Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces (Ep. 243)
Thanks to the Chad Wonderling Family, who sponsored this transcript in honor of Mercatus Center’s mission of bridging the gap between academic research and real-world problems.
感谢 Chad Wonderling 家族赞助了这份成绩单，以纪念 Mercatus 中心弥合学术研究与现实问题之间差距的使命。
Hello everyone and welcome back to Conversations with Tyler.
大家好，欢迎回到与泰勒对话。
Today, I’m delighted to be chatting with Theodore H.
今天，我很高兴能与 Theodore H. 聊天。
Schwartz.
施瓦茨。
I saw his book in a Barnes & Noble.
我在巴诺书店看过他的书。
I bought it, I read it, I loved it.
我买了它，我读了它，我喜欢它。
It is called Gray Matters: A Biography of Brain Surgery.
这本书的名字叫《灰色问题：脑外科传记》。
More generally, Theodore Schwartz was a professor at Cornell Medical Center at New York–Presbyterian Hospital.
更一般地说，西奥多·施瓦茨是纽约长老会医院康奈尔医学中心的教授。
He has written over 500 articles on neurosurgery and related topics, and he runs the science lab devoted to epilepsy research.
他撰写了 500 多篇有关神经外科及相关主题的文章，并经营着一个致力于癫痫研究的科学实验室。
Theodore, welcome.
西奥多，欢迎。
Tyler, thanks for having me.
泰勒，谢谢你邀请我。
It’s really a pleasure to be here.
很高兴来到这里。
Now, the medical education process for a neurosurgeon — there’s four years of undergraduate, eight years of medical school, and then how many years to be a neurosurgeon?
现在，神经外科医生的医学教育过程——“本科四年，医学院八年，然后成为神经外科医生多少年？”
Med school is actually four years for everybody.
医学院实际上对每个人来说都是四年。
It’s universal.
这是通用的。
Then neurosurgical training is anywhere from six to eight years.
神经外科培训的时间从六到八年不等。
The average is usually seven years.
平均时间通常是七年。
You do one year of internship.
你实习一年。
Then I did two years of a junior residency.
然后我做了两年的初级住院医师实习。
You often do research — could be one or two years folded into your residency training — and then you would do an additional two years of senior and chief residency.
你经常做研究 ——可能会在你的住院医师培训中花费一到两年的时间 ——然后你会再做两年的高级住院医师和首席住院医师。
So, I was not done with my training till I was 33 years old.
所以，直到33岁我才完成训练。
So, it could be as much as 16 years for a person.
所以，一个人的寿命可能长达16年。
Yes, it’s a long road.
是的，这是一条漫长的路。
Is there a way to condense or shorten that?
有没有办法压缩或缩短它？
Say you skip undergraduate education or most of it.
假设您跳过本科教育或大部分教育。
A person starts at age 21.
一个人从21岁开始。
They finish by age 26.
他们到 26 岁就结束了。
I found most of what can be taught can be taught in five years.
我发现大部分能教的东西都可以在五年内教完。
Is that not true?
这不是真的吗？
No, I do agree with you.
不，我确实同意你的观点。
I think that the undergraduate education — liberal arts — I was a philosophy and English major, which was wonderful, and I loved the expanding universe that I explored.
我认为本科教育 — 文科 — 我是哲学和英语专业，这很棒，我喜欢我探索的不断扩大的宇宙。
But to be a neurosurgeon, I did not need to read Nietzsche and Kierkegaard.
但要成为一名神经外科医生，我不需要读尼采和克尔凯郭尔的书。
Even in medical school, there’s a lot of things that are done that could be condensed.
即使在医学院，也有很多可以压缩的事情。
We rotate through the hospital for two years, choosing what we want to do.
我们在医院轮换两年，选择我们想做的事情。
If you know what you want to do, you could condense it.
如果你知道自己想做什么，你可以将其浓缩。
I do think that undergraduate education and medical school could probably be condensed into six years instead of eight.
我确实认为本科教育和医学院可能可以压缩为六年而不是八年。
I’m not sure that the neurosurgery training could be condensed as well.
我不确定神经外科培训是否也可以浓缩。
Obviously, you don’t have to do research.
显然，您不必进行研究。
If you’re not interested in research, you don’t need to do it.
如果你对研究不感兴趣，你就不需要这样做。
You probably could learn how to be a neurosurgeon in four years.
你可能可以在四年内学会如何成为一名神经外科医生。
But if you think about you being on the table, rolling into a hospital and looking up at the person who’s about to open your brain and take care of your most precious possession, you want them to have a little bit of experience.
但如果你想象一下你站在手术台上，滚进医院，抬头看着那个即将打开你的大脑并照顾你最珍贵财产的人，你希望他们有一点经验。
You want them to have some age and some wisdom when they’re taking care of you.
你希望他们在照顾你时有一定的年龄和智慧。
If we condense everything, then that person could be 26, 27 years old.
如果我们浓缩一切，那么那个人可能是26、27岁。
I think we have to balance education with the wisdom that’s required to be a great neurosurgeon.
我认为我们必须在教育与成为一名伟大的神经外科医生所需的智慧之间取得平衡。
But as you say in your book, the neurosurgeons with less than five years’ experience — on average, they’re not as good.
但正如您在书中所说，经验不足五年的神经外科医生 ——平均而言，他们的水平没有那么好。
If we shorten the earlier process, you’ll end up with many more neurosurgeons who have, say, 11 years of experience.
如果我们缩短早期流程，最终会得到更多拥有 11 年经验的神经外科医生。
If someone tells me, “Your surgeon — he raced through everything in six years, but he has 13 years’ experience doing this operation, and here’s his track record,” I’m going to be just delighted.
如果有人告诉我，“你的外科医生”——“他在六年内完成了所有的事情，但他有 13 年的手术经验，这是他的记录”，我会很高兴。
I’m not going to say I want someone who went through 16 years — some of which was hoop jumping — and he has only four years of doing this operation.
我不会说我想要一个经历了 16 年的人——其中一些是跳圈的——而他只做了四年的手术。
I don’t disagree with you.
我不同意你的观点。
Again, I’m not arguing with the training part.
再说一遍，我并不反对训练部分。
I think we could do it much more quickly, for sure.
我认为我们当然可以做得更快。
But as I mentioned, there’s a certain amount of maturity involved in making the decisions that we make that plays in.
但正如我所提到的，我们做出的决定需要一定的成熟度。
It’s not just years that you’ve been doing it, but it’s also wisdom.
这不仅是你多年来的努力，也是你的智慧。
Wisdom comes with age as it does with experience.
智慧随着年龄的增长而增长，也随着经验的增长而增长。
As you know, for ordinary medical diagnosis — and I do mean ordinary — even GPT-4 does slightly better than human doctors, on average.
如您所知，对于普通的医疗诊断 ——我的意思是普通的——平均而言，甚至 GPT-4 的表现也比人类医生稍好一些。
Are there parts of neurosurgery — and I don’t mean moving around your hand and making decisions on the spot — but where you think an AI model soon will just do better than the humans?
神经外科有哪些部分 ——我的意思不是指在你的手周围移动并当场做出决定——但你认为人工智能模型很快就会在哪些方面比人类做得更好？
I think that in the interpretation of MRI scans — when a patient comes into your office with a conglomerate of symptoms, and you’ve got to figure out what they have — those things in AI are very good at.
我认为，在解释 MRI 扫描时 ——当一名患有多种症状的患者来到你的办公室时，你必须弄清楚他们有什么症状——人工智能非常擅长这些东西。
But often, neurosurgery is different than internal medicine.
但神经外科通常与内科不同。
We’re usually not presented with diagnostic dilemmas or radiographic dilemmas.
我们通常不会遇到诊断困境或放射学困境。
The dilemmas that we face are physical decision-making in the operating room.
我们面临的困境是手术室里的物理决策。
That’s really what neurosurgery is all about.
这确实是神经外科的全部内容。
Remember, a patient will come to us — they already have an MRI scan in their hand.
请记住，患者会来找我们——他们手中已经有 MRI 扫描。
They’re coming in, and they’re saying, “I know I have a tumor.
他们进来后说：“我知道我得了肿瘤。
I know where it’s located.
我知道它在哪里。
What should I do about it?”
我该怎么办？
The other thing that’s tricky about having an AI make a decision — let’s say you have a tumor that could be observed, it could be radiated, it could be operated upon.
让人工智能做出决定的另一件事是棘手的——假设你有一个可以观察的肿瘤，可以对其进行放射治疗，可以对其进行手术。
So, you have three options.
所以，你有三个选择。
What’s going to factor into whether to do the surgery or not is how good the surgeon that you’re seeing is at doing that surgery.
决定是否进行手术的因素是您看到的外科医生在做手术方面的水平如何。
Not all surgeons are created equal.
并非所有外科医生都是生来平等的。
The AI will not necessarily be able to take into account the skill level of the particular surgeon that you’re seeing because that’s unique to that one surgeon and that one surgeon alone.
人工智能不一定能够考虑到您正在看诊的特定外科医生的技能水平，因为这对于该一位外科医生来说是独一无二的。
But we could measure that, right, if the surgeons would allow it?
但如果外科医生允许的话，我们可以测量它，对吗？
In theory, you could measure their outcomes and have them enter their outcomes into a database for every surgery that they do.
理论上，您可以衡量他们的结果，并让他们将每次手术的结果输入数据库。
Right now, we are so far from doing that.
目前，我们距离做到这一点还很远。
We have no idea what goes on.
我们不知道发生了什么。
Once that OR door is closed and a surgeon is on their own, there’s really nobody looking over their shoulder for the most part.
一旦手术室的门关闭，外科医生就只能靠自己了，基本上就没有人在背后监视了。
Yes, I think that data could be accumulated, but we’re not even close to accumulating any of that right now.
是的，我认为数据是可以积累的，但我们现在还没有接近积累任何数据。
Why isn’t there some institution — private sector, governmental — that insists that data be collected and processed?
为什么没有一些机构（私营部门、政府）坚持要求收集和处理数据？
That would be very valuable.
那将是非常有价值的。
Yes, what’s interesting is what’s collected now and tracked by hospitals is what they care about.
是的，有趣的是现在医院收集和跟踪的内容是他们关心的。
What you learn when you’re in the practice of medicine is that the priorities of a hospital and the priorities of an individual physician are not completely aligned.
当您从事医学实践时，您会了解到医院的优先事项和个体医生的优先事项并不完全一致。
They’re partially aligned.
它们是部分对齐的。
For example, one of the things that we measure now that hospitals are very concerned with is whether your patient comes back into the hospital after a certain period of time and whether they get an infection or not.
例如，我们现在衡量医院非常关心的一件事是你的病人在一段时间后是否回到医院，以及他们是否受到感染。
Atul Gawande — you mentioned before his checklist.
Atul Gawande ——你在他的清单之前提到过。
His checklist is wonderful for reducing infections and certain frequent complications.
他的清单对于减少感染和某些常见并发症非常有用。
But when I’m in the operating room, I’m concerned about whether I’m going to be able to get this whole tumor out or not.
但当我在手术室时，我担心我是否能够将整个肿瘤取出来。
I’m concerned about whether my patient is going to be able to see when they wake up after surgery, whether they’re going to be able to walk when they wake up after surgery.
我担心我的病人在手术后醒来时是否能够看见东西，在手术后醒来时是否能够走路。
Often there’s a push-pull decision-making, a Sophie’s choice of saying, “Should I leave some tumor behind to make sure that the patient can walk after surgery?
通常会出现推拉式的决策，苏菲会选择说：“我是否应该留下一些肿瘤以确保患者在手术后能够行走？
Or should I be more aggressive and try to take it out and try to cure them and put them at risk of some postoperative deficit?”
或者我应该更积极地尝试将其取出并治愈它们，并使它们面临术后缺陷的风险？”
None of that is tracked by hospitals.
