道，

what their doctor didn't know,

他们的医生不知道，

what the government didn't know,

他们的政府不知道，

is that this was a filter that was lined with asbestos --

这个过滤器的内衬是石棉——

(Gasps)

（惊呼）

so that when smokers were smoking this filtered cigarette

所以当吸烟者 吸食过滤香烟时

and still inhaling the chemicals and smoke

仍然吸入化学物质和烟雾，

that we know are associated with cancer and lung disease

这些我们知道跟癌症、肺病

and heart disease,

和心脏病相关的东西，

they were also sucking down asbestos fibers.

他们还在吮吸石棉纤维。

(Gasps)

（惊呼）

In the 1960s and the 1970s,

在 1960 和 1970 年代，

the so-called innovation was the light cigarette.

所谓的创新是淡味香烟。

This is a typical brand of the day called True.

这是当时一个典型品牌， 叫做 True。

And this is after the Surgeon General's reports have started coming out.

这是在卫生总署报告 开始发行后出现的。

And you see the look of concern on her face.

你可以看到她脸上的担忧。

[Considering all I'd heard,

【考虑到我听到的一切，

I decided to either quit or smoke True.

我决定，要么不戒烟， 要么抽 True。

I smoke True.]

我选择 True。】

(Laughter)

(笑声)

[The low tar, low nicotine cigarette.]

【低焦油，低尼古丁香烟。】

And then it says, "Think about it."

然后它说，“考虑一下。”

And then even below that in the small print

然后在更下面的地方， 用小字写着

are tar numbers and nicotine numbers.

焦油和尼古丁数据。

What was a light cigarette?

什么是淡味香烟？

How did it work?

它的原理是什么？

This is an illustration of the product modification

这个图例展示了

被称为“过滤通风”的产品修改设计。

known as "filter ventilation."

这并不是真正过滤器的放大图。

That's not a real filter blown up.

That's just a picture

这只是张图示，能让你看到

so that you could see the rows of laser-perforated ventilation holes

在过滤器上的

一排排激光穿孔的通风孔。

that were put on the filter.

When you look at a real cigarette,

现实中你观察香烟时，

it's harder to see.

它很难看到。

Every patent for this product shows

这种产品的每一项专利都说明

that the ventilation holes should be 12 millimeters

通风孔应和过滤器的唇端

相距 12 毫米。

from the lip end of the filter.

How did it work?

它的原理是怎样的？

The cigarette got stuck into a machine.

把香烟塞进机器里。

The machine started puffing away on the cigarette

机器开始吞云吐雾地吸烟，

and recording tar and nicotine levels.

并记录下焦油和尼古丁的含量。

As the machine smoked,

当机器抽烟时，

outside air came through those ventilation holes

外部空气进入这些通风孔，

and diluted the amount of smoke that was coming through the cigarette.

稀释了香烟产生的烟雾。

So as the machine smoked,

所以当机器抽烟时，

there really was less tar and nicotine being delivered

确实比常规香烟输送的

compared to a regular cigarette.

焦油和尼古丁要少。

What the tobacco industry knew

烟草工业知道

was that human beings don't smoke like machines.

人类不像机器那样抽烟。

How do human beings smoke this?

人类是如何抽烟的？

Where do the fingers go?

手指放在哪里呢？

(Murmurs)

（低语）

Where do the lips go?

嘴唇应该放在哪里？

I told you that the patent said

我说过，专利说

that the holes are 12 millimeters from the lip end.

通风孔距唇端 12 毫米。

The smoker didn't even know they were there,

吸烟者甚至不知道它们在那里，

but between fingers and lips, the holes get blocked.

但在手指和嘴唇之间， 通风孔被挡住了。

And when the holes get blocked, it's no longer a light cigarette.

当这些小孔被堵住时， 它就不再是淡味香烟了。

Turns out that there's actually

结果实际上，

basically as much nicotine inside a light cigarette

淡味香烟里面的尼古丁含量

其实跟常规香烟一样。

as a regular cigarette.

The difference was what's on the outside.

差异在于外面的东西。

But once you block what's on the outside,

但一旦你挡住外面的东西，

it's a regular cigarette.

它就是一支常规的香烟。

Congress put FDA in the business of regulating tobacco products

10 年前的六月，国会让 FDA

10 years ago this June.

介入烟草监管。

So you heard the statistics at the beginning

于是你在开头听到了那些

about the extraordinary contribution to disease and death that cigarettes make.

香烟导致疾病和死亡的惊人统计。

We've also been paying a lot of attention

我们也把很多注意力放到

to how the cigarette works as a drug-delivery device

香烟作为药物传输设备的工作原理

and the remarkable efficiency with which it delivers nicotine.

