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

譯者: Lilian Chiu 審譯者: Lo Hsien Huang

I'm going to tell you a story.

我跟各位講一個故事。

I'm going to tell you a story

我要講的這個故事

about how the deadliest consumer product imaginable

是關於我們所能想像最致命的 消費性產品是怎麼出現的。

came to be.

It's the cigarette.

這產品就是香菸。

The cigarette is the only consumer product

只有香菸這種消費性產品

that, when used as intended,

按照預期使用，

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

有一半的長期使用者， 在往後的生活中過早死亡。

But this is also a story

但這個故事也是關於

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

我們在食品及藥物管理局 所做的努力，

and specifically, the work that we're doing

明確來說，我們的努力

to create the cigarette of the future,

是為了創造未來的香菸，

that is no longer capable of creating or sustaining addiction.

這種香菸不再讓人成瘾。

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

很多人認為，菸草問題或抽菸問題

has been solved in the United States

在美國已經解決了，

because of the great progress that's been made

因為在過去四、五十 年間有很大的進展，

over the last 40, 50 years,

when it comes to both consumption and prevalence.

不論是消費面上 或普及面上皆是如此。

And it's true;

的確如此；

smoking rates are at historic lows.

抽菸比率達到史上的低點。

It's true for both adults and for kids.

成人是如此，孩子也是如此。

And it's true that those who continue to smoke

也的確，那些繼續抽菸的人

are smoking far fewer cigarettes per day

每天所抽的香菸數

than at any time in history.

也是史上最低。

But what if I told you that tobacco use,

但若我告訴各位菸草製品的使用，

primarily because of firsthand and secondhand exposure

主要是因為吸入 一手菸和二手菸

to the smoke in cigarettes,

remains the leading cause of completely preventable disease and death

在這個國家中，仍是可預防疾病

和死亡的主要成因，你們怎麼想？

in this country?

Well, that's true.

這是真的。

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

若我告訴各位，因此而死亡的人數

than we thought to be the case ever before?

比過去都還要多，你們怎麼想？

That's true, too.

這也是真的。

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

每年因抽菸而死亡的人數 超過酒精、愛滋病、車禍、

illegal drugs, murders and suicides combined.

非法藥物、謀殺， 及自殺通通加在一起。

Year in and year out.

每年皆如此。

In 2014,

2014 年，

Dr. Adams's predecessor released

美國前任的醫務總監發表了

the 50th anniversary Surgeon General's report

關於抽菸和健康的 五十週年醫務總監報告。

on smoking and health.

And that report upped the annual death toll from smoking,

該報告提高了抽菸 造成的年死亡人數，

because the list of smoking-related illnesses

因為抽菸相關疾病的清單

got bigger.

變得更長了。

And so it is now conservatively estimated

現在，根據保守估計，

that smoking kills 480,000 Americans every year.

抽菸每年造成四十八萬美國人死亡。

These are completely preventable deaths.

這些死亡都是可以避免的。

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

我們要如何了解像這樣的統計數字？

So much of what we've heard at this conference

在這次大會中，我們聽到好多內容

is about individual experiences and personal experiences.

都是關於個體、個人的經驗。

How do we deal with this at a population level,

我們要如何從全體人民層級 來處理這個問題：

when there are 480,000 moms,

每年有四十八萬個母親、

dads, sisters, brothers, aunts and uncles

父親、姐妹、兄弟、

阿姨、叔叔

dying unnecessary deaths every year from tobacco?

因為菸草而造成不必要的死亡？

And then what happens when you think about this trajectory

想想看，若根據這樣的軌道，

for the future?

未來會是怎樣的？

And just do the simple math:

簡單計算一下：

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

從五年前，五十週年 醫務總監報告發表之後，

when this horrible statistic was raised,

這個恐怖的統計數字提高之後，

just through mid-century --

才只到世紀中期——

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

美國就有超過一千七百萬人的 死亡是可以避免的，

from tobacco use,

他們的死因是使用菸草製品， 且主要是香菸。

primarily because of cigarettes.

The Surgeon General concluded

醫務總監的結論是

that 5.6 million children alive in the United States in 2014

在 2014 年會有五百六十萬名

還活著的美國孩子，

will die prematurely later in life because of cigarettes.

將來會因為香菸而提早死亡。

Five point six million children.

五百六十萬個孩子。

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

這是個重大的公共健康問題， 對所有人而言皆是如些，

but especially for us as regulators

但對我們食品及藥物管理局

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

以及菸草製品中心的 管理者而言更是如此。

What can we do about it?