医院都没有追踪到这些情况。
Hospitals are not really concerned with whether you get the whole tumor out or not.
医院并不真正关心是否能将整个肿瘤切除。
They’re concerned with whether you get an infection or not, whether you get a clot in your leg or not.
他们关心你是否受到感染，你的腿上是否有血栓。
There are certain very specific things that they track because that’s how the government judges them and determines their reimbursement.
他们追踪某些非常具体的事情，因为这就是政府判断他们并确定他们报销的方式。
Unfortunately, the things we measure are the things that are easier to measure and the things that the government wants us to measure, but they’re not necessarily the most important things to be measured in a neurosurgical operation.
不幸的是，我们测量的东西是更容易测量的东西，也是政府希望我们测量的东西，但它们不一定是神经外科手术中要测量的最重要的东西。
The same would be true of a cardiac surgery or urology, I presume.
我认为心脏手术或泌尿外科也是如此。
On how to pick a good neurosurgeon
关于如何选择一名好的神经外科医生
Let’s say I need a neurosurgeon and assume, also, I can’t contact you.
假设我需要一位神经外科医生，并且假设我无法联系到您。
I have a decent income, but not so much money that I can just buy the best talent in the world.
我有不错的收入，但没有那么多钱可以买到世界上最好的人才。
How should I actually make that choice?
我实际上应该如何做出选择？
The economics of medicine are quite different than other things because most doctors will take most insurance plans.
医学经济学与其他事物有很大不同，因为大多数医生都会购买大多数保险计划。
If you have a private insurance, whether it’s United, Blue Cross, or Aetna, you can see an incredibly good neurosurgeon who is likely to take your insurance.
如果您有私人保险，无论是美联航、蓝十字还是安泰保险，您都可以看到一位非常优秀的神经外科医生，他很可能会接受您的保险。
There are some pockets of places in the country where some physicians may not take insurance plans, but for the most part, most of them do, because the insurance companies have such a powerful control over the patients and the patient volume.
在这个国家的一些地方，一些医生可能不会购买保险计划，但在大多数情况下，大多数人都会购买保险，因为保险公司对病人和病人数量有如此强大的控制权。
I know economics is really what you are all about.
我知道你们真正关心的是经济学。
If you think about it, it’s somewhat unfair to the physician because the insurance company fixes the rate that they’ll pay a surgeon.
如果你想一想，这对医生来说有点不公平，因为保险公司固定了他们支付给外科医生的费率。
If I am day one out of my neurosurgery training, and I take out a brain tumor, and you have UnitedHealthcare, whatever your insurance is, I’ll get paid X dollars.
如果我在神经外科培训的第一天，我切除了脑肿瘤，并且你有联合医疗保险，无论你的保险是什么，我都会得到 X 美元。
If I’m 30 years older, and I have 30 years more experience, and I take UnitedHealthcare, and you come to me 30 years later, and you’re going to get a much better product, I get paid exactly the same amount as the resident who was the first day out of their training.
如果我年长 30 岁，我有 30 年以上的经验，我选择了 UnitedHealthcare，30 年后你来找我，你会得到更好的产品，我得到的报酬与第一天结束培训的住院医生的金额完全相同。
There’s no accounting for experience and expertise in reimbursement for physicians for what they do.
对于医生的工作报销，没有考虑到他们的经验和专业知识。
I may have a bigger volume.
我可能有更大的音量。
I may do more cases because more patients come to me because I have more experience and more of a reputation.
我可能会做更多的病例，因为更多的病人来找我，因为我有更多的经验和更多的声誉。
But for every widget I produce, I get paid exactly the same, and the quality of the product can be dramatically different.
但对于我生产的每一个小部件，我得到的报酬都是完全相同的，而且产品的质量可能会有很大的不同。
How do I find someone, say, as good as you?
我怎样才能找到像你一样优秀的人？
Do I call up Harvard?
我要给哈佛打电话吗？
What do I actually do, concretely?
具体来说，我实际上做了什么？
I google who’s the best neurosurgeon?
我用谷歌搜索谁是最好的神经外科医生？
Unfortunately, I’ve tried that, and you get some oddball answers.
不幸的是，我已经尝试过了，但你得到了一些奇怪的答案。
Some of them are correct; some of them are incorrect.
其中一些是正确的；其中一些是不正确的。
I think the best thing to do is try to find someone that you know, a friend of yours who’s in the healthcare profession, and have them call around and ask their friends because they’ll know someone who is a neurosurgeon.
我认为最好的办法是找到你认识的人，你在医疗保健行业的朋友，让他们打电话询问他们的朋友，因为他们会认识神经外科医生。
Really, neurosurgeons know who are the top neurosurgeons doing a particular operation because those are the people who write the most articles, give the most lectures, do the most volume.
事实上，神经外科医生知道谁是执行特定手术的顶级神经外科医生，因为这些人写的文章最多，讲课最多，做的量最大。
They’re people that are known to be very, very good.
他们是众所周知的非常非常好的人。
It can be very hard for a consumer to know that.
消费者可能很难知道这一点。
What I found is, most consumers are so awed by the fact that you are a brain surgeon, that you’ve gone through this training, that they take what most surgeons tell them at face value.
我发现，大多数消费者对你是一名脑外科医生、接受过这种培训这一事实感到非常敬畏，他们只相信大多数外科医生告诉他们的内容。
I happen to practice in New York City, where everyone gets second, third, fourth opinions, so people are a little more critical about their physicians and do more research.
我碰巧在纽约行医，那里每个人都会得到第二、第三、第四种意见，所以人们对他们的医生更加挑剔，并做了更多的研究。
I think it is very important to get second, third opinions and speak to people in the medical profession.
我认为获得第二、第三意见并与医学界人士交谈非常重要。
I know what economists are like, so I’d be very worried, no matter what my algorithm was for selecting someone.
我知道经济学家是什么样的，所以无论我选择某人的算法是什么，我都会非常担心。
Say the people who’ve only been doing operations for three years — should there be a governmental warning label on them the way we put one on cigarettes: “dangerous for your health”?
就拿那些只做了三年手术的人来说，政府是否应该在他们身上贴上一个政府警告标签，就像我们在香烟上贴上的那样：“对你的健康有害”？
If so, how is it they ever learn?
如果是这样，他们是如何学习的？
You raise a great point.
你提出了一个很好的观点。
I’ve thought about this.
我考虑过这个。
I talk about this quite a bit.
我对此谈了很多。
The general public — when they come to see me, for example, I’m at a training hospital, and I practiced most of my career where I was training residents.
公众 ——例如，当他们来看我时，我在一家培训医院，我职业生涯的大部分时间都是在培训住院医师的过程中进行的。
They’ll come in to see me, and they’ll say, “I want to make sure that you’re doing my operation.
他们会来看我，他们会说：“我想确保你正在为我做手术。
I want to make sure that you’re not letting a resident do the operation.” We’ll have that conversation, and I’ll tell them that I’m doing their operation, but that I oversee residents, and I have assistants in the operating room.
我想确保你们不会让居民来做手术。”我们会进行对话，我会告诉他们我正在做他们的手术，但我负责监督住院医师，并且我在手术室里有助手。
But at the same time that they don’t want the resident touching them, in training, we are obliged to produce neurosurgeons who graduate from the residency capable of doing neurosurgery.
但与此同时，他们不希望住院医师触摸他们，在培训中，我们有义务培养出住院医师毕业后能够进行神经外科手术的神经外科医生。
They want neurosurgeons to graduate fully competent because on day one, you’re out there taking care of people, but yet they don’t want those trainees touching them when they’re training.
他们希望神经外科医生毕业时能够完全胜任，因为在第一天，你就在那里照顾病人，但他们不希望那些受训者在训练时接触他们。
That’s obviously an impossible task, to not allow a trainee to do anything, and yet the day they graduate, they’re fully competent to practice on their own.
这显然是不可能完成的任务，不让学员做任何事情，但他们毕业的那一天，完全可以自己练习。
That’s one of the difficulties involved in training someone to do neurosurgery, where we really don’t have good practice facilities where we can have them practice on cadavers — they’re really not the same.
这是训练某人进行神经外科手术的困难之一，我们确实没有良好的练习设施可以让他们在尸体上练习 ——他们真的不一样。
Or have models that they can use — they’re really not the same, or simulations just are not quite as good.
或者有他们可以使用的模型——它们确实不一样，或者模拟效果不太好。
At this point, we don’t label physicians as early in their training.
在这一点上，我们不会在医生接受培训的早期就给他们贴上标签。
I think if you do a little bit of research when you see your surgeon, there’s a CV there.
我想如果你在看外科医生时做一点研究，那里就有一份简历。
It’ll say, this is when he graduated, or she graduated from medical school.
它会说，这是他毕业的时候，或者她从医学院毕业的时候。
You can do the calculation on your own and say, “Wow, they just graduated from their training two years ago.
你可以自己算一算，然后说：“哇，他们两年前刚刚培训毕业。
Maybe I want someone who has five years under their belt or ten years under their belt.” It’s not that hard to find that information.
也许我想要一个有五年或十年经验的人。”找到这些信息并不难。
How do you manage all the standing?
你如何管理所有的地位？
When I started out, I had horrible back pain standing in the operating room, excruciating.
当我刚开始的时候，站在手术室里我感到背部疼痛得厉害，令人难以忍受。
I couldn’t stand for more than half an hour, and my low back would go into spasm.
超过半个小时我就坚持不了，腰部就会痉挛。
I realized very early on that neurosurgery is a physical activity.
我很早就意识到神经外科手术是一项体力活动。
You not only have to stand for long periods of time, you can’t have a significant tremor.
你不仅要长时间站立，而且不能有明显的颤抖。
You have to be able to focus for long periods of time.
你必须能够长时间集中注意力。
You have to be able to work on very little sleep because sometimes you’re getting woken up at 2:00 in the morning to do emergency surgeries, and then you have to go back in the next morning and keep operating.
您必须能够在睡眠很少的情况下工作，因为有时您会在凌晨 2:00 起床进行紧急手术，然后您必须在第二天早上返回并继续手术。
What helped me in the end was learning how to do a lot of core exercises that strengthen your core — planks, and things like that.
最终对我有帮助的是学习如何进行大量的核心练习来增强你的核心肌群——平板支撑等等。
Then just practice and experience.
然后就是练习和体验。
Like anything, the more you do it, the more you strengthen those muscles, and the better you can tolerate it.
就像任何事情一样，你做得越多，你的肌肉就越加强，你就能更好地忍受它。
But for many years, I had excruciating back pain, and I was constantly stretching in the operating room.
但多年来，我的背部疼痛难忍，在手术室里不断地伸展身体。
I think a lot of surgeons go through that until those particular muscles that they need are strengthened.
我认为很多外科医生都会经历这个过程，直到他们需要的特定肌肉得到强化。
Let’s say we put you in charge of the process selecting who gets trained to become a neurosurgeon.
假设我们让您负责选择谁接受培训成为神经外科医生的过程。
How would you improve what we do now?
您将如何改进我们现在所做的事情？
We choose, at the top programs, surgeons often based on research criteria.
在顶级项目中，我们通常根据研究标准选择外科医生。
A lot of the top programs want someone who has worked in labs and proven that they have a research brain and that they’re going to contribute to the field.
许多顶级项目都希望聘用曾在实验室工作过并证明自己拥有研究头脑并且将为该领域做出贡献的人。
That is one aspect of neurosurgery for sure.
这肯定是神经外科的一方面。
We want people who are going to improve what we do because medicine is constantly evolving, and we need to get better.
我们希望人们能够改进我们的工作，因为医学在不断发展，我们需要变得更好。
But on the other hand, surgery is very much a tactile, physical sport that requires judgment and coordination and stamina and sacrifice and grit.
但另一方面，手术在很大程度上是一项触觉、体力运动，需要判断力、协调性、耐力、牺牲和勇气。
Some of the best neurosurgeons combine all of those qualities.