以及它传递尼古丁的非凡效率。

So let's take a look.

那么让我们看看。

When the smoker puffs on the cigarette,

当吸烟者吸一口烟时，

the nicotine from that puff gets up into the brain

这口烟里的尼古丁 会在不到 10 秒内

in less than 10 seconds.

进入大脑。

Less than 10 seconds.

不到 10 秒。

Up in the brain,

在大脑里，

there are these things called "nicotinic receptors."

有叫“尼古丁受体”的东西。

They're there ...

它们在那里……

waiting.

等待着。

They're waiting for, in the words of that Philip Morris document,

它们在等待，用菲利普·莫里斯 公司那份文件的话来说，

the next "dose unit of nicotine."

下一个“剂量单位”的尼古丁。

The smoker that you see outside,

你看到在外面的吸烟者，

huddled with other smokers,

跟其他吸烟者挤在一起，

in the cold,

在寒冷中，

in the wind,

在风中，

in the rain,

在雨中，

is experiencing craving

正在经历渴望，

and may be experiencing the symptoms of withdrawal.

并可能正在经历戒断症状。

Those symptoms of withdrawal are a chemical message

戒断症状是这些受体

that these receptors are sending to the body,

传递给身体的化学信息，

saying, "Feed me!"

说，“喂我！”

And a product that can deliver the drug in less than 10 seconds

一个可以在10 秒内 传递药物的产品

turns out to be an incredibly efficient and incredibly addictive product.

结果成为一种难以置信 的高效和上瘾的产品。

We've spoken to so many addiction treatment experts

多年来，我们跟很多成瘾治疗专家

over the years.

交谈过。

And the story I hear is the same over and over again:

我听到同样的故事不断重复：

"Long after I was able to get somebody off of heroin

“我早就能让某人戒掉海洛因、

or cocaine or crack cocaine,

可卡因或强效纯可卡因，

I can't get them to quit cigarettes."

但我无法让他们戒烟。”

A large part of the explanation is the 10-second thing.

很大一部分解释是 那个 10 秒钟。

FDA has it within its regulatory reach

FDA 已经在监管范围内

to use the tools of product regulation

使用产品监管工具

to render cigarettes as we know them minimally or nonaddictive.

让我们所知的香烟 成瘾性最低或不成瘾。

We're working on this.

我们正在为此努力。

And this could have a profound impact at a population level

这一个政策可能在人口层面上

from this one policy.

产生深远的影响。

We did dynamic population-level modeling a year ago,

一年前我们做了人口层面 的动态建模，

and we published the results in "The New England Journal."

我们在《新英格兰杂志》 上发表了研究结果。

And because of the generational effect of this policy,

因为这项政策的世代效应，

which I'll explain in a minute,

我马上会解释，

here's what we project out through the end of the century:

这是我们预测到的本世纪末的情况：

more than 33 million people

超过 3300 万

who would otherwise have gone on to become regular smokers won't,

本来会成为常规吸烟者的人 不会成为吸烟者，

because the cigarette that they'll be experimenting with

因为他们将要试验的香烟

can't create or sustain addiction.

不会产生或维持成瘾。

This would drive the adult smoking rate down to less than one and a half percent.

这将使成人吸烟率 下降到 1.5% 以下。

And these two things combined

这两件事情相结合

would result in the saving of more than eight million cigarette-related deaths

可以拯救那些本会因

世代影响而导致的

that would otherwise have occurred

800 多万例吸烟有关的死亡。

from the generational impact of this.

Now, why am I saying "generational"?

为什么我提到“世代”？

It's about kids.

这跟儿童有关。

Ninety percent of adult smokers started smoking when they were kids.

90% 的成人吸烟者 从孩童时期就开始吸烟。

Half of them became regular smokers

其中一半人在合法购烟年龄前

before they were legally old enough to buy a pack of cigarettes.

就成为了老烟民。

Half of them became regular smokers before they were 18 years old.

其中一半人在 18 岁之前 就成为了老烟民。

Experimentation.

尝试。

Regular smoking.

惯常吸烟。

Addiction.

上瘾。

Decades of smoking.

数十年烟龄。

And then the illness,

然后是疾病，

and that's why we're talking about a product

这就是为什么我们讨论的这个产品

that will kill half of all long-term users prematurely later in life.

会让一半的长期使用者 在以后过早死亡。

The generational impact of this nicotine-reduction policy

这个减少尼古丁的政策会带来深远

is profound.

的世代影响。

Those old industry documents had a word for young people.