我們能做些什麼？

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

我們能做什麼，來反轉 這疾病和死亡的軌道？

Well, we have an interesting guide to help unravel issues

我們有一份很有趣的指南，

來協助解決這類問題：

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

我們所知道的香菸是怎麼形成的？

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

菸草和香菸公司的真實本質是什麼？

How did the industry behave

在過去未受控管的市場上， 這個產業的行為模式是什麼？

in the historically unregulated marketplace?

And our guide

而我們的指南

is previously secret internal documents from the tobacco industry.

來自過去菸草業的內部機密文件。

Come with me

跟我一起坐上

in a tobacco industry document time machine.

菸草業文件的時光機器。

Nineteen sixty-three

1963 年，

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

也就是醫務總監終於斷定尼古丁

和香菸會讓人成癮的二十五年前。

that the nicotine and cigarettes was addictive.

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

在 1998 年醫務總監報告 發表之前完全沒有這回事。

Nineteen sixty-three

1963 年，

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

是 1964 年史上第一份 醫務總監報告發表的前一年。

I remember 1964.

我記得 1964 年。

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

我不記得醫務總監報告， 但我記得 1964 年。

but I remember 1964.

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

當時我是在紐約 布魯克林長大的孩子。

This was at a time

在那時，

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

美國幾乎兩名成年人中 就有一名會抽菸。

Both of my parents were heavy smokers at the time.

當時我的雙親都抽菸抽得很兇。

Tobacco use was so incredibly normalized

菸品使用是非常正常的，

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

正常到——且這不是北卡羅萊納、 維吉尼亞，或肯塔基，

this was Brooklyn --

這是布魯克林——

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

正常到我們在工藝課時 還會為父母做煙灰缸。

(Laughter)

（笑聲）

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

我做的煙灰缸很爛， 但確實是煙灰缸。

(Laughter)

（笑聲）

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

正常到我還記得

在我們房子和其他房子的門廳

of our house and other houses

會有一碗散裝香菸，

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

當作是朋友來訪時的歡迎表示。

OK, we're back in 1963.

好，回到 1963 年。

The top lawyer for Brown and Williamson,

當時，布朗與威廉姆森菸草公司 是美國的第三大菸草公司，

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

該公司的頂尖律師寫道：

wrote the following:

"Nicotine is addictive.

「尼古丁會成癮。」

「所以，我們做的是銷售尼古丁—— 成癮性藥物——的生意。」

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

It's a remarkable statement,

這聲明很不簡單，

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

有說和沒說的資訊都同樣不簡單。

他沒說他們做的是香菸生意。

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

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

沒有說他們做的是菸草生意。

他說他們做的是銷售尼古丁的生意。

He said they were in the business of selling nicotine.

Philip Morris in 1972:

1972 年，菲利普莫里斯說： （菲利普莫里斯是世上最大的菸草公司）

"The cigarette isn't a product,

「香菸不是產品，」

it's a package.

「而是包裝。」

The product is nicotine.

「產品是尼古丁。」

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

「一包香菸是裝有一天份 尼古丁的儲存容器。」

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

「香菸則是發放一單位劑量 尼古丁的配藥器。」

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

我們等下會再來談這種劑量的說法。

And R.J. Reynolds in 1972:

1972 年，R.J. 雷諾茲說： （雷諾茲煙草公司的創始人）

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

「在某種意義上，菸草產業 可以被視為是隸屬於製藥業底下，

highly ritualized and stylized segment of the pharmaceutical industry.

專門化、高度儀式化， 以及風格化的一部分。

Tobacco products uniquely contain and deliver nicotine,

菸草製品以獨特的方式 包裝及傳送尼古丁，

a potent drug with a variety of physiological effects."

尼古丁是一種強效藥物， 會造成多種心理效應。」

At the time, and for many decades, publicly,

在當時，且持續了數十年，

the industry completely denied addiction

該產業都公開完全否認成癮性，

and completely denied causality.

也完全否認造成死亡。

But they knew the true nature of their business.

但他們知道菸草生意的本質是什麼。

And from time to time,

而且，經常

there have been health scares made public about cigarettes,

就會出現和香菸有關的 健康恐慌被公諸於世，

going back many decades.

數十年前就有了。

How did the industry respond?

該產業怎麼回應？

And how did they respond

在這個過去並沒有受到規範的 市場上，他們的反應是什麼？

in this historically unregulated marketplace?

Going back to the 1930s,

回到三○年代，

it was with advertising that heavily featured imagery of doctors

是在廣告上大量使用醫生

與其他健康照護專業人士的畫像

and other health care professionals

sending messages of reassurance.