一些最好的神经外科医生结合了所有这些品质。
We interview the residents for 20 minutes when they come in.
当居民进来时，我们会采访他们 20 分钟。
It’s very hard to evaluate them on all of those qualifications.
很难根据所有这些资格来评估他们。
What a lot of students do who want to go into neurosurgery is, they’ll actually rotate at that program.
许多想要进入神经外科的学生所做的是，他们实际上会轮换该项目。
They’ll show up there and spend a month, and we’ll see what they’re like.
他们会在那里呆一个月，我们会看看他们是什么样的。
We’ll see if they have the stamina.
我们会看看他们是否有耐力。
We’ll see how they function at 6:00 am, and if they’re functioning just as well at 9:00 pm.
我们将了解它们在上午 6:00 的运作情况，以及它们在晚上 9:00 的运作是否同样良好。
If they’re upbeat and they can maintain a positive attitude and positive mood in the face of all of that work, then that’s a good sign that they’ll do well.
如果他们很乐观，并且能够在面对所有这些工作时保持积极的态度和积极的情绪，那么这是一个好兆头，表明他们会做得很好。
But I don’t think we fully evaluate our neurosurgery residents as well as we should.
但我认为我们没有像我们应该的那样充分评估我们的神经外科住院医生。
I think you’re right.
我认为你是对的。
We need some more grit, physical stamina assessments that we can apply to them.
我们需要对他们进行更多的勇气和体力评估。
How much does IQ matter?
智商有多重要？
I don’t think raw IQ matters that much.
我不认为原始智商那么重要。
At the end of the book, I quote this article that came out in the British Medical Journal that looked at the IQs of neurosurgeons, rocket scientists, and average professionals and essentially found that they were all about the same.
在书的最后，我引用了《英国医学杂志》上发表的一篇文章，该文章研究了神经外科医生、火箭科学家和普通专业人士的智商，发现他们基本上都是一样的。
I don’t think that raw IQ is what makes a great neurosurgeon.
我不认为原始智商能成为一名伟大的神经外科医生。
It is psychologically very demanding because you are taking care of people at a moment in their lives that is the most critical, where they’re in most need of help, and they basically hand over to you their most prized possession for four hours, six hours.
这在心理上要求很高，因为你要在人们生命中最关键的时刻照顾他们，他们最需要帮助，他们基本上把他们最珍贵的财产交给你四个小时，六个小时。
You have to be on you’re A game every time you’re under the microscope doing neurosurgery because one false move, one damaged blood vessel, one damaged nerve, and that individual that you’re taking care of may never walk again.
每次在显微镜下进行神经外科手术时，你都必须全力以赴，因为一个错误的举动，一根血管受损，一根神经受损，你所照顾的那个人可能再也不能走路了。
They may never see again.
他们可能再也见不到了。
They may never wake up from that operation.
他们可能永远不会从那次手术中醒来。
You don’t want to take that lightly.
你不想掉以轻心。
It’s an enormous responsibility.
这是一个巨大的责任。
So, you want to make sure you choose people who are going to be completely dedicated to the task.
因此，您要确保选择完全致力于这项任务的人员。
Just as you had to learn standing for so many hours in a row, did you have to learn concentration or did it just come to you naturally?
就像你必须学习连续几个小时站立一样，你是否必须学习集中注意力，还是自然而然地集中注意力？
I think I’ve always been pretty good at concentrating.
我认为我一直很擅长集中注意力。
We do have to take a lot of tests along the way, and you have to sit in your room and study and memorize an enormous amount of information.
一路上我们确实必须参加很多测试，你必须坐在自己的房间里学习并记住大量的信息。
That takes the ability to sit and focus for long periods of time.
这需要能够长时间坐着并集中注意力。
I’m also a musician, which I found very helpful because the ability of sitting in a room and practicing an instrument — which I would do for hours and hours and hours — if you want to become very proficient at it, is something that lends itself to neurosurgery.
我也是一名音乐家，我发现这非常有帮助，因为坐在房间里练习乐器的能力（我会花几个小时、几个小时、几个小时）如果你想变得非常精通，这种能力非常适合神经外科。
You play bass, right?
你弹贝斯，对吧？
Yes, I play the bass guitar.
是的，我弹低音吉他。
Classical or jazz?
古典乐还是爵士乐？
I started on upright, and I moved to jazz R&B funk fusion — that genre.
我从直立音乐开始，然后转向爵士 R&B 放克融合 ——这种流派。
Who’s your favorite jazz bass player?
你最喜欢的爵士贝司手是谁？
Ron Carter?
罗恩·卡特？
No, I love Ron Carter, but I have to say Jaco Pastorius.
不，我爱罗恩·卡特，但我不得不说雅科·帕斯托里斯。
He was an electric bass player.
他是一名电贝斯手。
I don’t know if you’re familiar with him.
不知道你对他是否熟悉。
Oh, it’s very flamboyant.
哦，真是太浮夸了。
It’s wonderful to listen to.
听起来真是太棒了。
Yes.
是的。
He was the man for sure.
他肯定就是那个人。
On the personal demands of the job
关于工作的个人要求
Why do so few women go into neurosurgery?
为什么从事神经外科手术的女性如此之少？
This surprised me when I learned it from your book.
当我从你的书中了解到这一点时，这让我感到惊讶。
The numbers are going up.
数字正在上升。
Women are actually doing better.
女性实际上做得更好。
They’re now at maybe 10 percent.
现在他们的比例可能是 10%。
I think we expect them to be at about 30 percent in a few years.
我认为我们预计几年后这一比例将达到 30% 左右。
It’s a very demanding career.
这是一个要求非常高的职业。
As you know women often are focused on childbirth and having the freedom to raise their children in the way they want to raise them.
如您所知，女性通常专注于分娩，并拥有按照自己想要的方式抚养孩子的自由。
Neurosurgery doesn’t always allow a woman to do that.
神经外科并不总是允许女性这样做。
But depending on how you want to run your life and what you want to do, obviously .
但这显然取决于您想要如何经营自己的生活以及您想做什么。
.
。
.
。
I know many women who are neurosurgeons and have children, and they’re wonderful mothers to their children.
我认识很多女性，她们是神经外科医生，也有孩子，她们是孩子的好母亲。
They may not have four or five children.
他们可能没有四五个孩子。
They may have one or two children, just to have the time.
他们可能有一两个孩子，只是为了有时间。
But I think that is a limitation, to know that you’re not going to be there as much as you may want to be for your children.
但我认为这是一个限制，因为你知道你不会像你想的那样陪伴你的孩子。
Why do so many neurosurgeons get divorced?
为什么这么多神经外科医生离婚？
I think it’s the same thing.
我认为这是同一件事。
When you have a career where not only are you out of the house for a long time, and you get called out of the house at awkward times, so that could be on Valentine’s Day, that could be at 2:00 in the morning.
当你从事的职业不仅需要长时间外出，而且还会在尴尬的时候被叫出家门，比如可能是情人节，也可能是凌晨 2:00。
But even when you’re there, even when you’re at home, there’s part of you that’s always absent.
但即使你在那里，即使你在家，你的一部分总是缺席的。
One thing that I realized is, no matter where I am, there’s always part of me that’s thinking about the patients that are in the hospital that I operated on last week and how they’re doing, and maybe one of them is struggling a little bit, and I have to be aware of that.
我意识到的一件事是，无论我身在何处，我的内心总是有一部分在思考上周我在医院接受手术的病人以及他们的情况，也许其中一个人有点挣扎，我必须意识到这一点。
I’m thinking about the patients I’m going to operate on next week, and the challenging cases coming up, and how those are going to go.
我正在考虑下周要为哪些患者进行手术，以及即将出现的具有挑战性的病例，以及这些病例将如何进行。
I’m visualizing them in advance constantly.
我不断地提前想象它们。
The past and the future of what you do is weighing on you all the time so that even when you’re present at home, you’re not fully present at home.
你所做的事情的过去和未来一直在压着你，所以即使你在家，你也不能完全在家。
It’s just a very demanding career, and it’s an unforgiving career.
这是一个要求非常高的职业，也是一个无情的职业。
I write in the book about stories of some famous neurosurgeons like Harvey Cushing or Gazi Yaşargil.
我在书中写了一些著名神经外科医生的故事，比如哈维·库欣（Harvey Cushing）或加齐·亚沙吉尔（Gazi Yaşargil）。
People don’t necessarily know all those names, but there’s a famous story about Cushing, who was really the founding forefather of neurosurgery in the turn of the century, 1905.
人们不一定知道所有这些名字，但有一个关于库欣的著名故事，他确实是 1905 年世纪之交神经外科的奠基人。
He really was the first surgeon to dedicate his career to neurosurgery, which at the beginning of the century had a mortality of about 50 percent, and at the end of his career, it was down to about 8 percent.
他确实是第一位将自己的职业生涯奉献给神经外科的外科医生，在本世纪初，神经外科的死亡率约为 50%，而在他职业生涯结束时，死亡率降至 8% 左右。
Really remarkable, what he had done to make neurosurgery safe.
他为确保神经外科手术的安全所做的努力真的很了不起。
He went in to operate on a Saturday morning on a patient, and he got the news that his second son who had just graduated or finished his third year at Yale was in a car crash and died.
周六早上，他进去给一位病人做手术，他得到的消息是，他刚刚毕业或在耶鲁大学读完三年级的二儿子遭遇车祸身亡。
He got the news in the morning, and he walked into the operating room, and he did the full operation that he was set to do, and then he went and claimed his son’s body when the operation was done.
他早上得到消息，走进手术室，做了他准备做的完整手术，手术完成后，他去领取了儿子的尸体。
That just tells you something about what kind of a human being he was, what sort of focus, dedication, self-restraint, and discipline was required of Harvey Cushing to move the field forward the way he did.
这只是告诉你他是一个什么样的人，哈维·库欣需要什么样的专注、奉献、自我约束和纪律才能以他的方式推动这个领域向前发展。
But wouldn’t a substitute be called for?
但难道不需要一个替代品吗？
If I’m the patient, I would want it arranged in advance that my surgeon — if that happened, they would sub in someone else.
如果我是病人，我希望提前安排我的外科医生——如果发生这种情况，他们会换其他人。
Maybe they raise the price to me.
也许他们会向我提高价格。
Even if some individuals might do it just fine, I would never know that.
即使有些人可能做得很好，我也永远不会知道。
Right.
正确的。
Think about it.
想一想。
Back when Harvey Cushing was a neurosurgeon, there was no one to sub in for him.
当哈维·库欣还是一名神经外科医生时，没有人可以代替他。
There were no neurosurgeons.
没有神经外科医生。
The field didn’t exist.
该领域不存在。
He was the first surgeon to dedicate his life just to neurosurgery.
他是第一位将一生奉献给神经外科的外科医生。
It wasn’t like there were other surgeons that had even remotely the ability.
似乎没有其他外科医生有这样的能力。
Even Harvey Cushing, with his son’s death weighing on him, would’ve given you a better outcome than any other surgeon of that era.
即使是哈维·库欣，因为儿子的去世给他带来了沉重的负担，他也会比那个时代的任何其他外科医生给你带来更好的结果。
Now, in the modern day, yes, of course, there are hundreds and hundreds of competent surgeons who could sub in, and yes, a surgeon nowadays should cancel that operation and hand it off to someone else.
现在，在现代，是的，当然，有成百上千的有能力的外科医生可以代替，是的，现在的外科医生应该取消该手术并将其交给其他人。
You can’t arrange for that in advance.
您无法提前安排。
We don’t have the ability to do that.
我们没有能力这样做。
I often think about that the morning when I see my patient.
当我早上见到病人时，我常常会想到这一点。
Before we go into surgery, every morning we come in, we see them, and we do consent, and we talk to them.