那些旧的行业文件中用 一个词形容年轻人。

They were described as "the replacement smokers."

他们被称为“替代吸烟者”。

The replacement smokers for addicted adult smokers

替代那些死亡或戒烟

who died or quit.

的成年烟民。

Future generations of kids, especially teens,

未来世代的小孩，尤其是青少年，

are going to engage in risky behavior.

将会进行高风险行为。

We can't stop that.

我们无法阻止他们。

But what if the only cigarette that they could get their hands on

但如果他们唯一能入手的香烟

could no longer create or sustain addiction?

无法产生或维持上瘾会怎样？

That's the public health return on investment

这是长期在人口层面上投资

at a population level over time.

的公共健康回报。

Haven't said anything about e-cigarettes.

我还没有说到任何有关 电子烟的事情。

But I have to say something about e-cigarettes.

但我得谈一下电子烟。

(Laughter)

（笑声）

We are dealing with an epidemic of kids' use of e-cigarettes.

我们正在应对电子烟 在小孩中的流行使用。

And what troubles us the most,

最让我们感到困扰的，

in combination with the rising numbers when it comes to prevalence,

是与不断上升的流行率相结合的

is frequency.

使用频率。

Not only are more kids using e-cigarettes,

不仅有更多小孩在使用电子烟，

but more kids are using e-cigarettes 20 or more days in the past 30 days

而且自电子烟推出市场以来， 在过去 30 天中

使用电子烟 20 天以上 的小孩数目达到了新高。

than at any time since e-cigarettes came onto the market.

And at FDA, we're doing everything that we can

在 FDA，我们正倾尽全力

使用项目和政策，

using program and policy,

first to get the word out to kids

首先向小孩传递信息说，

that this is not a harmless product

这不是一种无害的产品，

and to make sure that kids aren't initiating and experimenting

并确保孩子不会主动开始或尝试

on any tobacco product,

任何烟草制品，

whether combustion is present or not.

无论是否需要点燃。

But think about e-cigarettes in a properly regulated marketplace

但是想想电子烟在 一个合理监管的市场上，

as something that could be of benefit

对于那些试图戒掉香烟

to addicted adult cigarette smokers

的上瘾成年吸烟者来说

who are trying to transition away from cigarettes.

可能是有益的。

So, I'll leave you with this vision:

所以，我将留给你们如下的愿景：

imagine a world

想象这样一个世界，

where the only cigarette that future generations of kids

因为一个政策，

未来世代的儿童

could experiment with

could no longer create or sustain addiction

唯一能够尝试到的香烟

无法再产生或维持上瘾。

because of a single policy.

Imagine a world

想象这样一个世界，

where health-concerned cigarette smokers,

关注健康的吸烟者

可以过渡到危害更小的

especially if a policy goes into effect

其它尼古丁传递形式，

that takes the nicotine levels down to minimally or nonaddictive levels,

尤其是在让尼古丁水平降低到 最低或不上瘾程度

could transition to alternative and less harmful forms

的政策开始生效时。

of nicotine delivery,

starting with FDA-approved nicotine medications,

他们可以从 FDA 批准的 尼古丁药物开始，

like the gum, patch and lozenge.

比如口香糖、贴片和嚼锭。

And finally,

最后，

imagine a world and a properly regulated marketplace,

想象这样一个世界和 一个合理监管的市场，

whether it's e-cigarettes or whatever the technology of the day,

无论是电子烟还是 任何当时的科技，

it's not the product developers and the marketers

都不是由产品开发者和市场营销者

决定什么产品进入市场

who decide which products come to market

and what claims get made for them,

以及对产品做出声明，

it's review scientists at FDA,

而是由 FDA 的审批科学家

who look at applications

审查申请，

and decide, using the standard that Congress has entrusted us

并使用国会委托我们

实现和执行的标准，

to implement and enforce,

来决定一个特定的产品 是否能够进入市场，

whether a particular product should come to market,

because the marketing of that product and the words of our law

因为那个产品的营销 和我们遵循的法律

would be appropriate for the protection of the public health.

应当有益于保护公众健康。

These are the kinds of powerful regulatory tools

这些都是我们可以使用的

that are within our reach

强有力的监管工具，

to deal with what remains

可以用来处理这个国家的

the leading cause of completely preventable disease and death

完全可预防的疾病和死亡

in the country.

的要因。

If we get this right,

如果我们正确处理，

that trajectory, those 5.6 million kids,

就能打破那个趋势，

拯救那 560 万儿童。

is breakable.

Thank you.

谢谢。

(Applause)

（鼓掌）