來傳遞安心保證的訊息。

This is an ad for Lucky Strikes,

這是「好彩」的廣告，

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

好彩是三○年代 很有名的香菸品牌：

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

〔20,679 位醫生說： 『好彩香菸比較沒有刺激性』。〕

Your throat protection against irritation, against cough.]

〔保護你的喉嚨，對抗刺激物，〕

〔對抗咳嗽。〕

(Laughter)

（笑聲）

We laugh,

我們會笑，

but this was the kind of advertising

但當時就是這種廣告

that was there to send a health message of reassurance.

在傳遞安心保證的健康訊息。

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

快轉到五○、六○、七○年代。

And here, again, in the absence of regulation,

同樣的，也是沒有規範的時代，

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

我們接下來會看到的是 產品的改良和產品設計，

and product design

to respond to the health concerns of the day.

用以回應當時對健康方面的擔憂。

This is the Kent Micronite filter.

這是健牌香菸的微粒體濾嘴。

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

如果可以算是創新的話， 這裡的創新是有濾嘴的香菸。

[Full smoking pleasure ...

〔完全的抽菸之樂，〕

plus proof of the greatest health protection ever.]

〔加上已證明是史上 最偉大的健康保護。〕

What the smoker of this product didn't know,

這個產品的吸菸者並不知道，

what their doctor didn't know,

他們的醫生並不知道，

what the government didn't know,

政府並不知道，

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

這種濾嘴是用石棉填塞的——

(Gasps)

（驚訝聲）

so that when smokers were smoking this filtered cigarette

當抽菸者在抽這種 有濾嘴的香菸時，

and still inhaling the chemicals and smoke

他們仍然會吸入化學物質和煙，

that we know are associated with cancer and lung disease

而且我們已知這些東西和癌症、

肺部疾病，及心臟疾病有關，

and heart disease,

they were also sucking down asbestos fibers.

他們也會吸下石棉纖維。

(Gasps)

（驚訝聲）

In the 1960s and the 1970s,

在六○和七○年代，

the so-called innovation was the light cigarette.

所謂的創新是清淡型香菸。

This is a typical brand of the day called True.

這是當時很常見的品牌—真實牌。

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

而且這是醫務總監報告 開始釋出之後的事。

And you see the look of concern on her face.

各位可以看見她臉上的擔憂神情。

[Considering all I'd heard,

〔考量我所聽到的資訊，

I decided to either quit or smoke True.

我決定不是戒菸 就是抽真實牌香菸。

I smoke True.]

我抽真實牌香菸。〕

(Laughter)

（笑聲）

[The low tar, low nicotine cigarette.]

〔低焦油、低尼古丁的香菸。〕

And then it says, "Think about it."

接著，上面寫「考慮看看吧」。

And then even below that in the small print

下面還有用小字寫著

are tar numbers and nicotine numbers.

焦油和尼古丁的相關數字。

What was a light cigarette?

清淡型香菸是什麼？

How did it work?

它背後是什麼原理？

This is an illustration of the product modification

這張圖說明了所謂的

「濾嘴通風」這種產品改良設計。

known as "filter ventilation."

That's not a real filter blown up.

這並不是放大的真實濾嘴。

That's just a picture

這只是張圖，

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

讓各位可以看見濾嘴上有

一排一排用雷射打穿的通風孔。

that were put on the filter.

When you look at a real cigarette,

如果去看真實的香菸，

it's harder to see.

很難看見這些孔。

Every patent for this product shows

這個產品的所有專利資訊都顯示

that the ventilation holes should be 12 millimeters

通風孔與濾嘴脣端之間

from the lip end of the filter.

應該有十二公釐的距離。

How did it work?

這是什麼原理？

The cigarette got stuck into a machine.

香菸會被插入一台機器中。

The machine started puffing away on the cigarette

機器會開始抽那根香菸，

and recording tar and nicotine levels.

並記錄焦油和尼古丁的量。

As the machine smoked,

當機器在抽菸時，

outside air came through those ventilation holes

外部的空氣會通過這些通風孔，

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

讓通過香菸的煙被稀釋。

So as the machine smoked,

所以，當機器在抽菸時，

there really was less tar and nicotine being delivered

實際遞送的焦油和尼古丁

compared to a regular cigarette.

會比一般的香菸更少。

What the tobacco industry knew

菸草業知道

was that human beings don't smoke like machines.

人類抽菸和機器抽菸不一樣。

How do human beings smoke this?

人類怎麼抽這種香菸？

Where do the fingers go?

手指要放在哪裡？

(Murmurs)

（低語聲）

Where do the lips go?

嘴脣會放在哪裡？

I told you that the patent said

我剛說過專利有提到

that the holes are 12 millimeters from the lip end.