在我们进行手术之前，每天早上我们都会看到他们，我们同意并与他们交谈。
I can speak for myself.
我可以为自己说话。
I usually go to bed at ten o’clock the night before, and I haven’t had a bit of alcohol because I want to make sure I perform at my best.
我通常在前一天晚上十点钟上床睡觉，而且我没有喝一点酒，因为我想确保自己发挥出最佳状态。
But that patient doesn’t really know what I’ve been through.
但那个病人并不真正知道我经历了什么。
They don’t know that there wasn’t some horrible tragedy in my life the night before.
他们不知道前一天晚上我的生活中没有发生过可怕的悲剧。
They don’t know that I didn’t binge on something or that I’m not a drug addict at that moment in time, because we don’t do drug testing, and we don’t do any sort of testing for surgeons before they walk into the operating room.
他们不知道我当时没有暴饮暴食，也不知道我不是吸毒者，因为我们不进行药物测试，而且在外科医生走进手术室之前，我们不会为他们进行任何类型的测试。
I’m not saying that should be done because I think we’d all like our freedoms and not like to be under that kind of scrutiny.
我并不是说应该这样做，因为我认为我们都喜欢我们的自由，而不喜欢受到这种审查。
But it is ironic.
但这很讽刺。
We do give an enormous amount of trust to these individuals without really knowing what’s going on in their heads.
我们确实对这些人给予了极大的信任，但并不真正了解他们脑子里在想什么。
I think surgeons are expected also to .
我认为外科医生也应该这样做。
.
。
.
。
We’re held to a higher standard, and we should be.
我们必须遵守更高的标准，我们也应该如此。
We’re expected to take care of our personal lives in a way that separates it from the work that we do.
我们应该以一种将个人生活与工作分开的方式来照顾自己。
Putting yourself aside, do you think you’re a happy group of people overall?
抛开你自己不谈，你认为总体上你是一群快乐的人吗？
How would you assess that?
您对此有何评价？
I think we’re as happy as our last operation went, honestly.
老实说，我认为我们和上次手术一样高兴。
Yes, if you go to a neurosurgery meeting, people have smiles on their faces, and they’re going out and shaking hands and telling funny stories and enjoying each other’s company.
是的，如果你去参加神经外科会议，人们脸上都会挂着微笑，他们会出去握手，讲有趣的故事，享受彼此的陪伴。
It is a way that we deal with the enormous pressure that we face.
这是我们应对所面临的巨大压力的一种方式。
Not all surgeons are happy-go-lucky.
并非所有外科医生都是无忧无虑的。
Some are very cold and mechanical in their personalities, and that can be an advantage, to be emotionally isolated from what you’re doing so that you can perform at a high level and not think about the significance of what you’re doing, but just think about the task that you’re doing.
有些人的性格非常冷漠和机械，这可能是一个优势，在情感上与你正在做的事情隔离，这样你就可以高水平地工作，而不是考虑你正在做的事情的重要性，而只考虑你正在做的任务。
On the whole, yes, we’re happy, but the minute you have a complication or a problem, you become very unhappy, and it weighs on you tremendously.
总的来说，是的，我们很高兴，但是一旦你出现并发症或问题，你就会变得非常不高兴，这会给你带来巨大的压力。
It’s something that we deal with and think about all the time.
这是我们一直在处理和思考的事情。
The complications we have, the patients that we’ve unfortunately hurt and not helped — although they’re few and far between, if you’re a busy neurosurgeon doing complex neurosurgery, that will happen one or two times a year, and you carry those patients with you constantly.
我们遇到的并发症，我们不幸伤害但没有帮助的患者——尽管它们很少而且间隔很远，但如果你是一位忙碌的神经外科医生，做复杂的神经外科手术，这种情况每年都会发生一两次，而且你经常带着这些病人。
On the brain and longevity
关于大脑和长寿
Is the brain a relevant bottleneck to living forever?
大脑是永生的相关瓶颈吗？
Say longevity science — it somehow pans out.
就长寿科学而言——它以某种方式取得了成功。
We understand old age is a kind of disease; we get some sort of fix.
我们知道老年是一种疾病；我们得到了某种修复。
We can replace your liver, but not your brain — right?
我们可以取代你的肝脏，但不能取代你的大脑 —— 对吧？
— without killing you.
—— 不会杀了你。
That is true but —
确实如此，但是 ——
Is there a way around that?
有办法解决这个问题吗？
Yes, let’s hope that AI is because the brain is just a very complex information-processing machine.
是的，我们希望人工智能是因为大脑只是一个非常复杂的信息处理机器。
So, the hope is that someday we’ll have some inorganic way of reproducing the same connections we have in the brain so that we can live on more permanently in another form.
因此，希望有一天我们能有某种无机的方式来复制我们大脑中的相同连接，这样我们就可以以另一种形式更永久地生活。
Certainly, the biological material of the brain is problematic because those cells don’t reproduce and they deteriorate.
当然，大脑的生物材料是有问题的，因为这些细胞不会繁殖并且会恶化。
They don’t regenerate.
他们不会再生。
Do you have a view on the Star Trek transporter?
你能看到《星际迷航》运输车吗？
You’ve studied philosophy.
你学过哲学。
Does it kill you?
它会杀死你吗？
Would you step into one?
你愿意踏入其中吗？
I wouldn’t.
我不会。
What was that magic show?
那场魔术表演是什么？
The show about the magicians, with Hugh Jackman.
休·杰克曼主演的关于魔术师的节目。
Do you remember that show?
你还记得那个节目吗？
The Prestige, I think it was called.
我想它被称为“威望”。
That’s right.
这是正确的。
It’s a Nolan one.
这是诺兰的一部。
He would do this magic act, and it would literally kill him every time he did it, and he would be revived.
他会施展这种魔法，每次他施展魔法时，他都会被杀死，然后他就会复活。
I would let Spock go through first, and if Spock told me it was okay, I’d follow behind.
我会让Spock先走，如果Spock告诉我可以，我就会跟在后面。
It’s only the Spock copy that says it’s okay.
只有 Spock 副本说没问题。
We have data from television that says it copies you successfully, but is it really you?
我们从电视上得到的数据表明它成功复制了你，但那真的是你吗？
Or did we make a good copy of you, and you’re dead?
还是我们复制了你，而你却死了？
I would argue that over time, we all change.
我认为随着时间的推移，我们都会改变。
The Tyler Cowen of five seconds ago is different than the Tyler Cowen that’s sitting here right now.
五秒前的泰勒·考恩与现在坐在这里的泰勒·考恩不同。
If you could replicate yourself so that there were two Tyler Cowens, I think those two people would diverge in who they are.
如果你可以复制自己，这样就有两个泰勒·考恩斯，我认为这两个人的身份会有所不同。
They would be completely different people one second after they became a different person because their molecules would be on a different path.
他们在成为不同的人后一秒就会完全不同，因为他们的分子会走不同的路径。
They’d have different experiences.
他们会有不同的经历。
They’d be in a different location in space.
他们会在太空中的不同位置。
I think we’re constantly changing, so I think I would go in the transporter.
我认为我们在不断变化，所以我想我会乘坐运输车。
Given that people can live after split-brain events — does this mean we’re really two people or more people?
鉴于人们在裂脑事件后仍然可以生存 ——这是否意味着我们真的是两个人或更多人？
I don’t think that the unified self really exists in the way that we think it does.
我不认为统一的自我真的以我们认为的方式存在。
As you mentioned, there’s a neurosurgical operation called a corpus callosotomy, where we can split the two sides of the brain in half so that they become two independently functioning brains, and that person does not feel like two people.
正如你提到的，有一种神经外科手术称为胼胝体切开术，我们可以将大脑的两侧分成两半，使它们成为两个独立运作的大脑，并且那个人感觉不像两个人。
They feel like one self, even though the left side of the brain will make the right hand do one thing, and the right side of the brain will make the left side do something else.
他们感觉就像一个自我，尽管左脑会让右手做一件事，而右脑会让左手做另一件事。
Both halves of their body are being controlled by different brains, and sometimes they’re behaving in opposite ways, but yet the individual still feels like a unified individual.
他们的身体的两半都由不同的大脑控制，有时他们的行为方式相反，但个体仍然感觉像是一个统一的个体。
How is that possible, to have two brains and still feel like one self?
拥有两个大脑却仍然感觉像一个自我，这怎么可能呢？
We can also remove half a brain.
我们还可以去掉半个大脑。
We do a surgery called a hemispherectomy, where we take out half the brain.
我们进行一种称为半球切除术的手术，取出一半大脑。
That person doesn’t wake up feeling like half a person.
那个人醒来时不会感觉自己像个半人。
We know that all that we are is our brain.
我们知道我们的全部就是我们的大脑。
That’s what creates our selves.
这就是创造我们自己的东西。
I think that there are hundreds of different modules processing information in the brain and determining what behaviors we should do and making decisions for us, and then we carry out that behavior.
我认为大脑中有数百个不同的模块处理信息并确定我们应该做什么行为并为我们做出决定，然后我们执行该行为。
Then, there’s another part of the brain that basically is a storyteller, that tries to make sense of it all after the fact.
然后，大脑的另一部分基本上是一个讲故事的人，它试图在事后理解这一切。
I do not think we have free will in the way that most people do.
我不认为我们像大多数人那样拥有自由意志。
I think that our brains make decisions for us.
我认为我们的大脑为我们做出决定。
We carry out those behaviors, and then we write a story that makes it into a logical timeline that makes us feel as if we were the ones, that there was a self that made that decision, whereas, in fact, that self didn’t really exist.
我们执行这些行为，然后写一个故事，将其纳入逻辑时间线，让我们感觉好像我们就是那个人，有一个自我做出了这个决定，而事实上，那个自我并不真正存在。
What you think is you, in your opinion, is just the storyteller part at best.
你所认为的你，在你看来，充其量只是讲故事的部分。
At best, yes.
充其量是的。
It creates a story of a self, just like it creates a story of free will.
它创造了一个自我的故事，就像它创造了一个自由意志的故事一样。
Does the storyteller part also not have free will?
讲故事的人也没有自由意志吗？
Because that’s my view.
因为那是我的观点。
Are you willing to go that far?
你愿意走那么远吗？
Yes, I don’t think the storyteller part has free will.
是的，我不认为讲故事的人有自由意志。
I don’t think we know where those stories come from.
我认为我们不知道这些故事从何而来。
I don’t think we know where our ideas come from.
我认为我们不知道我们的想法从何而来。
I think they just emerge into our consciousness.
我认为它们刚刚出现在我们的意识中。
I can’t explain consciousness.
我无法解释意识。
I can’t explain why it’s something to be Tyler Cowen, and it’s something different to be Ted Schwartz.
我无法解释为什么泰勒·考恩 (Tyler Cowen) 很特别，而泰德·施瓦茨 (Ted Schwartz) 又不同。
I have no idea why that is.
我不知道为什么会这样。
That’s still a mystery.
这仍然是一个谜。
On deep brain stimulation and other neurological treatments
关于深部脑刺激和其他神经治疗
Deep brain stimulation — people tell me all the time, it has great potential.
深部脑刺激 — 人们一直告诉我，它具有巨大的潜力。
What’s your opinion?
你有什么看法？
Is it made up?
是编出来的吗？
Is it fraud?
是不是诈骗？
Does it have potential?
它有潜力吗？
It not only has potential, but that’s what we do right now.
它不仅具有潜力，而且这就是我们现在所做的。
The treatment of Parkinson’s disease right now is to put an electrode in the brain, and that will stop your tremor in your hand if you have Parkinson’s disease with a tremor.
目前帕金森病的治疗方法是在大脑中放置一个电极，如果您患有帕金森病并伴有震颤，这将阻止您手部的震颤。
We use deep brain stimulation for that purpose.
为此，我们使用深部脑刺激。
We also can reduce seizures.