通風孔和接觸嘴脣端之間 要有十二公釐的距離。

The smoker didn't even know they were there,

抽菸者根本不知道那裡有通風孔，

but between fingers and lips, the holes get blocked.

但在手指和嘴脣之間， 通風孔被堵住了。

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

當通風孔被堵住， 它就不再是清淡型香菸。

Turns out that there's actually

結果發現，其實，

basically as much nicotine inside a light cigarette

在清淡型香菸中的尼古丁量 和一般香菸一樣多。

as a regular cigarette.

The difference was what's on the outside.

差別是在外在。

But once you block what's on the outside,

但一旦你把外在的東西阻擋住了，

it's a regular cigarette.

它就是一般的香菸。

Congress put FDA in the business of regulating tobacco products

十年前的六月，國會 讓食品及藥物管理局

10 years ago this June.

來管理菸草製品。

So you heard the statistics at the beginning

所以在一開始時各位才會 聽到那些統計數據，

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

說明香菸對疾病及死亡的重大影響。

We've also been paying a lot of attention

我們也相當注意

to how the cigarette works as a drug-delivery device

香菸如何扮演藥物 遞送裝置的角色，

and the remarkable efficiency with which it delivers nicotine.

以及香菸遞送尼古丁的驚人效率。

So let's take a look.

咱們來看看。

When the smoker puffs on the cigarette,

當人在吸菸時，

the nicotine from that puff gets up into the brain

吸入的尼古丁就會在不到十秒鐘之內

in less than 10 seconds.

向上進入大腦。

Less than 10 seconds.

不到十秒鐘。

Up in the brain,

向上進入大腦，

there are these things called "nicotinic receptors."

大腦中有所謂的「菸鹼受體」。

They're there ...

它們在那裡……

waiting.

等待著。

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

用菲利普莫里斯公司 文件上的說法，它們是在等

the next "dose unit of nicotine."

下一口「單位劑量的尼古丁」。

The smoker that you see outside,

各位在外面看到的抽菸者，

huddled with other smokers,

和其他抽菸者聚擠在一起，

in the cold,

在冷天，

in the wind,

在風中，

in the rain,

在雨中可以看到，

is experiencing craving

這些人就是感到渴望，

and may be experiencing the symptoms of withdrawal.

可能還有戒斷的症狀。

Those symptoms of withdrawal are a chemical message

那些戒斷的症狀是這些受體

發送給身體的一種化學訊息，

that these receptors are sending to the body,

saying, "Feed me!"

這訊息是「餵我！」

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

而這個可以在不到十秒 就遞送藥物的產品

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

竟然是種非常有效 且非常容易成癮的產品。

We've spoken to so many addiction treatment experts

這些年來，我們和相當多

成癮治療專家談過。

over the years.

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

我一再聽到同樣的故事：

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

「我讓某個人戒掉海洛英、

or cocaine or crack cocaine,

古柯鹼，或快克古柯鹼之後很久，

I can't get them to quit cigarettes."

都還是無法讓他戒菸。」

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

這個十秒的特性是背後 很大的一個因素。

FDA has it within its regulatory reach

食品及藥物管理局可以管制它，

to use the tools of product regulation

要用產品規範的工具，

to render cigarettes as we know them minimally or nonaddictive.

讓香菸變成最低限度或不會成癮。

We're working on this.

這方面我們正在努力。

And this could have a profound impact at a population level

光這一項政策可能就會

對所有人有很大的衝擊。

from this one policy.

We did dynamic population-level modeling a year ago,

我們把一年前做的 動態人口模型的結果

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

刊登在《新英格蘭醫學雜誌》上。

And because of the generational effect of this policy,

因為這項政策的世代效應， 我等下會解釋這個效應，

which I'll explain in a minute,

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

這是我們所做的預測， 一直到這個世紀末：

more than 33 million people

超過三千三百萬人

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

應該會變成癮君子， 但最後沒有。

because the cigarette that they'll be experimenting with

因為他們所嘗試到的香菸

can't create or sustain addiction.

無法創造或維持成癮性。

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

這會讓成人抽菸率 下降到低於 1.5%。

And these two things combined

把這兩點結合起來，

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

就可以挽救超過八百萬例

香菸相關的死亡，

that would otherwise have occurred

否則這八百萬例死亡

from the generational impact of this.

會因世代相傳而發生。

Now, why am I saying "generational"?

為什麼我要說「世代」？

It's about kids.

和孩子有關。

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

九成的成年抽菸者 從小時候就開始抽菸。

Half of them became regular smokers

有一半的人在還不到 購買香菸的法定年齡之前

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

就已經變成癮君子。

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

一半的人在十八歲之前 就變成癮君子。

Experimentation.