我们还可以减少癫痫发作。
We can treat patients with epilepsy with deep brain stimulation and reduce their seizures.
我们可以通过深部脑刺激来治疗癫痫患者并减少他们的癫痫发作。
We’re getting to the point where we can start to treat depression and obsessive-compulsive disorder and Tourette’s and certain psychological issues with deep brain stimulation.
我们已经到了可以开始通过深部脑刺激来治疗抑郁症、强迫症、抽动秽语症和某些心理问题的阶段。
We can alter someone’s behavior, someone’s desires, feelings based on deep brain stimulation because all of our behaviors derive from circuits in the brain that are firing in a particular way.
我们可以根据大脑深层刺激来改变某人的行为、某人的欲望和感受，因为我们所有的行为都源于大脑中以特定方式放电的回路。
One great example was a patient who had deep brain stimulation, and when they turned on the stimulator, they started to like a particular type of music, a musician.
一个很好的例子是一位接受深度脑刺激的患者，当他们打开刺激器时，他们开始喜欢一种特定类型的音乐，即音乐家。
When they turned it off, they no longer liked that musician anymore.
当他们把它关掉后，他们就不再喜欢那个音乐家了。
If those kinds of desires can be created and extinguished by stimulating an electrode in the brain, the truth is, really, any part of your personality can be altered with an electrode or a number of electrodes placed in the right places and altering the circuitry of your brain appropriately.
如果这些欲望可以通过刺激大脑中的电极来产生和消除，那么事实是，实际上，通过将一个或多个电极放置在正确的位置并适当地改变大脑的电路，可以改变你性格的任何部分。
Any part of your personality?
你个性的任何一部分？
Or just there are some that are flexible?
或者只是有一些是灵活的？
I think any part because all parts of your personality are based on brain circuitry, and once we alter that circuitry, we will alter who you are.
我认为任何部分都是因为你性格的所有部分都是基于大脑回路，一旦我们改变了那个回路，我们就会改变你是谁。
Just like when someone develops Alzheimer’s disease and no longer recognizes their children, they become a different human being.
就像当某人患上阿尔茨海默氏症并且不再认得自己的孩子时，他们就变成了另一个人。
They become a different person because the brain wiring has changed.
他们变成了不同的人，因为大脑线路发生了变化。
Thirty years from now, would you have a forecast of what else we’ll be able to do with deep brain stimulation?
三十年后，您是否能预测我们还能利用大脑深层刺激做些什么？
Predicting the future is a tough one.
预测未来是一项艰巨的任务。
But you see research in the works.
但你会看到正在进行的研究。
You’re incredibly well-published, well-read.
你出版得非常好，博学多才。
Things in medical science can take 10 to 20 years anyway.
无论如何，医学领域的事情可能需要10到20年的时间。
You must have a sense.
你必须有一个感觉。
I think we’ll have a very effective treatment for depression and certain mental diseases, things where it’s circuitry that’s involved but the biology is still intact.
我认为我们将对抑郁症和某些精神疾病有一种非常有效的治疗方法，这些疾病涉及电路，但生物学仍然完好无损。
Then we can also talk about brain-computer interfaces because I find that to be one of the most exciting forefronts.
然后我们还可以讨论脑机接口，因为我发现这是最令人兴奋的前沿之一。
When you said deep brain stimulation, were you also referring to brain-computer interfaces?
当您说深度脑刺激时，您是否也指的是脑机接口？
Not yet, but I’m going to ask you about that.
还没有，但我会问你这个问题。
Fine.
美好的。
I just wanted to make sure you were differentiating.
我只是想确保你与众不同。
Yes, you could imagine disorders.
是的，你可以想象疾病。
There’s another famous case of someone who had a large brain tumor, and as the tumor got bigger, pushing on their frontal lobe, they became very interested in child pornography and couldn’t control themselves.
还有一个著名的例子，一个人的脑部长了一个很大的肿瘤，随着肿瘤越来越大，压迫他们的额叶，他们开始对儿童色情制品非常感兴趣，无法控制自己。
They were going to go to jail, and they found this huge brain tumor, and they took the tumor out, and those desires went away.
他们要进监狱了，他们发现了这个巨大的脑瘤，他们把肿瘤取出来，那些欲望就消失了。
Then five years later, they came back, and they re-imaged the patient’s head, and the brain tumor had recurred.
五年后，他们回来了，对病人的头部进行了重新成像，脑肿瘤又复发了。
That’s the frontal lobe.
那是额叶。
It’s the area where we did frontal lobotomies that is very sensitive for behavior.
这是我们进行额叶白质切除术的区域，该区域对行为非常敏感。
It’s clear that so much of who we are is based on the circuitry of our brain and how well it’s functioning.
很明显，我们是谁很大程度上取决于我们大脑的回路及其运作情况。
Alterations in those circuits can have profound effects on personality and behavior.
这些回路的改变会对人格和行为产生深远的影响。
Why do you think it’s so hard to find biochemical correlates of depression if it’s just a physical thing?
如果抑郁症只是一种物理现象，为什么你认为很难找到与抑郁症的生化相关性？
I think we have some.
我想我们有一些。
There are medications that we take that are pretty effective at alleviating depression.
我们服用的一些药物对于缓解抑郁症非常有效。
The thing about medications and the biochemical part of it is that when you take a medication as a pill, it goes everywhere in your brain.
关于药物及其生化部分的问题是，当您服用药丸形式的药物时，它会进入您大脑的各个地方。
Depression is probably only in certain places in your brain.
抑郁症可能只存在于大脑的某些部位。
There are only certain frontal lobe circuits that probably mediate the depression, but if you take a drug that alters a neurotransmitter in your brain as a pill, right now, that goes everywhere in your brain, so it’s going to have side effects.
只有某些额叶回路可能会介导抑郁症，但如果你服用一种改变大脑中神经递质的药物作为药丸，那么它会遍布你大脑的各个部位，所以它会产生副作用。
It’s not going to be selective for just the circuits that are causing the depression.
它不会只针对导致抑郁症的回路进行选择性。
There’s a new technique that we have, called focused ultrasound, which is a fascinating device where we can focus ultrasound beams through the skull into the brain and open up what’s called the blood-brain barrier.
我们有一种新技术，称为聚焦超声波，这是一种令人着迷的设备，我们可以将超声波束穿过头骨聚焦到大脑中，并打开所谓的血脑屏障。
When I take a drug orally, take a pill, put an IV drug in, a lot of those drugs don’t get into the brain, because there’s protection, because the brain doesn’t want poison or toxins to influence the brain, so not everything gets in.
当我口服药物、服用药丸、静脉注射药物时，很多药物不会进入大脑，因为有保护，因为大脑不希望毒物或毒素影响大脑，所以不是所有药物都会进入。
You could imagine a time in the near future where you take a pill for depression that’s very effective, and then you do focused ultrasound, open up the blood-brain barrier only in those circuits, in those anatomic areas that are important for depression, and that drug will only get into those specific areas in very high doses.
你可以想象在不久的将来，你服用一种非常有效的治疗抑郁症的药物，然后你进行聚焦超声波，仅在那些回路中、在那些对抑郁症很重要的解剖区域中打开血脑屏障，并且该药物只会以非常高的剂量进入这些特定区域。
That could be a much more effective treatment than what we have now.
这可能是一种比我们现在所拥有的更有效的治疗方法。
GLP-1 drugs seem to have the potential to limit addictive behavior.
GLP-1 药物似乎具有限制成瘾行为的潜力。
What do you think we learned from that?
您认为我们从中学到了什么？
Again, I think it says the same thing that I’ve been saying all along.
再说一次，我认为这和我一直在说的一样。
You speak about addiction — there’s another famous story about people who were taking a certain Parkinson’s drug, and they became compulsive gamblers.
你谈到上瘾 ——还有另一个著名的故事，讲述的是服用某种帕金森病药物的人，他们变成了强迫性赌徒。
We know that certain medications that you take — changing the chemistry of your brain can make you more prone to risky behaviors in gambling, and the same is true of addiction.
我们知道，您服用的某些药物会改变您大脑的化学成分，从而使您在赌博中更容易出现危险行为，成瘾也是如此。
Using deep brain stimulation to modify addiction is something that’s being tried right now.
目前正在尝试使用深层脑刺激来改变成瘾性。
There are animal models where that’s being done fairly effectively.
在一些动物模型中，这一点做得相当有效。
On brain-computer interfaces
关于脑机接口
What do you think of Neuralink as a company?
您如何看待 Neuralink 这家公司？
Their products, what they do.
他们的产品，他们所做的事情。
I am very interested in brain-computer interfaces.
我对脑机接口非常感兴趣。
I think that Neuralink has created a very unique and interesting device.
我认为 Neuralink 创造了一个非常独特且有趣的设备。
There are different ways to create brain-computer interfaces.
创建脑机接口有多种方法。
There are basically two different classes of devices.
基本上有两种不同类别的设备。
What Neuralink does is, it puts electrodes into the brain itself to record from individual neurons.
Neuralink 的作用是将电极放入大脑本身，以记录单个神经元的情况。
There are other devices out there that put electrodes on the surface of the brain.
还有其他将电极放置在大脑表面的设备。
We don’t know at this time which one is going to be better.
目前我们不知道哪一个会更好。
They’re probably both quite good.
他们可能都很好。
What Musk has done with Neuralink is, it’s a great device because the electrodes that he put in are malleable.
马斯克对 Neuralink 所做的事情是，这是一个很棒的设备，因为他放入的电极是可塑的。
They’re not rigid electrodes.
它们不是刚性电极。
The brain is constantly pulsating and moving, and the electrodes can move with the brain, which is great.
大脑不断地搏动和移动，电极可以随着大脑一起移动，这很棒。
Previously, all electrodes put in the brain would create a dense scar around the electrodes to try to pop them out.
此前，所有放入大脑的电极都会在电极周围形成致密的疤痕，以试图将它们弹出。
Those electrodes don’t appear to do that.
这些电极似乎并没有这样做。
I think what’s important for the audience to understand about brain-computer interfaces is, Neuralink is just one company among many companies out there that are creating brain-computer interfaces.
我认为让观众了解脑机接口最重要的是，Neuralink 只是众多创建脑机接口的公司之一。
In academic institutions around the world, we’ve already seen that you can put a brain-computer interface into someone’s brain who’s paralyzed.
在世界各地的学术机构中，我们已经看到可以将脑机接口放入瘫痪者的大脑中。
You can have them move a robotic arm.
你可以让他们移动机械臂。
You can have them drive a car.
你可以让他们开车。
You could have them speak.
你可以让他们说话。
If you have someone who cannot talk because they can’t move their mouth, you can take the language production out of their brain, put it into a computer, and have a robot or a picture of someone’s face speaking as that person is thinking what words they want to say.
如果有人因为嘴巴无法移动而无法说话，你可以将他们大脑中的语言产生过程取出，放入计算机中，然后让一个机器人或一张某人脸部的照片来说话，而这个人正在思考他们想说的话。
That technology already exists, and it’s just about making it commercially available and making it self-contained, so you don’t have wires sticking out of your head.
这项技术已经存在，只是将其商业化并使其独立，这样你就不会再有电线从你的头上伸出来了。
I think Neuralink’s going to be very successful.
我认为 Neuralink 将会非常成功。
I really do.
我真的这么做。
What I worry about in the short run is the business plan and the market.
短期内我担心的是商业计划和市场。
Right now, there’s a limited market for paralyzed people who have ALS or are locked in and need that type of a device, although the market is bigger.
目前，对于患有 ALS 或被锁定并需要此类设备的瘫痪患者来说，市场有限，尽管市场更大。
What will be fascinating is if we get to the point where we can do it in a non-invasive way and enhance normal human beings.
令人着迷的是，如果我们能够以非侵入性的方式做到这一点并增强正常人类的能力。
Someday, Tyler, we could be having this podcast, and you could have a device in your brain that allows you to communicate with me wirelessly through a computer.