嚐鮮。

Regular smoking.

固定抽菸。

Addiction.

成癮。

Decades of smoking.

抽菸數十年。

And then the illness,

得病，

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

這就是為什麼我們要談論一種

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

會讓一半的長期使用者 提早死亡的產品。

The generational impact of this nicotine-reduction policy

這項尼古丁減量政策的世代影響

is profound.

會非常大。

Those old industry documents had a word for young people.

在過去的產業文件中， 會用一個詞來形容年輕人。

They were described as "the replacement smokers."

年輕人會被說成是 「抽菸取代者」。

The replacement smokers for addicted adult smokers

成癮的成年抽菸者過世 或戒菸之後，由他們來取代。

who died or quit.

Future generations of kids, especially teens,

未來世代，特別是青少年

are going to engage in risky behavior.

將會做出高風險的行為。

We can't stop that.

我們無法阻止這一點。

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

但如果他們唯一能取得的香菸

could no longer create or sustain addiction?

是不能夠造成或維持 成癮性的香菸呢？

That's the public health return on investment

這是全民公共健康隨時間

at a population level over time.

所獲得的投資報酬。

Haven't said anything about e-cigarettes.

我還沒談到電子菸。

But I have to say something about e-cigarettes.

但我得要談談電子菸。

(Laughter)

（笑聲）

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

我們現在面對的是孩子 使用電子菸的流行。

And what troubles us the most,

最讓我們心煩的是，

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

普及率上升通常也會結合

is frequency.

使用頻率的上升。

Not only are more kids using e-cigarettes,

不僅有更多孩子會抽電子菸，

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

還有更多孩子， 在電子菸進入市場後，

在過去三十天中有二十天 以上都會抽電子菸。

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

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

食品及藥物管理局 盡全力透過專案計畫和政策，

using program and policy,

first to get the word out to kids

先要讓孩子能知道

that this is not a harmless product

這個產品並不是無害的，

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

並要確保孩子不會開始 嘗試任何菸草製品，

on any tobacco product,

whether combustion is present or not.

不論是否需要點燃的產品。

But think about e-cigarettes in a properly regulated marketplace

但是在有妥當規範的市場上，

電子菸可以被視為有益的產品，

as something that could be of benefit

to addicted adult cigarette smokers

讓成癮的成年的抽菸者

who are trying to transition away from cigarettes.

有一個轉換的方式，脫離香菸。

So, I'll leave you with this vision:

所以，我要留給大家一個遠景：

imagine a world

想像一個世界，

where the only cigarette that future generations of kids

在那裡，未來世代的孩子 能夠嘗試到的香菸

could experiment with

could no longer create or sustain addiction

只有不會造成或維持 成癮性的香菸，

because of a single policy.

這全都是一項政策的結果。

Imagine a world

想像一個世界，

where health-concerned cigarette smokers,

在那裡，在乎健康的抽菸者，

especially if a policy goes into effect

特別是如果有將尼古丁含量

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

減到最低或不會成癮 程度的政策實施生效，

could transition to alternative and less harmful forms

就有可能會改用比較無害的 替代方式來取得尼古丁，

of nicotine delivery,

starting with FDA-approved nicotine medications,

從食品及藥物管理局 核准的尼古丁藥物開始，

like the gum, patch and lozenge.

如口香糖、貼片和錠劑。

And finally,

最後，

imagine a world and a properly regulated marketplace,

想像在一個妥當控管市場的世界裡，

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

無論是電子菸還是當今任何技術，

it's not the product developers and the marketers

不由產品開發者和行銷人員

who decide which products come to market

決定推出哪些產品或怎麼宣稱它們，

and what claims get made for them,

it's review scientists at FDA,

而是把決定權交給 食品及藥物管理局的科學家，

who look at applications

他們會研究應用方式，

and decide, using the standard that Congress has entrusted us

並根據國會委託我們

實施和執行的標準來決定

to implement and enforce,

whether a particular product should come to market,

某樣產品是否能夠進入市場，

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

因為該產品的行銷和我們的法律

would be appropriate for the protection of the public health.

會比較適合保護公共健康。

These are the kinds of powerful regulatory tools

這些強大的管理工具

that are within our reach

是我們可以取得的，

to deal with what remains

可以協助解決現今美國

the leading cause of completely preventable disease and death

完全可預防之疾病 和死亡的主要成因。

in the country.

If we get this right,

如果我們把這件事做對，

that trajectory, those 5.6 million kids,

這五千六百萬名孩子的軌道

is breakable.

是可以改變的。

Thank you.

謝謝。

(Applause)

（掌聲）