有一天，泰勒，我们可能会有这个播客，你的大脑中可能有一个设备，可以让你通过计算机与我进行无线通信。
That is not unrealistic.
这并非不现实。
We could have this whole conversation virtually just by thinking about what we want to say to each other.
我们实际上可以通过思考我们想对对方说的话来进行整个对话。
Speculatively, what’s your best guess as to how long it might take until I’m hooked up to GPT-whatever it is by then?
推测一下，您对我可能需要多长时间才能连接到 GPT 的最佳猜测是多少——无论到那时是什么？
I think that making the surgery safe could be 15, 20 years.
我认为确保手术安全可能需要 15 年、20 年。
That could happen.
那可能会发生。
Do we have a way of getting the electrodes out of there?
我们有办法把电极取出来吗？
Would we need to do that or is it irreversible?
我们是否需要这样做，或者这是不可逆转的？
No, you can pull them out.
不，你可以把它们拉出来。
You can pull them out.
你可以把它们拉出来。
The electrodes that go in the brain — that’s one of the risks because if you have a normal human being, you don’t want to put electrodes in the brain and risk damaging the brain.
进入大脑的电极 ——这是风险之一，因为如果你有一个正常人，你不想将电极放入大脑中并冒着损坏大脑的风险。
Right now, the Neuralink device puts electrodes in the part of the brain that controls movement, and these are people that are paralyzed, so they’re not using that part of the brain.
目前，Neuralink 设备将电极放置在大脑控制运动的部分，而这些人都瘫痪了，所以他们没有使用大脑的那部分。
But there are other brain-computer interfaces that just put the electrodes on the surface of the brain, so they don’t damage the brain at all.
但还有其他脑机接口只是将电极放在大脑表面，因此根本不会损害大脑。
That’s the kind of thing you can do in a normal human being.
这是正常人可以做的事情。
You can get the same information from an electrode on the surface of the brain as you can from electrodes in the brain.
您可以从大脑表面的电极获得与从大脑内的电极获得的信息相同的信息。
The issue is, you have to open up the skin and the skull and slip them in, and there are some risks to doing that.
问题是，你必须打开皮肤和头骨并将它们滑进去，这样做有一些风险。
But just getting the electrodes on and off the brain without damaging the brain is something we can already do.
但我们已经可以做到，在不损伤大脑的情况下将电极装在大脑上或从大脑上取下。
Let’s say the FDA decides such devices are safe and, at least medically, they’re effective, say for people who are paralyzed.
假设 FDA 认定此类设备是安全的，并且至少在医学上是有效的，例如对于瘫痪的人。
Should we have institutions that regulate what people can do with these?
我们是否应该建立机构来规范人们可以用这些东西做什么？
Or should we just let people choose the enhancements they want?
或者我们应该让人们选择他们想要的增强功能？
No, I think they have to be regulated.
不，我认为他们必须受到监管。
Right now, all these kinds of studies are .
目前，所有这些类型的研究都是如此。
.
。
.
。
Any medical device is regulated.
任何医疗设备都受到监管。
There’s the FDA, and we have to do IRBs if we want to study them.
有 FDA，如果我们想研究它们，我们就必须进行 IRB。
Say we know it’s safe.
说我们知道它是安全的。
It’s past that barrier, and I just show up and say, “I’m Tyler, I’m fine, but I want to think like GPT-11.
跨越了这个障碍，我只是出现并说：“我是泰勒，我很好，但我想像 GPT-11 一样思考。
Please hook me up.” Should I be able to do that the way I might go to a hospital and ask to have my appendix out?
请联系我。”我是否可以像去医院要求切除阑尾一样这样做？
Well, that’s the difference.
嗯，这就是区别。
I don’t like that analogy of the appendix because you need your appendix out for a medical reason, as opposed to you just want to be hooked up to ChatGPT.
我不喜欢阑尾的类比，因为你出于医疗原因需要切除阑尾，而不是你只是想连接到 ChatGPT。
But you could ask to have your appendix taken out.
但您可以要求切除阑尾。
You say, “Oh, I’m going to North Korea for a year at the embassy.
你说：“哦，我要去朝鲜大使馆呆一年。
I want to have it taken out now just in case.” People have done this, plenty.
我现在想把它拿出来，以防万一。”人们已经这样做了，很多。
Yes, but there’s an indication for it.
是的，但是有一个指示。
I think the time will come if it can be completely safe to hook you up to a computer safely.
我认为，如果能够完全安全地将您安全地连接到计算机，那么这一时刻就会到来。
You don’t need permission to buy a cell phone.
您不需要获得许可即可购买手机。
Right now, we already have a brain-computer interface.
现在，我们已经有了脑机接口。
It’s a cell phone.
这是一部手机。
It’s just that it’s very slow.
只是速度非常慢。
Once it’s perfectly safe, then absolutely, it will not need to be regulated any more than Facebook and X need to be regulated by the government because of abuse.
一旦它完全安全，那么它绝对不需要受到监管，就像 Facebook 和 X 不需要因为滥用而受到政府监管一样。
Those types of things may need to be regulated — what you can do with it if we feel like it’s detrimental to society, but just the fact that you want to buy a cell phone — no one’s regulating your ability to buy a cell phone, and it’ll be the same thing.
这些类型的东西可能需要受到监管——“如果我们觉得它对社会有害，你可以用它做什么，但事实上你想买一部手机——”没有人监管你购买手机的能力，这将是同样的事情。
On shock therapy and epilepsy
关于休克疗法和癫痫
Do you have an opinion on electroconvulsive therapy, shock therapy?
您对电休克疗法、休克疗法有什么看法吗？
Yes.
是的。
ECT, basically, is giving someone a seizure.
ECT 基本上就是让人癫痫发作。
We found out years ago that patients who had depression and then suffered a seizure got much better.
几年前我们发现，患有抑郁症然后癫痫发作的患者病情好多了。
Their depression got better so we thought, huh, maybe we can trigger a seizure by essentially putting a cardiac defibrillator on the skull, stimulating the brain, causing a seizure with the patient under anesthesia, then wake them up.
他们的抑郁症好转了，所以我们想，嗯，也许我们可以通过在头骨上放置心脏除颤器，刺激大脑，在麻醉下的患者引起癫痫发作，然后唤醒他们来引发癫痫发作。
It does work.
它确实有效。
It makes people better.
它使人们变得更好。
I wouldn’t say it’s the most delicate, refined treatment for depression at the moment, and it’s only used for very refractory depression, but right now, it is one of the best treatments we have for depression.
我不会说这是目前治疗抑郁症最精致、最精致的方法，而且它只用于非常难治的抑郁症，但目前，它是我们治疗抑郁症的最佳治疗方法之一。
I think it should be used in capable hands and qualified hands.
我认为应该用在有能力的手和有资质的手上。
Hopefully, we’ll have more refined treatments for depression in the future, and we’ll look back at ECT and be like, “Wow, that was crazy.
希望我们将来能够有更完善的抑郁症治疗方法，当我们回顾 ECT 时，我们会说：“哇，这太疯狂了。
We were doing ECT.
我们当时正在做ECT。
We have such a better treatment now.”
现在我们有了更好的治疗方法。”
But the fact that it can work at all — what do you infer about the brain and depression, other than determinism?
但事实上它确实有效 ——除了决定论之外，你对大脑和抑郁症还有什么推断？
As we talked about, depression is a mechanical, neurologic, biochemical disorder, or it’s the normal of someone, but they don’t want that to be their normal.
正如我们所讨论的，抑郁症是一种机械性、神经性、生化障碍，或者是某人的正常现象，但他们不希望这成为他们的正常现象。
Any feeling, any emotion that you have can be altered based on changing the chemicals and the connections in your brain, and ECT does that.
你的任何感觉、任何情绪都可以通过改变大脑中的化学物质和连接来改变，ECT 就能做到这一点。
A seizure is a wave of neuronal depolarization and chemical release that’s very, very powerful in the brain that alters the network functioning of your brain.
癫痫发作是一种神经元去极化和化学物质释放的波，它在大脑中非常非常强大，会改变大脑的网络功能。
How has studying and treating epilepsy changed your view of what humans are and human behavior?
研究和治疗癫痫如何改变了您对人类和人类行为的看法？
Epilepsy is a fascinating disease because it’s a disease of the circuitry of the brain and not the anatomy of the brain.
癫痫是一种令人着迷的疾病，因为它是一种大脑电路的疾病，而不是大脑的解剖结构的疾病。
A lot of neurosurgical illnesses, in particular, brain tumors, aneurysms — there’s an anatomic problem.
许多神经外科疾病，特别是脑肿瘤、动脉瘤——都存在解剖学问题。
Often, when we operate on epilepsy, we see epilepsy.
通常，当我们对癫痫进行手术时，我们会看到癫痫。
The brain looks completely normal.
大脑看起来完全正常。
It’s the circuitry that’s abnormal.
就是电路不正常了。
Some of the symptoms that an epileptic can have are symptoms that mimic human experience.
癫痫患者可能出现的一些症状是模仿人类经历的症状。
There are famous cases, for example, I read about Dostoevsky, who was an epileptic.
有一些著名的案例，例如，我读到陀思妥耶夫斯基，他是一名癫痫患者。
He used to experience the presence of God when he had a seizure.
当他癫痫发作时，他常常体验到上帝的存在。
He was 100 percent certain that God exists, and he would have a religious experience associated with that seizure.
他百分百确定上帝存在，并且他会有与这次癫痫发作相关的宗教经历。
That’s been well-described.
这已经描述得很好了。
Then, when you treat them, either with medicine or surgery, and you cure them of their epilepsy, their religious experiences go away.
然后，当你用药物或手术治疗他们并治愈他们的癫痫时，他们的宗教经历就会消失。
I’m not trying to diminish religious experiences per se, but the fact that you can alter someone’s beliefs and their religious experiences by altering the brain tells us a lot about religion and about the human mind and the human brain.
我并不是想削弱宗教体验本身，但事实上，你可以通过改变大脑来改变某人的信仰和他们的宗教体验，这一事实告诉我们很多关于宗教、人类思想和人类大脑的信息。
People who are epileptics — what is that correlated with in terms of personality or temperament or any other features?
癫痫患者 ——“这与性格、气质或任何其他特征有什么相关性？”
Or is it just evenly, randomly distributed?
或者只是均匀、随机分布？
It’s mostly randomly distributed.
它大多是随机分布的。
It doesn’t say anything specific about who you’re going to be, what kind of a person you’re going to be.
它没有具体说明你将成为谁，你将成为什么样的人。
Unfortunately, there’re different types of epilepsy.
不幸的是，癫痫有不同类型。
There are epileptics who the medicines don’t really work that well, and epilepsy can be a devastating disease to those people.
有些癫痫患者的药物效果并不理想，而癫痫对这些人来说可能是一种毁灭性的疾病。
If you have it when you’re younger and you’re developing, your brain may not develop normally.
如果您在年轻且正在发育时患有这种疾病，您的大脑可能无法正常发育。
But there are some people who have epilepsy and take medication and have very few seizures, and they have very high IQs and are very highly functional.
但有些人患有癫痫症，服用药物后很少发作，而且他们的智商非常高，功能也非常强。
So, it doesn’t have to alter your brain or your personality in any particular way.
因此，它不必以任何特定的方式改变你的大脑或你的个性。
There are some lucky people who can live with it without any noticeable alterations.
有些幸运的人可以忍受它而没有任何明显的改变。
On the future of brain surgery
脑外科的未来
Taking all factors into account, what do you think is the most significant bottleneck limiting progress in brain surgery today?
考虑到所有因素，您认为限制当今脑外科进展的最重要瓶颈是什么？
I think the fact that we have to open up the head with a scalpel and a drill to get into the skull.
我认为我们必须用手术刀和钻头打开头部才能进入头骨。
I think the Holy Grail for us is to put down the scalpel and to not have to drill through the skull and to be able to deliver energy into the brain without opening up the head.
我认为我们的圣杯是放下手术刀，不必钻穿头骨，并且能够在不打开头部的情况下将能量输送到大脑中。
We can do that now with focused radiation, but focused radiation can only do so much.
我们现在可以通过聚焦辐射做到这一点，但聚焦辐射只能做这么多。
We can do it with focused ultrasound as well.
我们也可以用聚焦超声波来做到这一点。
Someday we’ll be able to optically focus light into the brain in certain areas and maybe have optogenetic things that we give into the brain so that the light alters the circuitry of the brain.
有一天，我们将能够将光以光学方式聚焦到大脑的某些区域，并且可能将光遗传学的东西输入到大脑中，以便光改变大脑的电路。
We can operate on the brain through the blood vessels, which is great.
我们可以通过血管对大脑进行手术，这很棒。
You can treat an aneurysm literally by sticking a needle into someone’s wrist and threading a catheter up into the brain and putting metal coils into an aneurysm, whereas in the past, we would have to open up their skin and their skull and go around the brain and dissect the brain and find the aneurysm and put a clip around it.
你可以通过将针插入某人的手腕并将导管穿入大脑并将金属线圈放入动脉瘤来治疗动脉瘤，而在过去，我们必须打开他们的皮肤和头骨，绕过大脑并解剖大脑，找到动脉瘤并在其周围放一个夹子。
It was very invasive and would take hours and hours, and now we can do it almost non-invasively with a little needle stick.
这是非常侵入性的，需要花费数小时和数小时，现在我们可以用小针刺几乎非侵入性地完成它。
I think our biggest problem is that we have the skull in the way.
我认为我们最大的问题是头骨挡住了我们的路。
Are nanobots a realistic hope?
纳米机器人是现实的希望吗？
Yes.
是的。
Fantastic Voyage, if you know that old movie —
奇幻之旅，如果你知道那部老电影 —
Of course.
当然。
— where they would shrink the scientists and the ship down into a nanobot size and put them into the blood.
- 他们将科学家和飞船缩小成纳米机器人大小，然后将它们放入血液中。
Yes, sure.
是的，当然。
I think that would be great.
我认为那太好了。
Again, you have to get out of the blood vessels and into the parenchyma of the brain to do things.
再说一遍，你必须离开血管，进入大脑实质才能做事。
There are some diseases you can treat from within a blood vessel, but there are other diseases that you can’t treat within a blood vessel.
有些疾病可以在血管内治疗，但有些疾病则无法在血管内治疗。
The nanobots have to be able to get out and get back in.
纳米机器人必须能够出去并返回。
John F.
约翰·F.
Kennedy — was there one shooter or two?
肯尼迪——有一个还是两个枪手？
What’s your perspective?
你的观点是什么？
I think there was one shooter.
我认为有一名枪手。
There’re many controversies about Kennedy.
关于肯尼迪，有很多争议。
Whether Lee Harvey was motivated by the FBI or the Mafia, I’m not going to weigh in on.
无论李·哈维的动机是联邦调查局还是黑手党，我都不会参与其中。
In terms of the bullets, what’s fascinating about that controversy is that when JFK was rolled into Parkland Memorial Hospital and was examined by neurosurgeon Walter Kemp Clark, he did not find an entrance wound in the back of the head.
就子弹而言，这场争议的有趣之处在于，当肯尼迪被滚进帕克兰纪念医院并接受神经外科医生沃尔特·坎普·克拉克检查时，他没有发现后脑勺有入口伤。
The Warren Commission said that Kennedy was shot in the back of the head, and that’s where Lee Harvey Oswald was standing.
沃伦委员会表示，肯尼迪的后脑勺中弹，而李·哈维·奥斯瓦尔德就站在那里。
It was never quite clear why the surgeon examining him didn’t find an entrance wound.
目前还不清楚为什么外科医生在检查他时没有发现入口伤口。
One of the things I tried to do with this book is, there’re a lot of papers written in the neurosurgical literature that the general public is not aware of.
我试图通过这本书做的一件事是，神经外科文献中有很多论文是公众不知道的。
Fifty years after Kennedy was shot, a guy named Bob Grossman, who was the chairman of neurosurgery down in Houston, wrote an article.
肯尼迪被枪杀五十年后，休斯敦神经外科主任鲍勃·格罗斯曼（Bob Grossman）写了一篇文章。
He said, “You know what?
他说：“你知道吗？
I was in trauma room one, and I was standing right next to Kemp Clark when he did his examination, but I was a first year out of my training.
我当时在创伤室一号，当肯普·克拉克做检查时，我就站在他旁边，但我是训练第一年。
There was an entrance wound, and I felt the entrance wound.
有一个入口伤口，我感觉到了入口伤口。
I’m not sure why Kemp Clark left it out of his report, but there definitely was an entrance wound.”
我不知道为什么坎普·克拉克在他的报告中漏掉了它，但肯定有入口伤口。”
So, there was a second witness who was in the room at that time, who corroborated the Warren Commission’s report that there was an entrance wound in the back of the head, which then places the single shooter in the back because you have just one entrance wound and an exit wound coming through the parietal lobe.
因此，当时在房间里的第二名目击者证实了沃伦委员会的报告，即后脑勺有一个入口伤口，然后将单个射手放在后面，因为只有一个入口伤口和一个穿过顶叶的出口伤口。
If you think about medicine as a whole, what do you think is your most nonconformist medical belief, the view that you hold that the other people you respect would think is a little weird or too speculative, or maybe just flat out disagree with?
如果你把医学作为一个整体来思考，你认为你最不墨守成规的医学信仰是什么？你认为你尊敬的其他人会认为有点奇怪或过于投机，或者可能只是完全不同意？
That’s a tough one because I tend to be very scientifically motivated in the opinions that I give.
这是一项艰巨的任务，因为我给出的观点往往非常具有科学动机。
I try to follow the literature.
我尝试遵循文献。
I tend not to be out on a limb too much.
我一般不会太过于冒险。
I will say there was a period of time in my career when I was starting to do minimally invasive neurosurgical procedures.
我想说的是，在我的职业生涯中，有一段时间我开始进行微创神经外科手术。
What that means is, instead of doing the procedures that I had learned, where you open up the side of the head and take off the skull and pull down the muscle and go around the brain, I was learning and pioneering surgeries where we go in through the nostrils with endoscopes or make little incisions in the eyelid.
这意味着，我不再按照我学过的方法，打开头部的一侧，取下头骨，拉下肌肉，绕过大脑，而是学习并开创性的手术，用内窥镜从鼻孔进入，或者在眼睑上做小切口。
At the time when I was doing those operations, most neurosurgeons thought they were crazy, and that they shouldn’t be done, and that they were unsafe.
当我做这些手术时，大多数神经外科医生都认为他们疯了，不应该做，而且不安全。
It was only because I was doing them at the time, and I knew that I could do it, and the other surgeons had never seen it done.
只是因为我当时正在做，我知道我能做到，而其他外科医生从未见过这样做。
They had never experienced it, so they didn’t realize what could be accomplished.
他们从未经历过，所以他们不知道能完成什么。
I think there are some instances where you’ve experienced something first-hand, and other people haven’t experienced it, and you may hold a belief that’s different than them.
我认为在某些情况下，你亲身经历过某些事情，而其他人没有经历过，你可能持有与他们不同的信念。
Ultimately, science will prevail.
最终，科学将占上风。
Ultimately, the burden of proof is on you to show that your new technique is as good or better than the other technique.
最终，您有责任证明您的新技术与其他技术一样好或更好。
I wouldn’t expect them to believe me until I was able to prove it by writing dozens and dozens of articles, and having other people who also were doing that surgery so it was reproducible, to prove that it was correct.
我不指望他们会相信我，直到我能够通过写几十篇文章来证明这一点，并让其他也在做该手术的人（因此它是可重复的）来证明它是正确的。
But in general, I tend to follow the science.
但总的来说，我倾向于遵循科学。
I’m not much of a wingnut.
我不太像个疯子。
Do you think there are areas of science, though, where the institutions are so screwed up that you don’t actually trust the product of what is coming out, and there’s some systematic bias in the ideas being generated?
不过，您是否认为在某些科学领域，机构如此混乱，以至于您实际上并不相信即将出现的产品，并且正在产生的想法存在一些系统性偏见？
I think, yes, there’s always going to be politics involved, and we always come to any problem from a unique single perspective, and institutions are going to have their biases.
我认为，是的，总是会涉及政治，我们总是从独特的单一角度来看待任何问题，而机构也会有自己的偏见。
Yes, that is true, but in the long run, the scientific method will figure it out, and there will be one right answer.
是的，确实如此，但从长远来看，科学方法会解决这个问题，并且会有一个正确的答案。
That institution — whatever their bias is — will be proven wrong in the long run.
该机构——“无论他们的偏见是什么——”从长远来看将被证明是错误的。
Now, those people might be dead and won’t be able to apologize at that point.
现在，那些人可能已经死了，那时无法道歉。
We’re not in the long run now.
从长远来看，我们现在还不是。
Like the food pyramid — it used to tell us, in essence, eat more carbohydrates.
就像食物金字塔一样，它过去常常告诉我们，本质上要多吃碳水化合物。
It’s not obvious that was the right thing to say.
显然这是否是正确的说法。
It’s probably the wrong thing to have said.
这可能是说错了话。
It was our best guess at that moment in time, based on the available evidence.
根据现有证据，这是我们当时最好的猜测。
That’s all science is.
这就是科学的全部。
It’s our best guess based on the available evidence.
这是我们根据现有证据做出的最佳猜测。
Once that evidence changes, then we could all be wrong.
一旦证据发生变化，那么我们都可能错了。
I think the best scientist is the one who says, “This is how I do it now, but I could be completely wrong.
我认为最好的科学家会说：“我现在就是这么做的，但我可能完全错了。
If you can show me better evidence, I will change my mind, but based on what I know now, this is what I’m saying.”
如果你能给我提供更好的证据，我会改变主意，但根据我现在所知道的，这就是我要说的。”
And you think the process is that efficient?
您认为这个过程有那么有效吗？
Again, it takes time.
再次强调，这需要时间。
I think it’s efficient over time.
我认为随着时间的推移，这是有效的。
Given enough time, it’s that efficient.
只要时间充足，效率就很高。
Given day-to-day, year-to-year, no, it’s not that efficient.
日复一日，年复一年，不，效率并不高。
On the Ted Schwartz production function
关于特德·施瓦茨生产函数
How do you think about your own production function, so to speak?
可以这么说，您如何看待自己的生产函数？
You have, what, 500 articles, 200 book chapters, 7 textbooks.
你有 500 篇文章、200 个书籍章节、7 本教科书。
One of my readers calculated that’s a paper or a chapter every two weeks for the last 35 years, plus all these operations.
我的一位读者计算出，在过去 35 年里，每两周就有一篇论文或一章，加上所有这些操作。
How is it you do it?
你是怎么做到的？
What’s your secret?
你的秘密是什么？
I think you become more efficient at things as you get older because you become better at them.
我认为随着年龄的增长，你做事情的效率会更高，因为你会变得更擅长做事情。
An operation that would take me eight hours ten years ago takes me four hours now, and then three hours.
十年前需要八个小时的手术现在需要四个小时，然后是三个小时。
You also have people who help you.
你也有帮助你的人。
If I’m writing a paper, I have a resident, and I may say “I have an idea for a paper.
如果我正在写一篇论文，我有一个住院医师，我可能会说“我有一个关于论文的想法。
Why don’t you write the paper and send me the rough draft?
你为什么不写论文并发给我草稿呢？
Here’s the data.”
这是数据。”
If I have six or seven of those people who are writing papers for me based on my ideas and giving me a rough draft, and then I have to edit it and make sure that the data is correct and help them with the introduction, the discussion, you can be much more efficient because you have people who are helping you.
如果我有六七个人根据我的想法为我写论文并给我一份草稿，然后我必须对其进行编辑并确保数据正确并帮助他们进行介绍和讨论，那么你会更有效率，因为有人在帮助你。
When you start your career, you don’t have those people under you who are helping you.
当你开始你的职业生涯时，你手下没有那些帮助你的人。
Once you’ve proven that you can write a lot of papers, then you get contacted by millions of people who say, “Hey, I want to write a paper with you” because they know that you can get it done.
一旦你证明自己可以写很多论文，就会有数百万人联系你，他们说：“嘿，我想和你一起写一篇论文”，因为他们知道你可以完成它。
I say, “Great, I have a great idea.
我说：“太好了，我有一个好主意。
You realize that idea.
你意识到这个想法了。
I will help you write it.” Then it allows you to multiply yourself by having people who work with you on what you do.
我帮你写。”然后，它可以让你通过与你一起工作的人来倍增自己。
Do you still play music?
你还玩音乐吗？
I do.
我愿意。
I’m in my office now.
我现在在办公室。
I have three basses and two guitars.
我有三把贝斯和两把吉他。
I played with a group of neurosurgeons in a band called the Neurosurgery Jazz Quintet for many years.
我与一群神经外科医生在一个名为“神经外科爵士五重奏”的乐队中一起演奏了很多年。
We played at all our meetings.
我们在所有会议上都演奏。
I have a friend whose 60th birthday is coming up who’s a friend of mine who’s a musician, and he asked me to bring my bass guitar so I’m practicing a little bit for that.
我有一个朋友，他的 60 岁生日即将到来，他是我的一位音乐家朋友，他让我带上我的贝斯吉他，所以我正在为此练习一点。
What’s the age at which, on average, neurosurgeons begin to decline enough where you wouldn’t necessarily want one handling your case?
平均而言，在什么年龄，神经外科医生的数量开始下降，以至于您不一定希望有人来处理您的病例？
Age is, as you can imagine, different with everybody.
正如您可以想象的那样，每个人的年龄都不同。
Just like the president of the United States, there’s no absolute age that a president is too old.
就像美国总统一样，总统没有绝对年龄。
It really has to do with the competence of that individual.
这确实与个人的能力有关。
But on average, right?
但平均而言，对吗？
A basketball player, on average, by age 38 is over the hill but LeBron is pretty good at 40.
篮球运动员平均年龄 38 岁就已经过了巅峰，但勒布朗 40 岁就已经相当出色了。
I would say somewhere in the early 70s.
我想说的是 70 年代初的某个地方。
There are surgeons in their early 70s who are quite good.
有70岁出头的外科医生，技术相当不错。
There’s going to be a bell-shaped curve.
将会出现一条钟形曲线。
You understand that, obviously.
显然，你明白这一点。
Some people are going to be on the tail end of that curve and operate well later than that.
有些人会处于曲线的末端，并且会比这晚得多。
I would say the middle of that bell-shaped curve is going to be late 60s, early 70s.
我想说钟形曲线的中间将是 60 年代末、70 年代初。
Do you think neurosurgeons are a group of people with excess self-confidence?
你认为神经外科医生是一群过于自信的人吗？
The stakes are so high.
赌注是如此之高。
It’s so nerve-wracking.
这太让人伤脑筋了。
You had to get through a lot of years of work even to get there.
即使要到达那里，你也必须经过很多年的努力。
It’s funny you mention it.
你提到它很有趣。
My brother-in-law who works at Goldman Sachs was telling me that he was at some meeting where someone was giving them a lecture about ego and confidence, and you can imagine Wall Street traders have a lot of ego and confidence.
我在高盛工作的姐夫告诉我，他正在参加一次会议，会上有人给他们做了关于自我和自信的讲座，你可以想象华尔街交易员有很多自我和自信。
The conclusion was that neurosurgeons have more ego and confidence than any of the Wall Street traders.
结论是，神经外科医生比任何华尔街交易员都更加自负和自信。
The way I talk about it is, you have to, at the same time, have confidence and humility.
我想说的是，你必须同时拥有自信和谦逊。
You have to combine the two, and it’s very difficult to do.
你必须将两者结合起来，这是非常困难的。
Yes, you have to have a certain amount of confidence to tell someone sitting in front of you, “I want you to trust me with the most important thing that you possess, which is your brain and your health.
是的，你必须有一定的信心才能告诉坐在你面前的人，“我希望你相信我拥有你所拥有的最重要的东西，那就是你的大脑和你的健康。
You’re going to basically go to sleep and give it to me for four hours and put it under my care, and I’m going to do some risky stuff.
你基本上会去睡觉，把它交给我四个小时，并把它交给我照顾，我会做一些冒险的事情。
You need to have that done, and I have to have the confidence to say I’m the best person to do this or I’m one of the best people to do this for you.” You have to feel that and you have to earn that.
你需要完成这件事，我必须有信心说我是做这件事的最佳人选，或者我是为你做这件事的最佳人选之一。”你必须感受到这一点，并且你必须赢得这一点。
At the same time, when you make a mistake, and it doesn’t come out the way you wanted — and that will inevitably happen to everyone — you have to have the humility to say, “What did I do wrong?
与此同时，当你犯了一个错误，而且结果没有按照你想要的方式发生时 ——每个人都不可避免地会遇到这种情况 ——你必须谦虚地说：“我做错了什么？
How can I do it better?” You also have to have the honesty to say to your patients, “Look, I’m going to do my best for you.
我怎样才能做得更好？”你还必须诚实地对你的病人说：“看，我会为你尽力而为。
That I can promise you, but these are the risks, and these are the known risks.”
我可以向你保证，但这些都是风险，而且是已知的风险。”
Because if you’re too confident, you get to be arrogant.
因为如果你太自信，你就会变得傲慢。
If you’re arrogant, then you’re telling your patients that they’re going to do perfect.
如果你很傲慢，那么你就是在告诉你的病人他们会做得很完美。
You’re lying to them, and then you don’t change.
你对他们撒谎，然后你就不会改变。
You don’t look introspectively when you make mistakes and say, “All right, this wasn’t perfect.
当你犯错误时，你不会反思并说：“好吧，这并不完美。
How am I going to do this better next time?” I think you have to be confident, but you have to be humble at the same time, and you have to have just that right balance.
下次我怎样才能做得更好呢？”我认为你必须自信，但同时必须保持谦虚，并且必须保持适当的平衡。
The neurosurgeons who are quite self-confident — do you think that’s compartmentalized?
那些非常自信的神经外科医生——你认为这是区隔化的吗？
Or do you think they’re generally quite confident in many other spheres of life?
或者您认为他们通常对生活的许多其他领域都非常有信心？
I think that changes person to person.
我认为这会因人而异。
I know some neurosurgeons who are quite talented, and they are humble, sweet.
我认识一些非常有才华的神经外科医生，他们很谦虚，很友善。
They don’t appear to be arrogant in other aspects of their life.
他们在生活的其他方面似乎并不傲慢。
I know others who are different.
我认识其他不同的人。
I really think that there’s no stereotype for that.
我真的认为这没有刻板印象。
I think the sweet ones in other areas — they’re often the most arrogant.
我认为其他领域的可爱者 ——他们往往是最傲慢的。
It’s a kind of front.
这是一种前台。
I would more likely suspect them of extreme arrogance than the apparently arrogant individuals.
与那些明显傲慢的人相比，我更有可能怀疑他们极端傲慢。
All right, now you’re two steps away.
好吧，现在你还差两步。
You’re double-thinking it.
你的想法是双重的。
I don’t know.
我不知道。
It’s hard to know.
很难知道。
What has it been in philosophy that’s interested you the most?
您对哲学最感兴趣的是什么？
You must still think about philosophical issues.
你还是得思考哲学问题。
You hold them in your hands every week or more.
您每周或更长时间都会将它们握在手中。
I read a lot about philosophy of mind and philosophy of intelligence and consciousness and self and agency.
我读了很多关于心灵哲学、智慧、意识、自我和能动性的哲学。
I’m constantly reading and listening to podcasts of new thinkers about those ideas.
我不断阅读和收听新思想家关于这些想法的播客。
I find that fascinating.
我觉得这很有趣。
Yes, it’s certainly based on my knowledge of the brain.
是的，这当然是基于我对大脑的了解。
My father was a Freudian psychoanalyst, so I grew up in a household that was very concerned with the brain and the mind and behavior.
我的父亲是一位弗洛伊德精神分析学家，所以我在一个非常关心大脑、思想和行为的家庭中长大。
I will often try to carve out an hour or two a day to try to read and better myself and think about those types of philosophical ideas.
我经常会尝试每天抽出一两个小时来尝试阅读和提高自己，并思考这些类型的哲学思想。
Circa 2025, what do you think of Freud?
大约2025年，你对弗洛伊德有何看法？
Has he become underrated?
他被低估了吗？
Look, I think the fact that Freud realized that we have an unconscious that is controlling what we do, based on what was going on at the time.
听着，我认为弗洛伊德意识到我们有一种无意识，它根据当时发生的事情来控制我们所做的事情。
Some people think, just like Copernicus and Darwin, Freud was that revolution that took our own agency and our control of ourselves — the ego — and said, “No, the ego is this little tiny thing.
有些人认为，就像哥白尼和达尔文一样，弗洛伊德是一场革命，它夺走了我们自己的能动性和我们对自己的控制——“自我”——并说：“不，自我只是一个小东西。
The unconscious is really what’s making all these decisions.”
无意识确实是做出所有这些决定的因素。”
Now, circa 2025, we realize that the brain is doing an enormous amount of processing that we’re not conscious of.
现在，大约在 2025 年，我们意识到大脑正在进行大量我们没有意识到的处理。
That unconscious processing is exactly what Freud was getting at back in Victorian Vienna.
这种无意识的处理正是弗洛伊德在维多利亚时代的维也纳所理解的。
Yes, I think he was probably underrated.
是的，我认为他可能被低估了。
If you look at Freud from a feminist perspective, and you don’t like penis envy, or you look at the Oedipal complex and just judge him that way, then sure, there’s a lot to criticize.
如果你从女权主义的角度看待弗洛伊德，并且你不喜欢阴茎嫉妒，或者你看待俄狄浦斯情结并只是这样评判他，那么当然，有很多可以批评的地方。
But if you look at his structure of the mind and how he subverted the power of the ego and validated the unconscious, I think he was brilliant.
但如果你看看他的思维结构，以及他如何颠覆自我的力量并验证无意识，我认为他很聪明。
Before we get to my last question, let me just plug the book again.
在我们讨论最后一个问题之前，让我再次插上这本书。
Gray Matters: A Biography of Brain Surgery, Theodore Schwartz.
灰色问题：脑外科传记，西奥多·施瓦茨。
Loved the book, read it cover to cover very quickly.
很喜欢这本书，很快就从头到尾读完了。
Congratulations on that.
对此表示祝贺。
Final question, what will you do next?
最后一个问题，你接下来要做什么？
You’ll appreciate this.
你会感激这一点的。
I’m starting a company to make a device.
我正在创办一家公司来制造设备。
It’s something I’ve always wanted to do.
这是我一直想做的事情。
I’m hopeful that it’s something that will allow me to touch not just one individual and help one individual, but it’ll be a medical device that will help thousands of people and hundreds of thousands of people.
我希望它不仅能让我接触到一个人并帮助一个人，而且它将成为一种可以帮助成千上万人和数十万人的医疗设备。
I’m going to move a little bit in that direction.
我将朝这个方向前进一点。
Good luck with that.
祝你好运。
Ted, thank you very much.
特德，非常感谢你。
Thank you.
谢谢。
Take care.
小心。
It’s been a pleasure.
这是一种乐趣。